South Asians Must Reduce Disease Burdens to Improve Prospects



Poverty, hunger, unsanitary or unsafe conditions and inadequate health care in South Asia's developing nations are exposing their citizens to high risk of a variety of diseases which may impact their intelligence. Every year, World Health Organization reports what it calls "Environmental Burden of Disease" in each country of the world in terms of disability adjusted life years (DALYs) per 1000 people and total number of deaths from diseases ranging from diarrhea and other infectious diseases to heart disease, road traffic injuries and different forms of cancer.



In the range of DALYs/1000 capita from 13 (lowest) to 289 (highest), WHO's latest data indicates that India is at 65 while Pakistan is slightly better at 58. In terms of total number of deaths per year from disease, India stands at 2.7 million deaths while Pakistani death toll is 318, 400 people. Among other South Asian nations, Afghanistan's DALYs/1000 is 255, Bangladesh 64 and Sri Lanka 61. By contrast, the DALYs/1000 figures are 14 for Singapore and 32 for China.

Recent research shows that there are potentially far reaching negative consequences for nations carrying high levels of disease burdens causing lower average intelligence among their current and future generations.

Published by the University of New Mexico and reported by Newsweek, new research shows that there is a link between lower IQs and prevalence of infectious diseases. Comparing data on national “disease burdens” (life years lost due to infectious diseases or DALYs) with average intelligence scores, the authors found a striking inverse correlation—around 67 percent. They also found that the cognitive ability is rising in some countries than in others, and IQ scores have risen as nations develop—a phenomenon known as the “Flynn effect.”



According to the UNM study's author Christopher Eppig and his colleagues, the human brain is the “most costly organ in the human body.” The Newsweek article adds that the "brainpower gobbles up close to 90 percent of a newborn’s energy. It stands to reason, then, that if something interferes with energy intake while the brain is growing, the impact could be serious and longlasting. And for vast swaths of the globe, the biggest threat to a child’s body—and hence brain—is parasitic infection. These illnesses threaten brain development in several ways. They can directly attack live tissue, which the body must then strain to replace. They can invade the digestive tract and block nutritional uptake. They can hijack the body’s cells for their own reproduction. And then there’s the energy diverted to the immune system to fight the infection. Out of all the parasites, the diarrheal ones may be the gravest threat—they can prevent the body from getting any nutrients at all".

Looking at the situation in South Asia, it appears from the WHO data that Pakistan is doing a bit better than India in 12 out of 14 disease groups ranging from diarrhea to heart disease to intentional injuries, and it is equal for the remaining two (Malaria and Asthma).

A detailed WHO report on World Health Statistics for 2010 assesses and compares its member nations on the basis of nine criteria including mortality and burden of disease, cause-specific mortality, selected infectious diseases, health service coverage, risk factors, health workforce-infrastructure, health expenditures and demographic and socioeconomic statistics. It shows that both India and Pakistan have some serious challenges to overcome to have any chance of meeting health-related Millennium Development Goals (MDGs 4, 5 and 6).

Related Links:

Haq's Musings

Infectious Diseases Kill Millions in South Asia

Infectious Diseases Cause Low IQ

Malnutrition Challenge in India and Pakistan

Hunger: India's Growth Story

WHO Report 2010 Blogger Analysis

Syeda Hamida of Indian Planning Commission Says India Worse Than Pakistan and Bangladesh

Global Hunger Index Report 2009

Grinding Poverty in Resurgent India

WRI Report on BOP Housing Market

Food, Clothing and Shelter For All

India's Family Health Survey

Is India a Nutritional Weakling?

Asian Gains in World's Top Universities

South Asia Slipping in Human Development

Comments

Riaz Haq said…
Here is a little trivia about India and Pakistan IQs:

According to Prof Richard Lynn's worldwide IQ data published by Webster Online dictionary, Pakistanis avg IQ rose from 81 in 2002 to 84 in 2006, while Indians's avg IQ increased by just one point from 81 to 82.

http://www.websters-online-dictionary.org/definitions/IQ+and+Global+Inequality?cx=partner-pub-0939450753529744%3Av0qd01-tdlq&cof=FORID%3A9&ie=UTF-8&q=IQ+and+Global+Inequality&sa=Search#922

A recent UNM study linking IQs and disease burdens can be the basis for rationalizing it.

Looking at the situation in South Asia, it appears from the WHO data that Pakistan is doing a bit better than India in 12 out of 14 disease groups ranging from diarrhea to heart disease to intentional injuries, and it is equal for the remaining two (Malaria and Asthma).

Poverty, hunger, unsanitary or unsafe conditions and inadequate health care in South Asia's developing nations are exposing their citizens to high risk of a variety of diseases which may impact their intelligence. Every year, World Health Organization reports what it calls "Environmental Burden of Disease" in each country of the world in terms of disability adjusted life years (DALYs) per 1000 people and total number of deaths from diseases ranging from diarrhea and other infectious diseases to heart disease, road traffic injuries and different forms of cancer.

In the range of DALYs/1000 capita from 13 (lowest) to 289 (highest), WHO's latest data indicates that India is at 65 while Pakistan is slightly better at 58. In terms of total number of deaths per year from disease, India stands at 2.7 million deaths while Pakistani death toll is 318, 400 people. Among other South Asian nations, Afghanistan's DALYs/1000 is 255, Bangladesh 64 and Sri Lanka 61. By contrast, the DALYs/1000 figures are 14 for Singapore and 32 for China.
Riaz Haq said…
Here's an excerpt from a paper by Professor J. Philippe Rushton on IQ variations across the world:

Classical anthropology often placed South Asians and North Africans in the same taxonomic group as Europeans and designated them both as Caucasoids. But modern genetic studies, such as those by L. L. Cavalli-Sforza, show the South Asians/North Africans are a surprisingly distinct "genetic cluster". They can be distinguished from Europeans to their north as well as from sub-Saharan Africans to their south and the other Asian groups to their east.

The evidence that the average IQ of the North Africans/South Asians is as low as 85 is extensive. Lynn reviewed 37 IQ studies from 16 countries such as India, Pakistan, Turkey, Iran, and Iraq and found an IQ range of from 77 to 96 with a median of 84. He reviewed 13 studies of immigrants from those countries in the UK and Australia and found a median IQ of 89. He reviewed 18 further studies of South Asians and North Africans in Continental Europe and found a median IQ of 84. He reviewed 9 studies of South Asians in Africa, Fiji, Malaysia, and Mauritius and found a median IQ of 88. Finally, Lynn reviewed 13 studies of select South Asian and North African high school and university students and found a median IQ of 92, eight points higher than that of general population samples.

Lynn’s finding of an average South Asian IQ of 85 has been corroborated by Jan te Nijenhuis and colleagues in Holland, who analyzed thousands of respondents including nationally representative samples. They found an average IQ of 81 for first generation Turks and Moroccans living in the Netherlands. They found an IQ of 88 for the second generation, who spoke Dutch and had been educated in the Dutch school system. They published their results in the 2004 European Journal of Personality.

Another finding of a low South Asian IQ came from a review of studies on the Gypsies (or Roma as they are now often called). This South Asian population migrated to southeastern Europe from northwest India between the 9th and 14th centuries and currently number between 4 and 10 million. Their average IQ in the Czech Republic and Slovakia, based on a review of 10 studies by Petr Bakalar, is below 80. His review was published in the 2004 Mankind Quarterly.

I too have confirmed the very low IQ for the Roma. This was in a study carried out in and around Belgrade, in Serbia. My colleagues and I individually tested 323 16- to 66-year-olds over a two-year period in three separate communities using the Raven’s Matrices, a widely-used, culture-reduced, non-verbal test of general intelligence, and four other tests usually given to children. On these tests, we found the Roma averaged at the level of Serbian 10-year-olds. (Our study was published in the January 2007 issue of Intelligence.)


http://www.vdare.com/rushton/070926_indians.htm
Riaz Haq said…
India's continued economic growth will be at risk unless quick action is taken to improve the health of its growing population, a report says carried by the BBC:

It says that India is in the early stages of a chronic disease epidemic which affects the health of both rich and poor people.

It calls for a comprehensive national health system to be set up by 2020.

The report consists of a series of studies published by the British medical journal, The Lancet.

"Rapidly improving socio-economic status in India is associated with a reduction of physical activity and increased rates of obesity and diabetes," says the paper on chronic diseases and injuries - led by Vikram Patel from the Sangath Centre in Goa.

It says that Indians are growing wealthier but exercising less and indulging in fatty foods.

They also risk injury by driving more often and faster on the country's notoriously dangerous roads, often under the influence of alcohol.

"The emerging pattern in India is characterised by an initial uptake of harmful health behaviours in the early phase of socio-economic development," Mr Patel's paper says.

He and other authors of the report argue that the problem can only be tackled by better education, because bad habits tend to decline once consumers become aware of risks to their health.

The report states that overall the poor in India are the most vulnerable to diseases - and are further burdened by having to pay for healthcare in a country where health indicators lag behind its impressive economic growth figures.

The study also says it is important that India, with its fast-growing population soon exceeding 1.2 billion, takes steps to prevent illnesses such as heart or respiratory diseases, cancer and diabetes.

It says that this can be funded by gradually increasing public expenditure and implementing new taxes on tobacco, alcohol and unhealthy foods.
Riaz Haq said…
There are reports that the use of gutka in India and Pakistan is causing growng incidence of oral cancer.

Businessweek has reported that India has the highest number of oral cancers in the world after a group of entrepreneurs known locally as “gutka barons” turned a 400-year-old tobacco product hand-rolled in betel leaves into a spicy blend sold for 2 cents on street corners from Bangalore to New Delhi. Sales of chewing tobacco, worth 210.3 billion rupees ($4.6 billion) in 2004, are on track to double by 2014, according to Datamonitor, a branch of the international research firm based in Hyderabad, India.

“Now you have an industrial version of a traditional thing” spurring demand, said Chaturvedi, who works at Tata Memorial Hospital in Mumbai, Asia’s largest cancer treatment center, and draws cartoons to warn of tobacco’s dangers in his spare time. “By the time you are experimenting with this product, you become the slave of the industry.”

India had almost 70,000 diagnosed cases of cancers of the mouth in 2008, the highest in the world ahead of the U.S. at 23,000 cases, according to statistics compiled by the World Health Organization’s International Agency for Research on Cancer.



Recent studies reported in Dawn on the subject show that Karachi has the highest incidence of oral cancer in the world. With the increasing number of oral cancer cases, the city may witness an epidemic in the coming years, medical experts believe.

A study conducted by the sociology department of Karachi University in 2006 found that 93 per cent children of 50 government and private schools in Saddar Town spent their pocket money on buying areca nut and seven per cent on betel leaf (paan) and gutka.

An Aga Khan University research titled, Socio-demographic correlates of betel, areca and smokeless tobacco use as high risk behaviour for head and neck cancers in a squatter settlement of Karachi, found that head and neck cancers were a major cancer burden in Pakistan.“They share a common risk factor profile, including regular consumption of products of betel, areca and tobacco. Use of paan, chhaalia, gutka, niswar and tobacco is acceptable in Pakistan and is considered a normal cultural practice.”
Riaz Haq said…
Here's a BBC report on pregnant women's deaths in Rajathan due to tainted UV fluids:

..The (three) doctors have been charged with negligence and irregularities in purchases of medicines.

The women died after they were given infected intravenous (IV) fluids at two hospitals in Jodhpur city.

Laboratory tests had confirmed that IV fluids supplied by a local company were "tainted", officials said.

The women died after severe haemorrhaging after they were administered with the IV fluids, authorities say.

India accounts for the highest number of maternal deaths in the world, with tens of thousands of women dying every year due to pregnancy-related problems.

...


Here's a Deccan Herald story on tainted medicines in India:

It is said that roughly 10 per cent of the medicines available in the market are counterfeit, contaminated or substandard. Profits are huge in the trade. This is a massive racket that involves not just illicit manufacturers but a long chain that includes distributors and then, of course, the shops and hospitals through which these spurious medicines are pushed. It is alleged that pharmacists selling counterfeit drugs profit from doing so. If manufactures are able to push their contaminated drugs easily, it is because hospital authorities are not vigilant. They prefer to purchase medicines from those who grease their palms rather than trusted manufacturers. The problem of contaminated medicines is not one that is confined to allopathic medicines. Testing of some samples of ayurvedic or homeopathic medicines has revealed presence of toxic metal.

Indian pharmaceutical companies export medicines to Africa and Latin America. Therefore, the manufacture of substandard drugs and contaminated fluids poses a grave public health threat that extends far beyond India’s borders. Stern action against those responsible for Jodhpur tragedy is welcome. But it must not stop there. The government must act against other manufacturers of counterfeit and contaminated medicines. The crime they are engaging in is not a minor one. It cannot be brushed aside as mere negligence as they are causing the death of people. They cannot be allowed to play with people’s lives. It is undermining the legitimacy of our medical system.
Riaz Haq said…
Here's a BBC report on resistant strains of TB growing in India:

On World Tuberculosis Day, health officials in the northern Indian state of Bihar are warning of an epidemic of a virulent form of multi drug-resistant TB unless cases are detected more quickly and accurately. The BBC's Geeta Pandey reports from the town of Hajipur, in Bihar, on a disease that kills two Indians every three minutes.

Kishori Rai, 42, looks emaciated and his entire body shakes when he coughs.

He stands in a corner of the dark and dingy hospital room, shifting uneasily from one foot to another, his mouth covered with a white handkerchief which has turned muddy with grime and blood.
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Day labourer Kishori Rai is a classic TB patient. The search for work takes poor people like him to cities like Delhi where they are forced to live in cramped slums and shanties - a hotbed of infectious diseases like TB.

India gets nearly two million new TB cases every year - the highest in the world - and the disease, which is fully curable, kills at least 280,000 people annually.

"TB is the largest killer of Indians between 15 and 45 years," Dr Mannan says.

In the past decade, India has made major strides in bringing down the numbers of deaths by aggressively following DOTS or "directly observed treatment, short course" - a programme instituted by the WHO where patients must swallow their medicines every day, watched by health workers or volunteers, until they complete their treatment.

But the authorities admit that the disease remains a major public health challenge and an enormous drain on the economy.

And the huge number of drug-resistant cases is threatening to undo the progress made so far - in 2007, India reported 131,000 drug-resistant cases and that number is steadily rising.
Riaz Haq said…
For those who are curious, suicides in Pakistan are among the lowest in the world.

At 3 per 100,000, the suicide rate in Pakistan is only a fifth of the suicide rate in India of 15 per 100,000, according to WHO data.

http://www.who.int/mental_health/resources/suicide_prevention_asia_chapter1.pdf

In addition to growing farmers' suicide, India has also experienced a spike in urban youth suicides.

http://articles.timesofindia.indiatimes.com/2011-02-16/nagpur/28551501_1_suicide-note-young-suicides-students-feeling
Riaz Haq said…
Here's a story of Pakistan's 100,000 ladies health workers reaching out to rural communities:

KARACHI, Mar 16, 2011 (IPS) - At eight in the morning 30-year-old Sultana Solangi steps out of her house ready for her day’s work. Wearing a black gown that shows only her eyes, she is shod in comfortable slippers and lugs a large black bag.

She will walk through this city’s poorest communities, visiting as many as 10 homes everyday, helping to raise awareness and improve maternal and child health.

In her bag is an assortment of medical supplies: Paracetamol tablets and oral rehydration salts, bandages, condoms, contraceptive pills, iron and folic acid tablets, eye ointments, and antiseptic lotion.

Solangi, the sole breadwinner in her family of four, works as a lady health worker (LHW), employed by the government’s National Programme for Family Planning and Primary Health Care.

Launched in 1994, the programme now has a veritable army of 100,000 LHWs covering 60 percent of the population - the biggest outreach intervention in South Asia.

These women venture where few doctors dare to go, from congested cities to far-flung and underdeveloped rural areas, acting as the link between communities and the public health system.

Over the years, their work has expanded to include health campaigns like administering polio drops to children under five, plus neonatal tetanus, measles, tuberculosis, and malaria control.

LHWs are particularly important in the rural areas where three-quarters of Pakistan’s population live, and where a trip to a health centre may require a hike of a couple of hours to as much as a day. Illiteracy is widespread in these areas and often customs prevent women from seeking health services without being chaperoned by a male family member.

Solangi cited the case of Zahida Sanghi, a woman Solangi’s age but already a mother of seven. Sanghi lives in People’s Colony, a community in Larkana city in Sindh province, some 322 kilometres from the southern port city of Karachi, which is part of Solangi’s coverage area.

"Zahida Sanghi was very weak and would not have survived another pregnancy. The husband is jobless. It took close to two months to convince her mother-in-law that it was all right for her to get a tubal ligation done since her family was complete. This is all part of my job," she said.

Every day, Solangi and her colleagues cover between five to 10 houses and talk to women like Sanghi about the importance of antenatal check-ups, vaccinations, safe delivery, the use and making of oral rehydration salts, and modern methods of family planning.

They also hold about eight group sessions each month where they discuss with local women issues related to mother and child health.

Yet despite the LHW programme, Pakistan remains a maternal and infant health hotspot.

The Pakistan Demographic and Health Survey (PDHS), conducted from 2006 to 2007, shows an infant mortality rate of 78 deaths per 1,000 live births. It also shows a mortality rate of children under five years old of 94 deaths per 1,000 live births. This means one in every 11 children born in Pakistan dies before reaching his or her fifth birthday.

The maternal mortality rate of 276 per 100,000 live births is also far too high, and has remained virtually unchanged since 1991.

Sadiqa Jaffery, president of the National Committee on Maternal and Neonatal Health, said the statistics would be much worse without the LHWs on the ground.

"It’s been established that where LHWs are present family planning services and routine immunisation is better. The problem is that the coverage is not blanket," Jaffery said.

But Farid Midhet, founder of the Safe Motherhood Pakistan Alliance, remains unconvinced of the impact of LHWs. "Family planning is the cornerstone of women’s health services and it still eludes millions," he said.
Riaz Haq said…
Here's a Christian Science Monitor report about inexpensive health insurance for the poor in Pakistan:

Karachi, Pakistan

Wilayat Shah, a security guard at the luxury Avari Towers Hotel in Karachi, Pakistan, was rushed to a hospital last December after experiencing headaches and losing consciousness at work.

Unlike the wealthy patrons of the hotel he guarded, the father of four wouldn't ordinarily have had access to top-notch medical treatment.

But thanks to a health-care program run by the nonprofit Naya Jeevan (New Life), Mr. Shah, who earns just $150 a month, paid nothing for the MRI scans and treatment he received, worth some $1,400. He now has returned to work.

Shah is one of some 13,000 low-income workers in Pakistan signed on to the Naya Jeevan program. It was founded in 2007 by surgeon-turned-social entrepreneur Asher Hasan and began operating in Pakistan last summer.

"In Pakistan, privileged people can afford their care," Dr. Hasan explains. "The poor, who work alongside the rich, were just excluded from the system."

Hasan left a successful career in the United States to return to Pakistan, where he had spent his formative years, on a mission to provide affordable health care to low-income workers.

He lived a "clichéd life," he says, with a résumé that includes an MBA from New York University, research work at Harvard Medical School, and a stint as a senior executive at a California-based pharmaceutical company.

"I knew there was much more I could be doing in Pakistan," Hasan says.

By working with insurance companies to spread risk across clusters of low-income workers, who typically earn less than $200 a month, Naya Jeevan opens up high-quality health care to a segment of the population that couldn't afford it before.

Each participant pays in about $1.80 per month. The maximum catastrophic payout is $1,800 per year – the average cost of heart bypass surgery at a good private hospital in Pakistan, Hasan says.

That low monthly premium, which he calculates as roughly 2.1 percent of the monthly income of the working poor, as well as the absence of deductibles and copayments, is "commendable," says Farasat Bokhari, a Pakistani-American health economist at King's College in London.

"More impressive is the fact that they have contracts with a large number of private hospitals, which are presumably of higher quality compared with the public hospitals, which are severely underfunded," Mr. Bokhari says.

Last year, the Pakistani government spent an average of $18 per person for health care, one of the consequences of its struggle to deal with an ongoing battle against Islamist insurgents on its western border and the aftermath of last year's catastrophic floods.
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Hasan has first-hand experience. Born in London into a middle-class family, his mother moved him and his three sisters to Karachi following the death of their father in 1983. On a trip back to Britain, Hasan's mother suffered a nervous breakdown. She had no contact with her children for the next three years.

During this time, Hasan grew close to the children of his maid. While his education was provided for by the colleagues and friends of his late father, his maid was unable to tap any wealthy connections when her father fell seriously ill, forcing her to withdraw her children from school.

"I realized that a single catastrophic event can lead to the perpetuation of the cycle of poverty," he says. "We had to create a system which could break that cycle."
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The next step after that, he says, will be to work with other major institutions to sign up 2.5 million Pakistanis and lobby the federal government to set up a similar program of private health-care insurance nationwide.
Riaz Haq said…
Among inherited diseases, sickle cell is one reported mainly in Africa, India and the Mediterranean countries, according to an Emory University study:

Millions of people worldwide suffer from the affects of sickle cell anemia – especially those of African, Mediterranean and Indian descent. According to CDC, more than 70,000 people in the United States have sickle cell disease, mostly African Americans. Each year more than 1,000 babies are born with sickle cell disease.

The inherited disorder affects the blood’s hemoglobin, which produces stiff, misshapen red blood cells that deliver less oxygen and can disrupt blood flow, resulting in joint and organ damage and potential clots and strokes. The sickling of red blood cells is aggravated by infections, extreme hot or cold temperatures, poor oxygen intake, not drinking enough fluids and stress.

Eckman says his Center is a unique resource – the only place in the world where patients can be treated 24 hours a day, seven days a week for sickle cell. He notes that the Center functions with admissions, emergency room and short-stay center. A patient can be admitted in 10- to 15-minutes, versus three hours in an ER. Eckman says the more quickly you treat the pain, the more likely it is to be controlled.

Facts About Sickle Cell Anemia

* Sickle cell disease is an inherited disorder involving the chemical known as hemoglobin contained in red blood cells. Hemoglobin carries oxygen to all parts of the body. When sickle hemoglobin loses its oxygen, it forms long rods inside the red blood cells. This causes the red blood cell to lose its round, donut shape and form a hard, sickle, crescent shape.
* Unlike normal red blood cells that are disc-shaped and move easily through the blood vessels, sickle cells are stiff and sticky and tend to form clumps and get stuck in the blood vessels.
* The clumps of sickle cells block blood flow in the blood vessels that lead to the limbs and organs. Blocked blood vessels can cause pain, serious infections and organ damage.
* Sickle cell disease primarily affects individuals of African descent, but can affect people from Italy, Greece, Israel, India, Pakistan, Spain, Central America, the Caribbean and many other ethnic groups.
* Sudden pain throughout the body is a common symptom of sickle cell anemia. This pain is called a “sickle cell crisis.” Sickle cell crises often affect the bones, lungs, abdomen and joints.
* Early diagnosis of sickle cell anemia is very important. Children who have the disease need prompt and proper treatment.
Riaz Haq said…
World Health Org study concludes cell phones can cause cancer, according to the Daily Mail:

Mobile phone users may be putting themselves at higher risk of cancer, a major new study has confirmed.

The World Health Organisation-funded study has found that microwave radiation from mobile phones can increase the risk of brain tumours.

The agency has now listed mobile phones as a 'carcinogenic hazard', alongside lead, engine exhaust fumes and chloroform.

Before its announcement today, the WHO had assured people that no ill-effects had been established.

A team of 31 scientists from 14 countries made the decision after reviewing peer-reviewed studies on mobile phone safety.

The team found evidence that personal exposure was 'possibly carcinogenic to humans.'

This means that there is not enough long-term evidence to conclude if radiation from mobile phones is safe, but there is enough data to show a possible connection to tumours.

Mobile phones emit a kind of radiation known as non-ionising. It has been compared to a very low-powered microwave oven.
---
Even more grave are the possible effects on children, who have thinner skulls and scalps - allowing radiation to penetrate much more deeply into the brain.

The rapid cell division of young brains could also multiply the mutating effects of radiation, according to Dr Black.

The WHO's warning joins a chorus of voices urging caution over excessive mobile phone use in recent years.

The European Environmental Agency has pushed for more studies, amid fears that the radiation from mobile phone handsets could be as dangerous to public health as smoking, asbestos and leaded petrol.

In 2010 the widest yet international study of the relationship between mobile phones and cancer found those who had used mobiles for a decade or more had double the rate of brain glioma, a type of tumour.


Read more: http://www.dailymail.co.uk/health/article-1392810/Mobile-phones-CAN-increase-cancer-risk-Shock-finding-major-study.html#ixzz1NyIHbuKI
Riaz Haq said…
UNICEF says India tops the world in open defecation, according to the Times of India:

NEW DELHI: With India facing the slur of topping the global list in open defecation, the Centre is keen to put the sanitation programme back on the centrestage by sensitizing the population about public hygiene.

The Union rural development ministry along with states will organize a month-long campaign from October 2, the birth anniversary of Mahatma Gandhi, to create awareness for its flagship scheme of Total Sanitation Campaign.

According to a UNICEF survey, 58% of the world's population practicing open defecation lives in India while China and Indonesia come a distant second by accounting for just 5% of the world numbers. Pakistan is down to third with 4.5%, tied with Ethiopia.

The numbers are astounding as the prosperity of liberalized India does not seem to translate into better sanitation.

RD minister Jairam Ramesh said, "I consider these numbers a matter of great anguish and shame. We must make sanitation a political campaign like Gandhiji did. Kerala, Sikkim, Maharashtra, Haryana and Himachal are doing well but other states have to pick up significantly."

There is little denying the anguish given that the numbers do not tie up with the sanitation standards expected of improving financial economy as well as urbanizing India.

As per national population figures, 54% of India's population practices open defecation against China's 4%.

The national figures do push up numbers in smaller and poor countries. Like Indonesia has 26% of its population practicing open defecation as against its contribution of only 5% to the world population. The national figure stands at 60% for Ethiopia, 28% for Pakistan and 50% for Nepal.

Neighbouring Sri Lanka, in contrast, has only 1% of its citizens going to toilet in the open.

Ramesh said, "We are going to focus now on `nirmal gram abhiyan' -- today 25,000 nirmal grams are a tiny fraction of 6 lakh villages. These nirmal grams are in Maharashtra and Haryana. Maharashtra is a success of social movements while Haryana an example of determined state government action."

As part of the awareness drive, the states have been asked to take active interest with chief secretaries issuing directions for the awareness drive up to the panchayat level. It may include household contact programme and gram sabha meetings to highlight the benefits of an environment free of open defecation. The panchayats would also train masons to construct toilets.


http://timesofindia.indiatimes.com/india/With-58-figures-India-tops-in-open-defecation/articleshow/10200781.cms
Riaz Haq said…
Minister says India’s rank as No. 1 country for open defecation a source of national shame, according to Washington Post and AP:

NEW DELHI — India’s rural development minister is pushing a campaign on public hygiene, after a recent survey revealed that India accounts for 58 percent of the world’s population practicing open defecation.

Jairam Ramesh says the revelation is a source of national shame and a “sad commentary” on society’s failure to address the issue through education and better sanitation.

The government says it spends $350 million a year to build rural toilets, but some 638 million still rely on fields or quiet corners.

The UNICEF report puts China and Indonesia in second place, with each representing 5 percent of the world’s 1.1 billion open defecators.

Ramesh said Sunday that filth was polluting the environment as well as public spaces, and Indian rivers had become sewers.


http://www.washingtonpost.com/world/asia-pacific/minister-says-indias-rank-as-no-1-country-for-open-defecation-a-source-of-national-shame/2011/10/02/gIQAdWTqGL_story.html
Riaz Haq said…
Here's a story about a Lancet study of Pakistan's "Ladies Health Workers" treating child pneumonia:

LONDON, 14 November 2011 (IRIN) - Pakistan’s army of “Lady Health Workers” – some 90,000 strong – was never meant to diagnose and treat serious illnesses. Instead, these female community health workers (in Pakistan, men cannot visit families) were expected to teach good hygiene and nutrition, provide family planning advice, monitor pregnant women, weigh and vaccinate babies and treat minor ailments.

Yet a new study shows that these same women could hold the key to treating pneumonia – the world’s leading killer of young children.

The study, published by The Lancet medical journal and conducted by Save the Children US, funded by the US Agency for International Development and coordinated by the World Health Organization (WHO), found that children suffering from severe pneumonia were more likely to recover if treated at home by these women rather than in a health facility.
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Sadruddin and his colleagues in Pakistan decided to see whether treatment could be given at home by the local Lady Health Worker. They ran a pilot project in Haripur district, in the south of Pakistan’s North West Frontier Province. Where the health workers identified severe pneumonia, with fever, rapid breathing and in-drawing of the lower chest, they were to give a full course of the WHO recommended antibiotic, liquid amoxicillin. “We wanted to see if they could do as well as conventional in-patient treatment. In fact, we found that they did better.”

The study followed 3,211 children, whose progress was checked six days after the start of treatment. Among those treated by their local health worker, only 9 percent failed to respond to treatment. In the control group, 18 percent failed to respond. The children visited at home started treatment sooner, and were sure to get the most suitable drug, while prescriptions in government and private clinics were far less consistent.

The Lady Health Workers taking part in the trial were carefully supervised. “These workers cannot just be left unsupervised after their training,” Sadruddin told IRIN. “They need ongoing support from their supervisors to attain their goals.”

The message was reinforced by the Elizabeth Mason, director of WHO’s Department for Newborn, Child and Adolescent Health.

“Supervision is absolutely critical, and it is one area that programmes have to ensure that they have well in place,” she told IRIN.

But she said WHO was extremely interested in the findings. “This is the kind of breakthrough research which is urgently needed. It is the first study of its kind and we will have to put it together with studies from other places. But I hope we may be able to review our guidelines to make treatment more accessible to poorer children and those living in remote communities, the ones who need it most.”

The programme also brought benefits to the women, elevating their status. In Haripur, when people saw that the women could treat seriously ill children and save their lives, their status rose dramatically, according to Sadruddin. By the end of the two-year trial, families were far more likely to make the Lady Health Worker their first port of call when their children were ill.

“When they started,” said Sadruddin, “the women themselves were not confident of their own abilities, and the community was also not confident. But when we went back, we found [so] much respect for the Lady Health Workers.”


http://www.irinnews.org/report.aspx?reportid=94200
Riaz Haq said…
Here's a NY Times report on Lancet study of child pneumonia home treatment by Pakistan's lady health workers:

Letting “lady health workers” in rural northern Pakistan treat children with severe pneumonia in their homes worked better than the established practice of telling parents to take them to a hospital, a new study has found.

The study, published in The Lancet this month, followed 1,857 children who were treated at home with oral amoxicillin for five days and 1,354 children in a control group who were given standard care: one dose of oral cotrimoxazole and instructions to go to the nearest hospital or clinic.

The home-treated group had only a 9 percent treatment-failure rate, while the control group children failed to improve 18 percent of the time.

Some parents could not afford to take their children to hospitals, which were often understaffed.

Researchers from Save the Children, the World Health Organization and Boston University did the study, which was financed by the United States Agency for International Development. Pneumonia is a major killer of infants and toddlers.

Pakistan’s network of 90,000 “lady health workers” was founded in 1994 by Benazir Bhutto, then the prime minister.

“It’s one of the best community-based health systems in the world,” said Dr. Donald Thea, a Boston University researcher who was one of the authors.

A Lancet editorial cautioned that not all local health workers are as well trained and supervised as Pakistan’s and that since northern Pakistan has a low AIDS rate, it would be wrong to assume that every country would do as well with such a system.


http://www.nytimes.com/2011/11/29/health/home-care-best-for-child-pneumonia-in-study.html
Riaz Haq said…
US CIA's fake vaccine ploy to get bin Laden has hurt Pakistan's polio fight, reports the Wall Street Journal:

The United Nations says a reportedly fake vaccination campaign conducted to help hunt down Osama bin Laden has caused a backlash against international health workers in some parts of Pakistan and has impeded efforts to wipe out polio in the country.

A number of families across Pakistan refused vaccinations from July, when news of the reportedly fake campaign broke, to September, said Dennis King, chief of polio vaccinations in Pakistan for Unicef. "Following the early reports, some families in the provinces did refuse to have their children vaccinated citing the fake campaign as the cause," Mr. King said.

The refusals, he added, have declined since September due to vigorous campaigning by international and local health workers to ensure families they are working only to vaccinate against polio, a disease eradicated in most of the world but still prevalent in Pakistan.

Pakistan military intelligence in July detained a local doctor, Shakeel Afridi, on charges of involvement with the reportedly fake vaccination campaign, supposedly involving vaccine against hepatitis B. Pakistan officials believe the campaign was an attempt to get DNA samples from bin Laden's family to confirm his location in a house in Abbottabad.

In May, U.S. Navy SEALs raided the house, killing bin Laden. A Pakistani judicial committee has recommended Dr. Afridi be charged with treason, which carries the death penalty. He hasn't been made available to comment since his arrest.

The U.S. Central Intelligence Agency, which Pakistani officials say carried out the purportedly fake program, hasn't publicly commented. Officials familiar with the bin Laden operation say the CIA did indeed institute a mock vaccine program with a local doctor who had previously been an informant in the tribal areas. The plan was to obtain DNA from residents of the Abbottabad compound as they got a vaccine injection, helping confirm bin Laden's presence there....
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Ghulam Rasool, a laborer from Khyber, found out in March that his 18-month-old son had polio after militants had warned off health workers.

"I know my child's future has been ruined, but I won't let it happen to my other kids," he says. "Now I have brought eight children of my extended family to Peshawar to get them vaccinated despite threats."

Senior Pakistani health officials condemn Mr. Afridi's role as unethical.

"Everybody in the medical profession resented his deceptive role. Defeating polio in Pakistan is challenging anyway, and this created negative associations," says Janbaz Afridi, deputy director at Khyber-Pakhtunkhwa's provincial health department in Peshawar.

Pakistan is one of the last significant polio reservoirs in the world, imperiling global eradication efforts, Unicef warns.


http://online.wsj.com/article/SB10001424052970204190504577038781784474056.html
Riaz Haq said…
Pakistan's private health care spending rises to $7.3 billion, reports Express Tribune:

Pakistanis are increasingly spending more on health, with spending rising to a total of Rs665 billion in 2011, up 14.5% over the previous year, according a to research report released by Business Monitor International (BMI), a UK-based research and consulting firm.

Within the overall sector, the largest in terms of total spending was that of hospitals and other healthcare facilities, which saw their total revenues rise to Rs456 billion in 2011, up 14.1% from the year before. The fastest growing segment was medical devices, which saw sales rise 18.1% to Rs35.5 billion. Pharmaceuticals grew a little slower, at 13.1%, to reach Rs173 billion in gross sales in Pakistan.

There are also several developments taking place within the sector that are likely to allow for even further expansion, according to BMI analysts.

In August 2011, the Drug Registration Board (DRB) approved the registration of 30 medical devices and 210 medicines after a meeting was held at the request of the Prime Minister Yousaf Raza Gilani, who called for the uninterrupted provision of medicines to patients. Products approved for registration included vaccines, biologicals, cancer therapeutics, drugs for the treatment of blood disorders such as thalassaemia, and devices used in cardiac procedures.

BMI points out that there are many reasons why investors, particularly those outside the country may want to consider investing in this sector. “Pakistan has one of the most liberal foreign investment regimes in South Asia, with a commitment to low tariffs and 100% foreign equity permitted,” said BMI analysts in the report.

The analysts also note that Pakistan’s rapidly growing population – currently closing in on 190 million – should also be considered an asset. “A growing population is feeding increased demand for pharmaceuticals.”
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Pakistan’s overall business environment gets a poor rating from BMI, which ranks the economy 16th out of the 18 economies that it tracks in the Asia-Pacific region. The only two economies behind Pakistan are Sri Lanka and Cambodia. “The business environment still suffers from poor infrastructure and, most problematically, an uncertain security situation that has declined considerably since March 2007,” said BMI analysts.

In addition, there are several structural challenges to the Pakistani healthcare industry itself that have little to do with the external environment of Pakistan that they operate in. “Procurement processes are bureaucratic and often lack transparency, raising the risks of corruption,” said BMI in its report.


http://tribune.com.pk/story/384773/money-and-doctors-private-healthcare-spending-in-pakistan-rises-to-7-3-billion/
Riaz Haq said…
Pakistan to get closer to meeting MDGs, reports News Tribe:

...According to the reports, Pneumonia kills an estimated 1.5 million children under the age of five years every year over the world – more than AIDS, malaria and tuberculosis combined. “Here in Pakistan the lack of awareness among masses has been furthering the rise of chronic diseases, which is alarming,’ he added.

But, he adds, luckily expensive pneumonia control vaccinations are being provided free of cost at EPIcenters in the country, as the government of Pakistan is introducing pneumococcal vaccine in the EPI programme with the help of Global Alliance for Vaccines and Immunization (GAVI).

Moreover, Dr. Tariq Bhutta added that reducing child mortality rate is one of the eight MDGs, which are the world’s time bound targets for reducing poverty in its various dimensions by 2015. Pakistan is heading towards achieving that targets, while the MDG on child mortality will require urgent action to control childhood deaths by pneumonia, which is 19 percent of the all the deaths of under-five children in the country.

Dr. Bhutta said that Pneumonia kills more children than any other illness – more than Aids, Malaria and Measles combined. ‘Yet, little attention is paid to this disease. After free availability of pneumonia vaccine at all government hospitals public awareness regarding the availability of vaccine needs to be increased for the EPI program to have its full time impact.

It is worth adding that Pneumonia is a severe form of acute lower respiratory infection that specifically affects the lungs. ‘Chest X-rays and laboratory tests are done to confirm the extent and location of the Pneumonia infection and its cause,’ he said, adding that but here in Pakistan suspected cases of pneumonia are diagnosed by their clinical symptoms due to non-availability of latest technologies. This becomes severe when transformed to other organs through the bloodstream causing meningitis, bacterimia and sepsis.

Dr Bhutta further said that during or shortly after birth babies are at higher risk of developing pneumonia. The statistics of World Health Organization (WHO) show that more than 150 million episodes of pneumonia occur every year among children under five in developing countries, accounting for more than 90 per cent of all new cases worldwide. Between 11 million and 20 million children with pneumonia will require hospitalization, and almost 1.8 million will die from the disease.

But, he adds, luckily Pakistan is fortunate in the sense that pneumonia prevention vaccine has been provided free of cost by GAVI Alliance, a global NGO, to vaccinate all 5 million babies that are born every year in Pakistan. ‘A course of three injections to newborns was previously costing approximately Rs 14000, but with the funding of GAVI this treatment is available free of cost across the country for the masses. Three vaccines include the measles, Hib and pneumococcal conjugate vaccines have the potential to significantly reduce child deaths from pneumonia,’ he added.

It is to be noted that immunizations help reduce childhood deaths from pneumonia in two ways: first, vaccinations help prevent children from developing infections that directly cause pneumonia such as Haemophilus influenzae type b (Hib); secondly, immunizations may prevent infections that can lead to pneumonia as a complication (e.g., measles and pertussis).

Dr Tariq Bhutta encouraged all parents to take their infants at 6, 10 and 14 weeks of ages to the government EPI center and hospitals in their vicinity for vaccination.


http://www.thenewstribe.com/2012/11/04/pakistan-to-get-closer-to-millennium-development-goals/
Riaz Haq said…
Here's Kantawala in Friday Times on India's Dengue outbreak killing Yash Chopra:

I'm still not over Yash Chopra dying from Dengue disease. I just thought I'd throw that out there. Of course it's sad that the Rom Com Don passed away and I do hope he is running through heavenly wheat fields while singing love songs to clouds and backup singers, like the many dream sequences he inspired in us all. But I would never have thought of Dengue and Bollywood in the same sentence until now (or Dengue and anything, really. It's still not so much a reality as a morbid punch-line). It just reminded me of how good India is at PR. During last year's Succubus Summer Solstice, when Dengue Mosquitoes hit the Punjab like a wife beater with Daddy Issues, we lost over 2,000 people to the disease. Judges, trainers, workers, rich, poor, women, men. We covered it (forgive me) to death in newspapers, and the news of the world was gripped with yet another Pakistan catastrophe. For six months it really was like the end of a disaster movie called Infection or Gestation Period or something clinically unimaginative.
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Last year, around this time, a water-based brain disease killed 500 children in a town in Northern India in one week. One week! It comes every year, it's just that that year was particularly bad. Now, how does a deadly, brain-eating, child specialist disease that may or may not have "come from Japan" not make it to the world's news? How? PR people. That's how. Get on that.


Here's NY Times on dengue fever in India:

NEW DELHI - An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world's nations.

"The global dengue problem is far worse than most people know, and it keeps getting worse," said Dr. Raman Velayudhan, the World Health Organization's lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India's capital, where areas of standing water contribute to the epidemic's growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.

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"I'd conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations," said Dr. Scott Halstead, a tropical disease expert focused on dengue research...


http://mobile.nytimes.com/2012/11/07/world/asia/alarm-over-indias-dengue-fever-epidemic.xml
Riaz Haq said…
India leads the world in dengue, reports The Hindu:

Dengue, the world’s most rapidly spreading mosquito-borne viral disease, is taking a far bigger human toll than was believed to be the case. As many as 390 million people across the globe could be falling victim to the virus each year, according to a multinational study published by Nature on Sunday.

India emerges in the analysis as the country with the world’s highest dengue burden, with about 34 per cent of all such cases occurring here.

According to the World Health Organisation (WHO), incidence of dengue has shot up 30 fold in the past 50 years. Its estimate has been that globally there were 50-100 million dengue infections taking place annually.

For their study, Samir Bhatt at the University of Oxford and his colleagues used a map-based approach to model how many dengue cases were occurring in various parts of the world, thereby capturing its global distribution.

They estimated that worldwide, 96 million people suffered each year from ‘apparent infections’ where the disease was severe enough to disrupt an individual’s regular routine. In addition, there were 294 million asymptomatic infections.

With “large swathes of densely populated regions coinciding with very high suitability for disease transmission,” Asia bore 70 per cent of the apparent infections that took place, the scientists pointed out in the paper.

Africa contributed about 16 per cent of the global dengue infections and the Americas 14 per cent.

“I consider it to be the most comprehensive study of dengue disease burden to date,” said Duane J. Gubler, an internationally known expert on the disease, when asked for his views on the Nature paper.

The study’s estimate of 390 million infections was “much closer to the actual figure than the 50 million WHO is still using,” observed Professor Gubler, who is now with the Duke-NUS Graduate Medical School in Singapore.

“Considering that mosquito control has failed in all dengue-endemic countries, that over half of the world’s population now lives in urban areas, and that dengue is an urban disease, even that number may be too low,” he said in an e-mail.

The study estimated that India had the largest number of dengue cases, with about 33 million apparent and another 100 million asymptomatic infections occurring annually.

However “these are estimates and there are many gaps which we now need to fill,” cautioned Jeremy Farrar, a senior author of the study, in an e-mail. “But it would not surprise me that India was home to the most dengue [patients] globally.”

The model used in the study could help provide a framework to estimate the burden of disease. Inevitably, there were gaps in the data and one needed to extrapolate from other areas. Better data collection should be encouraged so that the estimates were as accurate as possible, said Professor Farrar, who is director of the Wellcome Trust Vietnam Research Programme and Oxford University Clinical Research Unit Hospital for Tropical Diseases in Vietnam.

“We have a tremendous problem of dengue all over India,” said Umesh C. Chaturvedi, agreeing with the finding of the paper. A virologist who has studied the disease, he is a scientific consultant to the Indian Council of Medical Research.


http://www.thehindu.com/sci-tech/health/policy-and-issues/india-leads-the-world-in-dengue-burden-nature/article4592098.ece
Riaz Haq said…
Here's a story of how Lahore fought dengue outbreak in 2011:

..“No one expected this kind of political commitment,” said Qutbuddin Kakar, who oversees programmes to combat malaria and dengue in Pakistan for the World Health Organization (WHO). “In this part of the world, at least, we had not seen this kind of response before.”

The anticipated 1,000-plus deaths did not occur, and since then, dengue fever cases have dropped - 200 in the province (Punjab) last year, without any reported deaths.

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The results they collect are processed on site by specially-designed Android based applications on their smartphones, and uploaded to a centralized dengue prevention centre.

There, analysts match the entomological data with reports from hospitals showing where dengue patients are being treated. Based on the findings, a team is sent to fumigate areas where aedes mosquitos seem to be breeding and infecting people, or to identify and remove sources of standing water.

The key season for infections comes with monsoon rains, when the aedes aegyptus and aedes albopictus mosquitoes, which can carry the virus, begin to appear.

Chronology of an outbreak

In August 2011 heavy monsoon rain dumped 13 inches in a week, leaving parts of Lahore with large bodies of standing water, and raising immediate concerns about disease.

By mid-October, the provincial government in Punjab reported that more than 11,000 dengue cases were recorded by the provincial government.

“It was an exponential increase in number, and it really frightened the government,” said Faran Naru, a consultant hired by the provincial government to tackle the problem. “And the issue was resonating in the media... so it created a panic in the public which had to be contained.”

Most people infected with dengue recovered on their own, said Naru, but once media outlets began reporting on the extent of the outbreak, thousands showed up at hospitals and laboratories to get tested.

An initial team of 70 entomologists conducted 12,000 spot-checks to track where aedes mosquitos were present. By mid-October, this data had been mapped, along with the locations of 11,000 reported dengue patients.

The results surprised the scientists. The worst affected areas were some of the wealthiest neighbourhoods of Lahore: Model Town, Race Course, Mozang, and Gulberg.

“I saw that in Model Town there is a big park, and in Race Course there are two of Lahore's biggest parks… and I believe lots of breeding was happening there and mosquitoes were leaving from there and infecting people,” said Naru.

The mosquitoes need fresh water to lay their eggs, and the large puddles in Lahore's biggest public parks proved to be ideal homes.

Another hotspot was the Mozang neighbourhood, home to one of Pakistan's largest graveyards. The 150-acre area was found to be a major breeding ground for mosquitos. Gravediggers had dug large pits to hold water, which they used to soften the dirt when digging.

“It's fresh water,” said Naur, “from the tap, and there were 70 pits, and all of those were infected, full of larvae.”

Back in the hospital, dengue patients were separated into special areas for treatment. The home of each dengue patient was fumigated, along with 12 surrounding houses, three in each direction.

Sanitation workers unclogged sewers and drains in an effort to clear areas of rainwater; and parks, gardens, and cemeteries were also sprayed. Thousands of Mosquitofish and Garden Carp - fish species known to attack mosquito larvae - were also released into ponds and ditch canals.

Within a few weeks, entomologists detected far fewer aedes mosquitoes, and the prevalence of dengue cases rapidly decreased.


http://www.irinnews.org/Report/98010/Marshalling-smartphones-gravediggers-to-fight-dengue-in-Pakistan
Riaz Haq said…
Here's a Bloomberg story on a tourist's experience with Indian medical system:

Lill-Karin Skaret, a 67-year-old grandmother from Namsos, Norway, was traveling to a lakeside vacation villa near India’s port city of Kochi in March 2010 when her car collided with a truck. She was rushed to the Amrita Institute of Medical Sciences, her right leg broken and her artificial hip so damaged that replacing it required 12 hours of surgery.
Three weeks later and walking with the aid of crutches, Skaret was relieved to be home. Then her doctor gave her upsetting news. Mutant germs that most antibiotics can’t kill had entered her bladder, probably from a contaminated hospital catheter in India. She risked a life-threatening infection if the bacteria invaded her bloodstream -- a waiting game over which she had limited control, Bloomberg Markets magazine reports in its June issue.

“I got a call from my doctor who told me they found this bug in me and I had to take precautions,” Skaret remembers. “I was very afraid.”
Skaret was lucky. Eventually, her body rid itself of the bacteria, and she escaped harm from a new type of superbug that scientists warn is spreading faster, further and in more alarming ways than any they’ve encountered. Researchers say the epicenter is India, where drugs created to fight disease have taken a perverse turn by making many ailments harder to treat.
India’s $12.4 billion pharmaceutical industry manufactures almost a third of the world’s antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune in a pool of resistance that thwarts even high-powered antibiotics, the so-called remedies of last resort.
Medical Tourism
Poor hygiene has spread resistant germs into India’s drains, sewers and drinking water, putting millions at risk of drug-defying infections. Antibiotic residues from drug manufacturing, livestock treatment and medical waste have entered water and sanitation systems, exacerbating the problem.
As the superbacteria take up residence in hospitals, they’re compromising patient care and tarnishing India’s image as a medical tourism destination.
“There isn’t anything you could take with you traveling that would be useful against these superbugs,” says Robert Moellering Jr., a professor of medical research at Harvard Medical School in Boston.

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India is susceptible because it has many sick people to begin with. The country accounts for more than a quarter of the world’s pneumonia cases. It has the most tuberculosis patients globally and Asia’s highest incidence of cholera.
Most of India’s 5,000-plus drugmakers produce low-cost generic antibiotics, letting users and doctors switch around to find ones that work. While that’s happening, the germs the antibiotics are targeting accumulate genes for evading each drug. That enables the bugs to survive and proliferate whenever they encounter an antibiotic they’ve already adapted to.
India’s inadequate sanitation increases the scope of antibacterial resistance. More than half of the nation’s 1.2 billion residents defecate in the open, and 23 percent of city dwellers have no toilets, according to a 2012 report by the WHO and Unicef.
Uncovered sewers and overflowing drains in even such modern cities as New Delhi spread resistant germs through feces, tainting food and water and covering surfaces in what Dartmouth Medical School researcher Elmer Pfefferkorn describes as a fecal veneer..


http://www.bloomberg.com/news/2012-05-07/drug-defying-germs-from-india-speed-post-antibiotic-era.html
Riaz Haq said…
The latest 2012 IQ data published by Richard Lynn and Tatu Vanhanen puts mean IQ of Pakistanis at 84 and of Indians at 82.2, and Bangladeshis at 81.

Each country has big std deviations and large positive outliers.

The highest IQs are reported for East Asia (100+) and the lowest in sub-Saharan Africa (just over 70).

https://lesacreduprintemps19.files.wordpress.com/2012/08/intelligence-a-unifying-construct-for-the-social-sciences-richard-lynn-and-tatu-vanhanen.pdf
Riaz Haq said…
Here's a TOI story on link between low IQ and poverty:

Poverty and the all-consuming fretting that comes with it require so much mental energy that the poor have little brain power left to devote to other areas of life, according to the findings of an international study published on Thursday.


The mental strain could be costing poor people up to 13 IQ (intelligence quotient) points and means they are more likely to make mistakes and bad decisions that amplify and perpetuate their financial woes, researchers found.

"Our results suggest that when you are poor, money is not the only thing in short supply. Cognitive capacity is also stretched thin," said Harvard economist Sendhil Mullainathan, part of an international team that conducted the study.

In a series of experiments, researchers from Harvard, Princeton and other universities in North America and from Britain's University of Warwick found that pressing financial worries had an immediate impact on poor people's ability to perform well in cognitive and logic tests.

Far from signalling that poor people are stupid, the results suggest those living on a tight budget have their effective brain power, or what the researchers called "mental bandwidth", dramatically limited by the stress of making ends meet.

On average, someone weighed down by money woes showed a drop in cognitive function in one part of the study that was comparable to a 13 point dip in IQ, and similar to the performance deficit expected from someone who has missed a whole night's sleep.

"Previous views of poverty have blamed (it) on personal failings, on an environment that is not conducive to success," said Jiaying Zhao, an assistant professor of psychology at the University of British Columbia in Canada.

"We are arguing that the lack of financial resources itself can lead to impaired cognitive function," she said. ...
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The researchers studied two very different groups - shoppers at a mall in New Jersey in the United States, and sugar cane farmers in rural India.

In the mall study, they gathered dozens of low and middle-income shoppers and subjected them to a battery of tests to measure IQ and impulse control.

Half of the participants were first asked to think about what they would do if their car broke down and the repair cost $1,500 - designed to kick off worries about money. It was among these people that performance dipped significantly.

In India, the researchers found that farmers had diminished cognitive performance before getting paid for their harvest compared to afterwards, when their coffers have been replenished.

"One month after the harvest, they're pretty rich, but the month before - when the money has run out - they're pretty poor," Mullainathan said in a report of the research, which was published on Thursday in the journal Science.

"What we see is that IQ goes up, (when they are rich)... errors go way down, and response times go way down."

He said the effect in India was about two-thirds the size of the effect in the mall study - equal to around nine or 10 IQ points difference from one month to the next.


http://timesofindia.indiatimes.com/home/science/Poverty-reduces-brain-power-US-India-study/articleshow/22151485.cms
Riaz Haq said…
Antenatal and postnatal care for women in rural Pakistan has improved dramatically, thanks in part to the work of women like Shagufta Shahzadi, a skilled birth attendant trained under a UNICEF-supported programme.

KASUR DISTRICT, Pakistan, 3 December 2014 – “My biggest pleasure is to see that the mother and child are both healthy after the delivery,” says Shagufta Shahzadi, 30, a skilled birth attendant (SBA) who lives and works in Nandanpura village, Kasur district, in Pakistan’s Punjab province.

“There is a huge difference between services provided by a trained birth attendant and an untrained traditional midwife. A skilled person knows how to prevent and deal with complications during pregnancy, at the time of delivery and delivering postnatal care for mother and child.”

A day’s work for Shagufta could include delivering a baby, advising pregnant women on prenatal care, walking to the neighbouring village to provide postnatal care to a mother and the newborn. She takes a lot of pride in her work and feels a sense of achievement in the fact that due to her services, there hasn’t been a case of a pregnant mother or newborn death in her area over the last year.

Looking back at the struggle she had to make throughout her life, Shagufta recalls, “I was two months old when my father passed away. My mother raised me and my sister with the little money she earned by stitching cloths. Her resources were meagre, yet she made sure that we both completed our matriculation. Thereafter, we completed our respective trainings. My sister became a lady health worker, and I became a skilled birth attendant.”

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“Due to the positive results of this programme, the Government of Pakistan has scaled up the initiative across the country,” says Dr, Tahir Manzoor, Health Specialist at UNICEF Pakistan. “In Punjab province, more than 5,000 women have been trained and are performing valuable services within their own communities. We can already see the positive impact of their services and are certain that it will improve the scenario of mortality and morbidity for mothers and new born children in Pakistan over the next few years.”

Shagufta believes that ensuring health and safety for mother and child is imperative.

“If mothers and children are healthy, the entire society will be healthy. The future generations will be healthy," she says. "We must try to save lives, as life is precious, and you only get it once.”


http://www.unicef.org/infobycountry/pakistan_78038.html
Riaz Haq said…
How #Pakistan’s National Health Insurance Program Will Work http://on.wsj.com/1VrDRpC via @WSJIndia

Pakistan’s government launched a national health insurance program for its poorest households Thursday, marking the start of the most-ambitious public health project in the country’s history.

The Prime Minister’s National Health Program will from Thursday cover families that make less than $2 a day through a gradual rollout. In the first phase, over 3 million families will get health insurance in 23 districts, with the ultimate aim to cover 22 million households across the country, officials said.

“This is another step towards the welfare state that we promised to create when we came into power,”said Pakistani Prime Minister Nawaz Sharif.

The Pakistani government already subsidizes health care to varying degrees in public hospitals, but officials acknowledge these facilities are unable to handle the patient load or achieve public health targets.

The government said earlier this year that it wouldn’t be able to meet the United Nation’s targets for child and maternal mortality rates that formed part of the Millennium Development Goals, which had a deadline of 2015. Critics have blamed Pakistan’s low health spending and inadequate management as key factors in the poor health provision. Between July 2014 and March 2015, Pakistan spent just 0.42% of its GDP on health. The U.S. government spends about 8.3% of GDP on healthcare.

The new insurance program will cover treatment at both public and private hospitals. Private hospitals that sign up will then be offered loans on easy terms to upgrade their facilities, officials said, without providing further details about interest rates and conditions.

Saira Afzal Tarar, minister of state for health Services, regulations and coordination, said most Pakistanis pay out of pocket for treatment. “There is treatment at government-run hospitals, but there are long lines. Those who don’t have a recommendation have to wait months for treatment,” Ms. Tarar said at the launch ceremony in Islamabad. “With this [health insurance] card, you’ll be able to go to the hospitals where you weren’t allowed to even go to the front door. Now, you’ll be treated there with dignity and respect.” Ms. Tarar said.

The national health program, with an initial funding of 9 billion Pakistani rupees ($86 million) will pay for the treatment of the types of illnesses identified by the government as critical: heart disease, diabetes and related illnesses, cancer, kidney and liver diseases, complications from infections like HIV and Hepatitis, road accidents, and burn injuries. Officials said coverage can be extended to other conditions considered life-threatening.

The government said Thursday that the program will be run in partnership with provincial governments, which will share the financial burden. Beneficiaries will receive insurance cards, after selection from a database of low-income Pakistanis set up in 2008 for a separate cash support program.

The coverage includes 50,000 rupees for general treatment, and 300,000 rupees for serious illnesses. Mr. Sharif said on Thursday that the government is making arrangements for an emergency fund that would extend coverage to 600,000 rupees for cases that require longer treatment.

Officials on Thursday didn’t provide specific timelines for the rollout of the next phase, which is expected to cover another 3.3 million households. The finance ministry said earlier this year that the program aims to cover 22 million families.

The finance ministry, quoting World Bank data and 2008 population estimates, said last year that if living on $2 a day is taken as the poverty line, over 60% of the population would fall in that category.
Riaz Haq said…
Dailytimes | #ImranKhan to perform ground-breaking of #Karachi's cancer hospital on Dec 29 - #PTI http://go.shr.lc/2hjSPmp via @Shareaholic

The ground-breaking ceremony of Shaukat Khanum Memorial Cancer Hospital and Research Centre in Karachi would be held on December 29, 2016.

Pakistan Tehreek-e-Insaf's chairman Imran Khan, who is also Chairman Board of Governors Shaukat Khanum Memorial Trust will lay the foundation stone.

In February this year, the then Chief of Army Staff General Raheel Shareef had granted a 20 acre plot for the construction of the cancer hospital in Defence Housing Authority located at the Karachi-Hyderabad Super Highway.

A statement of Shaukat Khanum Memorial Trust said, "The construction of a comprehensive cancer diagnosis and treatment facility in Karachi will not only provide the most modern cancer treatment to the people of Sindh, but will also help raise healthcare standards and provide training and employment opportunities in the region."

It is Shaukat Khanum Memorial Trust's third Cancer Hospital and Research Centre in the country. Trust has already established two hospitals - one in Lahore and the other is in Peshawar.
Riaz Haq said…
Global Burden of Disease Study: India at 154, lags behind Bangladesh
India also lags behind Sri Lanka, Bangladesh, Bhutan and Nepal but ahead of Pakistan

http://www.business-standard.com/article/current-affairs/global-burden-of-disease-study-india-at-154-lags-behind-bangladesh-117052000010_1.html

India's healthcare access and quality (HAQ) index has increased by 14.1, up from 30.7 in 1990 to 44.8 in 2015.

India (44.8) lags behind Sri Lanka (72.8), Bangladesh (51.7), Bhutan (52.7) and Nepal (50.8) and ranks above Pakistan (43.1) and Afghanistan (32.5).

The HAQ index, based on death rates for 32 diseases that can be avoided or effectively treated with proper medical care, also tracked progress in each nation compared to the benchmark year of 1990.

As per the study, India has performed poorly in tackling cases of tuberculosis, diabetes, chronic kidney diseases and rheumatic heart diseases.

The journal lists India among the biggest underachievers in Asia in health care access.

Switzerland topped the health index, followed by Sweden and Norway. China stood 82nd and Sri Lanka 73rd.

Among the developed nations, those who did not perform well include the US and the UK.

Riaz Haq said…
India world’s leprosy epicentre, despite its ‘elimination’ in 2005
Leprosy cases with severe deformities have increased by 50% increase in the past six years, indicating that many cases of the curable disease are being detected late. This rising trend of late diognosis is a cause for concern, especially after the government had declared leprosy had been eliminated from India in 2005. WHO norms say leprosy is eliminated if the prevalence of the disease is less than one case per 10,000 people.
According to the WHO, 60% of the 2,12,000 people detected with leprosy globally in 2015 were from India. WHO norms say leprosy is eliminated if the prevalence of the disease is less than one case per 10,000 population. In 2005, India achieved statistical elimination of leprosy with a national prevalence rate of 0.96. The prevalence rate declined to 0.66 in 2015-16. The next step is eradicating the disease, when not a single case is reported.

http://www.hindustantimes.com/india-news/india-world-s-leprosy-epicentre-despite-its-elimination-in-2005/story-vIjQfcp2QuBdh9yfptD2AM.html


From the early 1960s on, Pfau helped lead the Marie Adelaide Leprosy Centre, transforming what was once a tiny makeshift dispensary into the hub for a system of 157 medical centers across the country, often in remote regions. With the partnership of the Pakistani government, Pfau developed the country's National Leprosy Control Programme and extended her efforts to include treatments for blindness and tuberculosis.

"We are like a Pakistani marriage," Pfau told the BBC of her occasionally strained collaboration with state officials. "It was an arranged marriage because it was necessary. We always and only fought with each other. But we never could go in for divorce because we had too many children."

But that partnership paid dividends. By 1996, the World Health Organization declared that leprosy had been controlled in Pakistan. The country's Dawn newspaper reports that last year, just 531 patients were in treatment for leprosy nationwide — down from 19,398 in the early 1980s.

For her efforts, Pfau earned the country's second-highest civilian honor, the Hilal-e-Imtiaz, in 1979. And she ultimately came to enjoy a celebrity in Pakistan on par with another nun known the world over for her work with the sick and the poor: Mother Teresa.

http://www.npr.org/sections/thetwo-way/2017/08/10/542588725/ruth-pfau-beacon-for-pakistan-s-leprosy-patients-dies-at-87

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