Public Health Perspective (PHP) Newsletter December 2012 Issue


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The Forgotten Victims
National News:
Health team on mission to eradicate dengue
Telemedicine service boon for Myagdi folk
Significant drop in HIV/AIDS cases
FCHVs seek recognition of their contributions
Call for strong public health leadership in South Asia
300-bed hospital in Humla likely
Featured Article:
HIV and Millennium Development Goal (MDG) Six (Pratik Khanal, Nepal)
Global Health:
Novel coronavirus infection - update
Ebola in Uganda - update
Yellow fever in the Republic of Congo
Guardian Examines Challenges of Eliminating River Blindness in Africa
Pakistan Reports 9th Death in Polio Worker Attacks, Resumes Vaccination Campaign under Police Escort
Journal Watch:
Recent trend of bacterial etiology of lower respiratory tract infections in a tertiary care centre of Nepal
Being Healthy:
Stay healthy by protecting yourself from STDs
WHO Publications:
Bulletin of WHO Vol. 90, No.12, 2012
WHO recommendations for the prevention and treatment of postpartum hemorrhage
The Global HIV/AIDS Epidemic (Factsheet, December 2012)
HIV/AIDS Knowledge and Behavior in Nepal (Key Findings)
Journal of Pakistan Medical Students (JPMS) becomes the first Pakistan-based journal to have an Impact Factor (IF) of 1.00
Welcome to our new campus liaison (Sharika Mahato, Nobel College, Sinamangal, Kathmandu, Nepal)

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Public Health Perspective (PHP) Newsletter December 2012 Issue

  1. 1. Public Health Perspective the first public health online newsletter of Nepal Vol. 2 Issue 11 December 2012 Editorial: The Forgotten Victims This December, people around who have no role in getting such interventions are still the globe have set up differ- the disease. Most of these not widely accessible or avail- Inside This Issue ent programs related to HIV/ children acquire HIV from able in most resource-limited AIDS. But children who are their HIV-infected mothers countries where the burden of the vulnerable people from during pregnancy, birth or HIV is highest. The number of every aspect of health includ- breastfeeding. So, why children receiving Anti Retro- National News 2&4 ing infectious disease such as should they have to suffer viral Therapy (ART) increased HIV/AIDS are not given due the HIV-related stigma and from about 456 000 in 2010 HIV and Millennium importance. It seems like the discrimination? to 562 000 in 2011, but this Development Goal 3 children infected with HIV/ represents coverage rate of (MDG) Six AIDS are forgotten in this very Progress is possible when we only 28 percent among chil- special day. Thus, to get our come together for a common dren in need of pediatric ART. readers acquainted with this cause-with vision, clear ob- The Global HIV/AIDS 4&7 different but important aspect jectives and strong sustained Providing ART for all HIV in- Epidemic (Factsheet) of HIV/AIDS, we tried to bring effort. The UNAIDS has fected children reduces AIDS- the Children infected with made a global plan towards related infant deaths by more Global Health 5 HIV—the forgotten victims in the elimination of new HIV than 50 percent. Preventing limelight. infections among children by HIV infection among women Journal Watch 6 2015 and keeping their and meeting unmet family At the end of 2011, an esti- mothers alive. The goal of planning needs of women Being Healthy 8 mated 3.4 million children the Global Plan is to move living with HIV can signifi- were living with HIV, says towards eliminating new HIV cantly contribute to reducing World Health Organization infections among children the need for antiretroviral WHO Publications 9 and keeping their mothers prophylaxis and treatment. (WHO). In Nepal, according to UNAIDS, the number of new alive. It says that the life of a New Subscribers 10 HIV infections among children child and a mother has the Children affected by HIV need was less than or equal to 500 same value, irrespective of appropriate care from their in 2009. In contrast, in high- where she or he is born and family members and the soci- income countries the number lives. ety. It is one of the important of new HIV infections among aspects of HIV related pro- children and maternal and It is possible to stop new HIV grams. However, due atten- child deaths due to HIV was infections among children tion has not yet been givenPublic Health Important virtually zero. In low- and and keep their mothers alive from the government level. middle-income countries, too if pregnant women living They need to be treated wellDays (December) few women are receiving HIV with HIV and their children by the society. The govern- prevention and treatment have timely access to quality ment should ensure equal1 December: World AIDS Day services to protect themselves life-saving antiretroviral rights to these children as or their children. drugs—for their own health, those enjoyed by other chil-3 December: International Day as indicated, or as a prophy- dren and empower these chil- of Persons with Disability laxis to stop HIV transmis- Children infected with HIV are dren so that they contribute 10 December: Human Rights becoming orphan and dying sion during pregnancy, deliv- to the society and the nation. Day due to lack of access to treat- ery and breastfeeding. With ment. These children are also efficacious interventions the suffering from HIV-related risk of mother-to-child HIV stigma and discrimination. transmission can be reduced They are the innocent people to two percent. However, Amrit Banstola HAPPY NEW YEAR 2013 For everybody in the world whatever color their skin may be, whatever their religion may be, whatever their situation may be, good health, lots of love, of possibilities and...peace!!! With regards, Public Health Perspective (PHP)
  2. 2. December 2012 Public Health Perspective (PHP) Page 2 National News launched in the village as lo- transmission. However, de- nium Development Goal cals cannot visit far-off city spite the decrease in the num-Health team on mis- hospitals owing to their finan- ber of PLWA, Nepal still has a in health. Dr Sinendra Uprety, director of the Family Health Di-sion to eradicate den- cial constraints. The clinic, long way to go if it is to bring vision under the Department of initiated by renowned social down the HIV/AIDS preva- Health Services, said that coun-gue worker Mahabir Pun, has been lence rate to 0.30 by 2015 to try’s health sector has been de-KAKADBHITTA, NOV 23 - catering to villagers at afford- meet the Millennium Develop- veloping due to the combined able prices for the last five ment Goal. “Nepal will not efforts of the government, FCHVsA team deputed from De- years. Doctors at Kathmandu meet its 2015 treatment tar- and donor agencies. He said that partment of Health Ser- Model Hospital in the Capital get if we do not triple our ef- the government had establishedvice has started inspections at are connected with locals forts by offering testing and a fund of Rs 50,000 in each VDCevery households, hotels and through a computer equipped treating to key affected popu- in the fiscal year 2007/08 in rec-vehicle stations in Mechinagar with wireless internet at the lations,” said Dr Ruben F Del ognition of the work of FCHVs.-10, Kakadbhitta prone to clinic where health workers Prado, UNAIDS Country Coor- The fund has been increased todengue fever. A team headed provide medicines to patients dinator for Nepal and Bhutan. Rs 90,000, along with allowancesby In-charge of Epidemiology as prescribed. for travel and clothes, accordingand Disease Control Division Source: to Dr Uprety. “Since this is volun-Dr Yubaraj Pokharel compris- Source: tary work, the ministry cannoting Dr Chandan Thakur, Vec- FCHVs seek recognition allocate a salary for such a largetor Control Inspector Par- Significant drop in HIV/ of their contributions number of volunteers,” he said.shuram Shrestha and District AIDS casesPublic Health Officer Dr Yo- Source: ekantipur.comgendra Prasad Bhagat had KATHMANDU, DEC 09 -minutely observed the possi- POKHARA, DEC 02 - Call for strong publicble area where female mos-quito of Aedes Ageptai and its T he number of people living with HIV/AIDS in Nepal F emale Community Health Volunteers (FCHVs) com- plained lack of recognition of health leadership inlarva are detected and cau- has more than halved within a South Asiationed house owners, hotel- their contributions by the gov-iers and entrepreneurs. year. According to the annual ernment. About 52,000 FCHVs KATHMANDU, DEC 19 - report publicized by the Na- have been delivering much- PFollowing the inspection of tional Centre for AIDS and needed health services to re- ublic health experts andaffected areas, activities such STD Control (NCASC) on De- mote and rural areas where stakeholders have stressedas destroying eggs and larva cember 01, the number has there are no hospitals and the need of a good leadership toof mosquito, distributing free fallen to 20,574—from 50,200 health facilities. These female ensure people’s health rights.medicines to patients, arrang- last year. The figure shows a volunteers are trained in fam- Speaking at a function to inaugu-ing blood for the patients and drop of about 30,000, the ily planning, maternity care, rate training on “Development ofproviding health check-up lowest estimate in years. The infant care, immunizations Leadership in Public Health inservices in different health number of People Living with and nutrition. According to South Asia” experts said the in-facilities was done, said Divi- HIV/AIDS (PLWA) had never Gunakeshari Shrestha, a FCHV creasing number of patients withsion Director Dr GD Thakur. fallen below 50,000. Dr based in Sindhupalchowk, the non-communicable disease andHe has pledged to halt dengue Krishna Kumar Rai, Director government needs to make the already existing problem ofoutbreak in the affected area of the centre, said that the sure that FCHVs are properly communicable disease in Southwithin a month. drop shows that HIV/AIDS motivated. “We do our job Asia has demanded a good lead- awareness among adults has sincerely and are available ership to manage the limitedSource: increased significantly over round the clock,” said resources and address the bur- the years, a major achieve- Shrestha. She argued that the geoning issues of public health.Telemedicine service ment of the HIV/AIDS inter- government should make pro- Rob Moodie, professor of pub- vention program in the coun- visions setting the retirementboon for Myagdi folk try. However, only 9,246 age at 60. “That does not lic health at Melbourne School of Population Health & a trainer on PLWA are enrolled in the Anti- mean we become useless with public health leadership, saidMYAGDI, NOV 29 - Retroviral Therapy (ART). Of age. Our contributions should with the growing disease burden them, 1,185 have died. The not be forgotten,” said & the constrained resources, it isT elemedicine service, in ART was started in Nepal in Shrestha. high time for the government to which doctors from urban 2004 at Teku Hospital. invest in developing leadershipareas provide medical advice Women volunteers play a piv- skills among health professionals,to patients in remote villages The government has been otal role in decreasing the who only receive technical areathrough wireless internet, has providing medication free of maternal mortality rate and trainings. President of Publicbrought smiles to the faces of cost. The report further improving health conditions of Health Foundation of India, Profpeople in a Myagdi village. claimed that four out of every women in rural as well as ur- Sanjay Zodpey, also underscored“Five to seven patients are five infections happen through ban areas. Their contributions the need of a good leadership foravailing the service on a daily sexual transmission. It speci- have helped reduce the ma- better public health services.basis,” said Lila Pun, an em- fied male labor migrants, par- ternal mortality rate by half inployee at a clinic run by the ticularly to India, and clients just 10 years. Due to their Continued on page 4local community in Ramche. of female sex workers in Ne- unfailing contribution, Nepal isHe said the service was pal as the main agents of closer to achieving the Millen-
  3. 3. December 2012 Public Health Perspective (PHP) Page 3 HIV and Millennium Development Goal (MDG) Six Pratik Khanal—Coordinator of District AIDS Coordination Committee, DHO, Gulmi, Nepal To combat HIV is one of the Millennium Development Goals (MDGs) — Goal six. MDGs are an interna- tional commitment and a developmental agenda which all member countries should abide by 2015. Nepal is on track to achieve number of goals such as those related to child mortality, maternal health and combating HIV/AIDS and other diseases. The total number of people living with HIV for 2011 was estimated at 50 200 with an overall national HIV prevalence of 0.3 percent. As of July 15 2012, the total HIV infections reported were 20 583. Of these 13 157 were male, 7 417 were female, and nine were transgender. People who inject drugs, men who have sex with men, female sex workers and their clients, and male labor migrants are population at higher risk in Nepal. Integrated Bio-behavioral Surveys conducted in Nepal shows that prevalence of HIV has been decreasing over the years owing to targeted intervention programs in the community level and there has been increasing in access to counseling and HIV testing services. Targets and Indicators of MDG related to HIV/AIDS Target 6 A: Indicators: Have halted by 2015 1. HIV prevalence among pregnant women aged 15-24 years and begun to re- 2. Condom use at last high risk sex verse the spread of 3. Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS HIV/AIDS 4. Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years. Target 6 B: Indicator: Achieve by 2010 1. Proportion of population with advanced HIV infection with access to anti-retroviral drugs universal access to treatment for HIV/ AIDS for all those who need it Progress made related to MDG-6 HIV testing and counseling services are provided free of cost to the population at higher risk, including general population. 104 666 people were tested for HIV in 2010 in Nepal. Nepal Demographic and Health Survey (NDHS) conducted in 2011 showed that 86 percent of women and 97 percent of men aged 15-49 have heard of AIDS. Among youth aged 15-24 years, it was 89 percent in women and 98 percent in men. Preven- tion knowledge has improved in recent years. As per NDHS 2011, 71 percent of women know that the risk of getting HIV can be reduced by using condoms and limiting sex to one faithful, uninfected partner which was only 55 percent in 2006. According to National Centre for AIDS and STD control, 2012, there has been a decline of HIV prevalence among youth aged 15- 24 years from an estimated 0.08 in 2000 A.D to 0.01 in 2011 A.D. The proportion of HIV cases among youths aged 15-24 years is 10.2 percent. By July 2012, total 7 142 patients with advanced HIV infection were on treatment in 39 Anti-Retroviral Therapy (ART) centers across the country (54.6 percent male, 44.8 percent female and 0.3 percent trans gender). The government of Nepal is providing ART service free of cost for all those in need. Barrier to achieving MDG-6 Though over the years, there has been extension of HIV related service sites, service coverage and utilization among high risk, to achieve the MDG needs is still low. Behavior change communication intervention programs have not reached to population at higher risk viz. male labor migrants, female sex workers and their clients, and people who inject drugs. There is a large gap in access to ART and community care services for people living with HIV. Nepal has to depend on international agencies to fulfill the funding gap in HIV program which could affect the sustainability and national commitment to combat HIV. Service statistics indi- cate that detection of HIV positive pregnant women and service received has increased over the time, but there is still challenge to provide 100 percent service to the mothers and babies who required ARV prophylaxis. Moreover, there are limited programs for HIV affected and infected children. Conclusion HIV prevalence has been declining in Nepal over the years but still concerted efforts are required to decrease HIV infections in male labor migrants and clients of female sex workers who are acting as bridging population groups that transfer infections from higher risk groups to low risk general population. Also, the service coverage of HIV testing and counseling, ART and PMTCT need to be increased through expansion of service sites. Since HIV / AIDS is a multi-sectoral concern, only integrated efforts from all sectors will help to achieve MDG-6 and bring us closer to realizing our collective vision of zero new HIV infections, zero discrimi- nation and zero AIDS related deaths.
  4. 4. December 2012 Public Health Perspective (PHP) Page 4 The Global HIV/AIDS Epidemic F A C T S H E E T December 2012HIV, the virus that causes AIDS, “acquired immunodeficiency syndrome,” has become one of the world’s most serious health anddevelopment challenges. The first cases were reported in 1981.Current Global SnapshotAccording to the latest estimates from UNAIDS: There were 34.0 million people living with HIV in 2011, up from 29.4 million in 2001, the result of continuing new infections, people living longer with HIV, and general population growth. The global prevalence rate (the percent of people ages 15–49 who are infected) has leveled since 2001 and was 0.8% in 2011. 1.7 million people died of AIDS in 2011, a 24% decrease since 2005. Deaths have declined due in part to antiretroviral treatment (ART) scale-up. HIV is a leading cause of death worldwide and the number one cause of death in Africa.New HIV infections overall have declined by more than 20% since 2001and, in 25 low- and middle-income countries, new infections have de-clined by more than 50%. Still, there were about 2.5 million new infec-tions in 2011 or more than 7,000 new HIV infections per day. Most new infections are transmitted heterosexually, although risk factors vary. In some countries, men who have sex with men, injecting drug users, and sex workers are at significant risk. Although HIV testing capacity has increased over time, enabling more people to learn their HIV status, the majority of people with HIV are still unaware they are infected. HIV has led to a resurgence of tuberculosis (TB), particularly in Africa, and TB is a leading cause of death for people with HIV worldwide. In 2011, approximately 13% of new TB cases occurred in people living with HIV. However, between 2004 and 2011 TB deaths in people living with HIV declined by 25%, largely due to the scale up of joint HIV/TB services. Women represent about half of all people living with HIV worldwide, and more than half (58%) in sub-Saharan Africa. HIV is the leading cause of death among women of reproductive age. Gender inequalities, differential access to services, and sexual violence increase women’s vulnerability to HIV, and women, especially younger women, are biologically more susceptible to HIV. Young people, ages 15–24, account for approximately 40% of new HIV infections (among those 15 and over). Globally, young women twice as likely to become infected with HIV than their male counterparts. In some areas, young women are more heavily impacted than young men. Globally, there were 3.3 million children living with HIV in 2011, 330,000 new infections among children (a decrease of 24% from 2009-2011), 230,000 AIDS deaths, and approximately 17.3 million AIDS orphans (children who have lost one or both parents to HIV), most of whom live in sub-Saharan Africa (88%).Sub-Saharan Africa: Sub-Saharan Africa, the hardest hit region, is home to more than two-thirds (69%) of people living withHIV but only about 12% of the world’s population. Most children with HIV live in this region (94%). Almost all of the region’snations have generalized HIV epidemics—that is, their national HIV prevalence rate is greater than 1%. In 9 countries, 10% ormore of adults are estimated to be HIV-positive. South Africa has the highest number of people living with HIV in the world (5.6 million). Swaziland has the highest prevalence rate in the world (26.0%). Continued on page 7National News ticular training recognizes the need to strengthen the lead- 300-bed hospital in treatment. A meeting of KCHS chaired by Prime Minister Babu-Continued from page 2 ership capacity in South Asia Humla likely ram Bhattarai, also chancellor of for developing sustainable and KCHS, on Monday endorsed the“It is high time to develop the efficient health system based HUMLA, DEC 28 - plan. The hospital will also pro-leadership in public health. A on the principle of equity and vide specialty services, said KCHSgood public health leadershipensures the health rights of justice across the region” The training is being organized by the Nepal Public Health Foun- I f the five-year plan of Kar- nali College of Health Sci- ence (KCHS) sees the light of register Shyam Lamsal. He said the meeting also decided to run classes of staff nurse for the firstpeople that require an in-depth analysis on how politi- dation with support from Aus- day, Humla will have a 300- time at the Karnali Technicalcal, bureaucratic and business tralian AID in collaboration bed modern hospital. In the School beginning next fiscal year.decisions make an impact on with the Nossal Institute of event of this, people from Lamsal said the meeting also de-people’s health,” said Dr Sha- Global Health, Melbourne, several parts of the district as cided to set up the head office ofrad Onta, head of the Depart- Australia and the Public well as from Jumla, Mugu and KCHS in Jumla and proposed ament of Community Medicine Health Foundation of India. Kalikot will no longer be com- total budget of Rs 3 billion for theat the Tribhuvan University pelled to visit urban areas for construction of a hospital build-Teaching Hospital. “This par- treatment or die for want of ing. Source:
  5. 5. December 2012 Public Health Perspective (PHP) Page 5 Global Health Field teams continue to investi- Laboratory confirmation was loa-loa, a parasite common inNovel coronavirus infec- gate cases alerted to them done at Institut National de forest areas”.tion - update from the communities. The Recherche Biomédicale Kin- Source: US Global Health major challenge faced in some shasa (INRB), and recon- Policy30 November 2012 – communities is the belief that firmed by a WHO regionalI Pakistan Reports 9th n addition to the fatal case of witch-craft and not Ebola was reference laboratory for yel- the cause of deaths, despite low fever, Institut Pasteur, novel coronavirus in Saudi ongoing intensive awareness Dakar, Senegal. Death in Polio Worker At-Arabia reported to WHO on 28 tacks, Resumes Vaccina-November, two fatal cases in campaigns. Social mobilizationJordan have been reported to teams are working closely with The vaccination campaign is tion Campaign under Po-WHO on 30 November, bringing traditional healers and religious being supported by the Inter- lice Escortthe total of laboratory- leaders to raise awareness on national Coordinating Groupconfirmed cases to nine. prevention and control of the on Yellow Fever Vaccine Pro- 21 December 2012 - " disease. vision (YF-ICG1), the GAVI Alliance and the European Another victim from attacksThe latest confirmed case from WHO and partners including Commission’s Humanitarian on UN backed anti-polioSaudi Arabia occurred in Octo-ber 2012 and is from the family the US Centers for Disease Aid and Civil Protection De- teams in Pakistan died oncluster of the two cases con- Control and Prevention (CDC), partment (ECHO). Thursday, bringing the three-firmed earlier. The two cases Médecins Sans Frontières Source: WHO day death toll in the wave (MSF), the Uganda Red Crossfrom Jordan occurred in April (URCS), African Field Epidemi- Guardian Examines of assaults on volunteers vac-2012. At that time, a number ofsevere pneumonia cases oc- ology Network (AFENET), and Challenges of Eliminat- cinating children across the Plan Uganda continue to sup- ing River Blindness in country to nine, officials said,"curred in the country and theMinistry of Health (MOH) Jordan port the national authorities in Africa the Associated Press reports .promptly requested a WHO Col- the response to the outbreak. "Four female health workerslaborating Centre for Emerging Through WHO, an expert on were killed in Karachi, shotand Re-emerging Infectious infection prevention and control 17 December 2012 - T dead by masked men on mo-Diseases (NAMRU – 3) team to has been deployed to the field. he Guardians "Global torbikes. The other five vic-immediately assist in the labo- Development Profession-ratory investigation. With respect to this event, als Network" blog "reports on tims, including a 17-year-old WHO does not recommend that the challenges of eliminating volunteer, were slain in Pesha-The MOH Jordan has requested any travel or trade restriction river blindness from Africa by war and Charsadda," InterWHO assistance in investigating be applied to Uganda. 2025." "The implications of Press Service notes . The at-these infections. A mission from Source: WHO shift from disease control to tacks "indicate a threat not elimination are considerable,WHO Eastern Mediterranean Yellow fever in the Re- as has been the case with the only to workers but also to theRegional Office (EMRO) andheadquarters arrived in Amman public of Congo objective to eliminate oncho- effort to eradicate the disease cerciasis (better known as -- locally and globally," Scien-on 28 November 2012 to assistin further epidemiological sur- 12 December 2012 – river blindness) by 2025, tific Americans "Observations"veillance and to strengthen thesentinel surveillance systems T he Ministry of Health of the Republic of Congo is launching an emergency mass- decided by the African Pro- gramme for Onchocerciasis Control (APOC) back in blog adds.for severe acute respiratory "The UN has halted its partici-infections (SARIs). vaccination campaign against 2009," the blog writes, de- yellow fever in Ewo District in tailing elimination efforts pation in a Pakistani-run polioIn summary, to date a total of Cuvette-Ouest region, begin- against the disease since the vaccination program followingnine laboratory-confirmed cases ning next week. 1970s. "Together, 20 years attacks on health care work-of infection with the novel coro- of vector control and 25 ers ..., but the governmentnavirus have been reported to The emergency vaccination years of ivermectin treatment said it would not end the cam-WHO – five cases (including 3 campaign aims to cover ap- have brought onchocerciasis paign," NPRs "The Two-Way"deaths) from Saudi Arabia, two proximately 35,000 people in prevalence down to insignifi- writes, adding, "Officials saycases from Qatar and two cases three health districts of Mbama, cant levels in many coun- Ewo and Okoyo, all of which tries," the blog states. the country is committed to(both fatal) from Jordan. belong to the administrative seeing polio eradicated andSource: WHO district of Ewo. However, "the disease still has suspended vaccinationsEbola in Uganda - up- exists," the blog notes and only in Sindh province, where The emergency vaccinationdate campaign is being carried out highlights a number of chal- Karachi is located". "Under lenges to achieving elimina- police guard, thousands of30 November 2012 – after recent confirmation of a tion, such as raising funds for health workers pressed on withA s of 28 November 2012, the case with yellow fever virus infection that occurred in Octo- surveillance efforts and a polio immunization program Ministry of Health inUganda reported 7 cases (6 ber 2012. The case was identi- achieving universal treatment 20 December 2012," the APconfirmed, 1 probable) with fied through the national sur- writes. coverage due to "a poten-Ebola haemorrhagic fever in veillance programme for yellow tially lethal reaction to theLuweero and Kampala districts. fever. Source: US Global Health Pol- drug in patients infected withOf these cases, 4 died. icy
  6. 6. December 2012 Public Health Perspective (PHP) Page 6 Journal Watch Recent trend of bacterial etiology of lower respiratory tract infections in a tertiary care centre of Nepal How to join PHP? H. influenzae and S. pneumoniae were the most common Gram‐negative and Gram‐positive bacte- rial isolates recovered, respectively from Lower Respiratory Tract Infection (LRTI) in a tertiary care e-Mail: center of Nepal, according to the study published in 2012 issue of Int J Infect Microbiol. A prospective study was conducted over a period of six months in the bacteriology laboratory of website: Tribhuvan University Teaching Hospital (TUTH) in Kathmandu. A total of 1120 specimens repre- senting lower respiratory tract were received from patients with suspected LRTIs. The specimens publications.php were collected and processed according to standard methodology. Respiratory pathogens were recovered from 44.4% cases (n=497). Gram‐negative Bacteria were recovered in 84.1% (n=488). Bacteria were more commonly recovered from endotracheal secre- tion (41/61, 67.2%) than in sputum (454/1039, 43.7%) and bronchial washing (2/20, 10%). Ninety‐one percent (n=454) growth was monomicrobial while the rest accounted for Benefits of mixed growth. Among the organisms isolated, Haemophilus influenzae (112, 21%) was the most predominant pathogen followed by Klebsiella pneumoniae (102, 19.1%), Pseudomo- Being a PHP nads (91, 17.1%), Acinetobacter baumannii calcoaceticus complex (60, 10.9%), Streptococcus pneumoniae (46, 8.6%), Escherichia coli (37, 6.9%). Subscriber This study urge for routine surveillance of microbial etiology of LRTI .  Can submit articles to Full text article is available at: Int J Infect Microbiol 2012;1(1):3-8 DOI: PHP newsletter  Heavy discount rate in Authors: Mishra SK, Kattel HP, Acharya J, Shah NP, Shah AS, Sherchand JB, Rijal BP, Pokhrel BM PHP trainings, work- shops, seminars, con- HIV/AIDS Knowledge and Behavior in Nepal (Key Findings) ferences  Get acquainted with Knowledge According to the 2011 Nepal Demographic and Health Survey (NDHS), 86% of women and 97% of public health news from men age 15-49 have heard of HIV and AIDS, but knowledge of HIV prevention measures is around the nation and slightly lower. Seventy-one percent of women and 84% of men know that the risk of getting HIV globe at a time can be reduced by using condoms and limiting sex to one faithful, uninfected partner. Knowledge of HIV prevention measures is higher among those with higher levels of education and those from  Enhances professional wealthier households. writing skills Prevention knowledge has improved in recent years, especially among women. In 2006, only 55% of women knew that the risk of getting HIV can be reduced by using condoms and limiting sex to one faithful, uninfected partner. Send Letters to the About 60% of women and men know that HIV can be transmitted by breast- Editor feeding. However, only 35% of women and 44% of men know  All readers can post that the risk of mother-to-child trans- comments on articles mission can be reduced by taking drugs and news mentioned in during pregnancy. PHP or could be sugges- tions and compliments. Multiple sexual partners and con- dom use  Send letters to: Multiple sexual partnerships are very rare in Nepal. Only 4% of men reported © 2004 Rebecca Callahan, Courtesy of Photoshare  Word limit 150 max. and having had more than one sexual part- the title of news or arti- ner in the year before the survey. Men report an average of 2.5 lifetime sexual partners. Five per- cles of critique. cent men report having ever paid for sex, while 2% report having paid for sex in the past year.  Email should include ‘letters to the editor’ Prior HIV testing in email subject line. Only 38% of women and 57% of men know where to get an HIV test. Only 3% of women and 8% of men were tested for HIV in the year before the survey and received the results. While this is low, it is an increase from 2006 when only 1% of women had ever been tested; in 2011, 5% of women reported that they had ever been tested. >> Source: Nepal Demographic and Health Survey 2011
  7. 7. December 2012 Public Health Perspective (PHP) Page 7 The Global HIV/AIDS Epidemic cont... continued from page 4 Recent data offer promising signs, with national HIV prevalence and/or incidence stabilizing or even declining in many countries in the region. Latin America & The Caribbean: About 1.6 million people are estimated to be living with HIV in Latin America and the Carib- bean combined, including 96,000 newly infected in 2011. The Caribbean itself, with an adult HIV prevalence rate of 1%, is the second hardest hit region in the world after sub-Saharan Africa. Seven countries in Latin America and the Caribbean have gener- alized epidemics, with the Bahamas having the region’s highest prevalence rate (2.8%), and Brazil the greatest number of people living with the disease. Eastern Europe & Central Asia: An estimated 1.4 million people are living with HIV in this region, including 140,000 newly infected in 2011. The epidemic is driven primarily by injecting drug use, although heterosexual transmission also plays an impor- tant role. While the number of new infections had remained relatively stable several years, recent estimates indicate an increase in new infections in the region. The Russian Federation and Ukraine have the highest prevalence rates in the region, and Russia has the region’s highest number of people living with HIV. Asia: More than 5 million people are living with HIV across South/South-East Asia and East Asia. While most national epidemics appear to have stabilized, HIV incidence has increased by more than 25% since 2001 in Bangladesh, Indonesia, the Philippines, and Sri Lanka. The region is also home to the two most populous nations in the world – China and India – and even relatively low prevalence rates translate into large numbers of people. Prevention and Treatment Numerous prevention interventions exist to combat HIV, and new tools, such as vaccines, are currently being researched.  Effective prevention strategies include behavior change programs, condoms, HIV testing, blood supply safety, harm reduc- tion efforts for injecting drug users, and male circumcision. Additionally, recent research has shown that providing HIV treat- ment to people with HIV significantly reduces the risk of transmission to their negative partners and the use of antiretroviral- based microbicide gel has been found to reduce the risk of HIV infection in women.  Experts recommend that prevention be based on “knowing your epidemic,” that is, tailoring prevention to the local context and epidemiology, and using a combination of prevention strategies, bringing programs to scale, and sustaining efforts over time.  Access to prevention, however, remains limited. HIV treatment includes the use of combination antiretroviral therapy to attack the virus itself, and medications to prevent and treat the many opportunistic infections that can occur when the immune system is compromised by HIV.  Combination ART, first introduced in 1996, has led to dramatic reductions in morbidity and mortality, and access has in- creased in recent years, rising from less than half a million people on treatment in 2003 to 8 million people in 2011, a 63% increase in the number of people on treatment since 2009. The Global Response to HIV/AIDS International efforts to combat HIV began in the first decade of the epidemic with the creation of the WHO’s Global Programme on AIDS in 1987. UNAIDS was formed in 1996 to serve as the UN system’s coordinating body and to help galvanize worldwide attention to AIDS. The role of affected country governments and civil society also has been critical to the response. Over time, funding by donors and others has increased and several key initiatives have been launched:  In 2000, all nations agreed to global HIV targets to halt and begin to reverse the spread of HIV by 2015, as part of the UN Millennium Development Goals (MDGs), and the World Bank launched its Multi-Country AIDS Program (MAP).  In 2001, a United Nations General Assembly Special Session on HIV/AIDS (UNGASS) was convened and the Global Fund was created. More recently, at the June 2011 UNGASS meeting, world leaders adopted a new Declaration that reaffirmed commitments and called for an intensification of efforts to combat the epidemic through new commitments and targets.  Most funding has come from international donors who disbursed $7.6 billion in 2011, up from $1.2 billion in 2002, to address HIV in low- and middle-income countries. The Global Fund has approved more than $13 billion for HIV efforts in more than 100 countries to date,16 and the private sector, including foundations and corporations, also plays a major role, particularly the Bill & Melinda Gates Foundation which has committed more than $2.5 billion for HIV, with additional funding provided to the Global Fund.  Despite these increases, UNAIDS estimates a resource gap of $7.2 billion annually. >> This publication (#3030-17) is available on the Kaiser Family Foundation’s website at
  8. 8. December 2012 Public Health Perspective (PHP) Page 8 Being Healthy tion, an organization that focuses on STD fessor of medicine at Emory University and a Stay healthy by prevention. "Part of the problem is that peo- guidelines coordinator in the Division of STD protecting yourself ple dont always perceive that they are at Prevention at CDC. risk. They think STDs happen to other peo- from STDs ple or that they only happen to people with "Realize that before embarking on a sexual a lot of partners. That is what people think, relationship there comes responsibility, andAt some point in our lives, most but the fact is everyone is at risk, even if the responsibility is not only to protect yourselfof us from romantic relation- they have only had one or two partners." but to protect your partner," Workowski says.ships. Intimate relationships canenhance our feelings of well- Many STDs are without symptoms, so its The most reliable way to protect yourself frombeing and bring a sense of hap- important to ask your health care provider STDs is to abstain from sex, which meanspiness, security and stability to about getting screened avoiding all types of intimate sexualour lives. But with intimacy for STDs, to talk to contact. If celibacy isnt for you, con-comes responsibility. your partner openly sider aiming for an exclusive relation- about the potential for ship with one partner.Anyone who has sex is at risk for sexually transmittedsexually transmitted diseases. infections and to dis- The good news is that sexually trans-Formerly called venereal dis- cuss condom use. mitted diseases are preventable, andeases, Sexually Transmitted when diagnosed early, many can beDiseases, or STDs, are infections You cant tell if some- treated effectively.that can be spread from one one has a sexuallyperson to another during sexual transmitted disease Most STDs affect both men andcontact. just by looking at her or him, so its impor- women, but in many cases, women pay a tant to know the facts if you want to steer higher price in terms of health problems. For"Young people have a dispropor- clear of becoming infected. Though it might example, some STDs can lead to infertility.tionate burden, but, really, eve- seem difficult, its important that you and Also, if a woman is pregnant and has an STD,ryone is at risk for STDs," says your partner have a frank discussion "prior the infection could cause her baby to haveFred Wyand, spokesman for the to the initiation of sex, not at the time of serious health issues. However, most problemsAmerican Social Health Associa- sex," says Kimberly Workowski, MD, a pro- can be prevented if the mother receives rou- tine prenatal care that includes screening tests for STDs. And dont forget that HIV is a sexually transmitted diseases, Of the more than 20 types of STDs, the most frequently re- Workowski warns, noting that people with sexually transmitted ported include gonorrhea, genital herpes, HIV/AIDS, human diseases are at increased risk of acquiring HIV. papillomavirus, syphilis and trichomoniasis. Talk to your health care provider about getting tested for Genital human papillomavirus, or HPV, is the most common STDs. Never try to treat a sexually transmitted disease your- sexually transmitted infection. So common self. STDs caused by bacteria or parasites can usually be is HPV that most people who are sexually treated with antibiotics or other medicines. Some STDs caused active will become infected with HPV at by viruses—such as genital herpes and HIV/AIDS—cant be some point in their lives. Most folks who cured, but often can be controlled with medication . become infected with HPV dont have Safe sex is important symptoms and it usually goes away on its own. But HPV can cause serious health If you are sexually ac- problems, including warts in the genital tive, its critical to prac- area as well as cell changes that can lead tice safe sex. When to a number of HPV-related cancers, in- used correctly, latex cluding cervical and anal cancer. condoms can greatly reduce your risk of ac- "Thats why Pap tests are important, and also why HPV vac- quiring an STD. And cines are also very important," Wyand says. keep in mind that birth control pills and spermi- Symptoms vary between STDs and can include cidal, though effective sores or warts on the genital areas, burning for preventing preg- while urinating, unusual discharge from the nancy, will not protect penis or vagina, itching and redness in the against STDs. genital area, and anal itching, soreness or bleeding. >> Courtesy: Teddi Dineley Johnson, Public Health Perspective (PHP) Online Newsletter published in Healthy You section of No- vember/December 2011 issue of ‘The Nations Health.’ >> For more tips, visit
  9. 9. December 2012 Public Health Perspective (PHP) Page 9 WHO PublicationsBulletin of WHO Vol. 90, No.12, 2012The Bulletin is one of the worlds leading public health journals. It is a peer-reviewed monthly with a special focus on developingcountries, giving it unrivalled global scope and authority. The Bulletin is one of the top 10 public and environmental health jour-nals with an impact factor of 5.4, according to the Institute of Scientific Information (ISI). It is essential reading for all publichealth decision-makers and researchers who require its special blend of research, well-informed opinion and news. Full bulletinis available at: recommendations for the prevention and treatment of postpartum hemorrhageThis guideline provides a foundation for the implementation of effective interventions to reduce the burden of postpartum hemor-rhage (PPH). It updates previous WHO recommendations and adds new recommendations for the prevention and treatment of PPH.Download is available at: Journal of Pakistan Medical Students (JPMS) becomes the first Pakistan-based journalNews from our partner to have an Impact Factor (IF) of 1.0031st Dec 2012 by Burhan Ahmed in International News— Journal of Pakistan Medical Students (JPMS) published 15 cite-able articles in 2011. To maintain high quality of the con-tent, it came at the expense of a high rejection rate of 78%. The quality of content is being increasingly recognized by the aca-demic contributors. To date, the journal has received 19 (11 external and 8 internal citations) from the peer reviewed scientificjournals. For the year 2011, JPMS articles received 9 external citations and 6 internal citations (15 citations for 2011 articles/15cite-able articles published in 2011=1.00 IF for 2011), which make the unofficial impact factor to be 1.00; highest for any journalfrom Pakistan and comparable to the prestigious journals from South Asia. JPMS team plans to work even harder to maintain andachieve a reasonable impact factor (IF). Talking to Medicalopedia, the Founding Editor and Associate Chief Editor, Anis Rehman, MD said: “We have to give backto science and contribute to the scientific literature. A lot more has to be done in the field. This is just a beginning.” Dr. Haris Riaz, the Chief Editor added, “We feel proud that JPMS has achieved such heights in such a short duration,thanks to the JPMS contributors and support from the scientific community across the globe”. Welcome Our New CampusOUR CAMPUS LIASIONS LiaisonIf you are interested in participating as a Campus Liaison and have any questions aboutthe Liaison position, please contact us. Email: Call for Articles for January/February Issue  500-700 words on any topic of public health importance  Do not include any graphs, tables and citations  PP size photo in jpeg format  email your articles to with the subject ‘article for PHP’  For more information:
  10. 10. December 2012 Public Health Perspective (PHP) Page 10 Public Health Perspective (PHP) Team International Honorary Editorial Advisories Dr. Santosh Raj Contributing Writers Poudel Editorial Advisories Dr. Duk Bahadur Dr. P. Ravi Shankar Residency (MD) in Inter-Ms. Rose Schneider -- Chhetri nal medicine Professor, Clinical Phar- RN MPH MD, Pathologist Interfaith Medical Cen- macology & Medical Edu- Chair of the Climate Western Regional Hos- ter, New York cationChange Working Group pital Lab. KIST Medical College of the APHA Interna- Pokhara Dr. Krishna Chandra Lalitpur, Nepal. tional Health Section. RijalSenior Health and HIV/ Mr. Balram Banstola Dept. of Otorhinolaryn- Dr. Anis Rehman AIDS Specialist Managing Director, gology and Head & Neck Associate Chief Editor at Health Systems Man- Senior Pharmacist Surgery, College of Journal of Pakistan Medi- agement Banstola Medical Hall Medical Sciences and cal Students (JPMS)1414 Perry Place NW - Kaski Teaching Hospital HIFA 2015 Country Rep- Suite 100 Bharatpur, Chitwan resentative for PakistanWashington, DC 20010 Board of Advisories Ms. Sami Pande Mr. Chandra Bhushan Newsletter Team B. Pharm, MPH Yadav Editor-in Chief Australian Leadership Information Officer Amrit Banstola Dr. Margaret Steb- Scholar, 2009 (MLIS) bing Kathmandu Nepal Health Research Section Editors PhD, Master of Public Council (NHRC) Anoj Gurung Health, Dip App Sci Ashik Banstola MOHP, Kathmandu Dikshya Sherchan Nursing M. Pharm Dipendra Malla Population Health Aca- (Pharmacology), PDCR Sandeep Pahari demic Rajiv Gandhi University Sangita Shrestha School of Rural Health, Bangalore Subash Timilsina Monash University Sulochana Prajapati Australia Madan Kc Msc. Medical and Health Care Devices Uni. of Bolton, UKWelcome to New SubscribersNepal InternationalAashika Pun Alexander KopachovPratik Khanal Eli Ben DavidSushil Pathak JablonskiUttam Ratna Shakya Labbaipierre Marius PopaArticles appearing in Public Health Perspective (PHP) Online Newsletter do not necessarily reflect the views of the PHP team but are in-tended to inform and stimulate thought, discussion and comment. The PHP newsletter don not discriminate on the basis of race, color, gen-der, religion, age, sexual orientation, national or ethnic origin, and disability . Contributions are welcome and should be sent to:The Editor, Public Health Perspective Online Newsletter,Banstola Medical Hall, Milanchowk, Hemja-8 VDC, Pokhara, Kaski, Nepal , or email