Public Health Perspective (PHP) Newsletter July 2012 Issue


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Inside this Issue:

Universal access to reproductive health: What does it mean to Nepal?

National News:
439 persons face the music for smoking in public places
World population day: Litany of challenges still stares at Gov
Health ministry to launch anti-typhoid vaccination campaign
Chitwan DPHO launches anti-dengue campaign
Global reproductive rights body opens office here
HIV cases on rise in Kavre
Gastrointestinal cases decline
MoHP intensifies disaster ac-tion plans

Featured Article:
The help seeking behavior of unmarried girls living in Mumbai slums for menstrual needs (Arundati Muralidharan)

World Population Day (2012) Special
World Hepatitis Day (2012) Special

Global Health:
Avian influenza – situation in Indonesia – up-date
Prequalification of medicines saves lives
WHO joins call for renewed focus on family planning
Severe complications of hand, foot and mouth disease (HFMD) caused by EV-71 in Cambodia conclusion of the joint investigation
Vaccine success story: congenital rubella syndrome
South Africa Making Progress against HIV/AIDS, But Still More Effort Needed, Health Minister Says
Whooping cough makes deadly return across Canada

Journal Watch:
Evaluation of knowledge, attitude and practice of newly diagnosed diabetes patients-a baseline study from Nepal

Letter to the editor:

Being Healthy:
ABCs: Abstain, Be faithful, and use Condoms

WHO Publications:
Bulletin of WHO Vol. 90, No. 07, 2012
Quality Assurance in Bacteriology and Immunology
Water Safety Planning for Small Community Water Supplies: Step-by-step risk management guidance for drinking water supplies in small countries
Safety Evaluation of Certain Food Additives and Contaminants

Welcome Our New Campus Liaisons
Amrit Dangi (Nobel College)
Barsha Shrestha (BPKIHS)
Sumit KC (CIST College)

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Public Health Perspective (PHP) Newsletter July 2012 Issue

  1. 1. Public Health Perspective the first online public health newsletter of Nepal Vol. 2 Issue 7 July 2012 Editorial: Universal access to reproductive health: What does it mean to Nepal? Nepal as a signatory of Millen- (Nepal Fertility and Family integrated reproductive ser- Inside This Issue nium Development Goals Planning Survey 1991) to vices, inaccessibility, non- (MDGs) has set targets to 36% (NDHS 2011) from evidence based interventions, achieve universal access to 1990 to 2011.The target is to inadequately trained service reproductive health by the increase to 60 percent by the providers, limited availability National News 2&4 year 2015. But what does it year 2015. Skilled birth at- of reproductive health equip- mean to Nepal—the target tendant (SBA) includes doc- ment, commodities and sup- versus current scenario, barri- tor, nurse or midwife. plies, and increasing rate of World Population Day 3 ers, and challenges on repro- HIV, among other barriers. ductive health are discussed Contraceptive Prevalence here in this editorial on the Rate (CPR) among married At the national level: financial World Hepatitis Day 3 special occasion of World women aged 15-49 increased constraints, lack of political Population Day 2012 and its from 24% in 1990 (MOH will, political instability, gen- theme “Universal Access to 1992) to 50 percent in 2011 der inequality, violation of Global Health 5 Reproductive Health Ser- (NDHS, 2011). The target for reproductive rights, and lim- vices”. Nepal is to increase the CPR ited human resources have to 67 percent by 2015. created barriers. Journal Watch 6 The concept of “universal ac- cess” here reflects equity in According to UNFPA Nepal, Challenges reproductive health services the rate of adolescent preg- In Nepal, reproductive health Featured Article (equal access for equal need). nancies is high and roughly problems are the leading (Arundati Muralidha- 7 20% of adolescent girls are cause of ill health and death In other words, it implies that ran ) reproductive information and pregnant or have given birth among women of childbearing services are “available, acces- to at least one child in Nepal. age. An increasingly large Being Healthy 8 sible and acceptable” to meet Only half of all pregnant number of young people are the different reproductive women make four or more entering their reproductive needs of all individuals. Antenatal Care (ANC) visits years, often without the ade- WHO Publications 9 during their entire pregnancy quate reproductive health Target VS current scenario as per the NDHS 2011. The knowledge, skills and services The target of universal access target is to make the four they need. Reproductive New Subscribers 10 to reproductive health i.e., visit or more for ANC cover- health services coverage is MDGs 5 is to reduce the ma- age at 100%. The current low among the rural poor, ternal mortality ratio by three- unmet need for family plan- Dalit, and Janjati women. The quarters between 1990 and ning services in Nepal is re- percentage of institutionalPublic Health Important 2015. Between 1990 and portedly 27%. deliveries among urbanDay (July) 2010, the MMR in Nepal fell women is more than double from 850 (UNDP 1992) to 229 Major barriers that of the rural women. Be- (Family Health Division, 2009) A number of barriers need to sides, adolescent sexual and per 100,000 live births. Sev- be tackled at various levels if reproductive health issues eral factors have played an universal access to reproduc- have not yet been incorpo- important role in reducing the tive health services is to be rated into the essential health nation’s MMR. Improvements achieved in Nepal. care services package of in maternal health services, MoHP. the National Safe Motherhood At user level: delay in decid- Program (2002-2007), the ing to seek care, delay in A way forward policy on skilled birth atten- reaching care in time, and If universal access to repro- dants (2006), safe mother- delay in receiving adequate ductive health services is to hood and neonatal health pro- treatment , high cost of be achieved, the Government gram, the birth preparedness health care, limited service of Nepal (GoN) should invest package (2008-2009), and a choices, inequalities in care, more in reproductive health, maternity incentive scheme poverty, and illiteracy has pay more attention to the (2005) among others are to created hindrance. Women’s poor, marginalized, under- mention a few. low education and poverty privileged and rural women’s are also consistently associ- reproductive health. The skilled birth attendance ated with low use of repro- and contraceptive prevalence ductive health services. rates have increased since 1990. The skilled birth atten- At service delivery level: dance rate increased from 7% inadequate funding, lack of Amrit Banstola
  2. 2. July 2012 Public Health Perspective (PHP) Page 2 National News smoking in public places. The planning and safe motherhood services (SAS) and 95,306 Act says those smoking in have been government priori-439 persons face the public places will be fined up ties but the rest remain in the women received safe abortion from 487 listed sites, said themusic for smoking in to Rs 100 and the civil ser- policy-making phase. Despite annual report of DoHS. How- vants doing so will be liable huge investments, newbornpublic places for departmental action. Sell- care hasn’t shown any signifi- ever, thousands of women are still undergoing unsafe abortions ing tobacco products to mi- cant improvement in the last with the government unable toKATHMANDU, JUL 06 – nors and pregnant women will five years, said experts. check the sale of illegal abortion incur a fine of up to Rs pills that are not registered withP olice arrested 439 people 10,000. The law also bans In family planning, the use of the Department of Drug Admini- from several parts of the advertising and promotion of modern contraceptives, ac- stration.Capital city for smoking in tobacco products. Smoking in cording to the Nepal Demo- Source: ekantipur.compublic places 10 days after the government offices, educa- graphic and Health Surveygovernment started enforcing tional and health institutions, (NDHS) 2011, is 43.2 per- Health ministry to launchthe “no smoking in public airports, public vehicles, day- cent—a one percent decreaseplaces” ban . According to the care centers, religious places, from 2006. This number previ- anti-typhoid vaccinationHanumandhoka Metropolitan old-age homes, orphanages, ously needed to reach 67 per- campaignPolice Range (MPR), the of- clubs, public toilets, indus- cent by 2015 according to thefenders were picked up from tries, factories, theatres, cin- MDG. According to Dr Sinen- KATHMANDU, JUL 12 -Bir Hospital, Singha Durbar, ema halls, hotels, restaurants, dra Uprety, director of the TThamel, Basantapur, New canteens, hostels, lodges and Family Health Division at the he Ministry of Health andRoad, Kamalpokhari, Tha- guesthouses have all been Department of Health Services Population will launch a vac-pathali and Ratna Park. The banned in the country by the (DoHS), the NDHS report cination campaign against ty-smokers were fined Rs 100 Act. showed that fertility rates de- phoid fever in Kathmandu soon.each and released after they Source: creased drastically from 5.1 Organizing a press conference invowed not to repeat the of- percent in 1984-86 to 2.6 in the Capital on July 12, the Childfence in writing. The Kath- World population day: 2008-11, meaning that de- Health Division under the Minis-mandu District Administration Litany of challenges spite the reduction of contra- try informed the media that theyOffice (DAO) recently came ceptive use, Nepal was on the have already geared up withunder severe criticism for not still stares at Gov right track. “However, the real internal preparations for the antiimplementing the Tobacco challenge is the unmet need -typhoid vaccination campaign.Control and Regulatory Act- KATHMANDU, JUL 11 - for contraceptives,” said Dr The Ministry has decided to2010 that the parliament had Uprety. “Looking at the data, launch the campaign in Kath-endorsed on August 7 lastyear. Security personnel are N epal marks this year’s World Population Day with the theme “Universal unmet need is highest among the age groups 15-19 and 20- 24, which is 42 and 37 per- mandu, following positive out- come of the previous campaignsincreasingly vigilant with a launched in Bhaktapur and Lalit-team of police in plainclothes Access to Reproductive Health cent respectively. This is the pur districts (the adjoining dis-being deployed to keep close Services” on Wednesday, population that is most sexu- tricts), said Division Chief Drwatch on public smokers, at even as many challenges lie ally active and if they lack Shyamraj Upreti. Typhoid, onethe behest of CDO Chauda- ahead. In its efforts to meet contraceptives, chances of of the most common diseases onmani Sharma. However, the fifth Millennium Develop- unwanted pregnancies, abor- children under 15, is caused bySharma said they were con- ment Goal, improving mater- tions, and venereal diseases Salmonella typhi virus. Con-centrating on an awareness nal health, the government increase.” Uprety said that the sumption of polluted water is thecampaign since not many has adopted and identified huge migrant population is main cause of typhoid fe-people know that public nine components in the Nepali another reason for the decline ver. According to Dr Upreti,smoking is a crime. “The cam- National Reproductive Strat- in contraceptive use. “When Kathmandu is a high-risk zone inpaign is yet to be imple- egy 2008. The components spouses are apart, the use of view of the typhoid fever.mented fully. We have priori- are family planning, safe contraceptives reportedly de- Source: ekantipur.comtized creating awareness motherhood, newborn care, clines.”among the public.” He said abortion, adolescent sexual Chitwan DPHO launchesthat the campaign has been and reproductive health, HIV/ Similarly, regarding safe AIDS and STDs, infertility and motherhood, the number of anti-dengue campaignreaching out to peoplethrough media. The local ad- sub fertility, gynecological women consulting doctors,ministration and the Ministry morbidities including uterine nurses or midwives during CHITWAN, JUL 13 -of Health and Population prolapsed and breast cancer, their pregnancy period has T(MoHP) have been dissemi- and gender based violence. increased significantly. How- he District Public Health Of-nating awareness information MDG 5 has four indicators: ever, according to the NDHS, fice (DPHO), Chitwan hasthrough radio, television and the contraceptive prevalence although 58 percent of women launched a campaign on July 12,newspapers. rate, adolescent birth rate, went for antenatal consulta- 2012 against dengue, a mos- antenatal care coverage and tions, only 36 percent of ba- quito-borne disease. Chitwan isThe first priority of the cam- family planning needs. A ma- bies were delivered by doc- a high risk zone for dengue.paign is public awareness. jor challenge for the govern- tors, nurses or midwives. A Under the campaign, larva andPolice have been coordinating ment on reproductive health total of 192 service providers, pupas of mosquito will bewith the MoHP, NGOs and the is the disparity between pro- including 74 nurses, have searched for and then ContinuedDAO to raise awareness about grams, say experts. Family been trained for safe abortion on page 4
  3. 3. July 2012 Public Health Perspective (PHP) Page 3 World Population Day World Population Day is an annual event, observed on July 11 every year, which seeks to raise awareness of global population issues. This year theme of WPD is “Universal Access to Reproductive Health Services”. Reproductive health is at the very heart of development and crucial to delivering the UNFPA vision — a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled. Universal access to reproductive health by 2015 is also one of the targets of the Millen- nium Development Goals. But we have a long way to go. Reproductive health problems remain the leading cause of ill health and death for women of childbearing age worldwide. Some 222 million women who would like to avoid or delay pregnancy lack access to effective family planning. Nearly 800 women die every day in the process of giving life. About 1.8 billion young people are entering their reproductive years, often without the knowledge, skills and services they need to protect themselves. On 11 July – World Population Day – many activities and campaigns will call attention to the essential part that reproductive health plays in creating a just and equitable world. Help us generate greater commitment to the idea that everyone has a right to reproductive health. >>Source: World Hepatitis Day On 28 July 2012, people around the world come together to mark World Hepatitis Day and raise awareness of viral hepatitis. It aims at raising global awareness on the dis- eases besides encouraging their prevention, diagnosis, and treatment. It is an opportunity around which interested groups can raise awareness and influence real change in disease prevention and access to testing and treat- ment. This year, the theme of World Hepatitis Day is - “Its closer than you think”. World Hepatitis Day is organized by the World Hepatitis Alliance in collaboration with the World Health Organization (WHO). The day was first launched in 2007 by the World Hepa- titis Alli- ance. It was officially recognized by the WHO on May 2010 following the World Health Assembly. Since its launch, thousands of events have taken place around the world, gen- erating massive public and media interest. The World Hepatitis Day aims to focus on specific actions such as:  Strengthening prevention, screening and control of viral hepatitis and its related diseases.  Increasing Hepatitis B vaccine coverage and integration into national immunization programs, and  Coordinating a global response to hepatitis to increase access to treatment. Despite its staggering toll on health, hepatitis remains a group of diseases that are largely unknown, undiagnosed and untreated. Hepatitis kills around one million people every year. Millions more suffer immediate sickness or long-term ill health. >> Source:;
  4. 4. July 2012 Public Health Perspective (PHP) Page 4 National News (cont…)Continued from page 2 of the disease at Dhulikhel Hospital on also recently conducted a camp at TalkuVector Control Supervisor Ram KC. Earlier, Wednesday. The Health Ministry has been and Chhaimale, places that are report-the Office had launched the anti-dengue conducting special programs in all the 75 edly seeing a rising number of diarrheal districts of the country to control HIV/drive in the district in the month of August cases, said Mahendra Shrestha of theand October, last year. A total of 200 AIDS. An official at the National Centre for DPHO to assess for cases workers and volunteers have been AIDS and STD Control, Sanjaya Dahal saiddeputized to operate the campaign that that an estimated 50,000 people were Source: ekantipur.combegan on Thursday, said Public Health Chiefliving with HIV in 2011 in the country.Kehar Singh Godar. Various sorts of orien- "The Health Ministry is working to control MoHP intensifies disaster ac- the disease," said Dahal. The governmenttation and public awareness programs has been distributing free antiretroviral tion plansabout dengue are taking place in differentparts of the district. A total of 68 denguedrugs to the HIV-infected from 36 depots KATHMANDU, JUL 22 -patients have been found so far in the dis-across the country. Available data showtrict since mid-July of last year and ofthem, one had died, said the Office. 6,483 people with HIV were taking the drug in 2011. To monitor the clients , the ministry would conduct 15 tests, free of T he Ministry of Health and Popula- tion (MoHP) has intensified pro- grams designed to minimize destruction Source: cost, for each of those infected. and casualties during and after a natural disaster. The MoHP recently drafted twoGlobal reproductive rights body Source: major schemes for disaster manage- ment--Mass Casualties Managementopens office here Gastrointestinal cases decline Strategy in Health System and plan for the early deployment of human re-KATHMANDU, JUL 19 - KATHMANDU, JUL 20 - sources in health during a disaster. Dr Tirtharaj Burlakoti, chief of the CurativeW ith an aim to ease and facilitate women’s access to affordable and T he only public hospital for tropical and infectious diseases, Sukraraj Tropical and Infectious Disease Hospital (STIDH), Service Division at the ministry, said as mass casualty management in health is a prerequisite for preparation and re-safe reproductive health services, the Cen-ter for Reproductive Rights (CRR), a global is seeing scores of patients for treatment sponse at the time of disaster, whenlegal advocacy organization, opened its first of diarrhea and typhoid this monsoon. various state actors come into play; theoffice in Kathmandu on Wednesday. The However, the number of patients has un- ministry lacked a working strategy forUSA-based CRR is working across the globe dergone a marked decline since last year. the crisis. “This strategy will guideto advance reproductive rights by launching The number of patients with gastrointesti- health professionals in managing casu-various campaigns, conducting research nal infections, including diarrhoea and alties during disasters such as fires andand encouraging capacity building activi- dysentery is 1,712 in 2011/12 and was floods,” he said.ties. In its first few years, the new office 2,167 in 2010/11. Similarly, 176 patientswill focus on a rights-based approach to the were treated for typhoid and 35 for hepati- He added the government had startedfull range of reproductive health care, in- tis in 2011/12, while 267 were treated for planning for maintaining a record ofcluding contraception, maternal health and typhoid and 30 for hepatitis in 2010/11. health professionals that can be de-safe abortion, through the implementation However, instances of snakebites have ployed to affected areas in the event ofof constitutional and legal protections, said increased from 209 cases to 284 in a disaster. Dr Burlakoti said the ministrya press statement issued by the CRR. 2011/12. was making preparations for providing Source: health workers with an identity card Dr Indra Prasad Prajapati, director of the indicating the name of their institution,HIV cases on rise in Kavre Sukraraj Hospital, said the decrease in the details about their residence and their number of patients with diarrhea and ty- specialization. He added the informationKAVRE, JUL 20 - phoid implies that people have begun will be archived on the website the min- adopting a hygienic lifestyle. “Perhaps istry is creating.T he number of people living with HIV in people have started drinking boiled water the district is on the rise, shows the and avoiding stale foods. However, pa- “We have recorded the resilience ofrecent data from the District Public Health tients can also have started visiting many hospital structures for around 53 hospi-Office (DPHO). The number of HIV-infected private hospitals and clinics that have tals with a minimum of 50 beds for ca-people reached 213 in the 2011-12 fiscal opened up instead of coming to the gov- pacity in case of natural disasters,” Dryears from 170 in 2010-11. "The number of ernment hospital,” Dr Prajapati said. Burlakoti said. All of these plans arepeople living with HIV increased signifi- Meanwhile, the STIDH discovered cholera slated to be finalized by the end of Au-cantly this year," said DPHO chief Dr Arjun in three patients from Kalimati, Tahachal gust. Meanwhile, the Patan Hospital hasPrasad Sapkota. He added that most of and Teku area. Dr Prajapati said that since been retrofitting its building with sup-those infected are Nepali migrants return- the cases are from different areas, there is port from the MoHP. The ministry, aideding from foreign jobs and sex workers. less evidence of an epidemic. The District by the World Health Organization and Public Health Office (DPHO), Kathmandu the UK Department for InternationalIn addition to raising awareness on safe has also started surveillance on patients Development, is set to begin in Augustsex through health workers and providing with dysentery, diarrhea and cholera in an earthquake vulnerability survey of 50anti retroviral treatment for those with HIV, various area hospitals to get early warning hospitals with 50 or more beds acrossthe DPHO launched an orientation program of an impending . A group of doctors and the country.on preventing mother-to-child transmission other health professionals under the DPHO Source:
  5. 5. July 2012 Public Health Perspective (PHP) Page 5 Global Health meet international standards of 62 cases reported by Kantha transmission rate dropped Avian influenza – situa- quality, safety and efficacy. Bopha hospital, and cases from 3.5 percent in 2010 to tion in Indonesia – up- Source: WHO reported from other hospi- 2.7 percent in 2011, getting date tals. Of these, the investiga- the country closer to its goal of WHO joins call for re- tion focused on 61 cases that reaching a two percent rate by6 July 2012 – newed focus on family fitted a specific criteria (the2015, the news service notes.T he Ministry of Health of In- planning case definition), and of which But Health Minister Aaron Mot- donesia has notified WHO of 54 had died. soaledi "told reporters Thurs-a new case of a human infection day in Johannesburg that 60with avian influenza A (H5N1) 11 July 2012 – The investigation revealed percent of HIV/AIDS patientsvirus. A t the launch of the Family Planning Summit in Lon- don, WHO commits to fast- that most of the cases were under 3 years of age, from 14 different provinces, with are female and they must be the focus to stem the epidemic in the country," VOA writes,The case is an 8 year-old fe-male from the province of West track its assessment and to some suffering from chronic adding, "Motsoaledi is urgingJava. She developed fever on step up its prequalification of conditions. A significant num- everyone to seek regular HIV18 June 2012 and then travelled new and existing quality con- ber of cases had been testing in an effort to reduceon vacation the following day to traceptives. “Access to modern treated with steroids at some the epidemic and diminish theSingapore, where she saw a contraception is a fundamental point during their illness. diseases stigma".private physician who diag- right of every woman,” says Steroid use has been shownnosed pharyngitis on 20 June. WHO Director-General Dr Mar- to worsen the condition of According to Agence France-Infection with avian influenza A garet Chan, who is chairing a patients with EV-71. Presse, "South Africa has the(H5N1) virus was identified panel at the Summit on in- Source: WHO worlds largest HIV caseload,later by the National Institute of creasing access and expanding choice. Vaccine success story: with six million people cur- rently living with the virus"Health Research and Develop-ment (NIHRD), Ministry of Source: WHO congenital rubella syn- and it "runs the worlds largestHealth, Indonesia. drome treatment program, serving Severe complications of 1.3 million people". NationalEpidemiological investigation hand, foot and mouth Public Radios "Shots" blog 13 July 2012 – examines how the FDAs re-has been conducted in the disease (HFMD) causedcase’s neighborhood and nearbymarket, which revealed that the by EV-71 in Cambodia – A newly released WHO fact sheet explains how vaccination has drastically cent approval of Truvada to reduce the risk of HIV infection in people at high-risk of con-case had contact with poultry conclusion of the jointwhen she went to a market with reduced congenital rubella tracting the virus "is beingher father to buy live chickens. investigation syndrome and describes the greeted with skepticism, deri-She was present when the global strategy to achieve sion and even worry by somechicken was culled in the desig- 13 July 2012 – elimination. An estimated doctors in South Africa".nated part of the market. T he investigation into the illnesses and deaths in Cambodia, which mainly af- 110 000 babies are born with congenital rubella syndrome every year. While the illness Source: Whooping cough makesThe Ministry of Health in Singa-pore has been informed about fected very young children, is generally mild in children, deadly return acrossthe case under the International concluded that a severe form of it has serious consequences CanadaHealth Regulations. hand, foot and mouth disease in pregnant women causing (HFMD) was the cause in these fetal death or congenital de- 23 July 2012 –To date, the total number ofhuman influenza A (H5N1) majority of cases reported to the Ministry of Health. fects. Source: WHO A highly contagious bacte- rial disease is spreading in four provinces, infecting ascases in Indonesia is now 190 South Africa Makingwith 158 fatalities. Samples from a total of 31 pa- many as 2,000 people with a Source: WHO tients were obtained and tested Progress against HIV/ violent, uncontrollable cough for a number of pathogens by and killing an infant in Alberta, Prequalification of medi- Institut Pasteur du Cambodge. AIDS, But Still More as public-health authorities cines saves lives Most of these samples tested Effort Needed, Health scramble to boost their vacci- positive for enterovirus 71 (EV- Minister Says nation programs.9 July 2012 – 71) which causes HFMD. AE very year, millions of pa- small proportion of samples British Columbia’s Fraser Val- tients in resource-limited also tested positive for other 20 July 2012 – ley, southern Alberta, parts ofcountries receive life-saving pathogens including Haemophi-medications that are purchased lus Influenzae type B and T hough South Africa has made progress against Southwestern Ontario and New Brunswick are dealing with severe outbreaks of a diseaseby or through international pro- Streptococcus suis. It was not HIV/AIDS over the past fewcurement agencies such as UNI- possible to test all the patients years, the countrys "health that was once on the wane –CEF, UNFPA, and the Global as some of them died before minister says much more pertussis, more commonlyFund to fight AIDS, TB, and appropriate samples could be needs to be done," VOA known as whooping cough,Malaria. The WHO Prequalifica- taken. News reports. Health officials which can be especially deadlytion of Medicines Program en- from South Africas Medical if contracted by infants.sures that selected medicines A total of 78 cases were identi- Research Council on Thurs- Source: theglobeandmail.comsupplied by these agencies fied. These included the initial day said the mother-to-child
  6. 6. July 2012 Public Health Perspective (PHP) Page 6 Journal Watch Evaluation of knowledge, attitude and practice of newly diagnosed diabetes patients-a baseline study from Nepal How to join PHP? Knowledge, attitude and practice is very low among newly diagnosed diabetes patients attending tertiary care teaching hospital of Western region of Nepal, according to the study published in 2012 issue 2 of International Journal of Pharmacy Teaching & Practices. e-Mail: A cross sectional study was conducted from July 2010 to December 2010 among 162 newly diag- nosed diabetes patients attending Manipal Teaching Hospital, Pokhara, Nepal. Enrolled patients website: were evaluated for their Knowledge, Attitude and Practice (KAP) about diabetes by using a self administered KAP questionnaire during their first day of hospital visit. In case of knowledge ques- publications.php tion, each ‘correct’ answer was scored as one (1) and as zero (0) for ‘incorrect’ answer. In case of attitude and practice questions, scoring was done on the basis of 5 point and 3 point Likert scales, respectively. According to the study, the median interquartile range scores were [3(2-7)] for knowledge, [12(11 -13)] for attitude and [1(0-2)] for practice. Thirteen patients (8.02%) reported their family had a Benefits of history of diabetes either on their father’s or their mothers’ side in equal proportion whereas there was no family history of diabetes for 133 (82.10%) patients. Only three patients (1.85%) had Being a PHP both their father and mother with a history of diabetes, as per the study. Subscriber The study stressed to provide structured education and counseling to diabetes patients by organiz- ing group education program at community level in a country like Nepal. Full text article is avail- able at: International Journal of Pharmacy Teaching & Practices 2012, Vol.3, Issue 2, 245-252.  Can submit articles to Authors: Dinesh K Upadhyay, Mohamed Izham M.I, Vijay. M Alurkar, Pranaya Mishra, Subish Palaian PHP newsletter  Heavy discount rate in I read with interest the article in the May edition of the Public Health Perspective PHP trainings, work- Newsletter titled “Have non-communicable diseases become the major health shops, seminars, con- problem in Nepal?” By Brecht Devleesschauwer and Prof. Dr. Jeevan Bahadur Sher- ferences chand. It seems that the rise in cardiovascular and other chronic, Non- Communicable Diseases (NCD) is occurring on a global scale. The authors draw our  Get acquainted with attention to some of the challenges faced by NCDs and possible ways forward. public health news from around the nation and In Australia, such NCDs as the main source of ill Letter to the Editor globe at a time health are also increasing and there is much work underway in addressing the determinants of health. Some states are empha-  Enhances professional sizing the importance of integrated or joint government work as part of the solution. It is exciting writing skills to see the potential of partnerships for policy implementation between government levels, science, academia, business, professional organisations, and non-governmental organizations to bring about sustained change. After all, as Brecht Devleesschauwer and Prof. Dr. Jeevan Bahadur Sherchand pointed out, health Send Letters to the is an outcome of a wide range of factors—such as changes to the natural and built environments and to social and work environments—many of which lie outside the activities of the health sector Editor and therefore require a shared responsibility and an integrated and sustained policy response across Government. In Australia, there is also recognition that the impacts of health determinants are not equally distributed among population groups. If achieving optimum health is to be a  All readers can post shared goal of all governments, then valuing the health of all citizens is important in both social comments on articles and economic development. And the need to regularly consult with citizens to link policy changes and news mentioned in with wider social and cultural changes around health and well-being should not be overlooked. PHP or could be sugges- tions and compliments. Health is a human right, a vital resource for everyday life and a key factor of not only sustainabil-  Send letters to: ity but also the economy. Acknowledging that all government policies can have positive or nega- tive impacts on the determinants of health and that such impacts are reflected both in the health  Word limit 150 max. and status of the population today, and in the health prospects of future generations, is an important the title of news or arti- step. This calls for identification of potential health impacts as well as the recognition that good cles of critique. health can contribute to achieving many governments’ targets. If we are to develop integrated solutions to both current and future policy challenges, efforts to improve the health of the popula-  Email should include tion will require those mechanisms that support government agencies to work collaboratively, to ‘letters to the editor’ be sustainable. Many of the most pressing health problems of course require long-term policy and in email subject line. budgetary commitment. This will require indicators of success to be equally long-term and regular monitoring and intermediate measures of progress will need to be established. —Dawn Skidmore, MBA, MSc Healthcare, Australia
  7. 7. July 2012 Public Health Perspective (PHP) Page 7 The help seeking behavior of unmarried girls living in Mumbai slums for menstrual needs Arundati Muralidharan — Dr.PH, MSW Menarche and menstruation are normal and healthy events, yet for unmarried adolescent girls living in Mumbai slums, experiences of these events are fraught with anxiety since they lack the information and social support they need to comprehend and respond to these events in a healthy way. Unmarried girls’ ability to manage menstruation and respond to menstrual problems is impacted by their incomplete and incorrect information about the female reproductive system, including how and why women menstruate, and erroneous beliefs that menstruation is the expulsion of impure blood from the body. Girls are often ill prepared for menstruation because their mothers believe that they are too young and inexperienced to Arundati Muralidharan comprehend this information before menarche. Girls neither ask for nor receive much information about menstruation apart from how to manage menstrual flow and the dietary, religious, and social restrictions to be followed. For girls living in Mumbai slums, their erroneous beliefs about basic reproductive processes “Being unable to seek extend to menstrual problems as well, the most common being irregular menstruation and menstrual pain. Misconceptions about what causes menstrual problems and their severity influ- and receive correct and ence if and when girls seek help and the kind of help they seek. Mothers’ perceptions that men- strual discomfort and pain are normal might strongly impact whether girls perceive the need for comprehensive help. Mothers typically perceive the need for help when they believe the condition will adversely information, and impact their daughter’s future fertility. social and clinical In Mumbai slums, girls’ perception of the need for information, social support, and treatment is influenced by a culture of silence that surrounds menstruation. This culture of silence is initi- services has strong ated by the reluctance of mothers to prepare their daughters for menarche and menstruation, and a widely perceived need to conceal menstruation and therefore a girl’s sexual maturity. implications for a Mothers further perpetuate this culture of silence by mediating their daughters’ understanding of and response to their menstrual needs. While girl’s menstrual mothers believe that they are protecting their daughters, they are severely limiting girls’ access health”. “For girls living in Mumbai to the information, support, and services they slums, their erroneous beliefs need to protect and promote their health. Being unable to seek and receive correct and comprehensive information, and social and clinical services has strong implica- about basic reproductive processes tions for a girl’s menstrual health in terms of her ability to manage regular men- struation, maintain personal and menstrual hygiene to protect herself from infec- extend to menstrual problems as tions, and seek appropriate help to treat menstrual problems in a timely manner. well, the most common being Girls living in Mumbai slums seek information and support from their mothers and friends, and seek treatment for menstrual problems primarily from private health irregular menstruation and care providers in the slum. Often, however, their ability to reach out to these sources of help is restricted as girls have limited opportunities to spend time with menstrual pain. ”. their peers; girls and their mothers hold strong ideas about the appropriateness of the kind of help needed and the sources of help available; and the poor availability and accessibility of female health care providers is a significant barrier that girls and mothers face in accessing treatment. PHP is now on facebook! Click button of the page and get connected with us. The instant access to the news and updates of PHP begins from here! We look forward to seeing you in our page.
  8. 8. July 2012 Public Health Perspective (PHP) Page 8 Being Healthy becoming infected with HIV. all new infections ABCs: Abstain, Be occur in the 15- faithful, and use According to UNAIDs, ABC stands for: to 24-year-old age group. Condoms  Abstinence (not engaging in sex, or delaying first sex) Be faithful pro-The ABC approach employs  Being safer, by being faithful to ones grams encouragepopulation-specific interventions partner or reducing the number of sex- individuals tothat emphasize abstinence for ual partners practice fidelityyouth and other unmarried per-  Correct and consistent use of condoms in marriage andsons, including delay of sexual other sexual re-debut; lationships as a Abstinence programs encouragemutual critical way to unmarried individuals to abstainfaithful- reduce risk of exposure to HIV. Once a person from sexual activity as the bestness and begins to have sex, the fewer lifetime sexual and only certain way to protectpartner partners he or she has, themselvesreduction the lower the risk of from expo-for sexu- contracting or spreading sure to HIVally ac- HIV or another sexually and othertive transmitted infection. sexuallyadults; transmittedand cor- infections. Correct and consistentrect and Abstinence Condom use programsconsis- until mar- support the provision oftent use riage pro- full and accurate infor-of con- grams are mation about correctdoms by particularly important and consistent condomthose whose behavior places for young people, as use reducing, but notthem at risk for transmitting or approximately half of eliminating, the risk of HIV infection; and support access How to Use a Condom Consistently and Correctly: to condoms for those most at risk for transmitting or becoming in-  Use a new condom for every act of vaginal, anal and oral fected with HIV. Latex condoms sex throughout the entire sex act (from start to finish). provide approximately 80-90 per-  Before any genital contact, put the condom on the tip of cent protection, when used consis- the erect penis with the rolled side out. tently. To achieve the protective effect of condoms, people must  If the condom does not have a reservoir tip, pinch the tip use them correctly and consis- enough to leave a half-inch space for semen to collect. tently, at every sexual encounter. Holding the tip, unroll the condom all the Failure to do so diminishes the way to the base of the erect penis. protective effect and increases the  After ejacula- tion and before the risk of acquiring a sexually trans- penis gets soft, grip the rim of mitted infection (STI) because transmission can occur with the condom and carefully with- even a single sexual encounter. Latex draw. Then gently pull the con- condoms, when used consistently and dom off the penis, making sure correctly, are highly effective in prevent- that semen doesnt spill out. ing transmission of HIV. In addition, cor-  Wrap the condom in a tissue rect and consistent use of latex condoms and throw it in the trash where others can reduce the risk of other sexually wont handle it. transmitted diseases (STDs), including Gonorrhea, Chlamydia,  If you feel the condom break at any point during sexual activity, stop immediately, withdraw, remove the broken and Genital ulcer diseases. condom, and put on a new condom.  Ensure that adequate lubrication is used during vaginal and anal sex, which might require water-based lubricants. >>More information at: Oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) should not be used because they can weaken latex, Public Health Perspective (PHP) Online Newsletter causing breakage. (Source: CDC)
  9. 9. July 2012 Public Health Perspective (PHP) Page 9 WHO PublicationsBulletin of WHO Vol. 90, No. 07, 2012The Bulletin of the World Health Organization is an international journal of public health with a special focus on developingcountries. Since it was first published in 1948, the Bulletin has become one of the worlds leading public health journals. As theflagship periodical of the World Health Organization (WHO), the Bulletin draws on WHO experts as editorial advisers, reviewers,and authors as well as on external collaborators. Full bulletin is available at: Assurance in Bacteriology and ImmunologyThere is an increasing dependence on clinical and public health laboratories for better patient management and also for preventingthe spread of emerging pathogens. With rapid and significant growth of laboratories at all levels of health care, it has become man-datory to check their results to assure that they are reliable and cost-effective, as well as comparable with those obtained by inter-national laboratories. Download is available at: Safety Planning for Small Community Water Supplies: Step-by-step risk management guidance fordrinking water supplies in small countriesThis manual is designed to engage, empower, and guide communities in the development and implementation of Water SafetyPlans (WSPs) for their drinking-water systems. It provides guidance on how to apply effective and achievable management actionsin order to improve the safety and quality of supplied water. Download is available at: Evaluation of Certain Food Additives and ContaminantsThe toxicological monographs in this volume summarize the safety data on a number of food additives: aluminum-containing foodadditives, Benzoe Tonkinensis, Ponceau 4R, pullulanase from Bacillus deramificans expressed in Bacillus licheniformis, QuinolineYellow and Sunset Yellow FCF. This volume also contains monographs summarizing the toxicological and dietary exposure data forthe contaminants cyanogenic, glycosides, and fumonisins. Download is available at : Welcome Our New Campus LiaisonsAPPLY FOR CAMPUS LIASION Our Campus LiaisonsIf you are interested in participating as a Campus Liaison and have anyquestions about the Liaison position, please contact us.Email: Call for Articles for August Issue  400-500 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. July 2012 Public Health Perspective (PHP) Page 10 Public Health Perspective (PHP) Team International Honorary Editorial Advisories Rajiv Gandhi University Contributing Writers Bangalore Editorial Advisories Dr. Duk Bahadur Dr. P. Ravi ShankarMs. Rose Schneider -- Chhetri Madan Kc Professor, Clinical Phar- RN MPH MD, Pathologist Msc. Medical and Health macology & Medical Edu- Chair of the Climate Western Regional Hos- Care Devices cationChange Working Group pital Lab. University of Bolton, UK KIST Medical College of the APHA Interna- Pokhara Lalitpur, Nepal. tional Health Section. Dr. Santosh RajSenior Health and HIV/ Mr. Balram Banstola Poudel Dr. Anis Rehman AIDS Specialist Managing Director, Residency (MD) in Inter- Associate Chief Editor at Health Systems Man- Senior Pharmacist nal medicine Journal of Pakistan Medi- agement Banstola Medical Hall Interfaith Medical Cen- cal Students (JPMS)1414 Perry Place NW - Kaski ter, New York HIFA 2015 Country Rep- Suite 100 resentative for PakistanWashington, DC 20010 Board of Advisories Dr. Krishna Chandra Ms. Sami Pande Rijal Newsletter Team B. Pharm, MPH Dept. of Otorhinolaryn- Editor-in Chief Australian Leadership gology and Head & Neck Amrit Banstola Dr. Margaret Steb- Scholar, 2009 Surgery, College of bing Kathmandu Medical Sciences and Section Editors PhD, Master of Public Teaching Hospital Anoj Gurung Health, Dip App Sci Arjun Poudel Bharatpur, Chitwan Dikshya Sherchan Nursing Msc. Pharm (Social and Dipendra Malla Population Health Aca- administrative Phar- Mr. Chandra Bhushan Sandeep Pahari demic macy) Yadav Sangita Shrestha School of Rural Health, Universiti Sains Malay- Information Officer Subash Timilsina Monash University sia, Penang , Malaysia (MLIS) Sulochana Prajapati Australia Nepal Health Research Ashik Banstola Council (NHRC) M. Pharm MOHP, Kathmandu (Pharmacology), PDCRWelcome to New SubscribersNepal Rachana Nakarmi International Dawn SkidmoreAmrit Dangi Ruja Luitel Alani Price Gani AlabiApsara Karki Sharika Mahato Amar Tamrakar Sharon BlairAvaniendra Chak- Shiv Raj Sunar Arundati Muralidharan Sree Tirukkovalluriravartty Shiva Raj Mishra Badrinatheswar Gelli Valasingham Ramesh-Birat Ghimire Sumit KC Venkata kumaarDinesh Upadhyay Upendra Dhakal Bob Gerzoff Zeeshan AyyazMadhav KC Churamany ChetryArticles 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