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Public Health Perspective                                     the first public health online newsletter of Nepal          ...
January 2013                                     P U B L I C H E A LT H P E R S P E C T I V E ( P H P )                   ...
January 2013                                         P U B L I C H E A LT H P E R S P E C T I V E ( P H P )               ...
January 2013                                 P U B L I C H E A LT H P E R S P E C T I V E ( P H P )                       ...
January 2013                                        P U B L I C H E A LT H P E R S P E C T I V E ( P H P )                ...
January 2013                                P U B L I C H E A LT H P E R S P E C T I V E ( P H P )                        ...
January 2013                                          P U B L I C H E A LT H P E R S P E C T I V E ( P H P )              ...
January 2013                                P U B L I C H E A LT H P E R S P E C T I V E ( P H P )                        ...
January 2013                                         P U B L I C H E A LT H P E R S P E C T I V E ( P H P )               ...
January 2013                                     P U B L I C H E A LT H P E R S P E C T I V E ( P H P )                   ...
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Public Health Perspective (PHP) Newsletter January 2013 Issue


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The Journey Continues
National News:
Doctor in health care after 13 yrs
Government to act strictly on medical waste management
Govt to set up 3 hi-tech TB labs
License test to be man-datory for all health professionals
UN lauds Nepal’s sanitation efforts
Reduced health budget will hamper MDG efforts: Experts
Elephantiasis eradication program to reach 56 districts
Featured Articles:
The New Superbug [Itishree Trivedi, University of Michigan]
World Leprosy Day
Global Health:
Boston declares public health emergency over flu
Dengue getting worse, but progress being made on other tropical diseases, reports WHO
Flu vaccine backlash: 800 children in Europe develop narcolepsy after swine flu vaccine
Vaccine against deadly meningitis strain approved for use in Europe
Stem cell research: Japanese scientists grow human kidney tissue out of stem cells
New action plan could be a turning point in global mental health
FAO urges stronger measures on global health threats
Journal Watch:
Involvement of males in antenatal care, birth preparedness, exclusive breast feeding and immunizations for children in Kathmandu, Nepal
Climate Change and Health
Being Healthy:
Protect your child’s health with regular vaccinations
WHO Publications:
Bulletin of WHO Vol. 91, No. 01, 2013
WHO Classification of Tumors: Pathology and Genetics of Tumors of Soft Tissue and Bone
Country List of PHP Subscribers & Viewers

Published in: Health & Medicine
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Public Health Perspective (PHP) Newsletter January 2013 Issue

  1. 1. Public Health Perspective the first public health online newsletter of Nepal Vol. 3 Issue 1 January 2013 Editorial: The Journey Continues Founded in 2011, Public TakingITGlobal, and List of advocating throughout this Health Perspective (PHP) is newspapers in Nepal on year for Climate Change Nepal’s first public health Wikipedia. To add, PHP is a issues to a greater extent. Inside This Issue online newsletter; pioneer in corporate partner of Journal The newsletter will also go the exchange of public health of Pakistan Medical Students through some changes in its related information, ideas, (JPMS), JPMS Blog, and board of advisories and the and resources. For more than Global Alliance for Clean newsletter team with the two years, we have led the Cook Stoves Alliance. Re- start of a new year. quest for innovation, better cently it became the member outcomes, and helped the of Global Health Workforce We feel proud that PHP has health professionals to update Alliance (GHWA)—an organi- achieved such heights in such their existing information. Our zation that work to address a short duration, thanks to newsletter directly benefit the the health workforce crisis. the PHP contributors and sup- health students and emerging port from the reader across public health professionals. The list of dedicated campus the globe. Now, with the start liaison rose dramatically in of a new year, we are in a Public Health Perspective the year 2012. We were voyage to support health care (PHP) published 11 articles in more than happy to welcome delivery in Nepal by organiz- 2012. To maintain high quality eight campus liaisons repre- ing programs on major public of the content, it came at the senting five institutions (four health important days. For expense of a high rejection national and one interna- this, we need financial and rate of 56%. The quality of tional institution). There was technical support. Our plan is content is being increasingly also a significant increase in to work with public health recognized by the academic the number of Facebook students, colleges, district contributors. Likes compared to 2011. public health offices, the Min- There were only 170 Face- istry of Health and Popula- To acknowledge the work of book at the end of the year tion, related health organiza- researchers, and strengthen 2011 which increased by tions and with allied health the research system in Nepal, fourthfold in the year 2012. professionals to support this we have highlighted 20 schol- Now there are more than initiative. Therefore, we re- arly articles related to Nepal 650 fans in our official Face- quest the interested organi- written by both Nepalese au- book page. The number of zations to support our pro-Public Health Important thor as well as foreigner. subscribers was moderately grams in any possible way increased; however. We feel they can. To help advanceDays (January) The year 2012 was also won- overwhelmed to mention this work, we look forward for derful for PHP as it was able that PHP has also subscribers similar help from our support-January 12: National Youth Day to establish a good partner- from Center of Disease Con- ers, advisories, subscribers, ship with various national and trol and Prevention (CDC); a campus liaisons, colleges,January 31: Anti-Leprosy Day leading public health organi- international organizations. universities, relatives, friends PHP is associated with Nepal zation of USA. To mention, in this program as well. If you Public Health Network we have subscribers and think you can help advance (NPHN), and is listed in the viewers from more than 90 this work or will like to join us Manmohan Memorial Institute countries. Thanks to our in our endeavor please feel of Health Sciences website campus liaison for their over- free to write to us at under other important links whelming support in increas- for journals of different or- ing the subscribers and Likes ganizations. Virtual Library of in the Facebook. Wishing you a happy and School of Public Health and healthy new year! Community Medicine of the We were also happy to have University of New South Dr Anis Rehman from Paki- Wales, Sydney, Australia has stan as a new contributing included in its list of public writer for PHP. health newsletter. Similarly, it has appeared in Australian Our readers will see a slight Development Gateway (ADG), difference in the PHP tem- Online — plate for this year. We have Amrit Banstola worlds largest listing of changed the color of our magazines on the web, under template to green as a sym- health and medical categories, bol of Go Green and will be
  2. 2. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 2 National News cal waste under the pre- KATHMANDU, JAN 25 - since last year, has been holding scribed standards rests withDoctor in health care licensing exams before nursesafter 13 yrs the person or institution that has generated the waste. Any individual or institution found I n a bid to ensure the qual- a r e allowed to ity and competence of The NHPC has so far registered health professionals other 50,442 health professionals. practice. improperly manag- than medical doctors andBAITADI, DEC 31 - ing waste can be charged nurses, the Nepal Health Pro- Source: between Rs 50,000 and Rs fessionals’ Council (NPHC) isA doctor has shown up at 100,000 or imprisoned for 15 planning to enforce licensing UN lauds Nepal’s sanita- the Kesharpur Primary days to three months by the examinations from this fiscalHealth Centre, Melauli in Bai- local authority as per the Act. year. The NHPC is the body tion effortstadi district, for the first time that registers health assis- KATHMANDU, JAN 29 -after 13 years. Locals are Source: tants, auxiliary health work-happy with the arrival of Dr ers, lab technicians, medical/ United Nations agencies in NepalYunus Tiwari at the health Govt to set up 3 hi-tech health laboratory technicians, have commended the govern-centre after 13 years of its TB labs public health professionals, ment’s efforts in expanding ac-establishment. The centre was microbiologists, physiothera- cess to sanitation for everyestablished in 2056 BS. Chief KATHMANDU, JAN 20 – pists, auxiliary Ayurved work- household and thus bringing theat the District Health Office, ers, dental hygienists and country closer towards becomingBaitadi, Dr. Gunraj Awasthi,said that his dream of sending N ment ational Tuberculosis Cen- tre (NTC), the govern- body overseeing ophthalmic assistants, before an open defecation-free zone. In providing them with a certifi- a joint statement, cate to practice. Till date, the UN agencies said that ana doctor to the centre is ful-filled after long efforts. Melauli the tuberculosis program in the NHPC has been registering increase in 19 percent of sanitaryis a day´s trek from the dis- the country, is planning to health professionals after they facilities in a year is a majortrict headquarters. The num- establish three sophisticated complete their respective achievement. In 1980, only threeber of patients visiting the laboratories for sputum cul- courses. These courses range percent of the households hadcentre has gone up after the tures outside the valley for from a 15-month training pro- sanitary facilities, which is cur-presence of the doctor there. the diagnosis of drug- gram after the completion of rently 62 percent, according to aNow, locals of lower Sworad resistant TB. The NTC has the School Leaving Certificate government report. UN ICEF-need not travel across the proposed operating one labo- to PhD programs. Dhana Nepal representative Hanaaborder to Indian towns for ratory at the BP Koirala Insti- P r a s a d P o u d e l , Singer attributed the increase totreatment. tute of Health Sciences in the NHPC registrar, said that the “power of the communities to Dharan for the eastern region, the licensing examination is take a collective decision to re-Source: one at the Regional TB Centre being planned as they have gain their pride and dignity by in Pokhara for the western been receiving complaints of stopping open defecation andGovernment to act region and another at the “incompetent” health workers cleaning up their immediate liv- Surkhet Regional Hospital for and about the quality of edu- ing environments.” “It is thestrictly on medical the far-western region. These cation pursued by students strong government leadership atwaste management laboratories will help in the abroad. all levels and the unified political diagnosis of TB for people support based on a strong jointKATHMANDU, JAN 01 - who have completed the first- “Since we monitor colleges vision on how to trigger and sus- line drug course of six months inside the country, we know tain these school and communityC oncerned over severe but are facing recurrences or their quality. Still, we want to -led initiatives,” Singer said in a health impacts of poor those who stopped taking reassure their competence,” of the hazardous medicine in the course of said Poudel. “However, theremedical waste, the govern- treatment. have been many complaints The government has repeatedlyment has decided to about students from aboard committed to eradicate openstrengthen effective imple- NTC Director Dr Rajendra who cannot perform even the defecation by providing subsidiesmentation of the Solid Waste Pant said that a cost of simplest experiments and to poor households and resourcesManagement Act (SWM) around $500,000 has been tests.” The Council has to schools. The Millennium Devel-2011. The government will estimated for the set-up of amended its Act to include a opment Goal (MDG) Accelerationtake stern action, including the laboratories. Currently, provision for licensing exami- Framework for Sanitation, signedthe cancellation of operating such laboratories are present nations. A five-member com- by the government, came aboutlicense, against individuals only in the Kathmandu val- mittee chaired by Dr Dinesh in response to the need to speedand health institutions failing ley—one at the NTC and the Bastola from the Institute of up the country’s progress towardto abide by the standards for other at the German Nepal TB Medicine has been formed to meeting the MDG on sanitation.medical waste management Project in Kalimati. draft directives for conducting “The way the MDG Accelerationas set under the SWM. Those the examination. Until now, Framework process was con-properly managing hazardous Source: Nepal Medical Council, the ducted is also something of amedical and chemical wastes government body regulating model,” said Robert Piper, UNwill be rewarded. The SWM License test to be man- medical doctors and medical resident coordinator for Nepal.2011 clearly states that the datory for all health pro- education, has been conduct- “The active participation of vari-responsibility of processing ing licensing tests for MBBS ous ministries and other stake-and managing hazardous, fessionals and post-graduate doctors. holders from the beginning of themedical and chemi- Similarly, the Nursing Council, Continued on page 4
  3. 3. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 3 The New Superbug Itishree Trivedi, M.D., Department of Internal Medicine, University of Michigan “What exactly is this C. diff?” Given the amount of media sensation this super-bug has created, it is not surprising that as an Internal Medicine specialist, I get asked this question a lot. With all justified press coverage this topic is getting, this is a reasonable and, in fact, a very important question to ask. To take a step back, there are several billion bacteria that reside in our colons, called gastroin- testinal “microbiome”. These bacteria talk to each other and to our colon and our immune system in very complicated ways to create a mutually dependent relationship. This allows every party, consist- ing of you, your colon, your microbiome, to exist in a happy balance. This healthy interaction pre- vents overtake of our guts by disease-causing bacteria, a concept known as “colonization resistance”. Taking certain antibiotics, like clindamycin, ciprofloxacin etc, kills off good bacterial species and de- crease the diversity of our microbiome. All this means that small amounts of bad bacteria, which were being suppressed and were waiting in the sidelines for their moment in the limelight, get their chance. Colonization resistance fails and these species take over. C. difficile, a kind of bacteria, is one such opportunist. Its spores are everywhere and we come across them in hospitals, clinics and other health care facilities. Lack of hand-washing hygiene is one of the most important ways in which spores of C. difficile spread. Those of us with a disturbed gut microbiome fall prey to the infection. The usual suspects are hospitalized patients, nurs- ing home residents, the elderly and those with recent exposure to antibiotics, though increasingly frequent occurrence of this infection in people with no contact with the healthcare system (so called “community-dwellers") is getting concerning. The inci- dence of C. difficile infections has increased alarmingly across the globe, especially in Western countries with half a million cases being reported annually in USA itself. Billions are being spent every year in controlling, diagnosing, treating and preventing this infection and this problem has taken on a public health scale. It is not a happy experience to come across C. difficile. Once it infects the colon, it can cause anywhere from mild to extremely severe, even life-threatening disease. Pain in the belly, bloating, cramps, and diarrhea are some of the milder manifestations. Severe dilation of the colon requiring emergency surgery, very high fever, and even death can occur. Treatment mostly con- sists, believe it or not, of antibiotics! Metronidazole and vancomycin are two of the most commonly used treatments. Unfortu- nately, even if treated, C. difficile infection can recur in anywhere from 20 to 66% patients after initial infection. This trend of severe infection that relapses makes this bacterium very costly to Governments and healthcare systems globally. New drugs and even vaccines are being developed in a bid to find some way to stop this tide. There is tremendous interest is figuring out low- cost, non-traditional ways to treat this infection. One such unorthodox method, also getting lots of media attention presently, is stool transplantation. Transplanting a very small amount of stool from a healthy donor to a recipient, a person with several bouts of C. difficile infection usually via a routine colonoscopy, although esthetically challenging, has seemed to work wonders. In fact, within weeks the gut microbiome of the recipient starts resembling the donor. With about 30 years of experience in stool transplantation procedure, called Fecal Bacteri- otherapy (FBT) and Intestinal Microbiota Transplantation (IMT), the results have been astounding with an almost 90% total cure rate for cases of recurrent C. difficile colitis. However, the studies from which these data are gleaned have been case-series and, as of yet, randomized data is not available to substantiate the results. Several questions remain before this treatment can be- come standard of care for recurrent C. difficile infection. Who is the ideal donor, potential for transmitting diseases via FBT, pre- screening for donors, role of FBT in initial C. difficile infection episode etc., are some of those questions. With more and more research into the field of gastrointestinal microbiome using high throughput, non-culture, and molecular-based methods the day might not be far when the questions above can be answered and we can be well on our way of finding a cure for this menace. In the meantime though, wash your hands vigorously with soap and water every time you are around patients in hospitals and clin- ics – we have not found the magic bullet yet! Country List of PHP Subscribers & Viewers Albania Croatia Ghana Italy Netherland Poland Spain Uganda Argentina Cuba Greece Japan New Zealand Qatar Sri Lanka Ukraine Australia Czech Republic Haiti Jordan Nigeria Qatar Sudan United Kingdom Bahrain Djibouti Hungary Kenya Norway Romania Swaziland USA Bangladesh Ecuador Iceland Laos Odua Rwanda Switzerland Yemen Belgium Egypt India Malawi Oman Saudi Arabia Taiwan Bhutan Ethiopia Indonesia Malaysia Pakistan Scotland Tanzania Canada Finland Iran Mexico Panama Singapore Tasmania China France Ireland Mozambique Peru South Africa Thailand Colombia Germany Israel Nepal Philippines South Korea Trinidad & Tobago Live Traffic Feed May 20, 2012 onwards
  4. 4. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 4 World Leprosy DayEvery last Sunday of January each marks the World Leprosy Day. On this day,organizations that work with people affected by leprosy will hold events such asrallies, lunches, church services and disability sports days to raise awareness of adisease that is completely curable but can cause great anguish for the people di-agnosed with it. In 1953, a great humanitarian, M. Raoul Follereau of France, pro- claimed the first World Leprosy Day to call attention to the plight of the world’s millions of people affected by this ancient, devastating dis- ease. Over the years, this obser- vance has grown and more than 100 countries now participate in World Leprosy Day on the last Sunday in January. Leprosy can cause physical disability if not treated quickly enough. In other words, those who had the disease had to live with the dis- abilities that are so common in leprosy – they simply had no choice. But perhaps worsethan the physical damage is the damage caused by stigma. For many centuries, leprosystigmatized those affected because there was no cure. In many countries leprosy is fearedand people who have it are rejected from their homes and communities. In some countriesthere are still laws discriminating against people affected by leprosy.World Leprosy Day helps to focus on the needs of some of the poorest and most marginal-ized people in the world – those affected by leprosy. It helps to tell the story to people whodo not know that leprosy still exists and that it can now be cured. It also helps raise fundsso that those with leprosy can be cured and cared for.Join us in celebrating World Leprosy Day on Sunday, January 26, 2014 and in standing forthose who face oppression and stigma every day. We are one body, supporting and caringfor one another. Source: >> >>leprosy.orgNational News Unit at the Health Ministry drugs, and transportation, he said the budget cut will ad- said. as elephantiasis has been eradi- cated in five out of the 61 dis-Continued from page 2 versely affect efforts to meet tricts where this disease wasprocess till the final produc- the MDG target. Although the prevalent.tion of the action plan has country is showing progress inbeen very impressive,” he so far as child mortality rate Elephantiasis eradica- Senior Public Health Officer Balsaid. and maternal mortality rate Krishna Bhusal said more than are concerned, the situation tion program to reach 85 per cent people in these could reverse if the budgetary 56 districts tricts would be given medicines allocations are not forthcom- for elephantiasis. So far, 13.4 Reduced health ing, said Marasini. million people have been admin- LALITPUR, JAN 31 - istered medicines against ele- budget will hamper The Finance ministry has allo- phantiasis. The campaign of MDG efforts: ExpertsKATHMANDU, JAN 29 - cated Rs 16.58 billion to the health sector for this fiscal T he elephantiasis eradication program is being imple- through interim arrangement mented in 56 districts across administering medicine was first started in 2003 from Parsa dis- trict. Twenty-eight thousand one of expenditure. Of the total the country this year. This pro- hundred and thirty-five peopleR eduction in health budget 24.92 billion budget ear- gram will be conducted on Feb- could create obstructions marked for the health sector ruary 2, 3 and 4 in the selectedin meeting the Millennium last fiscal, the ministry spent districts. The District Public are suffering from elephantiasis in Nepal. Elephantiasis comes second only to leprosy amongDevelopment Goals’ (MDG) only 20.62 billion. About 70 to Health Office, Lalitpur stated at the diseases resulting in disabil-target, health experts warned 72 per cent of health budget a press conference on Wednes- ity in Babu Ram Marasini, is spent on salary, incentives, day that the program is beingchief of Health Sector Reform procurement of food and conducted in 56 districts only
  5. 5. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 5 Global Health cases. in most countries." ported. Novartis is also seek-Boston declares public Source: ing to test the vaccine in thehealth emergency over Everyday Health reported US, Bloomberg reported. Dengue getting worse,flu about 30 million people re- Source: but progress being made ceived the vaccine and that a Stem cell research: Japa-January 9 2013 – on other tropical dis- link between the sleep disor- nese scientists grow hu-B oston has declared a public health emergency as it bat-tles a widespread flu outbreak eases, reports WHO der and Pandemrix has been man kidney tissue out of under investigation since stem cellsthat has killed 18 people this January 16 2013 – 2010. However, the companyseason across the state of Mas-sachusetts. The World Health Organiza- tion (WHO) trumpeted its said there was not enough information to link the two. January 23 2013 – I recent success in fighting 17 n a breakthrough for mod- Meanwhile, Finland, Sweden,Boston Mayor Thomas Menino neglected tropical diseases in a ern medicine, researchers France, Norway and Irelandsaid there had been around 700 new report —but warned that in Japan have succeeded inconfirmed cases of the flu in dengue fever has reached have seen a recent increaseBoston since the season began "pandemic" levels, infecting an in narcolepsy, according to growing human kidney tissuein October, compared with only estimate 50 million around the Everyday Health. from stem cells.70 all of last season, reports world. Source: globalpost.comCBS News. "This is the worst flu Kenji Osafune of Kyoto Univer-season weve seen since 2009, The January 2013 reports Vaccine against deadly sity explained that his teamand people should take the states that the WHO has meningitis strain ap- achieved success in using pre- was able to take stem cellsthreat of flu seriously," Menino proved for use in Europe ventative medicine to fight and "nudge them" in the direc-said in a news release. "This isnot only a health concern, but against four of the targeted tion of kidney tissues, whichalso an economic concern for diseases (lymphatic filariasis, have an especially complex January 22 2013 - A onchocerciasis, schistosomiasisfamilies, and Im urging resi- and soil-transmitted helminthi- vaccine against a structure, according to Agencedents to get vaccinated if they ases), managing to treat 711 deadly strain of menin- France-Presse.havent already. Its the bestthing you can do to protect million in 2010 alone. gitis has been licensed foryourself and your family. If Source: use in Europe. It is the first More than a million peopleyoure sick, please stay home Flu vaccine backlash: 800 of its kind to protect against suffer from renal disease. Ac-from work or school." meningococcal B meningitis. cording to the National Kidney children in Europe develop Foundation —because of howCity officials are encouraging narcolepsy after swine flu The manufacturer, Novartis, complex kidney tissue is —residents to get vaccinated vaccine has been given the go-ahead once its been damaged, theagainst the flu and are workingwith health care centers to offer for the marketing of Bexsero, tissue is extremely hard tofree flu shots, reports CBS. January 22 2013 - which can be administered to repair. Currently, people withAccording to AP, the Centers for E ight hundred children in Europe have developedDisease Control and Prevention narcolepsy after taking the anyone, including infants as failing kidneys rely on dialysis young as two months old, or organ transplants. Osa- Medical News Today re- funes research could changesaid Massachusetts was one of swine flu vaccine, according to that, although he cautions that ported.29 states reporting high levels his breakthrough is a prelimi- Reuters.of "influenza-like illness." Eight-een children have died from Of the five types of meningi- nary step.influenza and more than 2,200 Reuters reported the children in tis, type B is the only onepeople have been hospitalized Sweden and across Europe which has not previously had Stem cells, which are charac-since October. came down with the sleep dis- an effective vaccine. Previous terized by the ability to renew order after being vaccinated vaccines protected against themselves into a diverseNBC reports that the particu- range of specialized cells, have with the Pandemrix H1N1 vac- only some of the strains oflarly bad flu season has been cine which is made by GlaxoS- bacteria that cause Meningi- been used in research to treatblamed on an especially potent various diseases and disabili-strain of the flu, the A H3N2. mithKline. Regulators there tis B, Bloomberg Busi-Another common A strain, the have ruled Pandemrix should nessweek reported, whereas ties.H1N1, is also circulating along not be given to anyone under Bexsero covers 73 percent of Source: globalpost.comwith two strains of influenza B. the age of 20. Emmanuel Mi- cases. New action plan could be gnot, a Stanford University a turning point in globalInfectious disease experts told sleep disorder specialist, said Type B meningitis is the most mental healthNBC that vaccines prepared forthis year will protect against "theres no doubt in my mind common in Europe, and ac-three of the viruses although whatsoever that Pandemrix counts for between 3,000 tonot a fourth strain of influenza increased the occurrence of January 28 2013 - T 5,000 cases a year and hasB, which may account for up to narcolepsy onset in children in he World Health Organiza- caused 1,000 deaths since Continued on page 610 percent of this years flu some countries - and probably 2000, the Telegraph re-
  6. 6. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 6 Journal Watch Involvement of males in antenatal care, birth preparedness, exclusive breast How to join PHP? feeding and immunizations for children in Kathmandu, Nepal Men who were uneducated or had primary level education, aged above 25 years, had higher in- come, formal employment, came from Hindu religion and non-indigenous ethnicities demonstrated e-Mail: greater involvement in antenatal car, birth preparedness, exclusive breastfeeding and immuniza- tions for children in the Katmandu district of Nepal, according to the study published in BMC Preg- nancy and Childbirth 2013 issue. website: A cross-sectional survey was conducted among 2178 married males between May and December publications.php 2010 in 20 Village Development Committees (VDCs) and Kathmandu municipality of the district. As per the study, 39.3% of males accompanied their partners for Antenatal Care (ANC), 47.9 % arranged Skilled Birth Attendance (SBA), and 10.9 % accompanied them for child immunization. Those men who were uneducated or had primary level education (adjusted odds ratio 5.68, 95 % confidence interval 4.44 to 7.27), were aged 25 years or above (2.51, 1.89 to 3.33), with formal Benefits of employment (1.23, 1.01 to 1.49), had income NPR 5001 (exchange rate 1USD = 85 NPR) or above per month (1.47, 1.20 to 1.80), and of non-indigenous ethnicities (1.53, 1.18 to 1.99) were Being a PHP more likely to accompanied their partners on antenatal visit. Similarly, men with these traits were more likely to arranged money for delivery. These factors (illiteracy, income level, formal employ- Subscriber ment) have also significant positive role in birth preparedness. However, the study found that men with an income of NPR 5001 or above per month and of Hindu religion were less likely to encour- aged exclusive breast feeding. To add, people with former characteristics were less likely to ac-  Can submit articles to company their partners for the immunization of their child. PHP newsletter The study concludes that these factors should be emphatically considered during maternal health  Heavy discount rate in program development. PHP trainings, work- Full text article is available at: shops, seminars, con- BMC Pregnancy and Childbirth 2013, 13:14 doi: 10.1186/1471-2393-13-14 ferences  Get acquainted with Author: Dharma Nand Bhatta public health news from around the nation and nell, coordinator of the Mental FAO urges stronger meas- globe at a time Global Health Health-Psychosocial Working Group of the NGO Forum for ures on global health  Enhances professional Health, who attended the threats writing skills Continued from page 5 meeting. tion is attempting to improve The adoption of the action 29 January 2013 – the astounding statistics that plan would represent a turning The world risks a repeat of the surround mental healthcare point in global mental health- disastrous 2006 bird flu out- around the world. care, said O’Donnell. breaks unless surveillance and Send Letters to the “Regardless of income levels,” control of this and other dan- US Congress isn’t the only he said, “countries are really gerous animal diseases is Editor place where mental health coming on board and rallying strengthened globally, FAO discussions have surfaced around the need to put poli- warns. recently. The World Health cies and resources in place  All readers can post Organization (WHO) discussed and calling on WHO to help "The continuing international comments on articles the latest draft of a new with technical guidance.” economic downturn means and news mentioned in Global Mental Health Action less money is available for PHP or could be sugges- Plan last week, which, if The plan lists four objectives prevention of H5N1 bird flu tions and compliments. adopted, would set clear goals focused on leadership, com- and other threats of animal  Send letters to: for progress and aim to im- prehensive care, promotion origin. This is not only true prove accountability in im- and prevention, and research, for international organizations  Word limit 150 max. and proving mental healthcare and has an overall goal to but also countries them- the title of news or arti- around the world. “promote mental well-being, selves," says FAO Chief Veteri- cles of critique. prevent mental disorders, nary Officer Juan Lubroth.  Email should include The action plan will be offi- provide care, enhance recov- "Even though everyone knows ‘letters to the editor’ cially voted for at the World ery, promote human rights that prevention is better than in email subject line. Health Assembly in May, but and reduce the mortality, cure, I am worried because in the draft of the plan received morbidity, and disability for the current climate govern- wide support at the recent persons with mental disor- ments are unable to keep up WHO Executive Board meet- ders.” their guard." Source: ing, according to Kelly O’Don- Source:
  7. 7. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 7 Climate Change and Health Key facts  Climate change affects the social and environmental determinants of health – clean air, safe drinking water, sufficient food and secure shelter.  Global warming that has occurred since the 1970s caused over 140 000 excess deaths annually by the year 2004.  The direct damage costs to health (i.e. excluding costs in health-determining sectors such as agriculture and water and sani- tation), is estimated to be between US$ 2-4 billion/year by 2030.  Many of the major killers such as diarrhoeal diseases, malnutrition, malaria and dengue are highly climate-sensitive and are expected to worsen as the climate changes.  Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond.  Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved health. Climate change Over the last 50 years, human activities – particularly the burning of fossil fuels – have released sufficient quantities of carbon dioxide and other greenhouse gases to trap additional heat in the lower atmosphere and affect the global climate. In the last 100 years, the world has warmed by approximately 0.75oC. Over the last 25 years, the rate of global warming has accelerated, at over 0.18oC per decade. Sea levels are rising, glaciers are melting and precipitation patterns are changing. Extreme weather events are becoming more intense and frequent. What is the impact of climate change on health? Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and increased food production in certain areas, the overall health effects of a changing climate are likely to be overwhelmingly negative. Cli- mate change affects social determinants of health – clean air, safe drinking water, sufficient food and secure shelter. Patterns of infection Climatic conditions strongly affect water-borne diseases and diseases transmitted through insects, snails or other cold blooded animals. Changes in climate are likely to lengthen the transmission seasons of important vector-borne diseases and to alter their geo- graphic range. For example, climate change is projected to widen significantly the area of China where the snail-borne disease schistosomiasis occurs. Malaria is strongly influenced by climate. Transmitted by Anopheles mosquitoes, malaria kills almost 1 million people every year – mainly African children under five years old. The Aedes mosquito vector of dengue is also highly sensitive to climate conditions. Studies suggest that climate change could expose an additional 2 billion people to dengue transmission by the 2080s. Measuring the health effects Measuring the health effects from climate change can only be very approximate. Nevertheless, a WHO assessment, taking into account only a subset of the possible health impacts, concluded that the modest warming that has occurred since the 1970s was already causing over 140 000 excess deaths annually by the year 2004. Who is at risk? All populations will be affected by climate change, but some are more vulnerable than others. People living in small island devel- oping states and other coastal regions, megacities, and mountainous and polar regions are particularly vulnerable. Children – in particular, children living in poor countries – are among the most vulnerable to the resulting health risks and will be exposed longer to the health consequences. The health effects are also expected to be more severe for elderly people and people with infirmities or pre-existing medical conditions. Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to pre- pare and respond. WHO response In 2009, the World Health Assembly endorsed a new WHO workplan on climate change and health. This includes: Advocacy: to raise awareness that climate change is a fundamental threat to human health; Partnerships: to coordinate with partner agencies within the UN system, and ensure that health is properly represented in the climate change agenda; Science and evidence: to coordinate reviews of the scientific evidence on the links between climate change and health, and develop a global research agenda; Health system strengthening: to assist countries to assess their health vulnerabilities and build capacity to reduce health vulnerability to climate change. Available from:
  8. 8. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 8 Being Healthy pertussis — also known as whooping cough “People don’t realize how devastating these Protect your child’s — roared frighteningly through communi- diseases were,” Byington says. “Measles, po- health with regular ties. Today, thanks to vaccinations, those lio…these were diseases that left children dis- diseases and others have been largely si- abled, or killed children in large numbers prior vaccinations lenced. Thanks to successful vaccination to implementing the vaccine programs.” programs, smallpox has been eradicated Thankfully, most vaccine-preventable diseasesYou’re holding your newborn, worldwide, and polio has been eliminated in have pretty much disappeared in the Unitedand you whisper a soft promise the United States. Making sure your children States. But not so in many other countries,that nothing in the world will receive lifesaving vaccines is one of the where measles, rubella and rotavirus, to nameever harm her. most important ways a few, are still quite prevalent. And consider you can keep them this: Some of those germs are just a plane rideSadly, there are some things healthy. away. If not for vaccines, some diseases couldwe can’t control, like the com- spread quickly through communities.mon cold or their first broken According to thehearts. But happily, thanks to U.S. Department of According to the Centers for Disease Controldecades of scientific research, Health and Human and Prevention, just a few cases of measles,we now have the ability to con- Services, immuniza- for example, could quickly become “tens ortrol many diseases that at one tions are among the hundreds of thousands” of cases if we weren’ttime caused untold pain and most successful pub- protected by vaccines.suffering to families every- lic health interven-where. tions of all time. “I “If we stop vaccinating, the diseases would believe childhood immunizations have saved come back. They’re right there waiting to comeAbout 18 years ago, only eight more lives than any other medical interven- back,” says Lance Rodewald, MD, director ofserious diseases were prevent- tion in history,” says Carrie Byington, MD, the Immunization Services Division at with vaccines. Immuniza- professor of pediatrics at the University oftions now protect children and Utah and a member of the American Acad- In 2008, for example, there were a number ofteens against 16 serious dis- emy of Pediatrics Committee on Infectious small outbreaks in the United States of mea-eases. Not so long ago, diseases Diseases. sles because some parents declined to havesuch as diphtheria, measles and their children vaccinated. ington says.While some people have concerns over vaccines because of autism, scientific studies have And even though there are many more vaccines today, thanks shown that there is no con- to better vaccine technology, children are actually exposed to nection. fewer antigens than in the past. “Categorically, vaccination All children are born with a gift: antibodies that they receive does not lead to autism,” By- from their mothers at birth, making them immune to many ington says. “Multiple scientific diseases. But this immunity doesn’t last long. If your children studies have found no link aren’t vaccinated and are exposed to disease germs, their little between vaccination and au- tism.” Start early and stay on trackVaccines are very safe, and when reactions do occur, they are In general, vaccinations should start at 6 weeks to 2 monthsusually minor and temporary, such as a low-grade fever or of age. To get the best protection for your child, make suresoreness or redness at the vaccination site. Another common she or he is immunized on schedule.mis belief is that getting a “natural” infection is better than Your health care provider is the bestbeing vaccinated, but that is just a myth. Some infections may source of this information and cangive you lifelong immunity, but they may also result in severe help with reminders. Remember todisease or even death. So it is much safer for your child to re- keep personal records of your child’sceive the vaccine than to be exposed to the infection. vaccinations as well, as you may need to provide the information down the How vaccines do it line for school, trips or other Antigens are what make vaccines work. They childhood activities. trigger a reaction in your child’s immune sys- tem that protects against infection. “Antigens bodies might not be strong enough to fight them. are an individual protein, or a piece of the infec- “Childhood immunizations save lives and prevent suffering of tious agent that your child is exposed to,” By- children,” Rodewald says. >> Courtesy: Teddi Dineley Johnson, Public Health Perspective (PHP) Online Newsletter published in Healthy You section of De- cember 2009 issue of ‘The Nations Health.’ >> For more tips, visit vaccines
  9. 9. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 9 WHO PublicationsBulletin of WHO Vol. 91, No. 01, 2013The 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: Health Organization Classification of Tumors: Pathology and Genetics of Tumors of Soft Tissue andBoneWHO Classification of Soft Tissue and Bone is the fifth volume of the fourth edition of the WHO series on histological and genetictyping of human tumors. This authoritative, concise reference book provides an international standard for oncologists and patholo-gists and will serve as an indispensable guide for use in the design of studies monitoring response to therapy and clinical outcome.Download is available at: FOR CAMPUS LIASIONParticipation on the PHP team is an opportunity to get involved in PHP activities, develop and demonstrate leadership skills, as wellas work with some terrific colleagues. The campus Liaisons will have opportunities to shape the activities and strategic directions ofPHP. In addition, Liaisons serve as their college representative to the PHP by helping to: reporting news from their college in gen-eral and the program of study in specific.Serving as a campus liaison does not require a large time commitment. Campus liaisons distribute information, for example, byspeaking at new student orientations and to your student society or association about PHP. PHP will provide necessary materialsneeded for this position. This position will also provide students with a unique opportunity to become more cognizant of healthnews around the nation.Being a campus liaison for PHP is a great way to demonstrate the team work ability with the professional development as campusliaisons names and their colleges are mentioned in every issues of PHP.If you are interested in participating as a Campus Liaison and have any questions about the Liaison position, please contact us.Email: newsletter.php@gmail.comOUR CAMPUS LIASIONS Call for Articles for February/March 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. January 2013 P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 10 Public Health Perspective (PHP) Team International Honorary Editorial Advisories Dr. Santosh Raj Dr. Anis Rehman Poudel Associate Chief Editor at Editorial Advisories Dr. Duk Bahadur Residency (MD) in Inter- Journal of Pakistan Medi-Ms. Rose Schneider -- Chhetri nal medicine cal Students (JPMS) RN MPH MD, Pathologist Interfaith Medical Cen- HIFA 2015 Country Rep- Chair of the Climate Western Regional Hos- ter, New York resentative for PakistanChange Working Group pital Lab. of the APHA Interna- Pokhara Dr. Krishna Chandra Chief Executive Officer tional Health Section. RijalSenior Health and HIV/ Mr. Balram Banstola Dept. of Otorhinolaryn- Ashik Banstola AIDS Specialist Managing Director, gology and Head & Neck M. Pharm Health Systems Man- Senior Pharmacist Surgery, College of (Pharmacology), PDCR agement Banstola Medical Hall Medical Sciences and Rajiv Gandhi University1414 Perry Place NW - Kaski Teaching Hospital Bangalore Suite 100 Bharatpur, ChitwanWashington, DC 20010 Board of Advisories Newsletter Team Ms. Sami Pande Mr. Chandra Bhushan Editor-in Chief B. Pharm, MPH Yadav Amrit Banstola Australian Leadership Information Officer Dr. Margaret Steb- Scholar, 2009 (MLIS) Section Editors bing Kathmandu Nepal Health Research Anoj Gurung PhD, Master of Public Council (NHRC) Sandeep Pahari Health, Dip App Sci Dr. Sitaram Khadka MOHP, Kathmandu Sangita Shrestha Nursing Pharm D, Pakistan Subash TimilsinaPopulation Health Aca- Birendra Hospital Contributing Writers demicSchool of Rural Health, Dr. P. Ravi Shankar Madan Kc Professor, Clinical Phar- Monash University Msc. Medical and Australia macology & Medical Edu- Health Care Devices cation Uni. of Bolton, UK KIST Medical College Lalitpur, Nepal.Welcome to New SubscribersNepal InternationalBishal Subedi Itishree TrivediMohan Shrestha Jib AcharyaNitu GuptaPadam DarjiArticles 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