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Public Health Perspective (PHP) Newsletter April 2013 Issue

INSIDE THIS ISSUE

Editorial:
Public understanding of climate change as a human health risks in Nepal-A research need
National News:
Unsafe abortion goes unchecked in Mugu
Senior citizens to get free treatment at Bir Hospital
Nepali detained in US with chronic TB
Health insurance in the offing in five districts
Govt to distribute over 2.5m mosquito nets
World Health Day 2013: Message from the WHO Regional Director
World Malaria Day 2013
Global Health:
France makes abortion free
Obama wants to nearly double cigarette tax
HPV Vaccine Showing Successes in Australia
Low Vitamin-D Tied to Fibroids
Human infection with avian influenza A(H7N9) virus in China - update
Journal Watch:
Birth preparedness and its effect on place of delivery and post-natal check-ups in Nepal
Climate Change Section:
Back from the Past: International Conference of Mountain Countries on Climate Change,
5-6 April 2012
Being Healthy:
Get acquainted with Malaria
WHO Publications:
Bulletin of WHO Vol. 91, No. 04, 2013
Research Priorities for the Environment, Agriculture and Infectious Diseases of Poverty
Sustaining the Drive to Overcome the Global Impact of Neglected Tropical Diseases
Miscellanous:
Quiz-World Health Day
New Subscribers
Call for articles for June 2013 issue

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Public Health Perspective (PHP) Newsletter April 2013 Issue

  1. 1. Editorial: Public understanding of climate change as ahuman health risks in Nepal-A research needVol. 3 Issue 4 April 2013the first public health online newsletter of NepalPublic Health Perspectivecommunity. Similarly, WorldHealth Organization hasurged to emphasize researchon climate change and healthin order to improve the over-all global health and healthequity at an internationallevel. At the national level,the Nepal Health ResearchCouncil (NHRC) has priori-tized climate change as a keyenvironmental health re-search priority area for Nepalin 2006.Since public are the ones whohave closely observed thelocal climatic patterns, theirunderstanding and predic-tions of changes in climate,the consequences it places ontheir health and well-beingcan be an important source ofinformation for policy makersto develop effective mitiga-tion and adaptation meas-ures, provide important in-sights into the phenomenonfor scientists and help com-munities to better anticipateand cope with these conse-quences. Having said that,there is a need to expand theknowledge on climate changeand its health impact studiesat the community level whereadaptations ultimately takeplace. In addition, under-standing how people re-sponded and adapted to se-vere events in the past, willinform future policies andprograms that will work to-wards minimizing the impactsof extreme weather events onthe health and well-being ofpeople.Therefore there is a need forresearch on public under-standing of climate change asa human health risks in Ne-pal.Amrit Banstolaever, Pun et al., 2011 re-ported that it is now beingincreasingly diagnosed inpatients from non-endemicareas of Nepal. According tothem, in the five year period(from April 2004 to March2009), VL was reported in 15new non-endemic districtssuggesting that VL might beexpanding into newer areas.NHRC says, one of the rea-sons for increasing the dis-ease and geographicalspread might be because ofclimate change.The seasonal outbreak ofdifferent diseases which isthe major concern of Nepal-ese Health System clearlyshows the link between cli-mate change and health. Forexample, increasing trend ofrespiratory diseases linkedwith air pollution like AcuteRespiratory Infection (ARI),bronchitis, and asthmaamong others, temporal andspatial increment of waterand food borne disease(diarrhea, typhoid, giardi-asis, and jaundice). Theother major health impactsof climate change in Nepalare increasing morbidity andmortality due to cold wavesand heat waves in the south-ern plain area (Terai), disas-ters, famine and diseaseoutbreak triggered by pro-longed droughts and flashfloods. Data from the Minis-try of Home Affairs, Nepalshows that every year morethan one million people aresusceptible to climate in-duced disasters such asfloods, landslides, anddroughts.The Lancet (reputed journal)stated that climate change isthe biggest global healththreat of the 21st centuryand protecting health fromits impacts is an emergingpriority for the public healthVery little research to datehas been conducted in Nepalconcerning the local percep-tion of climate change andthey all are from farmers’perception and experience,biodiversity and agriculture.However, there has not beenany research on perception ofclimate change as a humanhealth risk in Nepal.The purpose of this article isto provide some argumentsshowing the usefulness ofresearch in understanding thepublic perception of climatechange and its impact on hu-man health in Nepal.In the context of Nepal (thefourth most climate vulnerablecountry in the world), thehealth impact of climatechange is obvious. NHRC re-ports that the first outbreak ofdengue in Nepal in Morang,Parsa, Chitwan, Dang, andNepalgunj in 2006 and Kath-mandu in 2009 may be attrib-uted by climate change. Thereport has also linked the out-break of diarrhea and cholerain mid-western developmentregion of Nepal in 2009 withclimate change. Now, thecommunity people have feltthat the mosquitoes are shift-ing in higher altitudes wherethere was no occurrence ofmosquitoes previously trans-mitting the mosquitoes bornediseases to non endemic ar-eas. For example, malaria,which was previously concen-trated in the Terai and innerTerai regions, is now distrib-uted over almost 65 districtsof the country. Similar is thecase for Japanese encephalitis(JE). It has been reportedfrom hilly districts of Nepalsince 2004 and is now presentin 24 districts. Visceralleishmaniasis (VL) also knownas Kala-azar was confined tothe southeast area in theTerai region of Nepal. How-Public Health ImportantDays (April)April 7: World Health DayTheme: High Blood PressureApril 25: World Malaria DayTheme: Invest in the future. Defeat ma-laria.Inside This Issue
  2. 2. National NewsPage 2P U B L I C H E A LT H P E R S P E C T I V E ( P H P )April 2013MUGU, APR 07 -A majority of women in thedistrict do not visit healthinstitutions for delivery, thusrisking the lives of both childand mother, health officialssaid. The District Public HealthOffice (DPHO) said at leastnine women die every yeardue to unsafe abortion. BirkhaBahadur Shahi, an official atthe DPHO, said more than 45women visited the DPHO fortreatment after undergoingunsafe abortion at home thisyear. The figure stood at 44last year. They said thosewomen who undergo un-safe abortion are between 16to 40 years of age. Auxiliarynurse midwife Saroja Ghimiresaid many women visit healthinstitutions only at the laststage after the abortion, thusmaking the matter worse. Ahealth worker said the figurealso includes unmarried girlsand women whose husbandsare abroad for employment.Source: ekantipur.comKATHMANDU, APR 15 –Bir Hospital has started toprovide free treat-ment services to senior citi-zens starting 15th April, 2013.Senior citizens will get freetreatment services availableat Bir, the countrys oldesthospital. Senior citizensshould submit identity cardsincluding elderly allowancecertificate and citizenship tog e t t h e f r e e t r e a t -ment services in the hospital.They will be entitled to get allthe health tests including X-ray and other laboratory fa-cilities under this service.Hospitals administrator,Khumkanta Acharya, said thatthe hospital has started top r o v i d e f r e e t r e a t -ment services as per their/(the senior citizens) requestto provide treatment serviceson discount. Acharya said thatthe hospital is committed tomaking the services moreeffective in the coming days.However, the senior citi-zens themselves should bearthe expenses for necessarymedicines after the tests.People above 70 years of ageare known as senior citi-zens as per national rule.Source: ekantipur.comKATHMANDU, APR 21 -The National TuberculosisCentre (NTC) has tracedthe family members of aNepali man who is undergoingmedical isolation in southTexas after being detained inNovember last year. Accord-ing to medical reports, theman—who was held aftercrossing the US-Mexico bor-der—was found to be infectedwith XDR-TB, “one of themost severe types of drug-resistant tuberculosis knowntoday”. The NTC—which over-sees the tuberculosis pro-gram—corresponded with thefamily members of the de-tainee, surnamed Sherpa,after a letter demanding theman’s identity was dispatchedfrom the Centre for DiseaseControl and Prevention. TheAtlanta-based health agencycommunicated with the WorldHealth Organization, Nepaland the NTC, briefing on thec u r r e n t c o n d i t i o n o fthe detained patient and ask-ing for further details abouthis family.A Wall Street Journal newsdispatch published on March 2reported that he is the “firstperson to cross and be held indetention while infected withone of the most severe typesof drug-resistant tuberculosisknown today”. “His three-month odyssey through 13countries—from his homelandof Nepal through South Asia,Brazil, Mexico and finally intoTexas—shows the way inwhich dangerous new strainsof the disease can migrateacross the world unchecked,”said the report.A medical team of WHO andNTC travelled to Dhunge-4 ofShyama VDC in Jiri searchingfor the family members. Oneof the team members said theman’s family consisted of hisfather and mother while hefrequently travelled and spentless time at his village home.The medical team has alsosampled sputum from his fam-ily members and neighborsciting possible fear of the drug-resistant TB, which wouldrequire at least 8 weeks toconfirm its presence in thebody, the NTC said. Dr Rajen-dra Pant, director of NTC, saidthe man is undergoing treat-ment in the US and his depor-tation was not yet confirmed.“Since it is one of the mostsevere forms of TB, he has toreceive an intensive treat-ment. His recent photos showhis improving health condi-tion,” he said. According to DrPant, WHO Nepal will write tothe CDC in Atlanta, briefing onhis family details for refer-ence. According to the NTC,1,221 drug-resistant TB pa-tients are receiving treatmentin Nepal while 251 new suchcases were reported last year.Furthermore, XDR-TB, themost severe form, has beendetected in 24 patients.Source: ekantipur.comKATHMANDU, APR 25 -The government hasstarted an initial assessmento f t h e m u c hvaunted health insurance pro-gram in five districts. The Min-istry of Health and Population(MoHP) is assessing servicesa v a i l a b l e a tthe health facilities in Ilam, Sar-lahi, Baglung, Banke and Kailalialong with the proposed insur-ance scheme that aims to coverall households in the five dis-tricts. Kabiraj Khanal, under-secretary at the MoHP, said theministry was sending anothersupervision team to those dis-tricts to monitor the assessmentwork this week. The insuranceprogram is likely to start fromnext fiscal year if the Cabinetendorses a draft of the NationalHealth Insurance Policy-2012.The draft has been sent to theNational Planning Commissionand the Ministry of Finance seek-ing recommendations and neces-sary changes.Earlier in 2003, the governmenthad piloted community healthi n s u r a n c e i n s i x p r i -mary health care centers, which,however, did not work out well.The program was implemented inMangalbare (Morang), Katari(Udaypur), Chandranigahapur( R a u t a h a t ) , D u m k a u l i(Nawalparasi), Lamahi (Dang)and Tikapur (Kailali), where amajority of the health centerswitnessed a dropout of over 50percent. Fatta Bahadur KC, chair-man of the Insurance Board Ne-pal, said the government has toinclude private insurance compa-nies to sustain the insurance pro-gram. Source: ekantipur.comKATHMANDU, APR 26 -In its efforts to meet the na-tional target of controlling ma-laria by 2015, the government isplanning to distribute over 2.5million Insecticide-treated bednets (ITNs). The Epidemiologyand Disease Control Division(EDCD) under the Department ofHealth services plans to distrib-ute 2,574,932 ITNs in 31 districtsaffected by malaria. As the coun-try marked World Malaria Day on25th April, Chief of the EDCD, DrGD Thakur said they will distrib-ute 1.4 million nets this fiscalyear, while the remaining will bedisturbed next year. The govern-ment will provide one net for twopeople aged more than five inContinue on page 4Unsafe abortion goesunchecked in MuguSenior citizens to getfree treatment at BirHospitalHealth insurance in theoffing in five districtsNepali detained in USwith chronic TBGovt to distribute over2.5m mosquito nets
  3. 3. Message from the Regional DirectorP 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 3April 2013The focus of this year’s World Health Day is high blood pressure1 also known as hypertension.High blood pressure is the single most important risk factor for mortality, accounting for 1 in every 10deaths in the South-East Asia Region. High blood pressure increases the risk of heart attack, stroke,loss of vision and kidney disease. Each year, hypertension kills nearly 1.5 million people in our Region.High blood pressure and related non-communicable diseases have become rampant. Globalization andunplanned urbanization are driving unhealthy lifestyle patterns in the population, such as increasedconsumption of processed foods containing excessive salt, low levels of physical activity, and use of tobacco and alcohol. Inaddition, increasing levels of mental stress contribute to the adoption of unhealthy behaviors thus putting people at a higherrisk of acquiring hypertension and related non-communicable diseases.High blood pressure can affect anyone regardless of age, race, ethnicity, gender or income level. Today, one in three adults inWHO’s South-East Asia Region has hypertension. As the population of our Region ages, more and more people are likely to beaffected.The good news is that high blood pressure is both preventable and treatable. A holistic approach based on health promotion andprimary prevention is required to address risk behaviors that cause hypertension and related non-communicable diseases.There is a need to promote healthy lifestyle behavior among populations. This includes increased physical activity to maintain ahealthy weight; avoiding tobacco use and limiting alcohol intake; and consumption of a healthy diet that is rich in fruits andvegetables, and low in saturated fats and salt. Promoting healthy behaviors will reduce mortality not only due to hypertension-related cardiovascular diseases but also due to other non-communicable diseases such as diabetes, cancer and chronic respira-tory diseases. Therefore, it should be our priority to educate and motivate people of all ages and in all walks of life to be proac-tive in preventing the onset of hypertension, by making health-promoting behaviors a part of their everyday lives.Prevention and management of hypertension and related non-communicable diseases is not the responsibility of the health sec-tor alone but requires integrated, multi-sectoral, multidisciplinary and culturally relevant approaches. As most of the major de-terminants of the disease burden lie outside the health sector, we need to ensure that the strategy for prevention and control ofhypertension and related non-communicable diseases cuts across all sectors and involves collaboration with many stakeholders.Education and labor, food and nutrition, transport and communications, urban development, sports and youth affairs sectors, allneed to come together to design interventions to raise awareness and encourage people to make healthy lifestyle choices. Na-tional governments of Member States in the South-East Asia Region need to institute programs in schools and workplaces to-wards healthy eating and effective physical fitness. The governments also need to work with the food industry to put regula-tions in place for decreasing the amount of salt/sodium added to processed foods and increasing the availability of healthierfood options.High blood pressure is a “silent killer” with no signs or symptoms. Many people, therefore, do not realize that they have hyper-tension. Thus, alongside promoting healthy behaviors for prevention of hypertension, it is also important to educate the popula-tion about regular check-ups of blood pressure levels as a means of timely diagnosis of hypertension. Timely diagnosis andtreatment can avoid complications such as stroke, heart attacks, kidney and eye damage. It is possible to diagnose and treathypertension at the primary health care level using simple equipment and standard treatment guidelines. Health systems needto be strengthened to make these services available, affordable and accessible. Improved access and affordability should par-ticularly focus on groups for whom the reach of health programs is low. In addition to improved access to treatment, counselingshould be offered to promote adherence to prescribed medicines and adoption of healthy lifestyles.In September 2011, at the historic meeting of the United Nations General Assembly on non-communicable diseases, MemberStates made commitments to take concerted and comprehensive actions for prevention and control of non-communicable dis-eases. These commitments must now be translated into concrete actions through adoption of effective public policies. Adequateresources should be dedicated to promote healthy lifestyles, empower communities and strengthen primary health systems tothwart the growing burden of these diseases.On World Health Day 2013, I urge all Member States and partner agencies to take tangible and sustained actions to combathigh blood pressure through national and local public health agencies and other organizations within and beyond the healthsector. Preventing and controlling hypertension means reducing disease, disability and death by protecting the people of theSouth-East Asia Region from the risk of heart disease, stroke and related non-communicable diseases, and thereby, furtherincreasing their health and well-being.WORLD HEALTH DAY 2013 | High Blood PressureDr Samlee Plianbangchang, Regional Director,World Health Organization, South-East Asia Region
  4. 4. World Malaria Day, 25 April 2013Page 4P U B L I C H E A LT H P E R S P E C T I V E ( P H P )April 2013National NewsContinue from page 2each household, while preg-nant women will be given thenets during their routine preg-nancy check-up. Earlier, thegovernment had provided thenets to only 13 districts bor-dering India.However, this time, apartfrom 10 districts in the Hima-laya region, the governmentwill provide the nets to 13most vulnerable and 18 vul-nerable districts. The 13 dis-tricts that the programmecovered earlier were Jhapa,Ilam, Morang, Dhanusa, Mo-hattari, Sindhuli, Kavre,Nawalparasi, Bardiya, Kailali,Kanchanpur, Dadeldhura andBanke. The added districtsinclude Panchthar, Dhankuta,Sunsari, Saptari, Siraha,Udayapur, Sarlahi, Rautahat,Bara, Parsa, Makawanpur,Chitwan, Sindhupalchowk,Rupandehi, Kapilvastu, Dang,Surkhet and Doti. Accordingto the EDCD, around 20.5million people of 65 districtsare affected by malaria. Thegovernment has also beenconducting malaria controlprograms with support fromthe Global Fund since 2004.The EDCD says that the num-ber of confirmed malariacases has decreased by 1/3 incomparison to 2004. Statisticsshow there are over 3,200malaria cases in Nepal at pre-sent.Source:ekantipur.comQuiz: World HealthDay Special1. Hypertension is high blood sugar high blood pressure high blood cholesterol2. A blood pressure readinghas two numbers, 120/80mmHg. The top number isthe _________ pressureand bottom number is the__________ pressure. diastolic and systolic systolic and diastolic3. A blood pressure readingof 146/92 mmHg is high low Normal4. Someone with high bloodpressure may haveearly morning headaches irregular heartbeats no symptoms all of the above5. The total daily intake ofsalt from all sources shouldbe no more than: 20 grams per day 5 grams per day 10 grams per day 15 grams per day6. Eating more fruits andvegetables helps to controlblood pressure because oftheir low potassium content low sodium content andhigh potassium content high sodium content andlow potassium content high sodium7. Treating high bloodpressure helps reduce therisk of complications suchas strokes, heart attacksand kidney disease true False8. Which of the followingcan help to prevent highblood pressure? regular physical activity not using tobacco limiting alcohol use all of the above9. High blood pressure kills__________ people eachyear in the WHO South-East Asia Region 100 000 150 000 1 500 000 1 000 00010. Blood pressure usuallyincreases as we grow older true False>>Check you answer on page 6World Malaria Day is commemorated each on April 25 andprovides an opportunity to reflect on the status of global effortsto "roll back malaria." The global campaign theme for 2013 andthe coming years "Invest in the future. Defeat malaria," is areminder of the need to continue to make progress and defeatmalaria.World Malaria Day was instituted by WHO Member States dur-ing the 2007 World Health Assembly. It is an occasion to high-light the need for continued investment and sustained politicalcommitment for malaria prevention and control. It is also anopportunity: for countries in affected regions to learn from each othersexperiences and support each others efforts; for new donors to join a global partnership against malaria; for research and academic institutions to flag scientific ad-vances to both experts and the general public; and for international partners, companies and foundations toshowcase their efforts and reflect on how to further scaleup interventions.Over the last decade, the world has made major progress in thefight against malaria. Since 2000, malaria mortality rates havefallen by more than 25%, and 50 of the 99 countries with ongo-ing transmission are now on track to meet the 2015 WorldHealth Assembly target of reducing incidence rates by morethan 75%. A major scale-up of vector control interven-tions, together with increased access to diagnostic test-ing and quality-assured treatment, has been key to thisprogress.But we are not there yet.Malaria still kills an esti-mated 660 000 peopleworldwide, mainly chil-dren under five years ofage in sub-Saharan Africa. Everyyear, more than 200 million casesoccur; most of these cases arenever tested or registered. A re-cent plateauing of internationalfunding has slowed down progress,and emerging drug and insecticide resistance threaten to reverserecent gains.
  5. 5. Global HealthP U B L I C H E A LT H P E R S P E C T I V E ( P H P )April 2013Page 5they found that having a vita-min D level above 20 de-creased the risk for fibroids by32 percent, and that each in-crease of 10 nanograms permilliliter in vitamin D was as-sociated with a 20 percentlower risk of having a fibroidtumor.Source: New York Times21 April 2013 -As of 21 April 2013(18:00CET), the NationalHealth and Family PlanningCommission notified WHO ofan additional six laboratory-confirmed cases of humaninfection with avian influenza A(H7N9) virus and one fatalcase from Shanghai Municipal-ity. Of the latest laboratoryconfirmed cases, five are fromZhejiang Province and one isfrom Shanghai Municipality.Additionally, 1 patient earlierreported from Zhejiang Prov-ince has died. To date, thereare a total of 102 laboratory-confirmed cases of humaninfection with avian influenza A(H7N9) virus in China; includ-ing 20 deaths. Contacts of theconfirmed cases are beingclosely monitored. Currently,70 patients are being treatedin hospital and 12 patientshave been discharged. Na-tional authorities continue toimplement prevention andcontrol measures.Source: WHOThe Obama administrationseems to be pushing this line."Young smokers are incrediblyprice sensitive," observedHealth and Human ServicesSecretary Kathleen Sebelius afew days ago, according to TheAssociated Press. Upping thetax to $1.95 a pack will pre-sumably be a further deterrent-- CNN said cigarette sales fellby ten percent four years agoafter the government increasedthe cigarette tax.Thus, Obamas proposed fed-eral cigarette tax "could have ahuge effect on public health"given that one-in-five Ameri-cans smoke, said AP.The US spends $193 billion ayear on smoking-related costs,if direct medical payments andproductivity losses are takeninto account, according to alarge Centers for Disease Con-trol study conducted in theearly 1990s, said CNN.Source: Global Post18 April 2013 -The American government’sgoal of vaccinating younggirls against the human papil-loma virus (HPV) has been dis-appointing, with less than athird of teenagers having com-pleted a full course of HPV vac-cine. But now the United Statescan look to Australia, which sixyears into a successful nation-wide HPV vaccination campaignhas experienced a sharp de-cline in the number of newcases of genital warts amongyoung men and women.The country, one of the first toestablish a nationally financedHPV vaccination program forgirls and young women, hasalso seen a decrease in thenumber of cases of cervicalabnormalities, a precursor tocervical cancer.Australia’s program, whichstarted in 2007, offers free HPV2 April 2013 -In France, any woman whochooses to can have an abor-tion for free. As of April 1, theFrench state covers 100 percentof the costs for 100 percent ofterminations. Previously onlygirls under 18 could claim thefull cost back from social secu-rity, while older women wouldreceive between 70 and 80 per-cent.The new provision, introducedas one of Socialist PresidentFrançois Hollandes campaignpromises in early 2012 and ap-proved in October, is part of adrive to bolster womens repro-ductive rights. The reform isdesigned to help remove thebarriers that continue to pre-vent women exercising their"fundamental right" to decidewhat happens to their bodies,said Health Minister MarisolTouraine.Source: Global Post10 April 2013 -US President BarackObamas new budget wouldnearly double the cigarette tax,slapping an additional 94 centsonto the current $1.01-a-packtax, reported CNN Money.The president wants to put themoney toward early childhoodeducation programs, but criticssay because most smokers aremiddle-to-lower class, the non-sliding-scale tax will hurt thosealready hardest-hit, said CNN.But Obama argues that the"increase would have substan-tial public health benefits, par-ticularly for young Americans,"CNN said, citing the budget."Researchers have found thatraising taxes on cigarettes sig-nificantly reduces consumption,with especially large effects onyouth smoking."France makes abortionfreevaccination to girls who are12 and 13 years old, andcatch-up programs for girlsand women under 26. Thevaccine protects againstgenital warts as well as can-cers of the cervix, head andneck.The vaccine is typically ad-ministered in three doses,beginning around age 12. In2010, coverage rates for girlsthat age in Australia’s school-based programs reached 83percent for the first dose, 80percent for the second doseand 73 percent for the third.Source: New York Times19 April 2013 -Inadequate levels of vita-min D may increase therisk for uterine fibroids, anew study reports.Vitamin D has been associ-ated with reduced risk forvarious diseases, but this isthe first to examine the con-nection to fibroids, benigntumors of the uterus that cancause pain and bleeding.Researchers randomly se-lected 620 black and 410white women, ages 35 to 49,and determined their vitaminD levels with blood tests andtheir health status with ques-tionnaires. Their analy-sis appears in the May issueof Epidemiology. About two-thirds of the women had fi-broid tumors. In the entiregroup, only 10 percent of theblack women and 50 percentof white women had vitaminD levels above 20 nanogramsper millilitre, generally con-sidered an adequate level.After adjusting for age,physical activity, sun expo-sure and other variables,Low Vitamin-D Tied toFibroidsObama wants to nearlydouble cigarette taxHuman infection withavian influenza A(H7N9)virus in China - updateHPV Vaccine Showing Suc-cesses in Australia
  6. 6. Birth preparedness is one of the critical factors in determining the likelihood of having institutionaldelivery and checkups after delivery, according to the study published in the 2013 issue of PLoSONE.Secondary data such as latest round of Nepal Demographic and Health Survey Data (NDHS, 2011)has been used in the study. Bivariate and multivariate models are applied as the methods of dataanalyses.As per the study, only 32% of women in Nepal have birth preparedness. The women who are wellprepared belong to higher age group (45%), higher education (36%) and with higher womenautonomy (86%). Women, who are well prepared for child birth (OR = 3.137, p<0.01) have agreater likelihood of going for institutional deliveries that women with no preparation (OR = 1).However, irrespective of level of birth preparedness, women in Nepal preferred to deliver the babyin public health facility than private health facility.The study recommend for ensuring adequate and universal birth preparedness in order to achievegoal 4 and 5 of MDGs at policy level.Full text article is available at: PLoS ONE 8(5): e60957. doi:10.1371/journal.pone.0060957Authors: Dipty Nawal, Srinivas GoliJournal WatchPage 6P U B L I C H E A LT H P E R S P E C T I V E ( P H P )April 2013Send Letters to theEditor All readers can postcomments on articlesand news mentioned inPHP or could be sugges-tions and compliments. Send letters to:newsletter.php@gmail.com Word limit 150 max. andthe title of news or arti-cles of critique. Email should include‘letters to the editor’in email subject line.How to join PHP?e-Mail:newsletter.php@gmail.comwebsite:www.bmhall.yolasite.com/publications.phpBenefits ofBeing a PHPSubscriber Can submit articles toPHP newsletter Heavy discount rate inPHP trainings, work-shops, seminars, con-ferences Get acquainted withpublic health news fromaround the nation andglobe at a time Enhances professionalwriting skillsBirth preparedness and its effect on place of delivery and post-natal check-ups in NepalQuiz: Answers with explanation1. high blood pressure is correct! Explanation: Blood pressure is the force exerted on the walls of blood vessels. This force isnecessary to make blood flow and deliver oxygen and nutrients to the body. If blood pressure constantly remains above the healthyrange, it is called hypertension or high blood pressure. High blood pressure is dangerous because it makes the heart work harderand increases the risk of heart attacks, strokes, kidney disease and blindness.2. systolic and diastolic is correct! Explanation: Blood pressure is written as two numbers, measured in millimetres of mercury(mmHg). The two numbers in the blood pressure reading represent the systolic pressure and the diastolic pressure, respectively.The systolic pressure is the pressure in your blood vessels when your heart beats. The diastolic pressure is the pressure in yourvessels when your heart rests between beats.3. high is correct! Explanation: An individual with a systolic blood pressure of 140 mmHg or higher and a diastolic blood pressure of90 mmHg or higher is considered to have hypertension or high blood pressure. If you have persistently high blood pressure, youshould consult a healthcare professional for further evaluation and treatment.4. all of the above is correct! Explanation: Someone with high blood pressure may not have any symptoms at all or may experi-ence one or more symptoms such as early morning headaches, irregular heartbeats and nosebleeds. Because it may not presentwith any signs or symptoms, high blood pressure is often called “the silent killer”. Therefore it is important to get your blood pres-sure checked regularly.5. 5 grams per day is correct! Explanation: WHO recommends no more than 5 grams of salt per day, which is the equivalent of onelevel teaspoon. Reduce the amount of salt consumed by avoiding “chutneys” and sauces, chips and biscuits, and processed foods.Limit the addition of excess salt during cooking.6. low sodium content and high potassium content is correct! Explanation: Excess sodium is linked to high blood pressurewhereas potassium has a protective effect against hypertension. Fruits and vegetables are a great choice as they both have lowsodium and high potassium contents.7. true is correct! Explanation: Over time, uncontrolled high blood pressure will cause damage to the blood vessels of the brain andheart, which can lead to strokes, and heart attacks. It can also cause kidney and eye damage. When lifestyle modification alone isnot adequate, blood-pressure-lowering medicine may be prescribed to control high blood pressure and to avoid associated compli-cations.8. all of the above is correct! Explanation: Adults should engage in moderate physical activity for at least 150 minutes throughoutthe week. Tobacco and excess alcohol increases the risk of high blood pressure and should be avoided.9. 1 500 000 is correct! Explanation: High blood pressure/Hypertension is the leading cause of risk for death. It kills 1.5 millionpeople in the South-East Asia Region each year. Approximately one third of the adult population in the South-East Asia Region hashypertension.10. true is correct! Explanation: Blood pressure increases progressively with age. Therefore, it is important to follow a healthy life-style from an early age. This can be achieved by eating a balanced diet low in salt and rich in fruits, vegetables and whole grains,as well as exercising regularly, avoiding tobacco and excess alcohol, and positively managing stress.
  7. 7. Climate Change: Back from the PastP U B L I C H E A LT H P E R S P E C T I V E ( P H P )April 2013Page 7International Conference of Mountain Countries on Climate Change,5-6 April 2012KATHMANDU CALL FOR ACTIONWe, the Ministers, Heads of Delegations and Representatives of International and National organizations, having attended theInternational Conference of Mountain Countries on Climate Change held from 5 to 6 April 2012 in Kathmandu, Nepal;Aware of the human-induced multiple impacts of climate change on mountain ecosystems, goods and services and implicationson livelihoods, health and welfare of the mountain people and environment;Recognizing the need for urgent, collaborative and effective actions at all levels for addressing climate-induced vulnerabilities andimpacts on mountains, enhancing the well-being of climate vulnerable communities and also strengthening the climate resilienceof the people of mountainous countries; andApplauding the Government of Nepal for starting the Mountain Initiative;Appreciating the international expert consultation on mountains and climate change and taking note of their recommendations;Also appreciating the South Asian Parliamentarians Workshop on Climate Change and taking note of their recommendations;Hereby express our resolve to:1. Reaffirm the spirit of solidarity and cooperation among the mountain countries and countries with mountainous regions foraddressing the common problems affecting all the mountainous regions, and for consolidating our common efforts to effec-tively integrate mountain issues into the global climate change and development agenda including the Rio+20 process andbeyond;2. Promote research as well as use of traditional knowledge for sharing, learning and exchange of information and best prac-tices to support science-policy interface and help find best solutions to climate change challenges through global cooperation,including south-south cooperation, recognizing that the mountains provide solutions for sustainable development using eco-system services, in particular, water, biodiversity, energy, and for enhancing food security;3. Reinforce that our collective actions will complement the objectives of achieving equitable and sustainable development in-cluding the Millennium Development Goals with a focus on reducing poverty and enhancing gender equity and social inclusionamong the people in mountain countries and regions;4. Agree to update the sustainable mountain development agenda in the context of growing challenges and opportunities, re-sulting from climate change and globalization;5. Encourage building appropriate incentive mechanisms at various levels to recognize and reward mountain communities forconservation and maintenance of mountain ecosystem services through climate change adaptation and conservation of criti-cal ecosystems;6. Strengthen and consolidate the Mountain Initiative as a global platform for all mountainous countries to discuss commonissues through collaborative and cooperative efforts for mobilizing the necessary support and raising awareness globallyabout the adverse impacts and vulnerabilities of mountain ecosystem services and implications on the livelihoods of the poorand disadvantaged people and make efforts to reduce impacts of climate change collectively;7. Urge the development partners to support through the establishment of dedicated funding arrangements for the adaptationand mitigation programs in mountain countries within the framework of UNFCCC and other sustainable development proc-esses and build the resilience of communities, women and disadvantaged groups in particular, through a comprehensive andholistic approach at the local, national, regional and international levels in the spirit of enhanced global partnership; and8. Recognize and build on high potentials of mountain ecosystem services to promote green growth strategies and strengthenlinkages between mountain ecosystem and other ecosystems to reduce poverty and promote sustainable development;9. Work collectively to mobilize global support to promote investment in mountain countries in an institutionalized manner, andto enhance the level of concrete cooperation among all the stakeholders, including the private sector, local communities, civilsociety and youth, with action plan based on mutual collaboration and commitments among the mountain countries and thedevelopment partners, UN system, including the Mountain Partnership, and multilateral organizations in order to ensure ade-quate and effective flow of financial resources, including innovative financing, technology and capacity building to the moun-tain countries;10. Agree to give continuity to the Mountain Initiative on a sustainable basis, organize the next conference through mutual con-sultations at an appropriate time, and develop the program of work to carry forward the Kathmandu Call for Action;Have hereby decided to adopt this Kathmandu Call for Action.Kathmandu, Nepal6 April 2012
  8. 8. Being HealthyPage 8P U B L I C H E A LT H P E R S P E C T I V E ( P H P )Get acquainted withMalariaApril 2013 Patient experiences the nausea, vomiting and body ache Diarrhea is also seen in some of the symptomatic patients Jaundice is commonDiagnosis and treatmentEarly diagnosis and treatment of malaria reduces disease andprevents deaths. It also contributes to reducing malaria trans-mission. The best available treatment, particularly for P. falci-parum malaria, is Artemisinin-based Combination Therapy(ACT). WHO recommends that all cases of suspected malaria beconfirmed using parasite-based diagnostic testing (either mi-croscopy or rapid diagnostic test) before administering treat-ment.PreventionVector control is the main way to reduce malaria transmissionat the community level. It is theonly intervention that can reducemalaria transmission from veryhigh levels to close to zero.For individuals,personal protec-tion against mos-quito bites repre-sents the first lineof defense formalaria prevention. Two forms of vector control are effective ina wide range of circum-stances. Insecticide-treated mos-quito nets (ITNs) Indoor spraying with re-sidual insecticidesIn addition, surroundingsaround the house should bekept clean and any malaria-breeding sites such as ditches,water ponds and swampyplaces should be removed. Itis also recommended to usefull-sleeved clothes, mosquito repellants to avoid mosquitobite.Malaria control program, Nepal: At a GlanceMalaria control program was started in Nepal in 1950 whichoperated the research on malaria control in Hetauda. In 1954,Insect-Born Disease Control program was launched with assis-tance from United Sates Overseas Mission (USOM), the objec-tive of which was to control malaria mainly in Terai belt ofEastern Nepal. On 4 December 1958, Malaria Eradication Pro-gram was processed with the assistance from USOM and WHOas a vertical program. Its objective was to eradicate malariafrom the country in a time-bound manner which was laterchanged into malaria control program in July 1978. This pro-grams was integrated into primary health care approach andnow is functional under the Disease Control Section.>>For more information, visit who.int/www.bmhall.yolasite.com/publications.phpparasite that causes malaria.There were 216 million episodes of malariaand 655,000 deaths worldwide in 2010,according to the World Health Organization(WHO). Most of the deaths had occurred inthe African region (91%), followed by theSouth East-Asian Region (6%) and the East-ern Mediterranean Region (3%). Similarly,around 86per centdeathswere ofchildrenglobally.Nepal isamong104 ma-laria en-demiccountriesin theworld.Although,it has al-readyachievedthe ma-laria control target for 2015 under Millen-Malaria is a vector-borne infec-tious disease caused by Plasmo-dium parasites that are trans-mitted to people through thebites ofinfectedfemaleAnophe-les mos-quitoes,whichbitemainlybetweendusk anddawn.Plasmo-diumfalcipa-rum andPlasmo-diumvivax arethe most common species ofnium Development Goal (MDG), it still has togo far for malaria eradication. More than 1,00,000 clinical malarial cases are reportedannually in Nepal among which 2000-3000cases are from tropical regions.Who is at risk?Specific population risk groups include: young children non-immune pregnant women semi-immune pregnant women semi-immune HIV-infected pregnantwomen people with HIV/AIDS; international travelers from non-endemicarea Immigrants from endemic areas and theirchildrenSymptomsGenerally, symptoms of malaria appear usuallytwo weeks after the infected mosquito bite. High grade fever along with chilling andsweating is the foremost sign of malaria Fever repeats in every 48-72 hrsPublic Health Perspective (PHP)
  9. 9. The 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: http://bit.ly/10MAXOMWHO PublicationsBulletin of WHO Vol. 91, No. 04, 2013P U B L I C H E A LT H P E R S P E C T I V E ( P H P )April 2013Page 9Research Priorities for the Environment, Agriculture and Infectious Diseases of PovertyThe Thematic Reference Group on Environment, Agriculture and Infectious Diseases of Poverty (TRG 4) addresses the nature of theintersections and interactions between environment, agriculture and infectious diseases of poverty in order to identify researchpriorities for improved disease control. The report is available for download at: http://bit.ly/12yevuRCall for Articles for June Issue 500-700 words on topic of public health importance (see website) Do not include any graphs, tables and citations PP size photo in jpeg format email your articles tonewsletter.php@gmail.com with the subject ‘article for PHP’ For more information:http://www.bmhall.yolasite.com/information-for-contributors.phpOUR CAMPUS LIASIONSAPPLY 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.comWelcome to our new campusLiaisonMahesh Prasad BistaIOM, Maharajgunj Campus, KathmanduSustaining the Drive to Overcome the Global Impact of Neglected Tropical DiseasesThe second WHO report on neglected tropical diseases builds on the growing sense of optimism generated by the 2012 publicationof the WHO Roadmap. The report is available for download at: http://bit.ly/13wYrs3
  10. 10. Public Health Perspective (PHP) TeamApril 2013P 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 10Dr. Santosh RajPoudelResidency (MD) in Inter-nal medicineInterfaith Medical Cen-ter, New YorkDr. Krishna ChandraRijalDept. of Otorhinolaryn-gology and Head & NeckSurgery, College ofMedical Sciences andTeaching HospitalBharatpur, ChitwanMr. Chandra BhushanYadavInformation Officer(MLIS)Nepal Health ResearchCouncil (NHRC)MOHP, KathmanduContributing WritersDr. P. Ravi ShankarProfessor, Clinical Phar-macology & Medical Edu-cationKIST Medical CollegeLalitpur, Nepal.Editorial AdvisoriesDr. Duk BahadurChhetriMD, PathologistWestern Regional Hos-pital Lab.PokharaMr. Balram BanstolaManaging Director,Senior PharmacistBanstola Medical HallKaskiBoard of AdvisoriesMs. Sami PandeB. Pharm, MPHAustralian LeadershipScholar, 2009KathmanduDr. Sitaram KhadkaPharm D, PakistanBirendra HospitalMadan KcMsc. Medical andHealth Care DevicesUni. of Bolton, UKDr. Anis RehmanAssociate Chief Editor atJournal of Pakistan Medi-cal Students (JPMS)HIFA 2015 Country Rep-resentative for PakistanChief Executive OfficerAshik BanstolaM. Pharm(Pharmacology), PDCRRajiv Gandhi UniversityBangaloreNewsletter TeamEditor-in ChiefAmrit BanstolaSection EditorsAnoj GurungSandeep PahariSangita ShresthaSubash TimilsinaInternational HonoraryEditorial AdvisoriesMs. Rose Schneider --RN MPHChair of the ClimateChange Working Groupof the APHA Interna-tional Health Section.Senior Health and HIV/AIDS SpecialistHealth Systems Man-agement1414 Perry Place NW -Suite 100Washington, DC 20010Dr. Margaret Steb-bingPhD, Master of PublicHealth, Dip App SciNursingPopulation Health Aca-demicSchool of Rural Health,Monash UniversityAustraliaWelcome to New SubscribersInternationalKristin MillerSadhu PandaNepalDeepak SapkotaDr. Kshitiz ShresthaMahesh BistaArticles 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 do not discriminate on the basis of race, color, gender,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 newsletter.php@gmail.com

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