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Public Health Perspective
                                      the first online public health newsletter of Nepal                    Vol. 2 Issue 7 July 2012




                                  Editorial: Universal access to reproductive health: What
                                  does it mean to Nepal?
                                  Nepal as a signatory of Millen-    (Nepal Fertility and Family       integrated reproductive ser-
          Inside This Issue       nium Development Goals             Planning Survey 1991) to          vices, inaccessibility, non-
                                  (MDGs) has set targets to          36% (NDHS 2011) from              evidence based interventions,
                                  achieve universal access to        1990 to 2011.The target is to     inadequately trained service
                                  reproductive health by the         increase to 60 percent by the     providers, limited availability
        National News       2&4   year 2015. But what does it        year 2015. Skilled birth at-      of reproductive health equip-
                                  mean to Nepal—the target           tendant (SBA) includes doc-       ment, commodities and sup-
                                  versus current scenario, barri-    tor, nurse or midwife.            plies, and increasing rate of
     World Population Day 3       ers, and challenges on repro-                                        HIV, among other barriers.
                                  ductive health are discussed       Contraceptive Prevalence
                                  here in this editorial on the      Rate (CPR) among married          At the national level: financial
     World Hepatitis Day    3     special occasion of World          women aged 15-49 increased        constraints, lack of political
                                  Population Day 2012 and its        from 24% in 1990 (MOH             will, political instability, gen-
                                  theme “Universal Access to         1992) to 50 percent in 2011       der inequality, violation of
        Global Health       5     Reproductive Health Ser-           (NDHS, 2011). The target for      reproductive rights, and lim-
                                  vices”.                            Nepal is to increase the CPR      ited human resources have
                                                                     to 67 percent by 2015.            created barriers.
        Journal Watch       6     The concept of “universal ac-
                                  cess” here reflects equity in      According to UNFPA Nepal,         Challenges
                                  reproductive health services       the rate of adolescent preg-      In Nepal, reproductive health
        Featured Article
                                  (equal access for equal need).     nancies is high and roughly       problems are the leading
     (Arundati Muralidha-   7                                        20% of adolescent girls are       cause of ill health and death
                                  In other words, it implies that
             ran )                reproductive information and       pregnant or have given birth      among women of childbearing
                                  services are “available, acces-    to at least one child in Nepal.   age. An increasingly large
        Being Healthy       8     sible and acceptable” to meet      Only half of all pregnant         number of young people are
                                  the different reproductive         women make four or more           entering their reproductive
                                  needs of all individuals.          Antenatal Care (ANC) visits       years, often without the ade-
       WHO Publications     9                                        during their entire pregnancy     quate reproductive health
                                  Target VS current scenario         as per the NDHS 2011. The         knowledge, skills and services
                                  The target of universal access     target is to make the four        they need. Reproductive
        New Subscribers     10    to reproductive health i.e.,       visit or more for ANC cover-      health services coverage is
                                  MDGs 5 is to reduce the ma-        age at 100%. The current          low among the rural poor,
                                  ternal mortality ratio by three-   unmet need for family plan-       Dalit, and Janjati women. The
                                  quarters between 1990 and          ning services in Nepal is re-     percentage of institutional
Public Health Important           2015. Between 1990 and             portedly 27%.                     deliveries among urban
Day (July)                        2010, the MMR in Nepal fell                                          women is more than double
                                  from 850 (UNDP 1992) to 229        Major barriers                    that of the rural women. Be-
                                  (Family Health Division, 2009)     A number of barriers need to      sides, adolescent sexual and
                                  per 100,000 live births. Sev-      be tackled at various levels if   reproductive health issues
                                  eral factors have played an        universal access to reproduc-     have not yet been incorpo-
                                  important role in reducing the     tive health services is to be     rated into the essential health
                                  nation’s MMR. Improvements         achieved in Nepal.                care services package of
                                  in maternal health services,                                         MoHP.
                                  the National Safe Motherhood       At user level: delay in decid-
                                  Program (2002-2007), the           ing to seek care, delay in        A way forward
                                  policy on skilled birth atten-     reaching care in time, and        If universal access to repro-
                                  dants (2006), safe mother-         delay in receiving adequate       ductive health services is to
                                  hood and neonatal health pro-      treatment , high cost of          be achieved, the Government
                                  gram, the birth preparedness       health care, limited service      of Nepal (GoN) should invest
                                  package (2008-2009), and a         choices, inequalities in care,    more in reproductive health,
                                  maternity incentive scheme         poverty, and illiteracy has       pay more attention to the
                                  (2005) among others are to         created hindrance. Women’s        poor, marginalized, under-
                                  mention a few.                     low education and poverty         privileged and rural women’s
                                                                     are also consistently associ-     reproductive health.
                                  The skilled birth attendance       ated with low use of repro-
                                  and contraceptive prevalence       ductive health services.
                                  rates have increased since
                                  1990. The skilled birth atten-     At service delivery level:
                                  dance rate increased from 7%       inadequate funding, lack of               Amrit Banstola
July 2012
                                   Public Health Perspective (PHP)                                                             Page 2

                                  National News
                                  smoking in public places. The      planning and safe motherhood      services (SAS) and 95,306
                                  Act says those smoking in          have been government priori-
439 persons face the              public places will be fined up     ties but the rest remain in the
                                                                                                       women received safe abortion
                                                                                                       from 487 listed sites, said the
music for smoking in              to Rs 100 and the civil ser-       policy-making phase. Despite      annual report of DoHS. How-
                                  vants doing so will be liable      huge investments, newborn
public places                     for departmental action. Sell-     care hasn’t shown any signifi-
                                                                                                       ever, thousands of women are
                                                                                                       still undergoing unsafe abortions
                                  ing tobacco products to mi-        cant improvement in the last      with the government unable to
KATHMANDU, JUL 06 –               nors and pregnant women will       five years, said experts.         check the sale of illegal abortion
                                  incur a fine of up to Rs                                             pills that are not registered with

P   olice arrested 439 people     10,000. The law also bans          In family planning, the use of    the Department of Drug Admini-
    from several parts of the     advertising and promotion of       modern contraceptives, ac-        stration.
Capital city for smoking in       tobacco products. Smoking in       cording to the Nepal Demo-                    Source: ekantipur.com
public places 10 days after the   government offices, educa-         graphic and Health Survey
government started enforcing      tional and health institutions,    (NDHS) 2011, is 43.2 per-         Health ministry to launch
the “no smoking in public         airports, public vehicles, day-    cent—a one percent decrease
places” ban . According to the    care centers, religious places,    from 2006. This number previ-     anti-typhoid vaccination
Hanumandhoka Metropolitan         old-age homes, orphanages,         ously needed to reach 67 per-     campaign
Police Range (MPR), the of-       clubs, public toilets, indus-      cent by 2015 according to the
fenders were picked up from       tries, factories, theatres, cin-   MDG. According to Dr Sinen-       KATHMANDU, JUL 12 -
Bir Hospital, Singha Durbar,      ema halls, hotels, restaurants,    dra Uprety, director of the

                                                                                                       T
Thamel, Basantapur, New           canteens, hostels, lodges and      Family Health Division at the          he Ministry of Health and
Road, Kamalpokhari, Tha-          guesthouses have all been          Department of Health Services          Population will launch a vac-
pathali and Ratna Park. The       banned in the country by the       (DoHS), the NDHS report           cination campaign against ty-
smokers were fined Rs 100         Act.                               showed that fertility rates de-   phoid fever in Kathmandu soon.
each and released after they               Source: ekantipur.com     creased drastically from 5.1      Organizing a press conference in
vowed not to repeat the of-                                          percent in 1984-86 to 2.6 in      the Capital on July 12, the Child
fence in writing. The Kath-
                                  World population day:              2008-11, meaning that de-         Health Division under the Minis-
mandu District Administration     Litany of challenges               spite the reduction of contra-    try informed the media that they
Office (DAO) recently came                                           ceptive use, Nepal was on the     have already geared up with
under severe criticism for not
                                  still stares at Gov                right track. “However, the real   internal preparations for the anti
implementing the Tobacco                                             challenge is the unmet need       -typhoid vaccination campaign.
Control and Regulatory Act-       KATHMANDU, JUL 11 -                for contraceptives,” said Dr      The Ministry has decided to
2010 that the parliament had                                         Uprety. “Looking at the data,     launch the campaign in Kath-
endorsed on August 7 last
year. Security personnel are      N    epal marks this year’s
                                       World Population Day
                                  with the theme “Universal
                                                                     unmet need is highest among
                                                                     the age groups 15-19 and 20-
                                                                     24, which is 42 and 37 per-
                                                                                                       mandu, following positive out-
                                                                                                       come of the previous campaigns
increasingly vigilant with a                                                                           launched in Bhaktapur and Lalit-
team of police in plainclothes    Access to Reproductive Health      cent respectively. This is the    pur districts (the adjoining dis-
being deployed to keep close      Services” on Wednesday,            population that is most sexu-     tricts), said Division Chief Dr
watch on public smokers, at       even as many challenges lie        ally active and if they lack      Shyamraj Upreti. Typhoid, one
the behest of CDO Chauda-         ahead. In its efforts to meet      contraceptives, chances of        of the most common diseases on
mani Sharma. However,             the fifth Millennium Develop-      unwanted pregnancies, abor-       children under 15, is caused by
Sharma said they were con-        ment Goal, improving mater-        tions, and venereal diseases      Salmonella typhi virus. Con-
centrating on an awareness        nal health, the government         increase.” Uprety said that the   sumption of polluted water is the
campaign since not many           has adopted and identified         huge migrant population is        main cause of typhoid fe-
people know that public           nine components in the Nepali      another reason for the decline    ver. According to Dr Upreti,
smoking is a crime. “The cam-     National Reproductive Strat-       in contraceptive use. “When       Kathmandu is a high-risk zone in
paign is yet to be imple-         egy 2008. The components           spouses are apart, the use of     view of the typhoid fever.
mented fully. We have priori-     are family planning, safe          contraceptives reportedly de-                 Source: ekantipur.com
tized creating awareness          motherhood, newborn care,          clines.”
among the public.” He said        abortion, adolescent sexual                                          Chitwan DPHO launches
that the campaign has been        and reproductive health, HIV/      Similarly, regarding safe
                                  AIDS and STDs, infertility and     motherhood, the number of
                                                                                                       anti-dengue campaign
reaching out to people
through media. The local ad-      sub fertility, gynecological       women consulting doctors,
ministration and the Ministry     morbidities including uterine      nurses or midwives during         CHITWAN, JUL 13 -
of Health and Population          prolapsed and breast cancer,       their pregnancy period has

                                                                                                       T
(MoHP) have been dissemi-         and gender based violence.         increased significantly. How-         he District Public Health Of-
nating awareness information      MDG 5 has four indicators:         ever, according to the NDHS,          fice (DPHO), Chitwan has
through radio, television and     the contraceptive prevalence       although 58 percent of women      launched a campaign on July 12,
newspapers.                       rate, adolescent birth rate,       went for antenatal consulta-      2012 against dengue, a mos-
                                  antenatal care coverage and        tions, only 36 percent of ba-     quito-borne disease. Chitwan is
The first priority of the cam-    family planning needs. A ma-       bies were delivered by doc-       a high risk zone for dengue.
paign is public awareness.        jor challenge for the govern-      tors, nurses or midwives. A       Under the campaign, larva and
Police have been coordinating     ment on reproductive health        total of 192 service providers,   pupas of mosquito will be
with the MoHP, NGOs and the       is the disparity between pro-      including 74 nurses, have         searched for and then Continued
DAO to raise awareness about      grams, say experts. Family         been trained for safe abortion    on page 4
July 2012
             Public Health Perspective (PHP)                                                                            Page 3

    World Population Day
 World Population Day is an annual event, observed on July 11 every year, which seeks to raise awareness of global population
 issues. This year theme of WPD is “Universal Access to Reproductive Health Services”.

              Reproductive health is at the very heart of development and crucial to delivering the UNFPA vision — a world
                                                                                     where every pregnancy is wanted, every
                                                                                     childbirth is safe, and every young person’s
                                                                                     potential is fulfilled.

                                                                                     Universal access to reproductive health by
                                                                                     2015 is also one of the targets of the Millen-
                                                                                     nium Development Goals. But we have a
                                                                                     long way to go.

                                                                                       Reproductive health problems remain the
                                                                                       leading cause of ill health and death for
                                                                                       women of childbearing age worldwide.
                                                                                       Some 222 million women who would like to
                                                                                       avoid or delay pregnancy lack access to
                                                                                       effective family planning. Nearly 800
 women die every day in the process of giving life. About 1.8 billion young people are entering their reproductive years, often
 without the knowledge, skills and services they need to protect themselves.

 On 11 July – World Population Day – many activities and campaigns will call attention to the essential part that reproductive
 health plays in creating a just and equitable world. Help us generate greater commitment to the idea that everyone has a right
 to reproductive health.
                                                                                 >>Source: unfpa.org/public/world-population-day


    World Hepatitis Day
 On 28 July 2012, people around the world
 come together to mark World Hepatitis
 Day and raise awareness of viral hepatitis. It
 aims at raising global awareness on the dis-
 eases besides encouraging their prevention,
 diagnosis, and treatment. It is an opportunity
 around which interested groups can raise
 awareness and influence real change in disease
 prevention and access to testing and treat-
 ment. This year, the theme of World Hepatitis
 Day is - “It's closer than you think”.

 World Hepatitis Day is organized by the World
 Hepatitis Alliance in collaboration with the
 World Health Organization (WHO). The day
 was first launched in 2007 by the World Hepa-
                                          titis Alli-
                                          ance. It was officially recognized by the WHO on May 2010 following the World Health
                                          Assembly. Since its launch, thousands of events have taken place around the world, gen-
                                          erating massive public and media interest.

                                       The World Hepatitis Day aims to focus on specific actions such as:
                                        Strengthening prevention, screening and control of viral hepatitis and its related
                                       diseases.
                                        Increasing Hepatitis B vaccine coverage and integration into national immunization
                                       programs, and
                                        Coordinating a global response to hepatitis to increase access to treatment.
                                       Despite its staggering toll on health, hepatitis remains a group of diseases that are
                                       largely unknown, undiagnosed and untreated. Hepatitis kills around one million people
                                       every year. Millions more suffer immediate sickness or long-term ill health.

                                                                                  >> Source: worldhepatitisalliance.org; who.int
July 2012
                                   Public Health Perspective (PHP)                                                              Page 4

                                  National News (cont…)
Continued from page 2                      of the disease at Dhulikhel Hospital on              also recently conducted a camp at Talku
Vector Control Supervisor Ram KC. Earlier, Wednesday. The Health Ministry has been              and Chhaimale, places that are report-
the Office had launched the anti-dengue    conducting special programs in all the 75            edly seeing a rising number of diarrheal
                                           districts of the country to control HIV/
drive in the district in the month of August                                                    cases, said Mahendra Shrestha of the
and October, last year. A total of 200     AIDS. An official at the National Centre for         DPHO to assess for cases diarrhea.
health workers and volunteers have been    AIDS and STD Control, Sanjaya Dahal said
deputized to operate the campaign that     that an estimated 50,000 people were                                   Source: ekantipur.com
began on Thursday, said Public Health Chiefliving with HIV in 2011 in the country.
Kehar Singh Godar. Various sorts of orien- "The Health Ministry is working to control           MoHP intensifies disaster ac-
                                           the disease," said Dahal. The government
tation and public awareness programs
                                           has been distributing free antiretroviral
                                                                                                tion plans
about dengue are taking place in different
parts of the district. A total of 68 denguedrugs to the HIV-infected from 36 depots             KATHMANDU, JUL 22 -
patients have been found so far in the dis-across the country. Available data show
trict since mid-July of last year and of
them, one had died, said the Office.
                                           6,483 people with HIV were taking the
                                           drug in 2011. To monitor the clients , the
                                           ministry would conduct 15 tests, free of
                                                                                                T    he Ministry of Health and Popula-
                                                                                                     tion (MoHP) has intensified pro-
                                                                                                grams designed to minimize destruction
                     Source: ekantipur.com cost, for each of those infected.                    and casualties during and after a natural
                                                                                                disaster. The MoHP recently drafted two
Global reproductive rights body                                      Source: ekantipur.com      major schemes for disaster manage-
                                                                                                ment--Mass Casualties Management
opens office here                               Gastrointestinal cases decline                  Strategy in Health System and plan for
                                                                                                the early deployment of human re-
KATHMANDU, JUL 19 -                             KATHMANDU, JUL 20 -                             sources in health during a disaster. Dr
                                                                                                Tirtharaj Burlakoti, chief of the Curative

W      ith an aim to ease and facilitate
       women’s access to affordable and         T    he only public hospital for tropical and
                                                     infectious diseases, Sukraraj Tropical
                                                and Infectious Disease Hospital (STIDH),
                                                                                                Service Division at the ministry, said as
                                                                                                mass casualty management in health is
                                                                                                a prerequisite for preparation and re-
safe reproductive health services, the Cen-
ter for Reproductive Rights (CRR), a global     is seeing scores of patients for treatment      sponse at the time of disaster, when
legal advocacy organization, opened its first   of diarrhea and typhoid this monsoon.           various state actors come into play; the
office in Kathmandu on Wednesday. The           However, the number of patients has un-         ministry lacked a working strategy for
USA-based CRR is working across the globe       dergone a marked decline since last year.       the crisis. “This strategy will guide
to advance reproductive rights by launching     The number of patients with gastrointesti-      health professionals in managing casu-
various campaigns, conducting research          nal infections, including diarrhoea and         alties during disasters such as fires and
and encouraging capacity building activi-       dysentery is 1,712 in 2011/12 and was           floods,” he said.
ties. In its first few years, the new office    2,167 in 2010/11. Similarly, 176 patients
will focus on a rights-based approach to the    were treated for typhoid and 35 for hepati-     He added the government had started
full range of reproductive health care, in-     tis in 2011/12, while 267 were treated for      planning for maintaining a record of
cluding contraception, maternal health and      typhoid and 30 for hepatitis in 2010/11.        health professionals that can be de-
safe abortion, through the implementation       However, instances of snakebites have           ployed to affected areas in the event of
of constitutional and legal protections, said   increased from 209 cases to 284 in              a disaster. Dr Burlakoti said the ministry
a press statement issued by the CRR.            2011/12.                                        was making preparations for providing
                        Source: ekantipur.com                                                   health workers with an identity card
                                                Dr Indra Prasad Prajapati, director of the      indicating the name of their institution,
HIV cases on rise in Kavre                      Sukraraj Hospital, said the decrease in the     details about their residence and their
                                                number of patients with diarrhea and ty-        specialization. He added the information
KAVRE, JUL 20 -                                 phoid implies that people have begun            will be archived on the website the min-
                                                adopting a hygienic lifestyle. “Perhaps         istry is creating.

T   he number of people living with HIV in      people have started drinking boiled water
    the district is on the rise, shows the      and avoiding stale foods. However, pa-          “We have recorded the resilience of
recent data from the District Public Health     tients can also have started visiting many      hospital structures for around 53 hospi-
Office (DPHO). The number of HIV-infected       private hospitals and clinics that have         tals with a minimum of 50 beds for ca-
people reached 213 in the 2011-12 fiscal        opened up instead of coming to the gov-         pacity in case of natural disasters,” Dr
years from 170 in 2010-11. "The number of       ernment hospital,” Dr Prajapati said.           Burlakoti said. All of these plans are
people living with HIV increased signifi-       Meanwhile, the STIDH discovered cholera         slated to be finalized by the end of Au-
cantly this year," said DPHO chief Dr Arjun     in three patients from Kalimati, Tahachal       gust. Meanwhile, the Patan Hospital has
Prasad Sapkota. He added that most of           and Teku area. Dr Prajapati said that since     been retrofitting its building with sup-
those infected are Nepali migrants return-      the cases are from different areas, there is    port from the MoHP. The ministry, aided
ing from foreign jobs and sex workers.          less evidence of an epidemic. The District      by the World Health Organization and
                                                Public Health Office (DPHO), Kathmandu          the UK Department for International
In addition to raising awareness on safe        has also started surveillance on patients       Development, is set to begin in August
sex through health workers and providing        with dysentery, diarrhea and cholera in         an earthquake vulnerability survey of 50
anti retroviral treatment for those with HIV,   various area hospitals to get early warning     hospitals with 50 or more beds across
the DPHO launched an orientation program        of an impending . A group of doctors and        the country.
on preventing mother-to-child transmission      other health professionals under the DPHO                           Source: ekantipur.com
July 2012
              Public Health Perspective (PHP)                                                                                 Page 5

    Global Health
                                     meet international standards of    62 cases reported by Kantha    transmission rate dropped
 Avian influenza – situa-            quality, safety and efficacy.      Bopha hospital, and cases      from 3.5 percent in 2010 to
 tion in Indonesia – up-                                Source: WHO     reported from other hospi-     2.7 percent in 2011, getting
 date                                                                   tals. Of these, the investiga- the country closer to its goal of
                                     WHO joins call for re-             tion focused on 61 cases that  reaching a two percent rate by
6 July 2012 –                        newed focus on family              fitted a specific criteria (the2015, the news service notes.

T   he Ministry of Health of In-     planning                           case definition), and of which But Health Minister Aaron Mot-
    donesia has notified WHO of                                         54 had died.                   soaledi "told reporters Thurs-
a new case of a human infection                                                                        day in Johannesburg that 60
with avian influenza A (H5N1)        11 July 2012 –                     The investigation revealed     percent of HIV/AIDS patients
virus.
                                     A   t the launch of the Family
                                         Planning Summit in Lon-
                                     don, WHO commits to fast-
                                                                        that most of the cases were
                                                                        under 3 years of age, from
                                                                        14 different provinces, with
                                                                                                       are female and they must be
                                                                                                       the focus to stem the epidemic
                                                                                                       in the country," VOA writes,
The case is an 8 year-old fe-
male from the province of West       track its assessment and to        some suffering from chronic    adding, "Motsoaledi is urging
Java. She developed fever on         step up its prequalification of    conditions. A significant num- everyone to seek regular HIV
18 June 2012 and then travelled      new and existing quality con-      ber of cases had been          testing in an effort to reduce
on vacation the following day to     traceptives. “Access to modern     treated with steroids at some the epidemic and diminish the
Singapore, where she saw a           contraception is a fundamental     point during their illness.    disease's stigma".
private physician who diag-          right of every woman,” says        Steroid use has been shown
nosed pharyngitis on 20 June.        WHO Director-General Dr Mar-       to worsen the condition of     According to Agence France-
Infection with avian influenza A     garet Chan, who is chairing a      patients with EV-71.           Presse, "South Africa has the
(H5N1) virus was identified          panel at the Summit on in-                          Source: WHO world's largest HIV caseload,
later by the National Institute of   creasing access and expanding
                                     choice.
                                                                         Vaccine success story: with six million people cur-
                                                                                                       rently living with the virus"
Health Research and Develop-
ment (NIHRD), Ministry of                               Source: WHO      congenital rubella syn- and it "runs the world's largest
Health, Indonesia.                                                       drome                         treatment program, serving
                                     Severe complications of                                           1.3 million people". National
Epidemiological investigation        hand, foot and mouth                                              Public Radio's "Shots" blog
                                                                        13 July 2012 –                 examines how the FDA's re-
has been conducted in the            disease (HFMD) caused
case’s neighborhood and nearby
market, which revealed that the      by EV-71 in Cambodia –             A     newly released WHO
                                                                             fact sheet explains how
                                                                        vaccination has drastically
                                                                                                       cent approval of Truvada to
                                                                                                       reduce the risk of HIV infection
                                                                                                       in people at high-risk of con-
case had contact with poultry        conclusion of the joint
when she went to a market with                                          reduced congenital rubella     tracting the virus "is being
her father to buy live chickens.
                                     investigation                      syndrome and describes the     greeted with skepticism, deri-
She was present when the                                                global strategy to achieve     sion and even worry by some
chicken was culled in the desig-     13 July 2012 –                     elimination. An estimated      doctors in South Africa".
nated part of the market.
                                     T   he investigation into the
                                         illnesses and deaths in
                                     Cambodia, which mainly af-
                                                                        110 000 babies are born with
                                                                        congenital rubella syndrome
                                                                        every year. While the illness
                                                                                                           Source: globalhealth.kff.org
                                                                                                        Whooping cough makes
The Ministry of Health in Singa-
pore has been informed about         fected very young children,        is generally mild in children,  deadly return across
the case under the International     concluded that a severe form of    it has serious consequences     Canada
Health Regulations.                  hand, foot and mouth disease       in pregnant women causing
                                     (HFMD) was the cause in these      fetal death or congenital de-  23 July 2012 –
To date, the total number of
human influenza A (H5N1)
                                     majority of cases reported to
                                     the Ministry of Health.
                                                                        fects.
                                                                                         Source: WHO      A  highly contagious bacte-
                                                                                                            rial disease is spreading in
                                                                                                       four provinces, infecting as
cases in Indonesia is now 190                                            South Africa Making
with 158 fatalities.             Samples from a total of 31 pa-                                        many as 2,000 people with a
                     Source: WHO tients were obtained and tested         Progress against HIV/ violent, uncontrollable cough
                                 for a number of pathogens by                                          and killing an infant in Alberta,
 Prequalification of medi- Institut Pasteur du Cambodge.                 AIDS, But Still More          as public-health authorities
 cines saves lives               Most of these samples tested            Effort Needed, Health scramble to boost their vacci-
                                 positive for enterovirus 71 (EV-        Minister Says                 nation programs.
9 July 2012 –                    71) which causes HFMD. A

E   very year, millions of pa-   small proportion of samples                                              British Columbia’s Fraser Val-
    tients in resource-limited   also tested positive for other         20 July 2012 –                    ley, southern Alberta, parts of
countries receive life-saving    pathogens including Haemophi-
medications that are purchased lus Influenzae type B and                T   hough South Africa has
                                                                            made progress against
                                                                                                          Southwestern Ontario and New
                                                                                                          Brunswick are dealing with
                                                                                                          severe outbreaks of a disease
by or through international pro- Streptococcus suis. It was not         HIV/AIDS over the past few
curement agencies such as UNI- possible to test all the patients        years, the country's "health      that was once on the wane –
CEF, UNFPA, and the Global       as some of them died before            minister says much more           pertussis, more commonly
Fund to fight AIDS, TB, and      appropriate samples could be           needs to be done," VOA            known as whooping cough,
Malaria. The WHO Prequalifica-   taken.                                 News reports. Health officials    which can be especially deadly
tion of Medicines Program en-                                           from South Africa's Medical       if contracted by infants.
sures that selected medicines        A total of 78 cases were identi-   Research Council on Thurs-        Source: theglobeandmail.com
supplied by these agencies           fied. These included the initial   day said the mother-to-child
July 2012
                                  Public Health Perspective (PHP)                                                          Page 6

                                Journal Watch
                                 Evaluation of knowledge, attitude and practice of newly diagnosed diabetes
                                 patients-a baseline study from Nepal
     How to join PHP?           Knowledge, attitude and practice is very low among newly diagnosed diabetes patients attending
                                tertiary care teaching hospital of Western region of Nepal, according to the study published in
                                2012 issue 2 of International Journal of Pharmacy Teaching & Practices.
 e-Mail:
 newsletter.php@gmail.com
                                A cross sectional study was conducted from July 2010 to December 2010 among 162 newly diag-
                                nosed diabetes patients attending Manipal Teaching Hospital, Pokhara, Nepal. Enrolled patients
 website:
                                were evaluated for their Knowledge, Attitude and Practice (KAP) about diabetes by using a self
 www.bmhall.yolasite.com/
                                administered KAP questionnaire during their first day of hospital visit. In case of knowledge ques-
 publications.php
                                tion, each ‘correct’ answer was scored as one (1) and as zero (0) for ‘incorrect’ answer. In case of
                                attitude and practice questions, scoring was done on the basis of 5 point and 3 point Likert scales,
                                respectively.

                                According to the study, the median interquartile range scores were [3(2-7)] for knowledge, [12(11
                                -13)] for attitude and [1(0-2)] for practice. Thirteen patients (8.02%) reported their family had a
         Benefits of            history of diabetes either on their father’s or their mothers’ side in equal proportion whereas there
                                was no family history of diabetes for 133 (82.10%) patients. Only three patients (1.85%) had
        Being a PHP             both their father and mother with a history of diabetes, as per the study.

         Subscriber             The study stressed to provide structured education and counseling to diabetes patients by organiz-
                                ing group education program at community level in a country like Nepal. Full text article is avail-
                                able at: International Journal of Pharmacy Teaching & Practices 2012, Vol.3, Issue 2, 245-252.
     Can submit articles to    Authors: Dinesh K Upadhyay, Mohamed Izham M.I, Vijay. M Alurkar, Pranaya Mishra, Subish
                                Palaian
      PHP newsletter
     Heavy discount rate in
                                               I read with interest the article in the May edition of the Public Health Perspective
      PHP trainings, work-                     Newsletter titled “Have non-communicable diseases become the major health
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      ferences                                 chand. It seems that the rise in cardiovascular and other chronic, Non-
                                               Communicable Diseases (NCD) is occurring on a global scale. The authors draw our
     Get acquainted with
                                               attention to some of the challenges faced by NCDs and possible ways forward.
      public health news from
      around the nation and                     In Australia, such NCDs as the main source of ill     Letter to the Editor
      globe at a time           health are also increasing and there is much work underway in
                                addressing the determinants of health. Some states are empha-
     Enhances professional     sizing the importance of integrated or joint government work as part of the solution. It is exciting
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                                After all, as Brecht Devleesschauwer and Prof. Dr. Jeevan Bahadur Sherchand pointed out, health
     Send Letters to the        is an outcome of a wide range of factors—such as changes to the natural and built environments
                                and to social and work environments—many of which lie outside the activities of the health sector
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                                across Government. In Australia, there is also recognition that the impacts of health determinants
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                                                                                     —Dawn Skidmore, MBA, MSc Healthcare, Australia
July 2012
             Public Health Perspective (PHP)                                                                              Page 7

    The help seeking behavior of unmarried girls living in
    Mumbai slums for menstrual needs
                            Arundati Muralidharan — Dr.PH, MSW

                         Menarche and menstruation are normal and healthy events, yet for unmarried adolescent girls living in
                         Mumbai slums, experiences of these events are fraught with anxiety since they lack the information and
                         social support they need to comprehend and respond to these events in a healthy way. Unmarried girls’
                         ability to manage menstruation and respond to menstrual problems is impacted by their incomplete and
                         incorrect information about the female reproductive system, including how and why women menstruate,
                         and erroneous beliefs that menstruation is the expulsion of impure blood from the body. Girls are often ill
                         prepared for menstruation because their mothers believe that they are too young and inexperienced to
 Arundati Muralidharan   comprehend this information before menarche. Girls neither ask for nor receive much information about
                         menstruation apart from how to manage menstrual flow and the dietary, religious, and social restrictions
                         to be followed.

 For girls living in Mumbai slums, their erroneous beliefs about basic reproductive processes        “Being unable to seek
 extend to menstrual problems as well, the most common being irregular menstruation and
 menstrual pain. Misconceptions about what causes menstrual problems and their severity influ-       and receive correct and
 ence if and when girls seek help and the kind of help they seek. Mothers’ perceptions that men-
 strual discomfort and pain are normal might strongly impact whether girls perceive the need for
                                                                                                          comprehensive
 help. Mothers typically perceive the need for help when they believe the condition will adversely      information, and
 impact their daughter’s future fertility.
                                                                                                       social and clinical
 In Mumbai slums, girls’ perception of the need for information, social support, and treatment is
 influenced by a culture of silence that surrounds menstruation. This culture of silence is initi-     services has strong
 ated by the reluctance of mothers to prepare their daughters for menarche and menstruation,
 and a widely perceived need to conceal menstruation and therefore a girl’s sexual maturity.           implications for a
 Mothers further perpetuate this culture of silence by mediating their daughters’ understanding
                                                 of and response to their menstrual needs. While         girl’s menstrual
                                                 mothers believe that they are protecting their
                                                 daughters, they are severely limiting girls’ access
                                                                                                              health”.
     “For girls living in Mumbai                 to the information, support, and services they
     slums, their erroneous beliefs              need to protect and promote their health. Being unable to seek and receive correct
                                                 and comprehensive information, and social and clinical services has strong implica-
   about basic reproductive processes            tions for a girl’s menstrual health in terms of her ability to manage regular men-
                                                 struation, maintain personal and menstrual hygiene to protect herself from infec-
    extend to menstrual problems as              tions, and seek appropriate help to treat menstrual problems in a timely manner.

      well, the most common being              Girls living in Mumbai slums seek information and support from their mothers and
                                               friends, and seek treatment for menstrual problems primarily from private health
      irregular menstruation and               care providers in the slum. Often, however, their ability to reach out to these
                                               sources of help is restricted as girls have limited opportunities to spend time with
           menstrual pain. ”.                  their peers; girls and their mothers hold strong ideas about the appropriateness of
                                               the kind of help needed and the sources of help available; and the poor availability
                                               and accessibility of female health care providers is a significant barrier that girls
                                               and mothers face in accessing treatment.



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July 2012
                                    Public Health Perspective (PHP)                                                           Page 8

                                    Being Healthy
                                     becoming infected with HIV.                     all new infections
   ABCs: Abstain, Be                                                                 occur in the 15-
   faithful, and use                 According to UNAID's, 'ABC' stands for:         to 24-year-old
                                                                                     age group.
   Condoms                            Abstinence (not engaging in sex, or
                                         delaying first sex)
                                                                                     Be faithful pro-
The ABC approach employs              Being safer, by being faithful to one's       grams encourage
population-specific interventions        partner or reducing the number of sex-      individuals to
that emphasize abstinence for            ual partners                                practice fidelity
youth and other unmarried per-        Correct and consistent use of condoms         in marriage and
sons, including delay of sexual                                                      other sexual re-
debut;                                                                               lationships as a
                                                Abstinence programs encourage
mutual                                                                               critical way to
                                                unmarried individuals to abstain
faithful-                                                                            reduce risk of exposure to HIV. Once a person
                                                from sexual activity as the best
ness and                                                                             begins to have sex, the fewer lifetime sexual
                                                and only certain way to protect
partner                                                                                                    partners he or she has,
                                                themselves
reduction                                                                                                  the lower the risk of
                                                from expo-
for sexu-                                                                                                  contracting or spreading
                                                sure to HIV
ally ac-                                                                                                   HIV or another sexually
                                                and other
tive                                                                                                       transmitted infection.
                                                sexually
adults;
                                                transmitted
and cor-
                                                infections.                                                 Correct and consistent
rect and
                                                Abstinence                                                  Condom use programs
consis-
                                                until mar-                                                  support the provision of
tent use
                                                riage pro-                                                  full and accurate infor-
of con-
                                                grams are                                                   mation about correct
doms by
                                     particularly important                                                 and consistent condom
those whose behavior places
                                     for young people, as                                                   use reducing, but not
them at risk for transmitting or
                                     approximately half of                                                  eliminating, the risk of


                                HIV infection; and support access     How to Use a Condom Consistently and Correctly:
                                to condoms for those most at risk
                                for transmitting or becoming in-         Use a new condom for every act of vaginal, anal and oral
                                fected with HIV. Latex condoms            sex throughout the entire sex act (from start to finish).
                                provide approximately 80-90 per-
                                                                         Before any genital contact, put the condom on the tip of
                                cent protection, when used consis-
                                                                          the erect penis with the rolled side out.
                                tently. To achieve the protective
                                effect of condoms, people must           If the condom does not have a reservoir tip, pinch the tip
                                use them correctly and consis-            enough to leave a half-inch space for semen to collect.
                                tently, at every sexual encounter.        Holding the tip,                unroll the condom all the
                                Failure to do so diminishes the           way to the                           base of the erect penis.
                                protective effect and increases the      After ejacula-                         tion and before the
                                risk of acquiring a sexually trans-       penis gets                              soft, grip the rim of
 mitted infection (STI) because transmission can occur with               the condom                               and carefully with-
 even a single sexual encounter. Latex                                    draw. Then                               gently pull the con-
 condoms, when used consistently and                                      dom off the                              penis, making sure
 correctly, are highly effective in prevent-                              that semen                               doesn't spill out.
 ing transmission of HIV. In addition, cor-                              Wrap the                               condom in a tissue
 rect and consistent use of latex condoms                                 and throw it in                     the trash where others
 can reduce the risk of other sexually                                    won't handle it.
 transmitted diseases (STDs), including
                  Gonorrhea, Chlamydia,
                                                                         If you feel the condom break at any point during sexual
                                                                          activity, stop immediately, withdraw, remove the broken
                  and Genital ulcer diseases.
                                                                          condom, and put on a new condom.
                                                                         Ensure that adequate lubrication is used during vaginal
                                                                          and anal sex, which might require water-based lubricants.
                               >>More information at: pepfar.gov          Oil-based lubricants (e.g., petroleum jelly, shortening,
                                                                          mineral oil, massage oils, body lotions, and cooking oil)
                                                                                                         should not be used because
                                                                                                         they can weaken latex,
              Public Health Perspective (PHP) Online Newsletter                                          causing breakage.

              www.bmhall.yolasite.com/publications.php                                                                  (Source: CDC)
July 2012
                Public Health Perspective (PHP)                                                                            Page 9

      WHO Publications
Bulletin of WHO Vol. 90, No. 07, 2012
The Bulletin of the World Health Organization is an international journal of public health with a special focus on developing
countries. Since it was first published in 1948, the Bulletin has become one of the world's leading public health journals. As the
flagship periodical of the World Health Organization (WHO), the Bulletin draws on WHO experts as editorial advisers, reviewers,
and authors as well as on external collaborators. Full bulletin is available at:
http://bit.ly/NnTwki

Quality Assurance in Bacteriology and Immunology
There is an increasing dependence on clinical and public health laboratories for better patient management and also for preventing
the spread of emerging pathogens. With rapid and significant growth of laboratories at all levels of health care, it has become man-
datory to check their results to assure that they are reliable and cost-effective, as well as comparable with those obtained by inter-
national laboratories. Download is available at:
http://bit.ly/O7tTsy


Water Safety Planning for Small Community Water Supplies: Step-by-step risk management guidance for
drinking water supplies in small countries
This manual is designed to engage, empower, and guide communities in the development and implementation of Water Safety
Plans (WSPs) for their drinking-water systems. It provides guidance on how to apply effective and achievable management actions
in order to improve the safety and quality of supplied water. Download is available at:
http://bit.ly/OQh2r0


Safety Evaluation of Certain Food Additives and Contaminants
The toxicological monographs in this volume summarize the safety data on a number of food additives: aluminum-containing food
additives, Benzoe Tonkinensis, Ponceau 4R, pullulanase from Bacillus deramificans expressed in Bacillus licheniformis, Quinoline
Yellow and Sunset Yellow FCF. This volume also contains monographs summarizing the toxicological and dietary exposure data for
the contaminants cyanogenic, glycosides, and fumonisins. Download is available at :
http://bit.ly/rLHxjn


                                                                                  Welcome Our New Campus Liaisons
APPLY FOR CAMPUS LIASION



                            Our Campus Liaisons




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.com


  Call for Articles for August Issue
    400-500 words on any topic of public health importance
    Do not include any graphs, tables and citations
    PP size photo in jpeg format
    email your articles to
            newsletter.php@gmail.com with the subject ‘article for PHP’
    For more information: http://www.bmhall.yolasite.com/information-for-contributors.php
July 2012
                                       Public Health Perspective (PHP)                                                                 Page 10

                                    Public Health Perspective (PHP) Team
 International Honorary                 Editorial Advisories               Rajiv Gandhi University                 Contributing Writers
                                                                                  Bangalore
   Editorial Advisories               Dr. Duk Bahadur                                                            Dr. P. Ravi Shankar
Ms. Rose Schneider --                      Chhetri                              Madan Kc                        Professor, Clinical Phar-
        RN MPH                         MD, Pathologist                    Msc. Medical and Health               macology & Medical Edu-
  Chair of the Climate               Western Regional Hos-                     Care Devices                              cation
Change Working Group                       pital Lab.                     University of Bolton, UK               KIST Medical College
 of the APHA Interna-                      Pokhara                                                                  Lalitpur, Nepal.
 tional Health Section.                                                       Dr. Santosh Raj
Senior Health and HIV/                Mr. Balram Banstola                          Poudel                           Dr. Anis Rehman
    AIDS Specialist                    Managing Director,                 Residency (MD) in Inter-              Associate Chief Editor at
 Health Systems Man-                   Senior Pharmacist                         nal medicine                   Journal of Pakistan Medi-
        agement                       Banstola Medical Hall                Interfaith Medical Cen-                 cal Students (JPMS)
1414 Perry Place NW -                         Kaski                             ter, New York                   HIFA 2015 Country Rep-
        Suite 100                                                                                                resentative for Pakistan
Washington, DC 20010                    Board of Advisories                Dr. Krishna Chandra
                                       Ms. Sami Pande                              Rijal                              Newsletter Team
                                         B. Pharm, MPH                    Dept. of Otorhinolaryn-
                                                                                                                      Editor-in Chief
                                      Australian Leadership               gology and Head & Neck
                                                                                                                      Amrit Banstola
  Dr. Margaret Steb-                     Scholar, 2009                      Surgery, College of
          bing                             Kathmandu                       Medical Sciences and
                                                                                                                     Section Editors
  PhD, Master of Public                                                      Teaching Hospital
                                                                                                                        Anoj Gurung
   Health, Dip App Sci                    Arjun Poudel                      Bharatpur, Chitwan
                                                                                                                     Dikshya Sherchan
         Nursing                     Msc. Pharm (Social and                                                           Dipendra Malla
 Population Health Aca-               administrative Phar-                Mr. Chandra Bhushan
                                                                                                                      Sandeep Pahari
          demic                               macy)                               Yadav
                                                                                                                     Sangita Shrestha
 School of Rural Health,             Universiti Sains Malay-                Information Officer
                                                                                                                     Subash Timilsina
   Monash University                 sia, Penang , Malaysia                       (MLIS)
                                                                                                                    Sulochana Prajapati
        Australia                                                         Nepal Health Research
                                        Ashik Banstola                        Council (NHRC)
                                           M. Pharm                         MOHP, Kathmandu
                                     (Pharmacology), PDCR

Welcome to New Subscribers
Nepal                        Rachana Nakarmi                International                 Dawn Skidmore
Amrit Dangi                  Ruja Luitel                    Alani Price                   Gani Alabi
Apsara Karki                 Sharika Mahato                 Amar Tamrakar                 Sharon Blair
Avaniendra Chak-             Shiv Raj Sunar                 Arundati Muralidharan         Sree Tirukkovalluri
ravartty                     Shiva Raj Mishra               Badrinatheswar Gelli          Valasingham Ramesh-
Birat Ghimire                Sumit KC                       Venkata                       kumaar
Dinesh Upadhyay              Upendra Dhakal                 Bob Gerzoff                   Zeeshan Ayyaz
Madhav KC                                                   Churamany Chetry


Articles 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 newsletter.php@gmail.com

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Public Health Perspective (PHP) Newsletter July 2012 Issue

  • 1. Public Health Perspective the first online public health newsletter of Nepal Vol. 2 Issue 7 July 2012 Editorial: Universal access to reproductive health: What does it mean to Nepal? Nepal as a signatory of Millen- (Nepal Fertility and Family integrated reproductive ser- Inside This Issue nium Development Goals Planning Survey 1991) to vices, inaccessibility, non- (MDGs) has set targets to 36% (NDHS 2011) from evidence based interventions, achieve universal access to 1990 to 2011.The target is to inadequately trained service reproductive health by the increase to 60 percent by the providers, limited availability National News 2&4 year 2015. But what does it year 2015. Skilled birth at- of reproductive health equip- mean to Nepal—the target tendant (SBA) includes doc- ment, commodities and sup- versus current scenario, barri- tor, nurse or midwife. plies, and increasing rate of World Population Day 3 ers, and challenges on repro- HIV, among other barriers. ductive health are discussed Contraceptive Prevalence here in this editorial on the Rate (CPR) among married At the national level: financial World Hepatitis Day 3 special occasion of World women aged 15-49 increased constraints, lack of political Population Day 2012 and its from 24% in 1990 (MOH will, political instability, gen- theme “Universal Access to 1992) to 50 percent in 2011 der inequality, violation of Global Health 5 Reproductive Health Ser- (NDHS, 2011). The target for reproductive rights, and lim- vices”. Nepal is to increase the CPR ited human resources have to 67 percent by 2015. created barriers. Journal Watch 6 The concept of “universal ac- cess” here reflects equity in According to UNFPA Nepal, Challenges reproductive health services the rate of adolescent preg- In Nepal, reproductive health Featured Article (equal access for equal need). nancies is high and roughly problems are the leading (Arundati Muralidha- 7 20% of adolescent girls are cause of ill health and death In other words, it implies that ran ) reproductive information and pregnant or have given birth among women of childbearing services are “available, acces- to at least one child in Nepal. age. An increasingly large Being Healthy 8 sible and acceptable” to meet Only half of all pregnant number of young people are the different reproductive women make four or more entering their reproductive needs of all individuals. Antenatal Care (ANC) visits years, often without the ade- WHO Publications 9 during their entire pregnancy quate reproductive health Target VS current scenario as per the NDHS 2011. The knowledge, skills and services The target of universal access target is to make the four they need. Reproductive New Subscribers 10 to reproductive health i.e., visit or more for ANC cover- health services coverage is MDGs 5 is to reduce the ma- age at 100%. The current low among the rural poor, ternal mortality ratio by three- unmet need for family plan- Dalit, and Janjati women. The quarters between 1990 and ning services in Nepal is re- percentage of institutional Public Health Important 2015. Between 1990 and portedly 27%. deliveries among urban Day (July) 2010, the MMR in Nepal fell women is more than double from 850 (UNDP 1992) to 229 Major barriers that of the rural women. Be- (Family Health Division, 2009) A number of barriers need to sides, adolescent sexual and per 100,000 live births. Sev- be tackled at various levels if reproductive health issues eral factors have played an universal access to reproduc- have not yet been incorpo- important role in reducing the tive health services is to be rated into the essential health nation’s MMR. Improvements achieved in Nepal. care services package of in maternal health services, MoHP. the National Safe Motherhood At user level: delay in decid- Program (2002-2007), the ing to seek care, delay in A way forward policy on skilled birth atten- reaching care in time, and If universal access to repro- dants (2006), safe mother- delay in receiving adequate ductive health services is to hood and neonatal health pro- treatment , high cost of be achieved, the Government gram, the birth preparedness health care, limited service of Nepal (GoN) should invest package (2008-2009), and a choices, inequalities in care, more in reproductive health, maternity incentive scheme poverty, and illiteracy has pay more attention to the (2005) among others are to created hindrance. Women’s poor, marginalized, under- mention a few. low education and poverty privileged and rural women’s are also consistently associ- reproductive health. The skilled birth attendance ated with low use of repro- and contraceptive prevalence ductive health services. rates have increased since 1990. The skilled birth atten- At service delivery level: dance rate increased from 7% inadequate funding, lack of Amrit Banstola
  • 2. July 2012 Public Health Perspective (PHP) Page 2 National News smoking in public places. The planning and safe motherhood services (SAS) and 95,306 Act says those smoking in have been government priori- 439 persons face the public places will be fined up ties but the rest remain in the women received safe abortion from 487 listed sites, said the music for smoking in to Rs 100 and the civil ser- policy-making phase. Despite annual report of DoHS. How- vants doing so will be liable huge investments, newborn public places for departmental action. Sell- care hasn’t shown any signifi- ever, thousands of women are still undergoing unsafe abortions ing tobacco products to mi- cant improvement in the last with the government unable to KATHMANDU, JUL 06 – nors and pregnant women will five years, said experts. check the sale of illegal abortion incur a fine of up to Rs pills that are not registered with P olice arrested 439 people 10,000. The law also bans In family planning, the use of the Department of Drug Admini- from several parts of the advertising and promotion of modern contraceptives, ac- stration. Capital city for smoking in tobacco products. Smoking in cording to the Nepal Demo- Source: ekantipur.com public places 10 days after the government offices, educa- graphic and Health Survey government started enforcing tional and health institutions, (NDHS) 2011, is 43.2 per- Health ministry to launch the “no smoking in public airports, public vehicles, day- cent—a one percent decrease places” ban . According to the care centers, religious places, from 2006. This number previ- anti-typhoid vaccination Hanumandhoka Metropolitan old-age homes, orphanages, ously needed to reach 67 per- campaign Police Range (MPR), the of- clubs, public toilets, indus- cent by 2015 according to the fenders were picked up from tries, factories, theatres, cin- MDG. According to Dr Sinen- KATHMANDU, JUL 12 - Bir Hospital, Singha Durbar, ema halls, hotels, restaurants, dra Uprety, director of the T Thamel, Basantapur, New canteens, hostels, lodges and Family Health Division at the he Ministry of Health and Road, Kamalpokhari, Tha- guesthouses have all been Department of Health Services Population will launch a vac- pathali and Ratna Park. The banned in the country by the (DoHS), the NDHS report cination campaign against ty- smokers were fined Rs 100 Act. showed that fertility rates de- phoid fever in Kathmandu soon. each and released after they Source: ekantipur.com creased drastically from 5.1 Organizing a press conference in vowed not to repeat the of- percent in 1984-86 to 2.6 in the Capital on July 12, the Child fence in writing. The Kath- World population day: 2008-11, meaning that de- Health Division under the Minis- mandu District Administration Litany of challenges spite the reduction of contra- try informed the media that they Office (DAO) recently came ceptive use, Nepal was on the have already geared up with under severe criticism for not still stares at Gov right track. “However, the real internal preparations for the anti implementing the Tobacco challenge is the unmet need -typhoid vaccination campaign. Control and Regulatory Act- KATHMANDU, JUL 11 - for contraceptives,” said Dr The Ministry has decided to 2010 that the parliament had Uprety. “Looking at the data, launch the campaign in Kath- endorsed on August 7 last year. Security personnel are N epal marks this year’s World Population Day with the theme “Universal unmet need is highest among the age groups 15-19 and 20- 24, which is 42 and 37 per- mandu, following positive out- come of the previous campaigns increasingly vigilant with a launched in Bhaktapur and Lalit- team of police in plainclothes Access to Reproductive Health cent respectively. This is the pur districts (the adjoining dis- being deployed to keep close Services” on Wednesday, population that is most sexu- tricts), said Division Chief Dr watch on public smokers, at even as many challenges lie ally active and if they lack Shyamraj Upreti. Typhoid, one the behest of CDO Chauda- ahead. In its efforts to meet contraceptives, chances of of the most common diseases on mani Sharma. However, the fifth Millennium Develop- unwanted pregnancies, abor- children under 15, is caused by Sharma said they were con- ment Goal, improving mater- tions, and venereal diseases Salmonella typhi virus. Con- centrating on an awareness nal health, the government increase.” Uprety said that the sumption of polluted water is the campaign since not many has adopted and identified huge migrant population is main cause of typhoid fe- people know that public nine components in the Nepali another reason for the decline ver. According to Dr Upreti, smoking is a crime. “The cam- National Reproductive Strat- in contraceptive use. “When Kathmandu is a high-risk zone in paign is yet to be imple- egy 2008. The components spouses are apart, the use of view of the typhoid fever. mented fully. We have priori- are family planning, safe contraceptives reportedly de- Source: ekantipur.com tized creating awareness motherhood, newborn care, clines.” among the public.” He said abortion, adolescent sexual Chitwan DPHO launches that the campaign has been and reproductive health, HIV/ Similarly, regarding safe AIDS and STDs, infertility and motherhood, the number of anti-dengue campaign reaching out to people through media. The local ad- sub fertility, gynecological women consulting doctors, ministration and the Ministry morbidities including uterine nurses or midwives during CHITWAN, JUL 13 - of Health and Population prolapsed and breast cancer, their pregnancy period has T (MoHP) have been dissemi- and gender based violence. increased significantly. How- he District Public Health Of- nating awareness information MDG 5 has four indicators: ever, according to the NDHS, fice (DPHO), Chitwan has through radio, television and the contraceptive prevalence although 58 percent of women launched a campaign on July 12, newspapers. rate, adolescent birth rate, went for antenatal consulta- 2012 against dengue, a mos- antenatal care coverage and tions, only 36 percent of ba- quito-borne disease. Chitwan is The first priority of the cam- family planning needs. A ma- bies were delivered by doc- a high risk zone for dengue. paign is public awareness. jor challenge for the govern- tors, nurses or midwives. A Under the campaign, larva and Police have been coordinating ment on reproductive health total of 192 service providers, pupas of mosquito will be with the MoHP, NGOs and the is the disparity between pro- including 74 nurses, have searched for and then Continued DAO to raise awareness about grams, say experts. Family been trained for safe abortion on page 4
  • 3. July 2012 Public Health Perspective (PHP) Page 3 World Population Day World Population Day is an annual event, observed on July 11 every year, which seeks to raise awareness of global population issues. This year theme of WPD is “Universal Access to Reproductive Health Services”. Reproductive health is at the very heart of development and crucial to delivering the UNFPA vision — a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled. Universal access to reproductive health by 2015 is also one of the targets of the Millen- nium Development Goals. But we have a long way to go. Reproductive health problems remain the leading cause of ill health and death for women of childbearing age worldwide. Some 222 million women who would like to avoid or delay pregnancy lack access to effective family planning. Nearly 800 women die every day in the process of giving life. About 1.8 billion young people are entering their reproductive years, often without the knowledge, skills and services they need to protect themselves. On 11 July – World Population Day – many activities and campaigns will call attention to the essential part that reproductive health plays in creating a just and equitable world. Help us generate greater commitment to the idea that everyone has a right to reproductive health. >>Source: unfpa.org/public/world-population-day World Hepatitis Day On 28 July 2012, people around the world come together to mark World Hepatitis Day and raise awareness of viral hepatitis. It aims at raising global awareness on the dis- eases besides encouraging their prevention, diagnosis, and treatment. It is an opportunity around which interested groups can raise awareness and influence real change in disease prevention and access to testing and treat- ment. This year, the theme of World Hepatitis Day is - “It's closer than you think”. World Hepatitis Day is organized by the World Hepatitis Alliance in collaboration with the World Health Organization (WHO). The day was first launched in 2007 by the World Hepa- titis Alli- ance. It was officially recognized by the WHO on May 2010 following the World Health Assembly. Since its launch, thousands of events have taken place around the world, gen- erating massive public and media interest. The World Hepatitis Day aims to focus on specific actions such as:  Strengthening prevention, screening and control of viral hepatitis and its related diseases.  Increasing Hepatitis B vaccine coverage and integration into national immunization programs, and  Coordinating a global response to hepatitis to increase access to treatment. Despite its staggering toll on health, hepatitis remains a group of diseases that are largely unknown, undiagnosed and untreated. Hepatitis kills around one million people every year. Millions more suffer immediate sickness or long-term ill health. >> Source: worldhepatitisalliance.org; who.int
  • 4. July 2012 Public Health Perspective (PHP) Page 4 National News (cont…) Continued from page 2 of the disease at Dhulikhel Hospital on also recently conducted a camp at Talku Vector Control Supervisor Ram KC. Earlier, Wednesday. The Health Ministry has been and Chhaimale, places that are report- the Office had launched the anti-dengue conducting special programs in all the 75 edly seeing a rising number of diarrheal districts of the country to control HIV/ drive in the district in the month of August cases, said Mahendra Shrestha of the and October, last year. A total of 200 AIDS. An official at the National Centre for DPHO to assess for cases diarrhea. health workers and volunteers have been AIDS and STD Control, Sanjaya Dahal said deputized to operate the campaign that that an estimated 50,000 people were Source: ekantipur.com began on Thursday, said Public Health Chiefliving with HIV in 2011 in the country. Kehar Singh Godar. Various sorts of orien- "The Health Ministry is working to control MoHP intensifies disaster ac- the disease," said Dahal. The government tation and public awareness programs has been distributing free antiretroviral tion plans about dengue are taking place in different parts of the district. A total of 68 denguedrugs to the HIV-infected from 36 depots KATHMANDU, JUL 22 - patients have been found so far in the dis-across the country. Available data show trict since mid-July of last year and of them, one had died, said the Office. 6,483 people with HIV were taking the drug in 2011. To monitor the clients , the ministry would conduct 15 tests, free of T he Ministry of Health and Popula- tion (MoHP) has intensified pro- grams designed to minimize destruction Source: ekantipur.com cost, for each of those infected. and casualties during and after a natural disaster. The MoHP recently drafted two Global reproductive rights body Source: ekantipur.com major schemes for disaster manage- ment--Mass Casualties Management opens office here Gastrointestinal cases decline Strategy in Health System and plan for the early deployment of human re- KATHMANDU, JUL 19 - KATHMANDU, JUL 20 - sources in health during a disaster. Dr Tirtharaj Burlakoti, chief of the Curative W ith an aim to ease and facilitate women’s access to affordable and T he only public hospital for tropical and infectious diseases, Sukraraj Tropical and Infectious Disease Hospital (STIDH), Service Division at the ministry, said as mass casualty management in health is a prerequisite for preparation and re- safe reproductive health services, the Cen- ter for Reproductive Rights (CRR), a global is seeing scores of patients for treatment sponse at the time of disaster, when legal advocacy organization, opened its first of diarrhea and typhoid this monsoon. various state actors come into play; the office in Kathmandu on Wednesday. The However, the number of patients has un- ministry lacked a working strategy for USA-based CRR is working across the globe dergone a marked decline since last year. the crisis. “This strategy will guide to advance reproductive rights by launching The number of patients with gastrointesti- health professionals in managing casu- various campaigns, conducting research nal infections, including diarrhoea and alties during disasters such as fires and and encouraging capacity building activi- dysentery is 1,712 in 2011/12 and was floods,” he said. ties. In its first few years, the new office 2,167 in 2010/11. Similarly, 176 patients will focus on a rights-based approach to the were treated for typhoid and 35 for hepati- He added the government had started full range of reproductive health care, in- tis in 2011/12, while 267 were treated for planning for maintaining a record of cluding contraception, maternal health and typhoid and 30 for hepatitis in 2010/11. health professionals that can be de- safe abortion, through the implementation However, instances of snakebites have ployed to affected areas in the event of of constitutional and legal protections, said increased from 209 cases to 284 in a disaster. Dr Burlakoti said the ministry a press statement issued by the CRR. 2011/12. was making preparations for providing Source: ekantipur.com health workers with an identity card Dr Indra Prasad Prajapati, director of the indicating the name of their institution, HIV cases on rise in Kavre Sukraraj Hospital, said the decrease in the details about their residence and their number of patients with diarrhea and ty- specialization. He added the information KAVRE, JUL 20 - phoid implies that people have begun will be archived on the website the min- adopting a hygienic lifestyle. “Perhaps istry is creating. T he number of people living with HIV in people have started drinking boiled water the district is on the rise, shows the and avoiding stale foods. However, pa- “We have recorded the resilience of recent data from the District Public Health tients can also have started visiting many hospital structures for around 53 hospi- Office (DPHO). The number of HIV-infected private hospitals and clinics that have tals with a minimum of 50 beds for ca- people reached 213 in the 2011-12 fiscal opened up instead of coming to the gov- pacity in case of natural disasters,” Dr years from 170 in 2010-11. "The number of ernment hospital,” Dr Prajapati said. Burlakoti said. All of these plans are people living with HIV increased signifi- Meanwhile, the STIDH discovered cholera slated to be finalized by the end of Au- cantly this year," said DPHO chief Dr Arjun in three patients from Kalimati, Tahachal gust. Meanwhile, the Patan Hospital has Prasad Sapkota. He added that most of and Teku area. Dr Prajapati said that since been retrofitting its building with sup- those infected are Nepali migrants return- the cases are from different areas, there is port from the MoHP. The ministry, aided ing from foreign jobs and sex workers. less evidence of an epidemic. The District by the World Health Organization and Public Health Office (DPHO), Kathmandu the UK Department for International In addition to raising awareness on safe has also started surveillance on patients Development, is set to begin in August sex through health workers and providing with dysentery, diarrhea and cholera in an earthquake vulnerability survey of 50 anti retroviral treatment for those with HIV, various area hospitals to get early warning hospitals with 50 or more beds across the DPHO launched an orientation program of an impending . A group of doctors and the country. on preventing mother-to-child transmission other health professionals under the DPHO Source: ekantipur.com
  • 5. July 2012 Public Health Perspective (PHP) Page 5 Global Health meet international standards of 62 cases reported by Kantha transmission rate dropped Avian influenza – situa- quality, safety and efficacy. Bopha hospital, and cases from 3.5 percent in 2010 to tion in Indonesia – up- Source: WHO reported from other hospi- 2.7 percent in 2011, getting date tals. Of these, the investiga- the country closer to its goal of WHO joins call for re- tion focused on 61 cases that reaching a two percent rate by 6 July 2012 – newed focus on family fitted a specific criteria (the2015, the news service notes. T he Ministry of Health of In- planning case definition), and of which But Health Minister Aaron Mot- donesia has notified WHO of 54 had died. soaledi "told reporters Thurs- a new case of a human infection day in Johannesburg that 60 with avian influenza A (H5N1) 11 July 2012 – The investigation revealed percent of HIV/AIDS patients virus. A t the launch of the Family Planning Summit in Lon- don, WHO commits to fast- that most of the cases were under 3 years of age, from 14 different provinces, with are female and they must be the focus to stem the epidemic in the country," VOA writes, The case is an 8 year-old fe- male from the province of West track its assessment and to some suffering from chronic adding, "Motsoaledi is urging Java. She developed fever on step up its prequalification of conditions. A significant num- everyone to seek regular HIV 18 June 2012 and then travelled new and existing quality con- ber of cases had been testing in an effort to reduce on vacation the following day to traceptives. “Access to modern treated with steroids at some the epidemic and diminish the Singapore, where she saw a contraception is a fundamental point during their illness. disease's stigma". private physician who diag- right of every woman,” says Steroid use has been shown nosed pharyngitis on 20 June. WHO Director-General Dr Mar- to worsen the condition of According to Agence France- Infection with avian influenza A garet Chan, who is chairing a patients with EV-71. Presse, "South Africa has the (H5N1) virus was identified panel at the Summit on in- Source: WHO world's largest HIV caseload, later by the National Institute of creasing access and expanding choice. Vaccine success story: with six million people cur- rently living with the virus" Health Research and Develop- ment (NIHRD), Ministry of Source: WHO congenital rubella syn- and it "runs the world's largest Health, Indonesia. drome treatment program, serving Severe complications of 1.3 million people". National Epidemiological investigation hand, foot and mouth Public Radio's "Shots" blog 13 July 2012 – examines how the FDA's re- has been conducted in the disease (HFMD) caused case’s neighborhood and nearby market, which revealed that the by EV-71 in Cambodia – A newly released WHO fact sheet explains how vaccination has drastically cent approval of Truvada to reduce the risk of HIV infection in people at high-risk of con- case had contact with poultry conclusion of the joint when she went to a market with reduced congenital rubella tracting the virus "is being her father to buy live chickens. investigation syndrome and describes the greeted with skepticism, deri- She was present when the global strategy to achieve sion and even worry by some chicken was culled in the desig- 13 July 2012 – elimination. An estimated doctors in South Africa". nated part of the market. T he investigation into the illnesses and deaths in Cambodia, which mainly af- 110 000 babies are born with congenital rubella syndrome every year. While the illness Source: globalhealth.kff.org Whooping cough makes The Ministry of Health in Singa- pore has been informed about fected very young children, is generally mild in children, deadly return across the case under the International concluded that a severe form of it has serious consequences Canada Health Regulations. hand, foot and mouth disease in pregnant women causing (HFMD) was the cause in these fetal death or congenital de- 23 July 2012 – To date, the total number of human influenza A (H5N1) majority of cases reported to the Ministry of Health. fects. Source: WHO A highly contagious bacte- rial disease is spreading in four provinces, infecting as cases in Indonesia is now 190 South Africa Making with 158 fatalities. Samples from a total of 31 pa- many as 2,000 people with a Source: WHO tients were obtained and tested Progress against HIV/ violent, uncontrollable cough for a number of pathogens by and killing an infant in Alberta, Prequalification of medi- Institut Pasteur du Cambodge. AIDS, But Still More as public-health authorities cines saves lives Most of these samples tested Effort Needed, Health scramble to boost their vacci- positive for enterovirus 71 (EV- Minister Says nation programs. 9 July 2012 – 71) which causes HFMD. A E very year, millions of pa- small proportion of samples British Columbia’s Fraser Val- tients in resource-limited also tested positive for other 20 July 2012 – ley, southern Alberta, parts of countries receive life-saving pathogens including Haemophi- medications that are purchased lus Influenzae type B and T hough South Africa has made progress against Southwestern Ontario and New Brunswick are dealing with severe outbreaks of a disease by or through international pro- Streptococcus suis. It was not HIV/AIDS over the past few curement agencies such as UNI- possible to test all the patients years, the country's "health that was once on the wane – CEF, UNFPA, and the Global as some of them died before minister says much more pertussis, more commonly Fund to fight AIDS, TB, and appropriate samples could be needs to be done," VOA known as whooping cough, Malaria. The WHO Prequalifica- taken. News reports. Health officials which can be especially deadly tion of Medicines Program en- from South Africa's Medical if contracted by infants. sures that selected medicines A total of 78 cases were identi- Research Council on Thurs- Source: theglobeandmail.com supplied by these agencies fied. These included the initial day said the mother-to-child
  • 6. July 2012 Public Health Perspective (PHP) Page 6 Journal Watch Evaluation of knowledge, attitude and practice of newly diagnosed diabetes patients-a baseline study from Nepal How to join PHP? Knowledge, attitude and practice is very low among newly diagnosed diabetes patients attending tertiary care teaching hospital of Western region of Nepal, according to the study published in 2012 issue 2 of International Journal of Pharmacy Teaching & Practices. e-Mail: newsletter.php@gmail.com A cross sectional study was conducted from July 2010 to December 2010 among 162 newly diag- nosed diabetes patients attending Manipal Teaching Hospital, Pokhara, Nepal. Enrolled patients website: were evaluated for their Knowledge, Attitude and Practice (KAP) about diabetes by using a self www.bmhall.yolasite.com/ administered KAP questionnaire during their first day of hospital visit. In case of knowledge ques- publications.php tion, each ‘correct’ answer was scored as one (1) and as zero (0) for ‘incorrect’ answer. In case of attitude and practice questions, scoring was done on the basis of 5 point and 3 point Likert scales, respectively. According to the study, the median interquartile range scores were [3(2-7)] for knowledge, [12(11 -13)] for attitude and [1(0-2)] for practice. Thirteen patients (8.02%) reported their family had a Benefits of history of diabetes either on their father’s or their mothers’ side in equal proportion whereas there was no family history of diabetes for 133 (82.10%) patients. Only three patients (1.85%) had Being a PHP both their father and mother with a history of diabetes, as per the study. Subscriber The study stressed to provide structured education and counseling to diabetes patients by organiz- ing group education program at community level in a country like Nepal. Full text article is avail- able at: International Journal of Pharmacy Teaching & Practices 2012, Vol.3, Issue 2, 245-252.  Can submit articles to Authors: Dinesh K Upadhyay, Mohamed Izham M.I, Vijay. M Alurkar, Pranaya Mishra, Subish Palaian PHP newsletter  Heavy discount rate in I read with interest the article in the May edition of the Public Health Perspective PHP trainings, work- Newsletter titled “Have non-communicable diseases become the major health shops, seminars, con- problem in Nepal?” By Brecht Devleesschauwer and Prof. Dr. Jeevan Bahadur Sher- ferences chand. It seems that the rise in cardiovascular and other chronic, Non- Communicable Diseases (NCD) is occurring on a global scale. The authors draw our  Get acquainted with attention to some of the challenges faced by NCDs and possible ways forward. public health news from around the nation and In Australia, such NCDs as the main source of ill Letter to the Editor globe at a time health are also increasing and there is much work underway in addressing the determinants of health. Some states are empha-  Enhances professional sizing the importance of integrated or joint government work as part of the solution. It is exciting writing skills to see the potential of partnerships for policy implementation between government levels, science, academia, business, professional organisations, and non-governmental organizations to bring about sustained change. After all, as Brecht Devleesschauwer and Prof. Dr. Jeevan Bahadur Sherchand pointed out, health Send Letters to the is an outcome of a wide range of factors—such as changes to the natural and built environments and to social and work environments—many of which lie outside the activities of the health sector Editor and therefore require a shared responsibility and an integrated and sustained policy response across Government. In Australia, there is also recognition that the impacts of health determinants are not equally distributed among population groups. If achieving optimum health is to be a  All readers can post shared goal of all governments, then valuing the health of all citizens is important in both social comments on articles and economic development. And the need to regularly consult with citizens to link policy changes and news mentioned in with wider social and cultural changes around health and well-being should not be overlooked. PHP or could be sugges- tions and compliments. Health is a human right, a vital resource for everyday life and a key factor of not only sustainabil-  Send letters to: ity but also the economy. Acknowledging that all government policies can have positive or nega- newsletter.php@gmail.com tive impacts on the determinants of health and that such impacts are reflected both in the health  Word limit 150 max. and status of the population today, and in the health prospects of future generations, is an important the title of news or arti- step. This calls for identification of potential health impacts as well as the recognition that good cles of critique. health can contribute to achieving many governments’ targets. If we are to develop integrated solutions to both current and future policy challenges, efforts to improve the health of the popula-  Email should include tion will require those mechanisms that support government agencies to work collaboratively, to ‘letters to the editor’ be sustainable. Many of the most pressing health problems of course require long-term policy and in email subject line. budgetary commitment. This will require indicators of success to be equally long-term and regular monitoring and intermediate measures of progress will need to be established. —Dawn Skidmore, MBA, MSc Healthcare, Australia
  • 7. July 2012 Public Health Perspective (PHP) Page 7 The help seeking behavior of unmarried girls living in Mumbai slums for menstrual needs Arundati Muralidharan — Dr.PH, MSW Menarche and menstruation are normal and healthy events, yet for unmarried adolescent girls living in Mumbai slums, experiences of these events are fraught with anxiety since they lack the information and social support they need to comprehend and respond to these events in a healthy way. Unmarried girls’ ability to manage menstruation and respond to menstrual problems is impacted by their incomplete and incorrect information about the female reproductive system, including how and why women menstruate, and erroneous beliefs that menstruation is the expulsion of impure blood from the body. Girls are often ill prepared for menstruation because their mothers believe that they are too young and inexperienced to Arundati Muralidharan comprehend this information before menarche. Girls neither ask for nor receive much information about menstruation apart from how to manage menstrual flow and the dietary, religious, and social restrictions to be followed. For girls living in Mumbai slums, their erroneous beliefs about basic reproductive processes “Being unable to seek extend to menstrual problems as well, the most common being irregular menstruation and menstrual pain. Misconceptions about what causes menstrual problems and their severity influ- and receive correct and ence if and when girls seek help and the kind of help they seek. Mothers’ perceptions that men- strual discomfort and pain are normal might strongly impact whether girls perceive the need for comprehensive help. Mothers typically perceive the need for help when they believe the condition will adversely information, and impact their daughter’s future fertility. social and clinical In Mumbai slums, girls’ perception of the need for information, social support, and treatment is influenced by a culture of silence that surrounds menstruation. This culture of silence is initi- services has strong ated by the reluctance of mothers to prepare their daughters for menarche and menstruation, and a widely perceived need to conceal menstruation and therefore a girl’s sexual maturity. implications for a Mothers further perpetuate this culture of silence by mediating their daughters’ understanding of and response to their menstrual needs. While girl’s menstrual mothers believe that they are protecting their daughters, they are severely limiting girls’ access health”. “For girls living in Mumbai to the information, support, and services they slums, their erroneous beliefs need to protect and promote their health. Being unable to seek and receive correct and comprehensive information, and social and clinical services has strong implica- about basic reproductive processes tions for a girl’s menstrual health in terms of her ability to manage regular men- struation, maintain personal and menstrual hygiene to protect herself from infec- extend to menstrual problems as tions, and seek appropriate help to treat menstrual problems in a timely manner. well, the most common being Girls living in Mumbai slums seek information and support from their mothers and friends, and seek treatment for menstrual problems primarily from private health irregular menstruation and care providers in the slum. Often, however, their ability to reach out to these sources of help is restricted as girls have limited opportunities to spend time with menstrual pain. ”. their peers; girls and their mothers hold strong ideas about the appropriateness of the kind of help needed and the sources of help available; and the poor availability and accessibility of female health care providers is a significant barrier that girls and mothers face in accessing treatment. PHP is now on facebook! facebook.com/publichealthperspective Click button of the page and get connected with us. The instant access to the news and updates of PHP begins from here! We look forward to seeing you in our page.
  • 8. July 2012 Public Health Perspective (PHP) Page 8 Being Healthy becoming infected with HIV. all new infections ABCs: Abstain, Be occur in the 15- faithful, and use According to UNAID's, 'ABC' stands for: to 24-year-old age group. Condoms  Abstinence (not engaging in sex, or delaying first sex) Be faithful pro- The ABC approach employs  Being safer, by being faithful to one's grams encourage population-specific interventions partner or reducing the number of sex- individuals to that emphasize abstinence for ual partners practice fidelity youth and other unmarried per-  Correct and consistent use of condoms in marriage and sons, including delay of sexual other sexual re- debut; lationships as a Abstinence programs encourage mutual critical way to unmarried individuals to abstain faithful- reduce risk of exposure to HIV. Once a person from sexual activity as the best ness and begins to have sex, the fewer lifetime sexual and only certain way to protect partner partners he or she has, themselves reduction the lower the risk of from expo- for sexu- contracting or spreading sure to HIV ally ac- HIV or another sexually and other tive transmitted infection. sexually adults; transmitted and cor- infections. Correct and consistent rect and Abstinence Condom use programs consis- until mar- support the provision of tent use riage pro- full and accurate infor- of con- grams are mation about correct doms by particularly important and consistent condom those whose behavior places for young people, as use reducing, but not them at risk for transmitting or approximately half of eliminating, the risk of HIV infection; and support access How to Use a Condom Consistently and Correctly: to condoms for those most at risk for transmitting or becoming in-  Use a new condom for every act of vaginal, anal and oral fected with HIV. Latex condoms sex throughout the entire sex act (from start to finish). provide approximately 80-90 per-  Before any genital contact, put the condom on the tip of cent protection, when used consis- the erect penis with the rolled side out. tently. To achieve the protective effect of condoms, people must  If the condom does not have a reservoir tip, pinch the tip use them correctly and consis- enough to leave a half-inch space for semen to collect. tently, at every sexual encounter. Holding the tip, unroll the condom all the Failure to do so diminishes the way to the base of the erect penis. protective effect and increases the  After ejacula- tion and before the risk of acquiring a sexually trans- penis gets soft, grip the rim of mitted infection (STI) because transmission can occur with the condom and carefully with- even a single sexual encounter. Latex draw. Then gently pull the con- condoms, when used consistently and dom off the penis, making sure correctly, are highly effective in prevent- that semen doesn't spill out. ing transmission of HIV. In addition, cor-  Wrap the condom in a tissue rect and consistent use of latex condoms and throw it in the trash where others can reduce the risk of other sexually won't handle it. transmitted diseases (STDs), including Gonorrhea, Chlamydia,  If you feel the condom break at any point during sexual activity, stop immediately, withdraw, remove the broken and Genital ulcer diseases. condom, and put on a new condom.  Ensure that adequate lubrication is used during vaginal and anal sex, which might require water-based lubricants. >>More information at: pepfar.gov Oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) should not be used because they can weaken latex, Public Health Perspective (PHP) Online Newsletter causing breakage. www.bmhall.yolasite.com/publications.php (Source: CDC)
  • 9. July 2012 Public Health Perspective (PHP) Page 9 WHO Publications Bulletin of WHO Vol. 90, No. 07, 2012 The Bulletin of the World Health Organization is an international journal of public health with a special focus on developing countries. Since it was first published in 1948, the Bulletin has become one of the world's leading public health journals. As the flagship periodical of the World Health Organization (WHO), the Bulletin draws on WHO experts as editorial advisers, reviewers, and authors as well as on external collaborators. Full bulletin is available at: http://bit.ly/NnTwki Quality Assurance in Bacteriology and Immunology There is an increasing dependence on clinical and public health laboratories for better patient management and also for preventing the spread of emerging pathogens. With rapid and significant growth of laboratories at all levels of health care, it has become man- datory to check their results to assure that they are reliable and cost-effective, as well as comparable with those obtained by inter- national laboratories. Download is available at: http://bit.ly/O7tTsy Water Safety Planning for Small Community Water Supplies: Step-by-step risk management guidance for drinking water supplies in small countries This manual is designed to engage, empower, and guide communities in the development and implementation of Water Safety Plans (WSPs) for their drinking-water systems. It provides guidance on how to apply effective and achievable management actions in order to improve the safety and quality of supplied water. Download is available at: http://bit.ly/OQh2r0 Safety Evaluation of Certain Food Additives and Contaminants The toxicological monographs in this volume summarize the safety data on a number of food additives: aluminum-containing food additives, Benzoe Tonkinensis, Ponceau 4R, pullulanase from Bacillus deramificans expressed in Bacillus licheniformis, Quinoline Yellow and Sunset Yellow FCF. This volume also contains monographs summarizing the toxicological and dietary exposure data for the contaminants cyanogenic, glycosides, and fumonisins. Download is available at : http://bit.ly/rLHxjn Welcome Our New Campus Liaisons APPLY FOR CAMPUS LIASION Our Campus Liaisons 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.com Call for Articles for August Issue  400-500 words on any topic of public health importance  Do not include any graphs, tables and citations  PP size photo in jpeg format  email your articles to newsletter.php@gmail.com with the subject ‘article for PHP’  For more information: http://www.bmhall.yolasite.com/information-for-contributors.php
  • 10. July 2012 Public Health Perspective (PHP) Page 10 Public Health Perspective (PHP) Team International Honorary Editorial Advisories Rajiv Gandhi University Contributing Writers Bangalore Editorial Advisories Dr. Duk Bahadur Dr. P. Ravi Shankar Ms. Rose Schneider -- Chhetri Madan Kc Professor, Clinical Phar- RN MPH MD, Pathologist Msc. Medical and Health macology & Medical Edu- Chair of the Climate Western Regional Hos- Care Devices cation Change Working Group pital Lab. University of Bolton, UK KIST Medical College of the APHA Interna- Pokhara Lalitpur, Nepal. tional Health Section. Dr. Santosh Raj Senior Health and HIV/ Mr. Balram Banstola Poudel Dr. Anis Rehman AIDS Specialist Managing Director, Residency (MD) in Inter- Associate Chief Editor at Health Systems Man- Senior Pharmacist nal medicine Journal of Pakistan Medi- agement Banstola Medical Hall Interfaith Medical Cen- cal Students (JPMS) 1414 Perry Place NW - Kaski ter, New York HIFA 2015 Country Rep- Suite 100 resentative for Pakistan Washington, DC 20010 Board of Advisories Dr. Krishna Chandra Ms. Sami Pande Rijal Newsletter Team B. Pharm, MPH Dept. of Otorhinolaryn- Editor-in Chief Australian Leadership gology and Head & Neck Amrit Banstola Dr. Margaret Steb- Scholar, 2009 Surgery, College of bing Kathmandu Medical Sciences and Section Editors PhD, Master of Public Teaching Hospital Anoj Gurung Health, Dip App Sci Arjun Poudel Bharatpur, Chitwan Dikshya Sherchan Nursing Msc. Pharm (Social and Dipendra Malla Population Health Aca- administrative Phar- Mr. Chandra Bhushan Sandeep Pahari demic macy) Yadav Sangita Shrestha School of Rural Health, Universiti Sains Malay- Information Officer Subash Timilsina Monash University sia, Penang , Malaysia (MLIS) Sulochana Prajapati Australia Nepal Health Research Ashik Banstola Council (NHRC) M. Pharm MOHP, Kathmandu (Pharmacology), PDCR Welcome to New Subscribers Nepal Rachana Nakarmi International Dawn Skidmore Amrit Dangi Ruja Luitel Alani Price Gani Alabi Apsara Karki Sharika Mahato Amar Tamrakar Sharon Blair Avaniendra Chak- Shiv Raj Sunar Arundati Muralidharan Sree Tirukkovalluri ravartty Shiva Raj Mishra Badrinatheswar Gelli Valasingham Ramesh- Birat Ghimire Sumit KC Venkata kumaar Dinesh Upadhyay Upendra Dhakal Bob Gerzoff Zeeshan Ayyaz Madhav KC Churamany Chetry Articles 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 newsletter.php@gmail.com