Inside this Issue:
Editorial:
Universal access to reproductive health: What does it mean to Nepal?
National News:
439 persons face the music for smoking in public places
World population day: Litany of challenges still stares at Gov
Health ministry to launch anti-typhoid vaccination campaign
Chitwan DPHO launches anti-dengue campaign
Global reproductive rights body opens office here
HIV cases on rise in Kavre
Gastrointestinal cases decline
MoHP intensifies disaster ac-tion plans
Featured Article:
The help seeking behavior of unmarried girls living in Mumbai slums for menstrual needs (Arundati Muralidharan)
World Population Day (2012) Special
World Hepatitis Day (2012) Special
Global Health:
Avian influenza – situation in Indonesia – up-date
Prequalification of medicines saves lives
WHO joins call for renewed focus on family planning
Severe complications of hand, foot and mouth disease (HFMD) caused by EV-71 in Cambodia conclusion of the joint investigation
Vaccine success story: congenital rubella syndrome
South Africa Making Progress against HIV/AIDS, But Still More Effort Needed, Health Minister Says
Whooping cough makes deadly return across Canada
Journal Watch:
Evaluation of knowledge, attitude and practice of newly diagnosed diabetes patients-a baseline study from Nepal
Letter to the editor:
Being Healthy:
ABCs: Abstain, Be faithful, and use Condoms
WHO Publications:
Bulletin of WHO Vol. 90, No. 07, 2012
Quality Assurance in Bacteriology and Immunology
Water Safety Planning for Small Community Water Supplies: Step-by-step risk management guidance for drinking water supplies in small countries
Safety Evaluation of Certain Food Additives and Contaminants
Miscellaneous:
Welcome Our New Campus Liaisons
Amrit Dangi (Nobel College)
Barsha Shrestha (BPKIHS)
Sumit KC (CIST College)
The Pixar Way: 37 Quotes on Developing and Maintaining a Creative Company (fr...
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
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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-
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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.
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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
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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-
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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
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Nepal Rachana Nakarmi International Dawn Skidmore
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