Public Health Perspective (PHP) Newsletter January 2013 Issue

advocating throughout this

year for 'Climate Change'

issues to a greater extent.

The newsletter will also go

through some changes in its

board of advisories and the

newsletter team with the

start of a new year.

We feel proud that PHP has

achieved such heights in such

a short duration, thanks to

the PHP contributors and sup-

port from the reader across

the globe. Now, with the start

of a new year, we are in a

voyage to support health care

delivery in Nepal by organiz-

ing programs on major public

health important days. For

this, we need financial and

technical support. Our plan is

to work with public health

students, colleges, district

public health offices, the Min-

istry of Health and Popula-

tion, related health organiza-

tions and with allied health

professionals to support this

initiative. Therefore, we re-

quest the interested organi-

zations to support our pro-

grams in any possible way

they can. To help advance

this work, we look forward for

similar help from our support-

ers, advisories, subscribers,

campus liaisons, colleges,

universities, relatives, friends

in this program as well. If you

think you can help advance

this work or will like to join us

in our endeavor please feel

free to write to us at

[email protected]

Wishing you a happy and

healthy new year!

Amrit Banstola

TakingITGlobal, and List of

newspapers in Nepal on

Wikipedia. To add, PHP is a

corporate partner of Journal

of Pakistan Medical Students

(JPMS), JPMS Blog, and

Global Alliance for Clean

Cook Stoves Alliance. Re-

cently it became the member

of Global Health Workforce

Alliance (GHWA)—an organi-

zation that work to address

the health workforce crisis.

The list of dedicated campus

liaison rose dramatically in

the year 2012. We were

more than happy to welcome

eight campus liaisons repre-

senting five institutions (four

national and one interna-

tional institution). There was

also a significant increase in

the number of Facebook

Likes compared to 2011.

There were only 170 Face-

book at the end of the year

2011 which increased by

fourthfold in the year 2012.

Now there are more than

650 fans in our official Face-

book page. The number of

subscribers was moderately

increased; however. We feel

overwhelmed to mention

that PHP has also subscribers

from Center of Disease Con-

trol and Prevention (CDC); a

leading public health organi-

zation of USA. To mention,

we have subscribers and

viewers from more than 90

countries. Thanks to our

campus liaison for their over-

whelming support in increas-

ing the subscribers and Likes

in the Facebook.

We were also happy to have

Dr Anis Rehman from Paki-

stan as a new contributing

writer for PHP.

Our readers will see a slight

difference in the PHP tem-

plate for this year. We have

changed the color of our

template to green as a sym-

bol of 'Go Green' and will be

Founded in 2011, Public

Health Perspective (PHP) is

Nepal’s first public health

online newsletter; pioneer in

the exchange of public health

related information, ideas,

and resources. For more than

two years, we have led the

quest for innovation, better

outcomes, and helped the

health professionals to update

their existing information. Our

newsletter directly benefit the

health students and emerging

public health professionals.

Public Health Perspective

(PHP) published 11 articles in

2012. To maintain high quality

of the content, it came at the

expense of a high rejection

rate of 56%. The quality of

content is being increasingly

recognized by the academic

contributors.

To acknowledge the work of

researchers, and strengthen

the research system in Nepal,

we have highlighted 20 schol-

arly articles related to Nepal

written by both Nepalese au-

thor as well as foreigner.

The year 2012 was also won-

derful for PHP as it was able

to establish a good partner-

ship with various national and

international organizations.

PHP is associated with Nepal

Publ ic Health Network

(NPHN), and is listed in the

Manmohan Memorial Institute

of Health Sciences website

under other important links

for 'journals of different or-

ganizations'. Virtual Library of

School of Public Health and

Community Medicine of the

University of New South

Wales, Sydney, Australia has

included in its list of public

health newsletter. Similarly, it

has appeared in Australian

Development Gateway (ADG),

Online Newspaper.com—

world's largest listing of

magazines on the web, under

health and medical categories,

Editorial: The Journey Continues

Vol. 3 Issue 1 January 2013 the first public health online newsletter of Nepal

Public Health Perspective

Public Health Important

Days (January)

January 12: National Youth Day

January 31: Anti-Leprosy Day

Inside This Issue

http://www.bmhall.yolasite.com/publications.php

mailto:[email protected]



National News

P U B L I C H E A LT H P E R S P E C T I V E ( P H P )

January 2013

BAITADI, DEC 31 -

A doctor has shown up at

the Kesharpur Primary

Health Centre, Melauli in Bai-

tadi district, for the first time

after 13 years. Locals are

happy with the arrival of Dr

Yunus Tiwari at the health

centre after 13 years of its

establishment. The centre was

established in 2056 BS. Chief

at the District Health Office,

Baitadi, Dr. Gunraj Awasthi,

said that his dream of sending

a doctor to the centre is ful-

filled after long efforts. Melauli

is a day´s trek from the dis-

trict headquarters. The num-

ber of patients visiting the

centre has gone up after the

presence of the doctor there.

Now, locals of lower Sworad

need not travel across the

border to Indian towns for

treatment.

Source: ekantipur.com

KATHMANDU, JAN 01 -

C oncerned over severe

health impacts of poor

management of the hazardous

medical waste, the govern-

ment has decided to

strengthen effective imple-

mentation of the Solid Waste

Management Act (SWM)

2011. The government will

take stern action, including

the cancellation of operating

license, against individuals

and health institutions failing

to abide by the standards for

medical waste management

as set under the SWM. Those

properly managing hazardous

medical and chemical wastes

will be rewarded. The SWM

2011 clearly states that the

responsibility of processing

and managing hazardous,

m e d i c a l a n d c h e m i -

cal waste under the pre-

scribed standards rests with

the person or institution that

has generated the waste. Any

individual or institution found

i m p r o p e r l y m a n a g -

ing waste can be charged

between Rs 50,000 and Rs

100,000 or imprisoned for 15

days to three months by the

local authority as per the Act.


KATHMANDU, JAN 20 –

N ational Tuberculosis Cen-

tre (NTC), the govern-

ment body overseeing

the tuberculosis program in

the country, is planning to

establish three sophisticated

laboratories for sputum cul-

tures outside the valley for

the diagnosis of drug-

resistant TB. The NTC has

proposed operating one labo-

ratory at the BP Koirala Insti-

tute of Health Sciences in

Dharan for the eastern region,

one at the Regional TB Centre

in Pokhara for the western

region and another at the

Surkhet Regional Hospital for

the far-western region. These

laboratories will help in the

diagnosis of TB for people

who have completed the first-

line drug course of six months

but are facing recurrences or

those who stopped taking

medicine in the course of

treatment.

NTC Director Dr Rajendra

Pant said that a cost of

around $500,000 has been

estimated for the set-up of

the laboratories. Currently,

such laboratories are present

only in the Kathmandu val-

ley—one at the NTC and the

other at the German Nepal TB

Project in Kalimati.


KATHMANDU, JAN 25 -

I n a bid to ensure the qual-

ity and competence of

health professionals other

than medical doctors and

nurses, the Nepal Health Pro-

fessionals’ Council (NPHC) is

planning to enforce licensing

examinations from this fiscal

year. The NHPC is the body

that registers health assis-

tants, auxiliary health work-

ers, lab technicians, medical/

health laboratory technicians,

public health professionals,

microbiologists, physiothera-

pists, auxiliary Ayurved work-

ers, dental hygienists and

ophthalmic assistants, before

providing them with a certifi-

cate to practice. Till date,

the NHPC has been registering

health professionals after they

complete their respective

courses. These courses range

from a 15-month training pro-

gram after the completion of

the School Leaving Certificate

to PhD programs. Dhana

P r a s a d P o u d e l ,

the NHPC registrar, said that

the licensing examination is

being planned as they have

been receiving complaints of

“incompetent” health workers

and about the quality of edu-

cation pursued by students

abroad.

“Since we monitor colleges

inside the country, we know

their quality. Still, we want to

reassure their competence,”

said Poudel. “However, there

have been many complaints

about students from aboard

who cannot perform even the

simplest experiments and

tests.” The Council has

amended its Act to include a

provision for licensing exami-

nations. A five-member com-

mittee chaired by Dr Dinesh

Bastola from the Institute of

Medicine has been formed to

draft directives for conducting

the examination. Until now,

Nepal Medical Council, the

government body regulating

medical doctors and medical

education, has been conduct-

ing licensing tests for MBBS

and post-graduate doctors.

Similarly, the Nursing Council,

since last year, has been holding

licensing exams before nurses

are al lowed to practice.

The NHPC has so far registered

50,442 health professionals.


KATHMANDU, JAN 29 -

United Nations agencies in Nepal

have commended the govern-

ment’s efforts in expanding ac-

cess to sanitation for every

household and thus bringing the

country closer towards becoming

an open defecation-free zone. In

a j o i n t s t a t e m e n t ,

the UN agencies said that an

increase in 19 percent of sanitary

facilities in a year is a major

achievement. In 1980, only three

percent of the households had

sanitary facilities, which is cur-

rently 62 percent, according to a

government report. UN ICEF-

Nepal representative Hanaa

Singer attributed the increase to

the “power of the communities to

take a collective decision to re-

gain their pride and dignity by

stopping open defecation and

cleaning up their immediate liv-

ing environments.” “It is the

strong government leadership at

all levels and the unified political

support based on a strong joint

vision on how to trigger and sus-

tain these school and community

-led initiatives,” Singer said in a

statement.

The government has repeatedly

committed to eradicate open

defecation by providing subsidies

to poor households and resources

to schools. The Millennium Devel-

opment Goal (MDG) Acceleration

Framework for Sanitation, signed

by the government, came about

in response to the need to speed

up the country’s progress toward

meeting the MDG on sanitation.

“The way the MDG Acceleration

Framework process was con-

ducted is also something of a

model,” said Robert Piper, UN

resident coordinator for Nepal.

“The active participation of vari-

ous ministries and other stake-

holders from the beginning of the

Continued on page 4

Doctor in health care

after 13 yrs

Govt to set up 3 hi-tech

TB labs

UN lauds Nepal’s sanita-

tion efforts

Government to act

strictly on medical

waste management

License test to be man-

datory for all health pro-

fessionals

The New Superbug

P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) January 2013

“What exactly is this C. diff?” Given the amount of media sensation this super-bug has created, it is

not surprising that as an Internal Medicine specialist, I get asked this question a lot. With all justified

press coverage this topic is getting, this is a reasonable and, in fact, a very important question to

ask. To take a step back, there are several billion bacteria that reside in our colons, called gastroin-

testinal “microbiome”. These bacteria talk to each other and to our colon and our immune system in

very complicated ways to create a mutually dependent relationship. This allows every party, consist-

ing of you, your colon, your microbiome, to exist in a happy balance. This healthy interaction pre-

vents overtake of our guts by disease-causing bacteria, a concept known as “colonization resistance”.

Taking certain antibiotics, like clindamycin, ciprofloxacin etc, kills off good bacterial species and de-

crease the diversity of our microbiome. All this means that small amounts of bad bacteria, which were

being suppressed and were waiting in the sidelines for their moment in the limelight, get their chance. Colonization resistance

fails and these species take over.

C. difficile, a kind of bacteria, is one such opportunist. Its spores are everywhere and we come across them in hospitals, clinics

and other health care facilities. Lack of hand-washing hygiene is one of the most important ways in which spores of C. difficile

spread. Those of us with a disturbed gut microbiome fall prey to the infection. The usual suspects are hospitalized patients, nurs-

ing home residents, the elderly and those with recent exposure to antibiotics, though increasingly frequent occurrence of this

infection in people with no contact with the healthcare system (so called “community-dwellers") is getting concerning. The inci-

dence of C. difficile infections has increased alarmingly across the globe, especially in Western countries with half a million cases

being reported annually in USA itself. Billions are being spent every year in controlling, diagnosing, treating and preventing this

infection and this problem has taken on a public health scale.

It is not a happy experience to come across C. difficile. Once it infects the colon, it can cause anywhere from mild to extremely

severe, even life-threatening disease. Pain in the belly, bloating, cramps, and diarrhea are some of the milder manifestations.

Severe dilation of the colon requiring emergency surgery, very high fever, and even death can occur. Treatment mostly con-

sists, believe it or not, of antibiotics! Metronidazole and vancomycin are two of the most commonly used treatments. Unfortu-

nately, even if treated, C. difficile infection can recur in anywhere from 20 to 66% patients after initial infection. This trend of

severe infection that relapses makes this bacterium very costly to Governments and healthcare systems globally. New drugs and

even vaccines are being developed in a bid to find some way to stop this tide. There is tremendous interest is figuring out low-

cost, non-traditional ways to treat this infection.

One such unorthodox method, also getting lots of media attention presently, is stool transplantation. Transplanting a very small

amount of stool from a healthy donor to a recipient, a person with several bouts of C. difficile infection usually via a routine

colonoscopy, although esthetically challenging, has seemed to work wonders. In fact, within weeks the gut microbiome of the

recipient starts resembling the donor. With about 30 years of experience in stool transplantation procedure, called Fecal Bacteri-

otherapy (FBT) and Intestinal Microbiota Transplantation (IMT), the results have been astounding with an almost 90% total cure

rate for cases of recurrent C. difficile colitis. However, the studies from which these data are gleaned have been case-series and,

as of yet, randomized data is not available to substantiate the results. Several questions remain before this treatment can be-

come standard of care for recurrent C. difficile infection. Who is the ideal donor, potential for transmitting diseases via FBT, pre-

screening for donors, role of FBT in initial C. difficile infection episode etc., are some of those questions. With more and more

research into the field of gastrointestinal microbiome using high throughput, non-culture, and molecular-based methods the day

might not be far when the questions above can be answered and we can be well on our way of finding a cure for this menace. In

the meantime though, wash your hands vigorously with soap and water every time you are around patients in hospitals and clin-

ics – we have not found the magic bullet yet!

Itishree Trivedi, M.D., Department of Internal Medicine, University of Michigan

Albania

Argentina

Australia

Bahrain

Bangladesh

Belgium

Bhutan

Canada

China

Colombia

Croatia

Cuba

Czech Republic

Djibouti

Ecuador

Egypt

Ethiopia

Finland

France

Germany

Ghana

Greece

Haiti

Hungary

Iceland

India

Indonesia

Iran

Ireland

Israel

Italy

Japan

Jordan

Kenya

Laos

Malawi

Malaysia

Mexico

Mozambique

Nepal

Netherland

New Zealand

Nigeria

Norway

Odua

Oman

Pakistan

Panama

Peru

Philippines

Poland

Qatar

Qatar

Romania

Rwanda

Saudi Arabia

Scotland

Singapore

South Africa

South Korea

Spain

Sri Lanka

Sudan

Swaziland

Switzerland

Taiwan

Tanzania

Tasmania

Thailand

Trinidad &

Tobago

Uganda

Ukraine

United Kingdom

USA

Yemen

Country List of PHP Subscribers & Viewers

Live Traffic Feed May 20, 2012 onwards

World Leprosy Day


January 2013

Every last Sunday of January each marks the World Leprosy Day. On this day,

organizations that work with people affected by leprosy will hold events such as

rallies, lunches, church services and disability sports days to raise awareness of a

disease that is completely curable but can cause great anguish for the people di-

agnosed with it.

In 1953, a great humanitarian, M.

Raoul Follereau of France, pro-

claimed the first World Leprosy Day

to call attention to the plight of the

world’s millions of people affected by

this ancient, devastating dis-

ease. Over the years, this obser-

vance has grown and more than 100

countries now participate in World Leprosy

Day on the last Sunday in January.

Leprosy can cause physical disability if not

treated quickly enough. In other words, those

who had the disease had to live with the dis-

abilities that are so common in leprosy – they

simply had no choice. But perhaps worse

than the physical damage is the damage caused by stigma. For many centuries, leprosy

stigmatized those affected because there was no cure. In many countries leprosy is feared

and people who have it are rejected from their homes and communities. In some countries

there are still laws discriminating against people affected by leprosy.

World Leprosy Day helps to focus on the needs of some of the poorest and most marginal-

ized people in the world – those affected by leprosy. It helps to tell the story to people who

do not know that leprosy still exists and that it can now be cured. It also helps raise funds

so that those with leprosy can be cured and cared for.

Join us in celebrating World Leprosy Day on Sunday, January 26, 2014 and in standing for

those who face oppression and stigma every day. We are one body, supporting and caring

for one another.

Source: >>leprosymission.org >>leprosy.org

National News Continued from page 2

process till the final produc-

tion of the action plan has

been very impressive,” he

said.

Source:ekantipur.com

KATHMANDU, JAN 29 -

R eduction in health budget

could create obstructions

in meeting the Millennium

Development Goals’ (MDG)

target, health experts warned

today. Babu Ram Marasini,

chief of Health Sector Reform

Unit at the Health Ministry

said the budget cut will ad-

versely affect efforts to meet

the MDG target. Although the

country is showing progress in

so far as child mortality rate

and maternal mortality rate

are concerned, the situation

could reverse if the budgetary

allocations are not forthcom-

ing, said Marasini.

The Finance ministry has allo-

cated Rs 16.58 billion to the

health sector for this fiscal

through interim arrangement

of expenditure. Of the total

24.92 billion budget ear-

marked for the health sector

last fiscal, the ministry spent

only 20.62 billion. About 70 to

72 per cent of health budget

is spent on salary, incentives,

procurement of food and

drugs, and transportation, he

said.

Source:thehimalayantimes.com

LALITPUR, JAN 31 -

T he elephantiasis eradication

program is being imple-

mented in 56 districts across

the country this year. This pro-

gram will be conducted on Feb-

ruary 2, 3 and 4 in the selected

districts. The District Public

Health Office, Lalitpur stated at

a press conference on Wednes-

day that the program is being

conducted in 56 districts only

as elephantiasis has been eradi-

cated in five out of the 61 dis-

tricts where this disease was

prevalent.

Senior Public Health Officer Bal

Krishna Bhusal said more than

85 per cent people in these dis-

tricts would be given medicines

for elephantiasis. So far, 13.4

million people have been admin-

istered medicines against ele-

phantiasis. The campaign of

administering medicine was first

started in 2003 from Parsa dis-

trict. Twenty-eight thousand one

hundred and thirty-five people

are suffering from elephantiasis

in Nepal. Elephantiasis comes

second only to leprosy among

the diseases resulting in disabil-

ity in Nepal.

Source:thehimalayantimes.com

Reduced health

budget will hamper

MDG efforts: Experts

Elephantiasis eradica-

tion program to reach

56 districts

Global Health


January 2013

ported. Novartis is also seek-

ing to test the vaccine in the

US, Bloomberg reported. Source: globalpost.com

January 23 2013 –

I n a breakthrough for mod-

ern medicine, researchers

in Japan have succeeded in

growing human kidney tissue

from stem cells.

Kenji Osafune of Kyoto Univer-

sity explained that his team

was able to take stem cells

and "nudge them" in the direc-

tion of kidney tissues, which

have an especially complex

structure, according to Agence

France-Presse.

More than a million people

suffer from renal disease. Ac-

cording to the National Kidney

Foundation —because of how

complex kidney tissue is —

once it's been damaged, the

tissue is extremely hard to

repair. Currently, people with

failing kidneys rely on dialysis

or organ transplants. Osa-

fune's research could change

that, although he cautions that

his breakthrough is a prelimi-

nary step.

Stem cells, which are charac-

terized by the ability to renew

themselves into a diverse

range of specialized cells, have

been used in research to treat

various diseases and disabili-

ties.

Source: globalpost.com

January 28 2013 -

T he World Health Organiza-

Continued on page 6

cases.


January 16 2013 –

T he World Health Organiza-

tion (WHO) trumpeted its

recent success in fighting 17

neglected tropical diseases in a

new report —but warned that

dengue fever has reached

"pandemic" levels, infecting an

estimate 50 million around the

world.

The January 2013 reports

states that the WHO has

achieved success in using pre-

ventative medicine to fight

against four of the targeted

diseases (lymphatic filariasis,

onchocerciasis, schistosomiasis

and soil-transmitted helminthi-

ases), managing to treat 711

million in 2010 alone.


January 22 2013 -

E ight hundred children in

Europe have developed

narcolepsy after taking the

swine flu vaccine, according to

Reuters.

Reuters reported the children in

Sweden and across Europe

came down with the sleep dis-

order after being vaccinated

with the Pandemrix H1N1 vac-

cine which is made by GlaxoS-

mithKline. Regulators there

have ruled Pandemrix should

not be given to anyone under

the age of 20. Emmanuel Mi-

gnot, a Stanford University

sleep disorder specialist, said

"there's no doubt in my mind

whatsoever that Pandemrix

increased the occurrence of

narcolepsy onset in children in

some countries - and probably

January 9 2013 –

B oston has declared a public

health emergency as it bat-

tles a widespread flu outbreak

that has killed 18 people this

season across the state of Mas-

sachusetts.

Boston Mayor Thomas Menino

said there had been around 700

confirmed cases of the flu in

Boston since the season began

in October, compared with only

70 all of last season, reports

CBS News. "This is the worst flu

season we've seen since 2009,

and people should take the

threat of flu seriously," Menino

said in a news release. "This is

not only a health concern, but

also an economic concern for

families, and I'm urging resi-

dents to get vaccinated if they

haven't already. It's the best

thing you can do to protect

yourself and your family. If

you're sick, please stay home

from work or school."

City officials are encouraging

residents to get vaccinated

against the flu and are working

with health care centers to offer

free flu shots, reports CBS.

According to AP, the Centers for

Disease Control and Prevention

said Massachusetts was one of

29 states reporting high levels

of "influenza-like illness." Eight-

een children have died from

influenza and more than 2,200

people have been hospitalized

since October.

NBC reports that the particu-

larly bad flu season has been

blamed on an especially potent

strain of the flu, the A H3N2.

Another common A strain, the

H1N1, is also circulating along

with two strains of influenza B.

Infectious disease experts told

NBC that vaccines prepared for

this year will protect against

three of the viruses although

not a fourth strain of influenza

B, which may account for up to

10 percent of this year's flu

Boston declares public

health emergency over

flu

in most countries."

Everyday Health reported

about 30 million people re-

ceived the vaccine and that a

link between the sleep disor-

der and Pandemrix has been

under investigation since

2010. However, the company

said there was not enough

information to link the two.

Meanwhile, Finland, Sweden,

France, Norway and Ireland

have seen a recent increase

in narcolepsy, according to

Everyday Health. Source: globalpost.com

January 22 2013 -

A vaccine against a

deadly strain of menin-

gitis has been licensed for

use in Europe. It is the first

of its kind to protect against

meningococcal B meningitis.

The manufacturer, Novartis,

has been given the go-ahead

for the marketing of Bexsero,

which can be administered to

anyone, including infants as

young as two months old,

Medical News Today re-

ported.

Of the five types of meningi-

tis, type B is the only one

which has not previously had

an effective vaccine. Previous

vaccines protected against

only some of the strains of

bacteria that cause Meningi-

tis B, Bloomberg Busi-

nessweek reported, whereas

Bexsero covers 73 percent of

cases.

Type B meningitis is the most

common in Europe, and ac-

counts for between 3,000 to

5,000 cases a year and has

caused 1,000 deaths since

2000, the Telegraph re-

Dengue getting worse,

but progress being made

on other tropical dis-

eases, reports WHO

Flu vaccine backlash: 800

children in Europe develop

narcolepsy after swine flu

vaccine

Stem cell research: Japa-

nese scientists grow hu-

man kidney tissue out of

stem cells

Vaccine against deadly

meningitis strain ap-

proved for use in Europe

New action plan could be

a turning point in global

mental health

Men who were uneducated or had primary level education, aged above 25 years, had higher in-

come, formal employment, came from Hindu religion and non-indigenous ethnicities demonstrated

greater involvement in antenatal car, birth preparedness, exclusive breastfeeding and immuniza-

tions for children in the Katmandu district of Nepal, according to the study published in BMC Preg-

nancy and Childbirth 2013 issue.

A cross-sectional survey was conducted among 2178 married males between May and December

2010 in 20 Village Development Committees (VDCs) and Kathmandu municipality of the district.

As per the study, 39.3% of males accompanied their partners for Antenatal Care (ANC), 47.9 %

arranged Skilled Birth Attendance (SBA), and 10.9 % accompanied them for child immunization.

Those men who were uneducated or had primary level education (adjusted odds ratio 5.68, 95 %

confidence interval 4.44 to 7.27), were aged 25 years or above (2.51, 1.89 to 3.33), with formal

employment (1.23, 1.01 to 1.49), had income NPR 5001 (exchange rate 1USD = 85 NPR) or

above per month (1.47, 1.20 to 1.80), and of non-indigenous ethnicities (1.53, 1.18 to 1.99) were

more likely to accompanied their partners on antenatal visit. Similarly, men with these traits were

more likely to arranged money for delivery. These factors (illiteracy, income level, formal employ-

ment) have also significant positive role in birth preparedness. However, the study found that men

with an income of NPR 5001 or above per month and of Hindu religion were less likely to encour-

aged exclusive breast feeding. To add, people with former characteristics were less likely to ac-

company their partners for the immunization of their child.

The study concludes that these factors should be emphatically considered during maternal health

program development.

Full text article is available at:

BMC Pregnancy and Childbirth 2013, 13:14 doi: 10.1186/1471-2393-13-14

Author: Dharma Nand Bhatta

Journal Watch


January 2013

Send Letters to the

Editor

All readers can post

comments on articles

and news mentioned in

PHP or could be sugges-

tions and compliments.

Send letters to:

[email protected]

Word limit 150 max. and

the title of news or arti-

cles of critique.

Email should include

‘letters to the editor’

in email subject line.

How to join PHP?

e-Mail:

[email protected]

website:

www.bmhall.yolasite.com/

publications.php

Benefits of

Being a PHP

Subscriber

Can submit articles to

PHP newsletter

Heavy discount rate in

PHP trainings, work-

shops, seminars, con-

ferences

Get acquainted with

public health news from

around the nation and

globe at a time

Enhances professional

writing skills

Involvement of males in antenatal care, birth preparedness, exclusive breast

feeding and immunizations for children in Kathmandu, Nepal

Continued from page 5

tion is attempting to improve

the astounding statistics that

surround mental healthcare

around the world.

US Congress isn’t the only

place where mental health

discussions have surfaced

recently. The World Health

Organization (WHO) discussed

the latest draft of a new

Global Mental Health Action

Plan last week, which, if

adopted, would set clear goals

for progress and aim to im-

prove accountability in im-

proving mental healthcare

around the world.

The action plan will be offi-

cially voted for at the World

Health Assembly in May, but

the draft of the plan received

wide support at the recent

WHO Executive Board meet-

ing, according to Kelly O’Don-

nell, coordinator of the Mental

Health-Psychosocial Working

Group of the NGO Forum for

Health, who attended the

meeting.

The adoption of the action

plan would represent a turning

point in global mental health-

ca re , sa i d O ’Donne l l .

“Regardless of income levels,”

he said, “countries are really

coming on board and rallying

around the need to put poli-

cies and resources in place

and calling on WHO to help

with technical guidance.”

The plan lists four objectives

focused on leadership, com-

prehensive care, promotion

and prevention, and research,

and has an overall goal to

“promote mental well-being,

prevent mental disorders,

provide care, enhance recov-

ery, promote human rights

and reduce the mortality,

morbidity, and disability for

persons with mental disor-

ders.”


29 January 2013 –

The world risks a repeat of the

disastrous 2006 bird flu out-

breaks unless surveillance and

control of this and other dan-

gerous animal diseases is

strengthened globally, FAO

warns.

"The continuing international

economic downturn means

less money is available for

prevention of H5N1 bird flu

and other threats of animal

origin. This is not only true

for international organizations

but also countries them-

selves," says FAO Chief Veteri-

nary Officer Juan Lubroth.

"Even though everyone knows

that prevention is better than

cure, I am worried because in

the current climate govern-

ments are unable to keep up

their guard." Source: fao.org

FAO urges stronger meas-

ures on global health

threats

Global Health





Climate Change and Health


January 2013

Key facts

Climate change affects the social and environmental determinants of health – clean air, safe drinking water, sufficient food

and secure shelter.

Global warming that has occurred since the 1970s caused over 140 000 excess deaths annually by the year 2004.

The direct damage costs to health (i.e. excluding costs in health-determining sectors such as agriculture and water and sani-

tation), is estimated to be between US$ 2-4 billion/year by 2030.

Many of the major killers such as diarrhoeal diseases, malnutrition, malaria and dengue are highly climate-sensitive and are

expected to worsen as the climate changes.

Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to

prepare and respond.

Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved

health.

Climate change

Over the last 50 years, human activities – particularly the burning of fossil fuels – have released sufficient quantities of carbon

dioxide and other greenhouse gases to trap additional heat in the lower atmosphere and affect the global climate.

In the last 100 years, the world has warmed by approximately 0.75oC. Over the last 25 years, the rate of global warming has

accelerated, at over 0.18oC per decade.

Sea levels are rising, glaciers are melting and precipitation patterns are changing. Extreme weather events are becoming more

intense and frequent.

What is the impact of climate change on health?

Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and increased

food production in certain areas, the overall health effects of a changing climate are likely to be overwhelmingly negative. Cli-

mate change affects social determinants of health – clean air, safe drinking water, sufficient food and secure shelter.

Patterns of infection

Climatic conditions strongly affect water-borne diseases and diseases transmitted through insects, snails or other cold blooded

animals.

Changes in climate are likely to lengthen the transmission seasons of important vector-borne diseases and to alter their geo-

graphic range. For example, climate change is projected to widen significantly the area of China where the snail-borne disease

schistosomiasis occurs.

Malaria is strongly influenced by climate. Transmitted by Anopheles mosquitoes, malaria kills almost 1 million people every year

– mainly African children under five years old. The Aedes mosquito vector of dengue is also highly sensitive to climate conditions.

Studies suggest that climate change could expose an additional 2 billion people to dengue transmission by the 2080s.

Measuring the health effects

Measuring the health effects from climate change can only be very approximate. Nevertheless, a WHO assessment, taking into

account only a subset of the possible health impacts, concluded that the modest warming that has occurred since the 1970s was

already causing over 140 000 excess deaths annually by the year 2004.

Who is at risk?

All populations will be affected by climate change, but some are more vulnerable than others. People living in small island devel-

oping states and other coastal regions, megacities, and mountainous and polar regions are particularly vulnerable.

Children – in particular, children living in poor countries – are among the most vulnerable to the resulting health risks and will be

exposed longer to the health consequences. The health effects are also expected to be more severe for elderly people and people

with infirmities or pre-existing medical conditions.

Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to pre-

pare and respond.

WHO response

In 2009, the World Health Assembly endorsed a new WHO workplan on climate change and health. This includes:

Advocacy: to raise awareness that climate change is a fundamental threat to human health; Partnerships: to coordinate with

partner agencies within the UN system, and ensure that health is properly represented in the climate change agenda; Science

and evidence: to coordinate reviews of the scientific evidence on the links between climate change and health, and develop a

global research agenda; Health system strengthening: to assist countries to assess their health vulnerabilities and build capacity

to reduce health vulnerability to climate change. Available from: http://www.who.int/mediacentre/factsheets/fs266/en/

Being Healthy


Protect your child’s

health with regular

vaccinations

January 2013

While some people have concerns over vaccines because of

autism, scientific studies have

shown that there is no con-

nection.

“Categorically, vaccination

does not lead to autism,” By-

ington says. “Multiple scientific

studies have found no link

between vaccination and au-

tism.”

Vaccines are very safe, and when reactions do occur, they are

usually minor and temporary, such as a low-grade fever or

soreness or redness at the vaccination site. Another common

mis belief is that getting a “natural” infection is better than

being vaccinated, but that is just a myth. Some infections may

give you lifelong immunity, but they may also result in severe

disease or even death. So it is much safer for your child to re-

ceive the vaccine than to be exposed to the infection.

How vaccines do it

Antigens are what make vaccines work. They

trigger a reaction in your child’s immune sys-

tem that protects against infection. “Antigens

are an individual protein, or a piece of the infec-

tious agent that your child is exposed to,” By-

ington says.

And even though there are many more vaccines today, thanks

to better vaccine technology, children are actually exposed to

fewer antigens than in the past.

All children are born with a gift: antibodies that they receive

from their mothers at birth, making them immune to many

diseases. But this immunity doesn’t last long. If your children

aren’t vaccinated and are exposed to disease germs, their little

bodies might not be strong enough to fight them.

“Childhood immunizations save lives and prevent suffering of

children,” Rodewald says.

>> Courtesy: Teddi Dineley Johnson,

published in Healthy You section of De-cember 2009 issue of ‘The Nations'

Health.’

>> For more tips, visit www.cdc.gov/vaccines

www.bmhall.yolasite.com/publications.php

pertussis — also known as whooping cough

— roared frighteningly through communi-

ties. Today, thanks to vaccinations, those

diseases and others have been largely si-

lenced. Thanks to successful vaccination

programs, smallpox has been eradicated

worldwide, and polio has been eliminated in

the United States. Making sure your children

receive lifesaving vaccines is one of the

most important ways

you can keep them

healthy.

According to the

U.S. Department of

Health and Human

Services, immuniza-

tions are among the

most successful pub-

lic health interven-

tions of all time. “I

believe childhood immunizations have saved

more lives than any other medical interven-

tion in history,” says Carrie Byington, MD,

professor of pediatrics at the University of

Utah and a member of the American Acad-

emy of Pediatrics Committee on Infectious

Diseases.

You’re holding your newborn,

and you whisper a soft promise

that nothing in the world will

ever harm her.

Sadly, there are some things

we can’t control, like the com-

mon cold or their first broken

hearts. But happily, thanks to

decades of scientific research,

we now have the ability to con-

trol many diseases that at one

time caused untold pain and

suffering to families every-

where.

About 18 years ago, only eight

serious diseases were prevent-

able with vaccines. Immuniza-

tions now protect children and

teens against 16 serious dis-

eases. Not so long ago, diseases

such as diphtheria, measles and

“People don’t realize how devastating these

diseases were,” Byington says. “Measles, po-

lio…these were diseases that left children dis-

abled, or killed children in large numbers prior

to implementing the vaccine programs.”

Thankfully, most vaccine-preventable diseases

have pretty much disappeared in the United

States. But not so in many other countries,

where measles, rubella and rotavirus, to name

a few, are still quite prevalent. And consider

this: Some of those germs are just a plane ride

away. If not for vaccines, some diseases could

spread quickly through communities.

According to the Centers for Disease Control

and Prevention, just a few cases of measles,

for example, could quickly become “tens or

hundreds of thousands” of cases if we weren’t

protected by vaccines.

“If we stop vaccinating, the diseases would

come back. They’re right there waiting to come

back,” says Lance Rodewald, MD, director of

the Immunization Services Division at CDC.

In 2008, for example, there were a number of

small outbreaks in the United States of mea-

sles because some parents declined to have

their children vaccinated.

Start early and stay on track In general, vaccinations should start at 6 weeks to 2 months

of age. To get the best protection for your child, make sure

she or he is immunized on schedule.

Your health care provider is the best

source of this information and can

help with reminders. Remember to

keep personal records of your child’s

vaccinations as well, as you may need

to provide the information down the

line for school, trips or other

childhood activities.

Public Health Perspective (PHP) Online Newsletter


The Bulletin is one of the world's leading public health journals. It is a peer-reviewed monthly with a special focus on developing

countries, giving it unrivalled global scope and authority. The Bulletin is one of the top 10 public and environmental health jour-

nals with an impact factor of 5.4, according to the Institute of Scientific Information (ISI). It is essential reading for all public

health decision-makers and researchers who require its special blend of research, well-informed opinion and news. Full bulletin

is available at: bit.ly/S64apE

WHO Publications

Bulletin of WHO Vol. 91, No. 01, 2013


January 2013

World Health Organization Classification of Tumors: Pathology and Genetics of Tumors of Soft Tissue and

Bone

WHO Classification of Soft Tissue and Bone is the fifth volume of the fourth edition of the WHO series on histological and genetic

typing of human tumors. This authoritative, concise reference book provides an international standard for oncologists and patholo-

gists and will serve as an indispensable guide for use in the design of studies monitoring response to therapy and clinical outcome.

Download is available at: http://bit.ly/sXskgk

Call for Articles for February/March Issue

500-700 words on any topic of public health importance

Do not include any graphs, tables and citations

PP size photo in jpeg format

email your articles to

[email protected] with the subject ‘article for PHP’

For more information:

http://www.bmhall.yolasite.com/information-for-contributors.php

OUR CAMPUS LIASIONS

APPLY FOR CAMPUS LIASION

Participation on the PHP team is an opportunity to get involved in PHP activities, develop and demonstrate leadership skills, as well

as work with some terrific colleagues. The campus Liaisons will have opportunities to shape the activities and strategic directions of

PHP. In addition, Liaisons serve as their college representative to the PHP by helping to: reporting news from their college in gen-

eral and the program of study in specific.

Serving as a campus liaison does not require a large time commitment. Campus liaisons distribute information, for example, by

speaking at new student orientations and to your student society or association about PHP. PHP will provide necessary materials

needed for this position. This position will also provide students with a unique opportunity to become more cognizant of health

news around the nation.

Being a campus liaison for PHP is a great way to demonstrate the team work ability with the professional development as campus

liaisons names and their colleges are mentioned in every issues of PHP.

If you are interested in participating as a Campus Liaison and have any questions about the Liaison position, please contact us.

Email: [email protected]

bit.ly/S64apE

http://bit.ly/sXskgk


http://www.bmhall.yolasite.com/information-for-contributors.php


Public Health Perspective (PHP) Team

January 2013


Dr. Santosh Raj Poudel

Residency (MD) in Inter-nal medicine

Interfaith Medical Cen-ter, New York

Dr. Krishna Chandra

Rijal Dept. of Otorhinolaryn-

gology and Head & Neck

Surgery, College of Medical Sciences and

Teaching Hospital Bharatpur, Chitwan

Mr. Chandra Bhushan

Yadav Information Officer

(MLIS)

Nepal Health Research Council (NHRC)

MOHP, Kathmandu

Contributing Writers

Dr. P. Ravi Shankar

Professor, Clinical Phar-macology & Medical Edu-

cation KIST Medical College

Lalitpur, Nepal.

Editorial Advisories

Dr. Duk Bahadur Chhetri

MD, Pathologist

Western Regional Hos-pital Lab.

Pokhara

Mr. Balram Banstola Managing Director,

Senior Pharmacist Banstola Medical Hall

Kaski

Board of Advisories

Ms. Sami Pande

B. Pharm, MPH Australian Leadership

Scholar, 2009

Kathmandu

Dr. Sitaram Khadka Pharm D, Pakistan

Birendra Hospital

Madan Kc Msc. Medical and

Health Care Devices

Uni. of Bolton, UK

Dr. Anis Rehman Associate Chief Editor at

Journal of Pakistan Medi-cal Students (JPMS)

HIFA 2015 Country Rep-resentative for Pakistan

Chief Executive Officer

Ashik Banstola M. Pharm

(Pharmacology), PDCR Rajiv Gandhi University

Bangalore

Newsletter Team

Editor-in Chief Amrit Banstola

Section Editors

Anoj Gurung Sandeep Pahari

Sangita Shrestha Subash Timilsina

International Honorary

Editorial Advisories

Ms. Rose Schneider --

RN MPH Chair of the Climate

Change Working Group

of the APHA Interna-tional Health Section.

Senior Health and HIV/AIDS Specialist

Health Systems Man-agement

1414 Perry Place NW - Suite 100

Washington, DC 20010

Dr. Margaret Steb-

bing PhD, Master of Public

Health, Dip App Sci Nursing

Population Health Aca-

demic School of Rural Health,

Monash University Australia

Welcome to New Subscribers

International

Itishree Trivedi

Jib Acharya

Nepal

Bishal Subedi

Mohan Shrestha

Nitu Gupta

Padam Darji

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 [email protected]


Public Health Perspective (PHP) Newsletter January 2013 Issue

Health & Medicine

Transcript of Public Health Perspective (PHP) Newsletter January 2013 Issue