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PH Important DayPublic HealthPublic Health Events

World Immunization Week 2017 #VaccinesWork

by Public Health Update April 28, 2017
written by Public Health Update
The last week of April each year is marked by WHO and partners as World Immunization Week. It aims to accelerate action to increase awareness and demand for immunization and improve vaccination delivery services so that people everywhere can be protected against deadly diseases.

In 2016, under the global slogan “Close the immunization gap”, the campaign focused on immunization for all throughout life. .More than 180 countries, territories and areas marked the week with activities including vaccination campaigns, training workshops, round-table discussions and public information campaigns. The theme for World Immunization Week 2017 is #VaccinesWork.

Theme: #VaccinesWork

World Immunization Week – celebrated in the last week of April – aims to promote the use of vaccines to protect people of all ages against disease. Immunization saves millions of lives and is widely recognized as one of the world’s most successful and cost-effective health interventions. Today, there are still 19.4 million unvaccinated and under-vaccinated children in the world.

#VaccinesWork to save lives
#VaccinesWork to fight diseases
#VaccinesWork to leave no one behind
#VaccinesWork to build a secure world 
#VaccinesWork. Let’s get to work

wiw banner

2017 Campaign objectives


The main goal of the campaign is to raise awareness about the critical importance of full immunization throughout life, and its role in achieving the 2030 Sustainable Development Goals.
As part of the 2017 campaign, WHO and partners aim to:



    • Immunization prevents illness, disability and death from vaccine-preventable diseases including cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis (whooping cough), pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
    • Highlight the importance of immunization as a top global health investment priority.
    • Promote understanding of the action steps required to achieve the Global Vaccine Action Plan.
    • Showcase immunization’s role in sustainable development and global health security.

      Why immunization matters now more than ever:
      Expanding access to immunization is crucial to achieving the Sustainable Development Goals. Routine immunization is a building block of strong primary health care and universal health coverage—it provides a point of contact for health care at the beginning of life and offers every child the chance at a healthy life from the start.
      Immunization is also a fundamental strategy in achieving other health priorities, from controlling viral hepatitis, to curbing antimicrobial resistance, to providing a platform for adolescent health and improving antenatal and newborn care.

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      Key facts
      Global vaccination coverage is generally holding steady.
      Uptake of new and underused vaccines is increasing.
      Immunization currently averts an estimated 2 to 3 million deaths every year. An additional 1.5 million deaths could be avoided, however, if global vaccination coverage improves.
      An estimated 19.4 million infants worldwide are still missing out on basic vaccines.

      NEPAL (NDHS 2016): 
      • 78% of children have received all basic vaccinations, and 38%
        have received all age-appropriate vaccinations.
      • Ninety-eight percent of children have received BCG.
      • 97% have received the first dose of pentavalent, and 98% have received polio 1.
      • Eighty-six percent and 88% of children have received the third doses of the pentavalent and polio vaccines, respectively.
      • Coverage of vaccination against measles rubella is 90%.
      • One percent of children in Nepal have not received any vaccinations.
      READ MORE: 
      • Nepal Demographic and Health Survey 2016 Key Indicators Report (Short Notes)
      • Nepal Demographic and Health Survey 2016 Key Indicators Report
      Original Links:

      • http://www.who.int/campaigns/immunization-week/2017/en/
      • http://www.who.int/mediacentre/factsheets/fs378/en/
      • http://www.who.int/en/


      April 28, 2017 0 comments
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      National Plan, Policy & GuidelinesPublic HealthPublic Health NotesPublic Health Programs

      Disease Control: Malaria (Background, Vision, Mission, Goals, Objectives & Target), Nepal

      by Public Health Update April 26, 2017
      written by Public Health Update
      Background: 
      Malaria control project in Nepal was first initiated in 1954 with the support from USAID (the then USOM), with the objective of controlling malaria, mainly in plain region (Terai belt) of central Nepal. 

      IMG 20170425 084743




      In 1958, national malaria eradication program was launched with the objective of eradicating malaria from the country. Due to various reasons the eradication concept reverted to control program in 1978. Following the call of WHO to revamp the malaria control programs in 1998, Roll Back Malaria (RBM) initiative was launched to control malaria transmission in hard‐core forests, foot‐hills, inner‐Terai and hill river valleys, which accounted for more than 70 % of the total malaria cases in the country. The high risk of acquiring the disease is attributed to the abundance of vector mosquitoes, mobile and vulnerable population, relative inaccessibility of the area, suitable temperature, environmental and socio‐economic factors. The recent micro‐stratification, based on number of malaria cases, geo‐ecology, vector breeding and vulnerability due to migration and population movements, further narrowed down the essentials to VDC level risks as compared to earlier district as units of risks. It has clearly shown that only 54 VDC’s are at high risk, 201 VDC’s at moderate risk and 999 VDC’s at low risk. Based on the micro‐stratification report 2013, approximately 13.02 million population (47.9%) live in malaria endemic areas (VDCS); out of which ~1 million (3.62%) live in high risk VDCs, 2.66 million (9.8%) live in moderate risk VDCs, and 9.38 million(34.52%) live in low risk VDCs. A total population of 14.13 (52.1%) is estimated to live in VDCs where there is no malaria transmission. The high risk areas consist of foothills with river belts, forest fringe areas in terai, hill river valleys, inner terai areas. Low risk VDCs lie in plain cultivated outer Terai, mountain, and valleys in the mountains.




      Nepal’s current National Malaria Strategic Plan (NMSP‐2014‐2025) has identified following vision, mission, goals and objectives:
      Vision: Malaria‐free Nepal in 2025
      Mission: To empower the health staff and the communities at risk of malaria to contribute towards the vision of malaria‐free Nepal in 2026.
      Goals:
      • To sustain zero death due to malaria from 2012 onwards;
      • To reduce the incidence of indigenous malaria cases by 90% by 2018 (relative to 2012);
      • To reduce no. of VDCs having indigenous malaria cases by 70% by 2018 (relative to 2012);
      • To receive WHO certification of malaria free status by 2025.
      Objective‐1: To enhance strategic information for decision making towards malaria
      elimination.
      Key targets / milestones:
      Ward‐wise risk stratified and appropriate/rational interventions executed: 
      • By the end of 2015, ward‐wise malaria risk micro‐stratification will be, so the intervention units could be wards in place of current VDC’s and earlier districts.

      Development and roll over of SMS and web based recording and reporting system for strengthening malaria surveillance, including suspected and confirmed cases reporting.

      • Introduction of Case based surveillance in all districts by the end of 2014.
      • All malaria cases will be recorded and reported through SMS and Web‐based MDIS by the end of 2015.
      • Establishment and expansion of Border check posts: 2 in 2014, 2 in 2015 and 3 in 2016 and continued thereafter.

      Quarterly review of the recorded data and plan interventions accordingly

      • Three quarterly reviews will be conducted and validation of data completed by the
      • end of each year.

      Foci investigation rolled out by the end of 2014

      • At least 54 foci will be investigated in 2014, 160 in 2015 and 100 each year after.
      • Investigated foci will be eliminated gradually and by the end of 2016 a total of 214
      • foci will be eliminated, sustained thereafter and gradually increased as per above
      • target.

      Number of operational research will be carried out generating evidence for policy making.


      Objective‐2: To further reduce malaria transmission and eliminate the foci.
      Key targets / milestones:
      Guideline for IVM developed and rolled over by the end of 2014 for implementation.
      Prevention using LLIN: Coverage of high risk VDC population through mass campaign and pregnant women in high and moderate risk VDCs through ANC visits.

      • 471,747 LLINs in 2014; 149,969 LLINs in 2015; 252,440 LLINs in 2016; 491,112 LLINs
      • in 2017 and 155,851 LLINs in 2018.
      Prevention using IRS: Regular annual spray covering people living in high risk every year and responsive spraying as indicated by foci investigation.
      • 88,444 households in 2014; 60,000 households in 2015 and 30,000 households in 2016.
      • Foci elimination and documentation of lessons learnt for prospective activities.
      • 54 in 2014; 160 in 2015 and 100 every year thereafter.
      Objective‐3: To improve quality of and access to early diagnosis and effective treatment of malaria.
      Key targets / milestones:
      Update the malaria diagnosis and treatment policy, manual and roll over its application by the end of 2014
      Development of training package on malaria case management: development and roll out by 2015
      Training on case management of malaria by 2015

      • FCHVs in remote VDCs to detect malaria using RDTs,
      • Training on malaria case management for public & private sector health care providers

      Expand and improve quality of malaria microscopy service‐continued annually

      • Finalize and roll over of the SOP on malaria microscopy
      • Establish slide banks for training and reference in malaria microscopy
      • Conduct internal competency assessment of malaria lab technicians and assistant
      • Conduct external competency assessment lab technicians and assistants
      • Conduct instructional skills development training for trainers in malaria microscopy
      • Basic and refresher training in microscopy
      • training in malaria microscopy
      • Training on preventive maintenance of microscopes
      • Supportive supervision and monitoring of malaria microscopists
      • Cross‐checking / validation of blood smears
      Expand the use of RDTs and set up QA QC of combo RDTs‐ by the end of 2015
      Procurement and supply of antimalarial drugs and diagnostics to avoid stock out
      • Regular monthly recording and reporting through FMIS/MDIS.
      • Annual health facility survey conducted to document no stock out of logistics.
      Objective‐4: To sustain support from the political leadership and the communities
      towards malaria elimination.
      Key targets / milestones:
      Develop and roll out of comprehensive BCC strategy by the end of 2015
      • Develop communication package to mobilize communities for malaria prevention
      Develop specific materials (print, audio and video) to improve the following behaviors: sleep under nets every night; seek early diagnosis and treatment for malaria, and adhere to treatment on malaria.
      Organize Multi‐sector advocacy meetings at national / district levels to support malaria elimination
      • Commemorate World Malaria Day: April 25.
      • Cross–border collaboration meetings annually for sharing the information and harmonizing interventions.
      Objective‐5: To strengthens programmatic technical and managerial capacities towards
      malaria elimination
      Key targets / milestones:
      • Training key program staffs in malariology, case management, entomology, health informatics, GIS mapping , malaria microscopy etc.‐ annual targets in annex‐ budget sheet 
      • Convene Malaria Technical Working Group; at least 3/yr
      • Periodically update the national malaria strategic plan: by the end of 2018, review and revise as necessary
      • Supervision, monitoring and evaluation: Annually as per M & E Plan.
      • Strengthen VBDRTC capacity in malaria training and research: Equipment provided and staffs deployed as necessary
      • Recruit and fill vacant positions at EDCD, VBDRTC, Regions and Districts: By the end of 2014, vacant positions will be filled and sustained there after
      • Strengthen partnership with WHO and other national/international institutions: Collaborative meetings, activities implemented
      DoHS, Annual Report 2071/72 (2014/2015) Disease Control: Malaria.


      April 26, 2017 0 comments
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      PH Important DayPublic Health

      End Malaria for Good – World Malaria Day 2017

      by Public Health Update April 26, 2017
      written by Public Health Update
      April 25
      World Malaria Day gives people the chance to promote or learn about the efforts made to prevent and reduce Malaria around the world. It is observed on April 25 each year.

      World Malaria Day is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control.



      IMG 20170425 084509


      IMG 20170425 084637



      IMG 20170425 084732


      IMG 20170425 084743


      IMG 20170425 084755


      IMG 20170425 084959


      IMG 20170425 085140


      IMG 20170425 100408
      Chief PHA Dinesh Kumar Chapagain, DPHO Kaski
      IMG 20170425 101003
      RHD, Dr. Taranath Poudel, WRHD


      A push for prevention
      This year’s global theme for World Malaria Day is End Malaria for Good. In the lead-up to 25 April, WHO is shining a spotlight on prevention, a critical strategy for reducing the toll of a disease that continues to kill more than 400 000 people annually.
      Since 2000, malaria prevention has played an important role in reducing cases and deaths, primarily through the scale up of insecticide-treated nets and indoor spraying with insecticides.

      WMD17 square cover

      The World Health Organization Regional Office for Africa (WHO/AFRO) announced that Ghana, Kenya, and Malawi will take part in a WHO-coordinated pilot implementation programme that will make the world’s first malaria vaccine available in selected areas, beginning in 2018.
      The injectable vaccine, RTS,S, was developed to protect young children from the most deadly form of malaria caused by Plasmodium falciparum. RTS,S will be assessed in the pilot programme as a complementary malaria control tool that could potentially be added to the core package of WHO-recommended measures for malaria prevention. WHO
       

      WMD17 square4 final

      Key facts
      • Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.
      • In 2015, 91 countries and areas had ongoing malaria transmission.
      • Malaria is preventable and curable, and increased efforts are dramatically reducing the malaria burden in many places.
      • Between 2010 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by 21% globally. In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 35% among children under 5.
      • The WHO African Region carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.


      NEPAL:

      Nepal has surpassed the Millennium Development Goal #6 by reducing malaria morbidity and mortality rates by more than 50% in 2010 as compared to 2000. Therefore, Government of Nepal has set a vision of Malaria free Nepal in 2025. Confirmed cases dropped from 2092 in FY 2069/70 to 1,352 in 2071/72. The proportion of P. falciparum infections has sharply increased and reached 20.26% in reporting year. There is a decreasing trend of confirmed case, case severity with sustaining zero death due to scaling up access to RDT and ACT to public health facilities, high coverage of LLINs in endemic districts and increased socio‐economic status of community people. There is rapid decreasing trend of indigenous PF, whereas slow decreasing trend of indigenous Plasmodium vivax cases indicates that P vivax may remain a challenge for malaria elimination in Nepal. (DoHS, Annual Report 2071/72 (2014/2015)
      Read Also: 
      Disease Control: Malaria (Background, Vision, Mission, Goals, Objectives & Target), Nepal


      Further reading:
      •  http://www.who.int/campaigns/malaria-day/2017/en/
      • http://www.who.int/malaria/media/world-malaria-report-2016/en/
      • http://www.who.int/mediacentre/factsheets/fs094/en

      April 26, 2017 0 comments
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      National Plan, Policy & GuidelinesPH Important DayPublic Health EventsResearch & Publication

      Standard Treatment Protocol for mental health services into the Primary Health Care System

      by Public Health Update April 6, 2017
      written by Public Health Update
      Depression
      There are many types of disorders of mood (emotion) like unipolar depression, bipolar affective disorder, etc. Among them, unipolar depression is a very common presentation in primary health care set-up. For the sake of simplicity, unipolar depression will be referred as depression from this point on. 

      depre
      Cover Page : Standard Treatment Protocol (STP) for Mental Health Services into the Primary Health Care System


      Core symptoms: 

      1. Depressed mood for most time of the day for most of the days 
      2. Loss of interest or pleasure in previously pleasurable activities 
      3. Easy fatigue or decreased energy 
      Other features: 
      1. Feelings of guilt 
      2. Feelings of worthlessness 
      3. Poor attention and concentration 
      4. Low confidence and self-esteem 
      5. Negative view of the future 
      6. Ideas or attempts of suicide 
      7. Poor sleep 
      8. Poor appetite 
      To diagnose a case of depression: At least 2 core symptoms and at least 3 other symptoms need to be present for at least 2 weeks.
      Rule out other physical conditions that can mimic symptoms like depression, such as anemia, malnutrition, thyroid disorders, and medication reaction (steroids, Oral Contraceptive Pills, statins, some anti-hypertensives). If any of these are present, manage them first before starting medication for depression. Refer when management for this condition is not possible from the health center. 
      Rule out the presence of manic episode in the past. If there are symptoms like extremely expansive, elated or irritable mood, increased activity and extreme talkativeness, flight of ideas, decreased need for sleep, grandiosity, extreme distractibility or reckless behavior for a duration of at least a week, mania should be suspected and the patient should be referred for further management. 

      Special considerations: 
      It is very common in general health clinics for patient with depression to present with multiple physical complaints like non-specific aches and pains, dizziness, tingling (jhamjham) sensation of body. Prescription of multi-vitamins without elaborate history taking is not fruitful for the patient.
      Depression can also be seen in children and old age population. These cases need to be referred whenever possible as special considerations need to be taken during management. If the symptoms of depression start during pregnancy, within a month of delivery of a child (post-partum depression) or in a lactating mother, they need to be referred for further management. When people are currently exposed to severe adversity (eg. grief), symptoms may be similar to depression, there should be impairment in daily functioning to make a diagnosis of depression. 
      Risk of suicide: 
      Risk of suicide needs to be assessed in every person suspected of having mental health issues. It should always be asked when depression is suspected as a large portion of suicide is caused due to underlying depression. It is not true that asking about suicide initiates a person to commit suicide. Always ask about suicidal ideas/thoughts, plan or previous suicide attempts. Inform family members about risk of suicide and ask for close monitoring of the patient, including removal of harmful objects. Serious risk of suicide is an indication for admission, so refer to a hospital with psychiatric care.



      Management of depression: 
      Note: Re-confirm that there is no past history of mania before starting antidepressants Management with antidepressants (SSRI- Selective Serotonin Reuptake inhibitor): 
      Capsule Fluoxetine 10 mg should be started in the morning, after food and increased to 20 mg after a week. Evaluate after 6 weeks and continue same dose if symptom of depression start decreasing. If there is no change in the symptoms even after 6 weeks, patient should be referred.
      For MBBS doctors: 
      Dose of Fluoxetine can be gradually increased by 10 mg every 6 weeks for a maximum up to 40 mg. It is important to wait for 6 weeks at every dose to assess the effectiveness of the dose. Refer if treatment seems ineffective even at 40 mg/day. 
      • When insomnia or severe restlessness is present: Add Tab. Diazepam 5mg PO HS along with fluoxetine. Decrease the dose to 2.5mg after 1 week and then stop Diazepam within 2 weeks. Do not give diazepam for more than 2 weeks.
      • Stop the medication and refer whenever there are symptoms of mania. 
      Total duration of treatment: Medication should be given for 9 more months after the symptoms improve significantly. Decrease the dose by 10 mg every 4 weeks and stop the medication. If symptoms restart, refer.
      Side effects of Fluoxetine: 
      Common Side effects Restlessness, nervousness, insomnia, anorexia gastrointestinal disturbances, headache, sexual dysfunction 
      Serious side –effects marked / prolonged akathisia , bleeding abnormalities in those who regularly use aspirin and other non-steroidal anti-inflammatory drug Refer in case of prolonged or serious side-effects. 
      Psychosocial management: 



      If symptoms are present but not enough to make a diagnosis of depression, psychosocial support itself may be enough for treatment. Even when medications are started, psychosocial support needs to be provided to the patient. Advice to patient and family members relating to depression: 
      1. Symptoms of depression are not a result of patient’s laziness or lack of effort. It is a disease and the symptoms cannot be controlled by patient’s will-power. 
      2. Mention of suicidal ideation should always be taken seriously and immediately followed up. 
      3. Patient should be encouraged to continue regular sleep routine and physical activity routine. 
      4. Patient should also be encouraged to take part in activities that they used to enjoy even if they do not currently do so. 
      5. Treatment is effective in most of the patients, but will take a few weeks to show the desired effects. 
      6. Ensure the intake of medications 

      Final%2BEdit1
      Addressing the current psychosocial stressors: 
      1. Provide the opportunity for the patient to talk about their current stressors. Ask them about their understanding of the cause of the stressors. 
      2. If there are issues of abuse, contact local centers/ resources to try to manage it. 
      3. Help the patient to cope with the current stressors. Involve the support system that the patient already has, such as- friends, family or local groups. 
      4. Encourage moderate physical activity (Example: 45 minute walk, 3 times a week). Find out the daily activity of the patient and advice physical activity accordingly. It can be started with shorter duration of activity which can gradually be increased. 
      Source: Standard Treatment Protocol (STP) for Mental Health Services into the Primary Health Care System



      Depression: let’s talk – 7 April 2017 | World Health Day
      Depression: let’s talk – 7 April 2017 | World Health Day
      Depression: let’s talk – 7 April 2017 | World Health Day





      April 6, 2017 0 comments
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      PH Important DayPublic HealthPublic Health Events

      Depression: let’s talk – 7 April 2017 | World Health Day

      by Public Health Update April 4, 2017
      written by Public Health Update
      World Health Day

      World Health Day, celebrated on 7 April every year to mark the anniversary of the founding of the World Health Organization, provides us with a unique opportunity to mobilize action around a specific health topic of concern to people all over the world.

      WHO 58e26d4bf420f


       


      The theme of our 2017 World Health Day campaign is depression.
      Slogan: Depression: let’s talk

      Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. At worst, depression can lead to suicide, now the second leading cause of death among 15-29-year olds.

      What is depression?

      Depression is an illness characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. In addition, people with depression normally have several of the following symptoms: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.

      Overarching messages

      • Depression is a common mental disorder that affects people of all ages, from all walks of life, in all countries.
      • The risk of becoming depressed is increased by poverty, unemployment, life events such as the death of a loved one or a relationship break-up, physical illness and problems caused by alcohol and drug use.
      • Depression causes mental anguish and can impact on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends.
      • Untreated depression can prevent people from working and participating in family and community life.
      • At worst, depression can lead to suicide.
      • Depression can be effectively prevented and treated. Treatment usually involves either a talking therapy or antidepressant medication or a combination of these.
      • Overcoming the stigma often associated with depression will lead to more people getting help.
      • Talking with people you trust can be a first step towards recovery from depression.
      http://www.who.int/campaigns/world-health-day/2017/event/en/



      Key facts (Fact sheet Updated February 2017)

      • Depression is a common mental disorder. Globally, more than 300 million people of all ages suffer from depression.
      • Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.
      • More women are affected by depression than men.
      • At its worst, depression can lead to suicide.
      • There are effective treatments for depression.
      WORLD HEALTH ORGANIZATION
      JOIN CAMPAIGN NOW
      Related: Standard Treatment Protocol (STP) for Mental Health Services into the Primary Health Care System
      Depression: let’s talk – 7 April 2017  | World Health Day

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      International Plan, Policy & GuidelinesPublic Health Programs

      Microplanning for immunization service delivery using the Reaching Every District (RED) strategy

      by Public Health Update April 3, 2017
      written by Public Health Update

      The RED strategy

      ‘Reaching Every District’ (RED) is the name given to a strategy of district capacity building to address common obstacles to increasing immunization coverage, with a focus on planning and monitoring.

      RED poster1
      DOWNLOAD WHO :RED Strategy

      The first steps in developing the RED strategy were taken in July 2002 at a meeting of immunization partners, who identified common obstacles and ways to improve access to immunization, in order to achieve the global immunization goal 80% coverage in all districts, and 90% nationally by 2010.





      Description of the five RED operational components

      1. Re-establishing outreach services
      In many countries a large proportion of the population can only be reached regularly though outreach sessions. Outreach is any delivery strategy that requires health facility staff to leave their facility to deliver immunization. Ideally a minimum of four contacts per year are required to fully immunize an infant. For some communities, access can only be provided irregularly, and may require mobile teams to provide outreach, which will involve resources beyond the health facility and district level. Outreach sessions, especially mobile teams present opportunities to provide other interventions with immunization.



      2. Supportive supervision
      Supportive supervision implies providing on site training to health workers at the time of a supervisory visit, or at regular district meetings. To be supportive, supervisors should make regular schedules for visits, help to solve problems locally and follow up regularly with supply and resource issues. Supervisors will themselves need training to adapt their own approaches to supervision.
      3. Linking services with communities
      Involving the community with the planning and delivery of the service will encourage community ownership and improve attendance. Identifying community volunteers providing them with a role, such as follow up of defaulters, and holding regular meetings is an important step towards building a link with the community.
      4. Monitoring and use of data for action
      Monitoring and use of data for action implies not only the timely collection of data at district level, but the use of the data to solve problems. Some simple tools, including wall charts that display access and utilization need little training, but are very useful to take action according to monthly progress. Not only do districts collect coverage data, but also a large amount of other information, including logistics, supply, surveillance, all of which should be used to improve the immunization system. Some qualitative data may not be available in regular reports and may need to collected though supervisory visits.



      5. Planning and
      management of resources
      The district micro plan is the key to the RED strategy. The micro plan should be based upon a local situation analysis which involves every health facility and through them the community that they serve. At the national level, there is a responsibility to ensure the needed financial and human resources are available to the district, while the district must ensure the resources are efficiently used, through regular monitoring and adjusting the micro plan. Continuing to fund the RED strategy for more than the first year of implementation is vital for sustainability of coverage increase.
      There are 10 steps to making a health facility microplan:
      • STEP 1: Quantitative analysis of local immunization data 
      • STEP 2: Preparing and reviewing an operational map 
      • STEP 3: Identifying special activities for the hard-to-reach and problem areas 
      • STEP 4: Preparing a health facility session plan 
      • STEP 5: Problem solving using the RED strategy 
      • STEP 6: Making a workplan for one quarter 
      • STEP 7: Using a monitoring chart 
      • STEP 8: Working with the community and tracking defaulters 
      • STEP 9: Managing supplies 
      • STEP 10: Making use of the monthly report
      There are six steps to making a district microplan by putting together all the health facility microplans: 
      STEP 1: Analyses of district level data to identify priority areas 
      STEP 2: Making a map to show all health facilities and outreach sites 
      STEP 3: Making a district workplan 
      STEP 4: Making an estimate of resource requirements 
      STEP 5: Conducting regular monitoring and review of progress
      STEP 6: Taking action based on a review of progress
      Source of info DOWNLOAD WHO :RED Strategy





      April 3, 2017 0 comments
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      PH Important Day

      World Autism Awareness Day 2017: "Toward Autonomy and Self-Determination"

      by Public Health Update April 2, 2017
      written by Public Health Update
      Autism is a lifelong neurological condition that manifests during early childhood, irrespective of gender, race or socio-economic status. The term Autism Spectrum refers to a range of characteristics. Appropriate support, accommodation and acceptance of this neurological variation allow those on the Spectrum to enjoy equal opportunity, and full and effective participation in society. 

      430264 10150655451958548 181152395 n



      Autism is mainly characterized by its unique social interactions, non-standard ways of learning, keen interests in specific subjects, inclination to routines, challenges in typical communications and particular ways of processing sensory information. 

      The rate of autism in all regions of the world is high and the lack of understanding has a tremendous impact on the individuals, their families and communities.
      The stigmatization and discrimination associated with neurological differences remain substantial obstacles to diagnosis and therapies, an issue that must be addressed by both public policy-makers in developing nations, as well as donor countries.
      Throughout its history, the United Nations family has celebrated diversity and promoted the rights and well-being of persons with disabilities, including children with learning differences and developmental disabilities. In 2008, the Convention on the Rights of Persons with Disabilities entered into force, reaffirming the fundamental principle of universal human rights for all. Its purpose is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. It is a solid tool to foster an inclusive and caring society for all and to ensure that all children and adults with autism can lead full and meaningful lives.
      UN

      The United Nations General Assembly unanimously declared 2 April as World Autism Awareness Day to highlight the need to help improve the quality of life of those with autism so they can lead full and meaningful lives as an integral part of society.
       Theme for World Autism Awareness Day 2017: “Toward Autonomy and Self-Determination”

      Autism spectrum disorders
      Fact sheet (January 2016)


       Key facts

      • 1 in 160 children has an autism spectrum disorder (ASD).
      • ASD begin in childhood but tend to persist into adolescence and adulthood.
      • While some people with ASD are able to live independent and productive lives, others have severe disabilities and require life-long care and support.
      • Evidence-based psychosocial interventions, such as behavioural treatment, can reduce difficulties in communication and social behaviour, with a positive impact on wellbeing and quality of life.
      • Interventions targeting people with ASD need to be accompanied by broader actions for making physical, social and attitudinal environments more accessible, inclusive and supportive.
      • Worldwide, people with ASD are often subject to stigma, discrimination and human rights violations. Globally, access to services and support for people with ASD is inadequate.

      World Health Organization





      April 2, 2017 0 comments
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      National Plan, Policy & GuidelinesPublic Health NotesPublic Health Programs

      National Tuberculosis Programme, NEPAL

      by Public Health Update March 23, 2017
      written by Public Health Update
      Tuberculosis (TB) remains as a public health problem in Nepal, as it is responsible for ill health among thousands of people each year. TB also ranks as the sixth leading cause of death in the country. During this reporting year, NTP registered 34,121 TB cases.



      Among them 15,655 (46%) were new smear positive TB cases, 2,202 (6%) were smear positive retreatment cases, 6,686 (20%) were sputum smear negative and 8,966 (26%) were extra‐pulmonary TB cases. Out of total registered cases in NTP, there were 12,300 (36%) female and 21,821 (64%) male. According to the latest WHO data published in May 2014, tuberculosis deaths in Nepal reached 5,506. This is 3.5% of total deaths. The age adjusted death rate is 27.80 per 100,000 of population. This ranks Nepal as 43 in the world. 

      WHO HQ Reports G2 PROD EXT TBCountryProfile1
      The majority of TB cases and deaths occur among men, the burden of disease among women seems significantly lower (2:1). TB mortality is unacceptably high given that most deaths are preventable if people can access tuberculosis care for diagnosis and the correct treatment is provided. Short‐course regimens of first‐line drugs that can cure around 90% of all cases (Treatment success rate reported in 2014/15) have been recorded for a decade. National Tuberculosis Program has adopted the global STOP TB Strategy and Million Development Goals (MDGs) as TB control strategy of the country Tuberculosis (TB), a major public health problem of Nepal infected About 45 percent of the total population. Every year, about 45,000 people develop active TB, out of them 20,000 have infectious pulmonary disease and that are able to spread the disease to others. Treatment by Directly Observed Treatment Short course (DOTS) has reduced the number of deaths. DOTS have successfully been implemented throughout the country since April 2001.




      A total of 4244 DOTS treatment centers are providing TB treatment service. Expansion of this cost effective and highly successful treatment strategy has proven its efficacy in reducing the mortality and morbidity in Nepal. The NTP has coordinated with the public sectors, private sectors, local government bodies, I/NGOs, social workers, educational sectors and other sectors of society in order to sustain the present significant results achieved by National Tuberculosis Program (NTP).

      Vision: 
      Tuberculosis free Nepal
      Goal: 
      To reduce mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem
      Objectives:
      • To dramatically reduce the National burden of TB by 2015 in line with the Millennium Development Goals and the Stop TB Partnership targets
      • Achieve universal access to high‐quality diagnosis and patient‐centered treatment
      • Reduce the human suffering and socioeconomic burden associated with TB
      • Protect poor and vulnerable populations from TB, TB/HIV and multi‐drug‐resistant TB
      Targets:
      • MDG 6, Target 8: …halted by 2015 and begun to reverse the incidence.
      • Targets linked to the MDGs and endorsed by the Stop TB Partnership:
      1. By 2005: detect 100% of new sputum smear‐positive TB cases and cure at least 85%of these cases.
      2. By 2015: reduce prevalence of and death due to TB by 50% relative to 1990.
      3. By 2050: eliminate TB as a public health problem (<1 case per million population).
      Components of the Stop TB strategy
      1. Pursue high‐quality DOTS expansion &enhancement
      • Political commitment with increased and sustained financing
      • Case detection through quality‐assured bacteriology
      • Standardized treatment with supervision and patient support
      • An effective drug supply and management system
      • Monitoring and evaluation system, and impact measurement


      2. Address TB/HIV, DR‐TB and other challenges

      • Implement collaborative TB/HIV activities
      • Prevent and control multi‐drug‐resistant TB
      • Address prisoners, refugees and other high‐risk groups and special situations
      3. Contribute to health system strengthening
      • Actively participate in efforts to improve system‐wide policy, human resources, financing,management, service delivery, and information systems
      • Share innovations that strengthen systems, including the Practical Approach to Lung Health (PAL)
      • Adapt innovations from other fields
      4. Engage all care providers
      • Public‐Public, and Public‐Private Mix (PPM) approaches
      • International Standards for Tuberculosis Care (ISTC)




      5. Empower people with TB, and communities

      • Advocacy, communication and social mobilization
      • Community participation in TB care
      • Patients’ Charter for Tuberculosis Care
      6. Enable and promote research
      • Programme‐based operational research
      DoHS, Annual Report 2071/72 (2014/2015)
      END%2BTB
      END TB STRATEGY (WHO)
      World TB Day 2017 – Unite efforts to leave no one behind #UnitetoEndTB
      March 23, 2017 0 comments
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      PH Important Day

      World TB Day 2017 – Unite efforts to leave no one behind #UnitetoEndTB

      by Public Health Update March 23, 2017
      written by Public Health Update
      World TB Day, falling on March 24th each year, is designed to build public awareness that tuberculosis today remains an epidemic in much of the world, causing the deaths of nearly one-and-a-half million people each year, mostly in developing countries. It commemorates the day in 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus. At the time of Koch’s announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people. Koch’s discovery opened the way towards diagnosing and curing TB.

      WTBD2017 CallToActionLogo2 RGB

      This year, we commemorate the 135th anniversary of Dr Robert Koch’s announcement in 1882 of his discovery of the TB bacillus, the cause of tuberculosis. His groundbreaking research opened the way toward diagnosing and curing this disease.




      World TB Day is an opportunity for people everywhere to join this fight by helping to educate others about TB and by urging governments to take action.

      http://www.stoptb.org
      Key facts
      • Tuberculosis (TB) is one of the top 10 causes of death worldwide.
      • In 2015, 10.4 million people fell ill with TB and 1.8 million died from the disease (including 0.4 million among people with HIV). Over 95% of TB deaths occur in low- and middle-income countries.
      • Six countries account for 60% of the total, with India leading the count, followed by Indonesia, China, Nigeria, Pakistan and South Africa.
      • In 2015, an estimated 1 million children became ill with TB and 170 000 children died of TB (excluding children with HIV).
      • TB is a leading killer of HIV-positive people: in 2015, 35% of HIV deaths were due to TB.
      • Globally in 2015, an estimated 480 000 people developed multidrug-resistant TB (MDR-TB).
      • TB incidence has fallen by an average of 1.5% per year since 2000. This needs to accelerate to a 4–5% annual decline to reach the 2020 milestones of the “End TB Strategy”.
      • An estimated 49 million lives were saved through TB diagnosis and treatment between 2000 and 2015.
      • Ending the TB epidemic by 2030 is among the health targets of the newly adopted Sustainable Development Goals.
      World Health Organization
      end%2Btb%2Bstary
      DOWNLOAD 







      National Tuberculosis Programme, NEPAL
      March 23, 2017 0 comments
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      PH Important Day

      World Water Day 2017 : Why waste water?

      by Public Health Update March 22, 2017
      written by Public Health Update
      World Water Day, on 22 March every year, is about taking action to tackle the water crisis. Today, there are over 663 million people living without a safe water supply close to home, spending countless hours queuing or trekking to distant sources, and coping with the health impacts of using contaminated water. This year’s theme: Why waste water? in support of SDG 6.3 on improving water quality and reducing, treating and reusing wastewater. 

      WWD GENERIQ CMJN hindi 2017 square 01

      Globally, the vast majority of all the wastewater from our homes, cities, industry and agriculture flows back to nature without being treated or reused – polluting drinking and bathing and irrigation and losing valuable nutrients and other recoverable materials.



      Reducing and safely treating and reusing wastewater, for example in agriculture and aquaculture, protects worker, farmers and consumers promotes food security, health and well-being.
                                                                                        WHO
      READ MORE  (Why waste water? )

      http://www.unwater.org
      http://www.worldwaterday.org

      Water and health
      Contaminated water and poor sanitation are linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and polio. Absent, inadequate, or inappropriately managed water and sanitation services expose individuals to preventable health risks. This is particularly the case in health care facilities where both patients and staff are placed at additional risk of infection and disease when water, sanitation and hygiene services are lacking. Globally, 15% of patients develop an infection during a hospital stay, with the proportion much greater in low-income countries.


      Inadequate management of urban, industrial and agricultural wastewater means the drinking-water of hundreds of millions of people is dangerously contaminated or chemically polluted.
      Some 842000 people are estimated to die each year from diarrhoea as a result of unsafe drinking-water, sanitation and hand hygiene. But diarrhoea is largely preventable, and the deaths of 361 000 children aged under 5 each year could be avoided each year if these risk factors were addressed. Where water is not readily available, people may decide handwashing is not a priority, thereby adding to the likelihood of diarrhoea and other diseases.
      Diarrhoea is the most widely known disease linked to contaminated food and water but there are other hazards. Almost 240 million people are affected by schistosomiasis – an acute and chronic disease caused by parasitic worms contracted through exposure to infested water.
      In many parts of the world, insects that live or breed in water carry and transmit diseases such as dengue fever. Some of these insects, known as vectors, breed in clean, rather than dirty water, and household drinking-water containers can serve as breeding grounds. The simple intervention of covering water storage containers can reduce vector breeding and may also have a co-benefit of reducing faecal contamination of water at the household level.
      WHO





      March 22, 2017 0 comments
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