Public Health

Zika Virus International Emergency- WHO

by Public Health Update
written by Public Health Update
Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific.
Genre: Flavivirus
Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
Reservoir: Unknown
Transmission
Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. This is the same mosquito that transmits dengue, chikungunya and yellow fever.
Zika virus disease outbreaks were reported for the first time from the Pacific in 2007 and 2013 (Yap and French Polynesia, respectively), and in 2015 from the Americas (Brazil and Colombia) and Africa (Cape Verde). In addition, more than 13 countries in the Americas have reported sporadic Zika virus infections indicating rapid geographic expansion of Zika virus. READ MORE

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The Himalayantimes (2/3/2016)

Capture
Kantipur (2/3/2016)


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PH Important DayPublic HealthPublic Health Notes

February: National Iodine Month (Prevention and Control of Iodine Deficiency Disorder)

by Public Health Update
written by Public Health Update
The government is observing February as National Iodine Month with an aim of creating awareness among people about consumption of iodized salt.
Iodine is an essential element for thyroid function, necessary for the normal growth, development and functioning of the brain and body.
It also influences a variety of metabolic processes in the body (converting food to energy, regulating growth and fertility, and maintaining body temperature).


Nepal ENPHO Iodized Salt


Highlights
NATIONAL NUTRITION POLICY 2004

IDD 

Objective 3: To virtually eliminate iodine deficiency disorders and sustain the elimination.
Target 1: To virtually eliminate iodine deficiency disorders by the year 2017.

Strategies for Control of Iodine Deficiency Disorders (National Nutrition Program)

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  • Strengthen the implementation of Iodized Salt Act, 2055 for regulation and monitoring of iodized salt trade to ensure that all edible salt is iodized
  • Encourage better storage practices to prevent iodine loss
  • Ensure systematic monitoring of iodized salt
  • Increase the accessibility and market share of iodized packet salt with ‘two‐child’ logo
  • Create awareness about the importance of use of iodized salt for the control of IDD through social marketing campaign
  • Develop IDD monitoring system and implement the monitoring survey at national level

Prevention and Control of Iodine Deficiency Disorder

A policy to fortify all edible salt with iodine in Nepal was adopted by MoHP in 1973. A social marketing campaign along with celebration of the month of February as “Iodine Month” continues to raise awareness about the government endorsed “two‐child‐logo” packaged salt for consumption of adequately iodized salt at household level.The Five Year National Plan of Action to achieve optimal Iodine Nutrition in Nepal: 2015‐2019 prioritized Universal Salt Iodization (USI) as the primary intervention to improve iodine status while reducing reliance on iodine supplementation, which had been in place earlier. The plan focused on creating the necessary infrastructure that could provide a foundation for sustaining achievements. The plan outlines the key successes, further strengthening critical program elements and incorporating lessons from other countries where USI programs are maturing.

This year, a social campaign was successfully conducted in Achham and Doti of the Far‐Western Hills where DHS data has shown the lowest coverage for the household consumption of iodized salt. The major activities carried out were: Iodine tests in those VDCs, orientation to FCHVs, and conduction of IDD classes, street drama show, and community level orientation.

DoHS, Annual Report 2070/71 (2013/2014)


Important Points
  • Nepal Demographic Health Survey-2011 shows that about 80 per cent of Nepali households have access to iodised salt.
  • Iodine deficiency, which leads to decline in cognitive capacity and brain damage, is most lethal to foetuses and young children. Inadequate consumption of iodine increases chances of miscarriage and stillbirth.
  • According to the UNICEF, 30 per cent of the households in the developing world are not consuming iodised salt and 41 million infants and newborns are at the risk of iodine deficiency.
  • The national survey to study the impact of iodine deficiency and availability of iodised Salt in Nepal-2007 found that 23 per cent of Nepali households were still consuming salt with inadequate iodine content.
  • The survey further found that 84.2 per cent of the salt being sold at retail outlets around the country contained iodine.  only 67.8 per cent salt in retail stores had iodine content more than the recommended 30 parts per million (ppm). The survey stated that Nepal’s ecological and biophysical conditions have made Nepalis more susceptible to iodine deficiency.


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PH Important DayPublic HealthPublic Health Notes

World Leprosy Day (63rd) : 'To live is to help to live'

by Public Health Update
written by Public Health Update
World Leprosy Day takes place on the last Sunday in January, The day aims to raise awareness of a disease that many people believe to be extinct. It was chosen by French humanitarian Raoul Follereau in 1953. Leprosy is an infectious disease of the skin and nerves which, if not diagnosed and treated quickly, can result in debilitating disabilities. The effects of leprosy are exacerbated by the negative stigma surrounding the disease.


The theme of World Leprosy Day 2016 is’To live is to help to live’.It is a 63rd World Leprosy Day. Leprosy is one of the Neglected tropical diseases.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes, apart from some other structures. Leprosy has afflicted humanity since time immemorial. It once affected every continent and it has left behind a terrifying image in history and human memory – of mutilation, rejection and exclusion from society.

Situation of Leprosy in Nepal
During the FY 2070/71 a total number of 3,223 new leprosy cases were detected and were put under MDT and 2,271 cases were under treatment at the end of the fiscal year. At the end of FY 2070/71 there were 2,271 leprosy cases receiving MDT in the country, which makes the registered prevalence rate of 0.83/10,000 populations at national level. This rate is well below the cut‐off point of <1 /10,000 population. 109 cases of visible disability (G2D) were recorded in the fiscal year 2070/71.
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(Annual Report 2071/71 DOHS)
Evolution and milestones of leprosy control program in Nepal
leprosy
Gorkhapatra Daily (1/31/2016)
  • 1960 ‐Leprosy survey by Government of Nepal (GoN) in collaboration with World Health Organization (WHO).

  • 1966 ‐Pilot project to control leprosy launched with Dapsone monotherapy.
  • 1982 ‐Introduction of Multi Drug Therapy (MDT) in leprosy control program.
  • 1987 ‐Integration of vertically shaped leprosy control program into general basic health services.
  • 1991 ‐National leprosy elimination goal was set.
  • 1995 ‐Focal persons (TB and Leprosy Assistants‐TLAs) for districts & regions appointed.
  • 1996 ‐All 75 districts were brought on MDT
  • 1999/2000‐
  • 2001/02
  • Two rounds of National Leprosy Elimination Campaign (NLEC) were implemented.
  • 2008 ‐Intensive efforts made for achieving elimination at national level
  • 2009 ‐Leprosy elimination achieved at national level
  • 2010 ‐Elimination at national level declared
  • 2011 ‐National strategy was introduced
  •        – National guidelines was revised
  • 2012‐2013 ‐Elimination sustained at national level
  • 2013‐2014 ‐Mid Term Evaluation on Strategy 2011‐2015




Disease Control: LEPROSY
Targets
  • Reduce New Case Detection Rate (NCDR) by 25 % at national level by the end of 2015 in comparison to 2010

  • Reduce Prevalence Rate (PR) by 35 % at national level by the end of 2015 in comparison to 2010
  • Reduce by 35% Grade 2 disability (G2D) amongst newly detected cases per 100,000 population by the end of 2015 in comparison to 2010

  1.  Additional deformity during treatment <5% by eyes, hands and feet (EHF)         score

  2.  80% health workers are able to recognize and manage /refer                   reaction/complications
  3. Promote prevention of disability in leprosy(POD) and Self care

These targets will be revised after midterm evaluation.


Globally WHO has guided to reduce the burden due to Leprosy and Bangkok declaration has committed to reduce the G2D below 1/1 million and to increase the resources for leprosy, early diagnosis awareness to reduce stigma and rehabilitation in partnership approach. 

Goal
Reduce further the burden of leprosy and to break channel of transmission of leprosy from person to
persons by providing quality service to all affected community.
Objectives
  1. To eliminate leprosy (Prevalence Rate below 1 per 10,000 population) and further reduce disease burden at district level.

  2. To reduce disability due to leprosy.
  3. To reduce stigma in the community against leprosy.
  4. To provide high quality service for all persons affected by leprosy.5. To integrate leprosy in the integrated health care delivery set‐up for provision of quality services. 
    leprosyy
    Kantipur (2/1/2016)

Strategies
The new national strategy has envisioned delivering quality leprosy services through seventeen strategic
areas including greater participation and meaningful involvement of people affected by leprosy and
right based approaches in leprosy services broadly they are categorized into 10 which are as follows:
  1. Early new case detection and their timely and complete management

  2. Quality leprosy services in an integrated setup by qualified health workers
  3. Prevention of leprosy associated impairment and disability
  4. Rehabilitation of people affected by leprosy, including medical and community based rehabilitation
  5. Reduce stigma and discrimination through advocacy, social mobilization and IEC activities and address gender equality and social inclusion.
  6. Strengthen referral centers for complications management
  7. Meaningful involvement of people affected by leprosy in leprosy services, and address human right issues
  8. Promote and conduct operational researches/studies
  9. Monitoring, supportive supervision including onsite coaching, surveillance and evaluation to ensure/strengthen quality leprosy services
  10. Strengthen partnership, co‐operation and coordination with local government, external development partners, civil society and community based organizations.

Source: DoHS, Annual Report 2070/71 (2013/2014)
Other sources:


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    Public Health

    Zika virus: Emerging mosquito-borne virus in Public Health

    by Public Health Update
    written by Public Health Update
    Zika virus
    Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific.
    Genre: Flavivirus
    Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
    Reservoir: Unknown
    Transmission
    Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. This is the same mosquito that transmits dengue, chikungunya and yellow fever.
    Zika virus disease outbreaks were reported for the first time from the Pacific in 2007 and 2013 (Yap and French Polynesia, respectively), and in 2015 from the Americas (Brazil and Colombia) and Africa (Cape Verde). In addition, more than 13 countries in the Americas have reported sporadic Zika virus infections indicating rapid geographic expansion of Zika virus.

    The incubation period (the time from exposure to symptoms) of Zika virus disease is not clear, but is likely to be a few days. The symptoms are similar to other arbovirus infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache. These symptoms are usually mild and last for 2-7 days.
    Diagnosis
    Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples. Diagnosis by serology can be difficult as the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow fever.

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    Prevention
    Mosquitoes and their breeding sites pose a significant risk factor for Zika virus infection. Prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people.
    This can be done by using insect repellent; wearing clothes (preferably light-coloured) that cover as much of the body as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets. It is also important to empty, clean or cover containers that can hold water such as buckets, flower pots or tyres, so that places where mosquitoes can breed are removed.
    Special attention and help should be given to those who may not be able to protect themselves adequately, such as young children, the sick or elderly.
    During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.
    Travellers should take the basic precautions described above to protect themselves from mosquito bites.
    Treatment
    Zika virus disease is usually relatively mild and requires no specific treatment. People sick with Zika virus should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available.

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    Public Health

    6 Recommendations of ECHO to reversing the rising trend of childhood obesity and overweight

    by Public Health Update
    written by Public Health Update
    25 January 2016

    World Health Organization

    The Commission on Ending Childhood Obesity (ECHO) presented its final report to the WHO Director-General today, culminating a two-year process to address the alarming levels of childhood obesity and overweight globally.


    According to the report, many children are growing up today in environments encouraging weight gain and obesity. Driven by globalization and urbanization, exposure to unhealthy (obesogneic) environments is increasing in high-, middle- and low-income countries and across all socioeconomic groups. The marketing of unhealthy foods and non-alcoholic beverages was identified as a major factor in the increase in numbers of children being overweight and obese, particularly in the developing world.

    The ECHO report proposes a range of recommendations for governments aimed at reversing the rising trend of children aged under 5 years becoming overweight and obese. 
    At least 41 million children in this age group are obese or overweight, with the greatest rise in the number of children being obese or overweight coming from low- and middle-income countries.

    echo recommendations
    Overweight prevalence among children aged under 5 years has risen between 1990 and 2014, from 4.8% to 6.1%, with numbers of affected children rising from 31 million to 41 million during that time. The number of overweight children in lower middle-income countries has more than doubled over that period, from 7.5 million to 15.5 million.





    In 2014, almost half (48%) of all overweight and obese children aged under 5 lived in Asia and one-quarter (25%) in Africa. The number of overweight children aged under 5 in Africa has nearly doubled since 1990 (5.4 million to 10.3 million).

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    Public Health

    “GBV Not Only a Societal Problem, a Public Health Problem Too”- WHO

    by Public Health Update
    written by Public Health Update
    Late Post
    At a WHO-sponsored event in Kathmandu organized as a part of ‘16 days of activism against gender based violence’ (GBV) from 25 November to 10 December, WHO Nepal’s Dr Akjemal Magtymova emphasized the public health dimensions of GBV and reiterated WHO’s commitment to help end the problem. 

    “Violence against women is not only a societal problem, it is a public health problem too as it can have lasting physical and psychological effects. Strengthening health systems to address GBV is an important part of WHO’s support to its member states,” she said. 



    According to Dr Magtymova, the problem of GBV – both at a global and local level – is significant. “While every third woman experiences physical or sexual violence globally, the burden in WHO’s South-East Asia Region is almost 38%, higher than the world average. In Nepal, as per 2011 data, 22% of women of reproductive age had experienced physical violence at least once since the age of 15, and 12% had experienced sexual violence at least once in their lifetime. The majority of victims never sought help,” she said.
    While Dr Magtymova stressed the importance of high-level tools to help stem GBV – including World Health Assembly Resolution WHA67.15, which urges states to strengthen the role of the health system in addressing violence, in particular against women, girls and children – she said awareness-raising and advocacy efforts are needed to convert these into systemic and behavioral change. “Advocacy events such as this are crucial in disseminating positive messages to the youth, as well as sensitizing policymakers to the ways in which public health institutions can help end GBV,” she said. “As public health advocates we have a duty to effect change. We take that duty seriously.”
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    Public Health

    Latest Ebola outbreak over in Liberia; West Africa is at zero, but new flare-ups are likely to occur -WHO

    by Public Health Update
    written by Public Health Update
    14 JANUARY 2016 | LIBERIA – Today, WHO declares the end of the most recent outbreak of Ebola virus disease in Liberia and says all known chains of transmission have been stopped in West Africa. But the Organization says the job is not over, more flare-ups are expected and that strong surveillance and response systems will be critical in the months to come.


    �
    Liberia was first declared free of Ebola transmission in May 2015, but the virus was re-introduced twice since then, with the latest flare-up in November. Today’s announcement comes 42 days (two 21-day incubation cycles of the virus) after the last confirmed patient in Liberia tested negative for the disease 2 times.
    All 3 countries at zero
    “WHO commends Liberia’s government and people on their effective response to this recent re-emergence of Ebola,” says Dr Alex Gasasira, WHO Representative in Liberia. “The rapid cessation of the flare-up is a concrete demonstration of the government’s strengthened capacity to manage disease outbreaks. WHO will continue to support Liberia in its effort to prevent, detect and respond to suspected cases.”
    This date marks the first time since the start of the epidemic 2 years ago that all 3 of the hardest-hit countries—Guinea, Liberia and Sierra Leone—have reported 0 cases for at least 42 days. Sierra Leone was declared free of Ebola transmission on 7 November 2015 and Guinea on 29 December.
    9k=
    “Detecting and breaking every chain of transmission has been a monumental achievement,” says Dr Margaret Chan, WHO Director-General. “So much was needed and so much was accomplished by national authorities, heroic health workers, civil society, local and international organizations and generous partners. But our work is not done and vigilance is necessary to prevent new outbreaks.”
    Vigilance needs to be maintained


    �
    WHO cautions that the 3 countries remain at high risk of additional small outbreaks of Ebola, like the most recent one in Liberia. To date, 10 such flare-ups have been identified that were not part of the original outbreak, and are likely the result of the virus persisting in survivors even after recovery. Evidence shows that the virus disappears relatively quickly from survivors, but can remain in the semen of a small number of male survivors for as long as 1 year, and in rare instances, be transmitted to intimate partners.
    “We are now at a critical period in the Ebola epidemic as we move from managing cases and patients to managing the residual risk of new infections,” says Dr Bruce Aylward, WHO’s Special Representative for the Ebola Response. “The risk of re-introduction of infection is diminishing as the virus gradually clears from the survivor population, but we still anticipate more flare-ups and must be prepared for them. A massive effort is underway to ensure robust prevention, surveillance and response capacity across all three countries by the end of March.”
    WHO and partners are working with the Governments of Guinea, Liberia and Sierra Leone to help ensure that survivors have access to medical and psychosocial care and screening for persistent virus, as well as counselling and education to help them reintegrate into family and community life, reduce stigma and minimize the risk of Ebola virus transmission.
    The Ebola epidemic claimed the lives of more than 11 300 people and infected over 28 500. The disease wrought devastation to families, communities and the health and economic systems of all 3 countries.

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    MiscellaneousPublic Health Notes

    Human Development Report -2015

    by Public Health Update
    written by Public Health Update
    Human Development Index (HDI): A composite index measuring average achievement in three basic dimensions of human development—a long and healthy life, knowledge and a decent standard of living. 
    See Technical note 1 at http://hdr.undp.org/sites/default/files/hdr2015_technical_notes.pdf for details on how the HDI is calculated.
    HHH

    Life expectancy at birth: Number of years a newborn infant could expect to live if prevailing patterns of age-specific mortality rates at the time of birth stay the same throughout the infant’s life.

    Expected years of schooling: Number of years of schooling that a child of school entrance age can expect to receive if prevailing patterns of age-specific enrollment rates persist throughout the child’s life.

    Mean years of schooling: Average number of years of education received by people ages 25 and older, converted from education attainment levels using official durations of each level.
    Gross national income (GNI) per capita: Aggregate income of an economy generated by its production and its ownership of factors of production, less the incomes paid for the use of factors of production owned by the rest of the world, converted to international dollars using PPP rates, divided by midyear population.

    HDI RANK OF NEPAL: 145 
    Low Human Development
    HDI VALUE: 0.548

    Very high human development 0.800 and above 

    High human development 0.700–0.799 
    Medium human development 0.550–0.699 
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