Sugata Mukhopadhyay
Universal Health
Universal Health
Sunday, March 24, 2013
Tuesday, March 19, 2013
Bangladesh makes dramatic advances in child survival.
In 1990, the infant mortality rate in Bangladesh, 97 deaths per 1,000 live births, was 16% higher than India’s 81. By 2004, the situation was reversed, with Bangladesh’s infant mortality rate (38) 21% lower than India’s (48).
Three main factors seem to explain the dramatic improvements.
First, economic empowerment of women through employment in the garment industry and access to microcredit transformed their situation. The vast majority of women in the garment industry are migrants from rural areas. This unprecedented employment opportunity for young women has narrowed gender gaps in employment and income. The spread of microcredit has also aided women’s empowerment. Grameen Bank alone has disbursed $8.74 billion to 8 million borrowers, 95% of them women. According to recent estimates, these small loans have enabled more than half of borrowers’ households to cross the poverty line, and new economic opportunities have opened up as a result of easier access to microcredit. Postponed marriage and motherhood are direct consequences of women’s empowerment, as are the effects on child survival.
Second, social and political empowerment of women has occurred through regular meetings of women’s groups organized by nongovernmental organizations. For example, the Grameen system has familiarized borrowers with election processes, since members participate in annual elections for chairperson and secretaries, centre-chiefs and deputy centre-chiefs, as well as board member elections every three years. This experience has prepared many women to run for public office. Women have also been socially empowered through participation in the banks. A recent analysis suggests much better knowledge about health among participants in credit forums than among nonparticipants.
Third, the higher participation of girls in formal education has been enhanced by nongovernmental organizations. Informal schools run by the nongovernmental organization BRAC offer four years of accelerated primary schooling to adolescents who have never attended school, and the schools have retention rates over 94%. After graduation, students can join the formal schooling system, which most do. Monthly reproductive health sessions are integrated into the regular school curriculum and include such topics as adolescence, reproduction and menstruation, marriage and pregnancy, family planning and contraception, smoking and substance abuse, and gender issues. Today, girls’ enrolment in schools exceeds that of boys (15 years ago, only 40% of school attendees were girls). Women’s empowerment has gone hand-in-hand with substantial improvements in health services and promotion. With injectable contraceptives, contraceptive use has surged. Nearly 53% of women ages 15–40 now use contraceptives, often through services provided by community outreach workers. BRAC also provided community-based instruction to more than 13 million women about rehydration for children suffering from diarrhoea.
Today Bangladesh has the world’s highest rate of oral rehydration use, and diarrhoea no longer figures as a major killer of children. Almost 95% of children in Bangladesh are fully immunized against tuberculosis, compared with only 73% in India. Even adult tuberculosis cases fare better in Bangladesh, with BRAC-sponsored community volunteers treating more than 90% of cases, while India struggles to reach 70% through the formal health system.
Article taken from UN HDI Report by Ms Anita Rego.
Saturday, March 16, 2013
Engaging UK Citizens in the #post2015 development agenda has important implications both home and away. Let’s take a look at Bradford…
Becca Degan, UK
“In the early years the focus remains
on reducing child poverty, improved housing, improved nutrition and lifestyles for
women and their children… In addition, ensuring access to free high quality
early education and childcare for all children including those with
disabilities remains a key focus.” 1
Reading
this description of health priorities, reducing poverty, ensuring access to
education for all, where would you assume the author was describing?
This is
an extract from Bradford City Council’s 2012 Public Health Report. In 2010
27.1% of children in Bradford were living in poverty, compared to the national
average of 21.9%. It has one of the highest rates of infant mortality across
England, with the majority being from deprived areas2. A response to
these statistics has seen the launch of a number of projects, including Born in
Bradford, a project that has the potential to help those much further afield
than Bradford due to its focus on equality.
As the post Millennium Development Goals
(MDGs) are being discussed, I think child and maternal health in Bradford
provide a good example of how these goals can be made truly universal. Post 2015
goals should have a greater focus on inequality and the use of disaggregated
measures, committing governments to tackling inequality, in areas such as
Bradford, as well as in cities and countries more traditionally considered as experiencing
poverty. International development agendas could be seen as an opportunity to
engage in the worldwide community to figure out and action the best ways for
all of us to help those in poverty, in our own neighbourhoods, towns and cities
in the UK, as well as those on other continents.
Encouraging our politicians to focus on and
commit to tackling inequalities has the potential to benefit people worldwide. Inequality
has been a major barrier to achieving the current MDGs, despite broad success across
several goals, many of the world’s poorest or most vulnerable have made little
or no development progress over the past fifteen years and inequalities are now
greater than ever3.
Bradford City Council has drafted their
Health and Wellbeing Strategy for 2013-2017 and there first goal is to ‘Give
every child the best start in life in the Bradford district’, this is
determined as important due to the high levels of child poverty and infant
mortality in Bradford. Their strategy also calls for ‘a healthy standard of
living for all’, stating that the gap between the richest and the poorest parts
of Bradford is greater than the gap in most other Local Authority areas4.
In the post 2015 global agenda we need to
address issues that are truly universal, working together to ensure that those
across the globe who are most vulnerable are not forgotten about and left
behind, regardless of whether they live in a rich or poor nation. These goals
should be and could be used by citizens in the UK as well as globally to
pressure our governments to achieving goals that have been internationally
ratified.
References:
About the author:
Having recently completed an MA in
Globalisation and Development I am looking to develop my knowledge of global
issues, to try and influence policy makers on topics that I am passionate
about. I currently work in the health sector in pursuit of a career in
public health policy and am particularly interested in the role that social
media has on engaging citizens with policy.
Saturday, March 2, 2013
FAQ: TB/HIV Co-infection
What is a co-infection?
Co-infection means infection with more than one
disease at the same time. Some co-infections commonly seen in people infected
with HIV include:
• HIV/hepatitis B virus (HBV) co-infection
• HIV/hepatitis C virus (HCV) co-infection
• HIV/tuberculosis (TB) co-infection
People infected with HIV should be tested for HBV,
HCV, and TB.
Why
risk of Tuberculosis is higher among people living with HIV than someone
without HIV?
TB germs are available in
the air. When we inhale air, TB germs enter in our body through air. In all
likelihood, many of us may be carrying the TB germ inside our body in inactive
state. We don’t get the Tuberculosis as long as our body immune system which
protects us from diseases remains strong.
When HIV damages the body immune system, the TB germ in the body becomes
active and causes Tuberculosis.
Why
is the risk of tuberculosis/TB higher among people with HIV?
TB germs are released
in air when a TB patient coughs or sneezes. When we inhale air, TB germs enter
in our body through air. In all likelihood, many of us may be carrying the TB
germs inside our body. Our body’s immune
system, which protects us from the diseases keeps the TB germs inactive and
prevents Tuberculosis.HIV damages body’s immune system and weakens it. The weak immune system cannot keep theTB
germs inactive any more. The TB germs become active and cause Tuberculosis.
The chance of getting
TB in lifetime is around 10% in a person not infected by HIV. The chance of
getting TB increases up to 50 – 60% after one is infected with HIV.
If
I have HIV, when I should suspect that I may have Tuberculosis?
If one has HIV and
develops any one of the symptoms of any duration like cough, fever, loss of weight,
loss of appetite or sweats at night, Tuberculosis should be suspected.
How
do I protect myself from Tuberculosis, if I have HIV?
a. Know
about the Tuberculosis symptoms; if you have any one of the symptoms, please
visit to the TB clinic of the local public hospital or health centre. Similarly
know in details where in your locality free services of TB diagnosis and
treatment available in the public health system.
b. It
is advised to take Isoniazid (INH) tablet daily.This is known as INH
Prophylactic Treatment (IPT). IPT prevents Tuberculosis in people living with
HIV.
c. If
you are already taking Antiretroviral Treatment (ART), you should adhere to the
treatment. ART reduces the chances of Tuberculosis in people living with HIV by
protecting the immune system which prevents the already existing TB germ in the
body from causing Tuberculosis.
d. Always
cover your mouth whenever you cough or sneeze to stop shedding TB germs into
the environment and advise your friends and relatives to do the same.
If
I am infected by HIV and suspect to have TB symptoms what should I do?
Please visit immediately to the near-by DMC
(Designated Microscopy Centre) and get yourself evaluated for TB by the Medical
Officer of DMC. Don’t waste any time by visiting private doctors or pharmacists
and avoid self-medication.
Why
TB patients are advised to go for HIV counseling and testing?
Almost 5% of the TB cases of India are infected by
TB, which means for every 20 TB cases 1 person is infected by HIV. The death
rate among HIV-infected TB cases is as high as 14% in India when the same in
HIV-uninfected TB cases is 2-3%. But early diagnosis of HIV in TB cases will
help the person to seek HIV care and treatment on time which will decrease
chances of relapse of TB and premature death by TB in people living with HIV.
This is why all the newly diagnosed TB cases are
advised to go for HIV counseling & testing.
How
HIV care on time can reduce chances of relapse of TB and death by TB in people
living with HIV?
TB is the commonest opportunistic infections and
also the major killer of people living with HIV. In India, a person living with
HIV has chance of having TB disease 50 – 60% in his life time while the same is
only 10% for a HIV-negative individual. TB is estimated to cause one in four
deaths among PLHIV in India.
WHO has
recommended to initiative Anti Retro-Viral Treatment (ART)[1] to
all HIV-infected TB cases even without evaluating the CD4 count[2].
ART improves the CD4 count in the body which further decreases occurrence of
opportunistic infections[3] in
the person living with HIV including TB.
Can
a person infected by HIV and affected by TB take both ART and ATT (Anti-TB
Treatment) together?
Yes, the person can take both ART & ATT together
under strict medical supervision. The Medical Officer of ART centre is the best
person to guide you in this regards.
If
a person is infected by HIV and affected by TB and not on ART, which
medications should start first?
The TB medications should be started as soon as the
diagnosis of TB is confirmed. Once ATT is well-tolerated by the person, ART
should be initiated (generally 2-4 weeks after ATT).
What
else
a person who is infected by HIV and
affected by TB should take other than ATT & ART?
The person should also take CPT (Co-trimoxazole
Prophylactic Therapy) to prevent pneumonia caused by other opportunistic
organisms.
Can
DOTS be equally effective for treating TB in persons living with HIV and
affected by TB?
Scientific evidences
prove that DOT is
equally effective to treat and cure TB in people living with HIV if treatment
adherence is strictly followed.
How
TB disease enhances progress of HIV in the body?
In a TB/HIV
co-infected person, the immune response to TB bacilli increases HIV replication.
As a result of the increase in number of viruses in the body, there is rapid progression
of HIV infection. The viral load can increase by 6-7 folds. As a result, there
is a rapid decline in CD4 count and patient starts developing symptoms of
various opportunistic infections. Thus the health of the patient who has dual
infection deteriorates much more rapidly than with a single infection. Amongst
the AIDS cases, TB is the most common opportunistic infection. The mortality
due to TB in AIDS cases is also high.
What are the differences of manifestation of TB in
different stages of HIV infection?
Early stage
(when CD4 count is normal): TB is mostly Pulmonary Sputum Smear Positive TB
Late stage (when
CD4 count is below normal): Pulmonary Sputum Smear Negative TB and Extra-Pulmonary
TB.
Why TB services should be integrated with HIV
prevention program? (Collaboration between Targeted Intervention and RNTCP)
HIV prevention
programs (known as Targeted Intervention) aims to prevention of HIV
transmission in HIV high risk groups namely sex workers, IDUs, migrants and
truckers. Different studies revealed that these groups are equally vulnerable
to TB not only because of co-infection with HIV but also due to socio-economic
factors like poverty, unhealthy life-style in crowded and poorly-ventilated
places, effects of drugs, malnutrition and migration. This is why the HIV
prevention programs covering these groups should be integrated with TB services
to provide them TB/HIV service packages within the same strategy and
intervention cost-effectively.
Universal Health
Universal Health
[1]
Antiretroviral medicines
prevent multiplication and spread of HIV in the body. After antiretroviral
treatment is started, HIV can’t destroy CD4 cells like before and the CD4 count
gradually rises. Usually, the CD4 test is used to determine when a person
living with HIV should start the antiretroviral treatment. After antiretroviral
treatment is started CD4 count is repeated time to time to know the progress
achieved after the treatment. The CD4
count is measured by a simple blood test and is reported as the number of CD4
cells per cubic millimetre of blood. People those are not infected by HIV have
CD4 counts between 600 and 1200 CD4 cells per cubic millimetre of blood. People
living with HIV have CD4 counts less than 500, and people who have developed
AIDS can have CD4 count 200 cells per cubic millimetre or fewer.
[2]
CD4 are cells in the body that protect from disease producing germs such as
bacteria and viruses and prevent occurrence of diseases. CD4 count is a
measurement of how many CD4-cells is circulating in the blood. Once a person is
infected by HIV, HIV destroys the CD4 cells in the body and his/her CD4 count
gradually falls. As CD4 count falls, the immune system of the body starts
losing the power to fight against the disease producing germs. The lowering of
CD4 count indicates weakening of the immune system. Improving the CD4 count and
strengthening the immune system of the HIV infected person is of critical
importance; otherwise he/she may be affected by life-threatening condition of
AIDS.
[3]
There are disease-producing germs which remain within our environment and also
inside our body. In normal condition they cannot produce any diseases because
our healthy immune system easily fights them off. These germs produce diseases when the immune
system is damaged and weakened by HIV. We call these diseases ‘Opportunistic
Infections’ as these germs find the weak immune system the opportunity to cause
diseases.
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