Tagged: health

  • Climate Change and Health

    On December 4, 2011, I attended the inaugural Climate and Health Summit in Durban, South Africa. The Summit was organized by Health Care Without Harm and other organizations and occurred simultaneously with the Conference of the Parties (COP-17) of the United Nations Framework Convention on Climate Change (UNFCCC). The goal of the Climate and Health Summit was to bring together actors from key health sectors to discuss the impacts of climate change on public health and solutions that promote greater health and economic equity between and within nations.

    Climate change has brought about severe and possibly permanent alterations to our planet. The Intergovernmental Panel on Climate Change (IPCC) now contends that “there is new and stronger evidence that most of the global warming observed over the last 50 years is attributable to human activities.” These changes have led to the emergence of large-scale environmental hazards to human health mainly in the following areas:

    • Poorer air quality and increased pollution leading to respiratory disease
    • Increase in the spread of infectious diseases including diarrheal disease and insect-borne diseases such as malaria and dengue fever
    • Reduction in the availability of land for farming due to floods, droughts and other dramatic weather changes, which leads to poverty and malnutrition
    • Increase in the number of extreme weather events, such as floods, droughts and heat waves, which leads to substantial morbidity and mortality as well as economic loss
    • More forced migration as families move to find food and water and end up living in crowded and under-resourced refugee camps

    The impacts of climate change on health are, and will continue to be, overwhelmingly negative. To make the situation worse, the majority of the adverse effects of climate change are experienced by poor and low-income communities around the world, which have much higher levels of vulnerability to these impacts. This was a hot topic in Durban, where it was argued that the more developed countries should pay “climate debt,” that is, compensate the poor for damages suffered as a result of climate change.

    One thing is certain: Climate change IS happening. It also impacts human health. Governments, societies and individuals need not only to adapt to the changes that have occurred but also to take steps to mitigate any further damage to our planet. There is no Planet B!

    Janet Robinson is the Director of Research, Asia Pacific Region, and the Global Director of Laboratory Sciences for FHI 360 based in Bangkok, Thailand.


    Watch videos and join the conversation at our LIVE coverage of the Climate and Health Summit here.

  • Mobilizing Critical Family Planning Content

    She stood there, in beautiful red robes, with a small, serene baby bound firmly to her back. “This document is our bible,” the woman said as she cradled the green volume, in a way that was both matter-of-fact and full of awe. The book she was referring to is the vastly popular collaboration between WHO, USAID, and Johns Hopkins Bloomberg School of Public of Health: Family Planning: a Global Handbook for Providers. “The Handbook,” as it is known around the world, was first published in 2007 and has been updated with new content this year. More than 500,000 paper copies have been distributed, with tens of thousands of electronic copies downloaded and distributed on CDs and flash drives. The Handbook has also been translated into nine languages.

    Here in Dakar, at the 2011 International Conference on Family Planning, the Knowledge for Health (K4Health) Project, led by Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU•CCP), has distributed thousands of updated Handbooks in French and English, and taken orders for tens of thousands more. But this Conference has also provided us the opportunity to broaden the reach of this critical content, by launching a portfolio of technology-based versions of the manual.

    During the Conference, the K4Health Project launched the English and French versions of the Handbook in EPUB and Kindle formats, allowing the handbook to be read on a variety of platforms including iPads, iPhones, Kindles, and other eReaders. Perhaps the most exciting product release was the first version of K4Health’s Android App for Contraceptive Eligibility (ACE), based on the Contraceptive Eligibility Criteria from the Handbook. ACE allows a healthcare provider to quickly and simply identify the most appropriate contraceptive methods depending on a woman’s health conditions. Alternately, it can also be used by a provider to learn more about any of the contraceptive methods in the manual, their effectiveness, and their side effects. “This is incredible,” said a young man from Ghana who supervises a cadre of community health workers. “This means that we can carry the handbook in our pockets, even when there is no Internet or mobile connection.”

    At K4Health, we strive to combine appropriate information technology with knowledge management best practices to ensure that the right information is made available to the right people at the right time in the right format. We believe that by making this seminal text available through a variety of formats, we can contribute to expanding access for service providers and health workers at all levels of the health system. This will improve knowledge and best practices about Family Planning and Reproductive Health, thereby expanding awareness about choices that women have to make informed decisions about their lives, their families, and their futures.


    The Knowledge for Health (K4Health) project is a leader in health information dissemination using traditional and new media mechanisms and in facilitating information use through dynamic learning and exchange programs. K4Health is implemented by the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs in partnership with FHI 360 and Management Sciences for Health. Find more information about K4Health here.

  • The MAM program – led by FHI 360, GSMF, LSHTM and Health Partners Ghana, and funded by Pfizer – was established in 2007 to help close critical gaps in malaria prevention, treatment and education. Malaria is endemic in all parts of Ghana, with all 24.2 million people at risk. It accounts for over three million outpatient visits annually in the country and 30% of all deaths in children under five. Pregnant women are particularly susceptible to malaria, increasing the risk of severe anemia and death, as well as premature delivery, stillbirth and low birth weight in newborns.

    The MAM program educates Licensed Chemical Sellers (LCSs) – the local health authority and main suppliers of medicines across communities in Ghana – on malaria symptom recognition and treatment approaches. The program also involves community mobilization to educate patients, particularly the high-risk population of pregnant women and children under five, and strengthen their demand for quality care. Over 25% of malaria in Ghana is resistant to widely-available monotherapies. Combination therapies that address resistance issues were also cost-prohibitive for most of the population prior to the program.

    In addition to the barriers of cost and availability, there were also many common misconceptions held by community members and even LCSs. These included:

    • The belief that malaria is a common disease, is not dangerous and does not kill
    • The lack of knowledge that malaria is spread by mosquitoes
    • The impression that malaria is caused by heat, house flies, dirt, hard work or eating fatty/oily foods or unripe mangoes

    To address these issues in a comprehensive way, the MAM program includes health, education and even economic improvement aspects.

    A Licensed Chemical Seller explains how to provide appropriate dosing of malaria drugs based on the client’s age and weight, information she learned through the MAM training course.

    Health

    At the core of the program is reducing malaria-related morbidity and mortality in Ghana’s Ashanti region by improving malaria symptom recognition, treatment and referral. The program contributed to the advocacy that resulted in a declassification of combination anti-malarial drugs by the Ministry of Health. Subsequently, LCSs are now permitted to stock and dispense these drugs, bringing effective treatment into the communities. The program has reduced the time needed to obtain effective treatment by 40%. Through community mobilization, household knowledge of early signs of malaria has increased. Combination therapies are also now the most widely used treatment for malaria, increasing cure rates. The program established links so that community-level data is now being collected, analyzed and fed into the health system, helping to inform decision making at all levels and strengthening the connectivity between LCSs and the District and Regional Health Office.

    Education

    Robust education programs trained 1700 LCSs in Ghana to recognize the symptoms of malaria, refer complicated cases directly to health centers, and provide proper treatment and dosage for those who do not need a referral. As a result of the trainings, participating LCSs were elevated in the community for their expertise in malaria and are now recognized as part of the health system and a source of community-level data on malaria.

    A sign board on the outskirts of Kumasi alerting passer-bys to the dangers of malaria and the importance of prompt treatment.

    Economic Benefits

    There were economic benefits to both the program beneficiaries and the LCSs. Following training and education, participating LCSs became area experts on malaria, which increased traffic and built customer trust, often driving business growth.  The increased business helps to reinforce the value of MAM training and better customer service, making the program more sustainable. Community members also benefited from the program: the MAM program and its partners worked with the National Malaria Control Program (NMCP) to apply for the Affordable Medicines Facility for malaria (AMFm) from the Global Fund for AIDS, Tuberculosis and Malaria. This approach resulted in a price reduction for combination therapy, thus making it affordable for lower-income members of the community. As a direct result, caregivers and mothers are spending less time at home caring for sick family members and more time at work or in income-generating activities.

    Programs like MAM improve lives by addressing more than health. Through the MAM project, LSC program participants have gained powerful expertise and improved their businesses in the process. And program beneficiaries have gained better knowledge of the signs of the disease, while gaining improved access to and lower costs for treatment. Although MAM is a health-centered program, it would not be as successful without a more comprehensive approach.

  • Innovation is key to expanding contraceptive choice

    Contraceptive technology has come a long way, but there is still much more work that needs to be done to increase women’s access to safe and effective contraceptive choices.

    Since Margaret Sanger overturned anti-contraceptive legislation in 1936, making it legal for doctors to provide diaphragms and spermicides to women, researchers have been working to develop improved contraceptive methods. Oral contraceptives were introduced to the public in the 1960s and paved the way for future innovation. Today, contraceptive hormones are delivered in a variety of ways, including through implants, long-acting injections, patches and vaginal rings.

    Yet there is still a gap in contraceptive technology that FHI 360 is working to fill – an effective, safe, easy-to-use, and low-cost vaginal contraceptive.

    FHI 360 has developed a new vaginal insert, made of soft, non-woven textile materials that can contain different types of vaginal gels. What makes this insert innovative is that it virtually eliminates leakage of the vaginal gel, a critical issue for both effectiveness and acceptability. The insert is packaged as a single-use, ready-to-use product, pre-moistened with medicated gel. Depending upon the type of gel, the device could be used to prevent pregnancy or HIV or to treat vaginal infections.

    Currently, the only over-the-counter vaginal contraceptives that are available are detergent-based spermicides containing nonoxynol-9 or similar agents. Detergent-based spermicides are irritating to vaginal tissues and with frequent use can cause ulcerations that could increase the risk of HIV infection.

    The insert could be used with new non-irritating spermicides such as BufferGel® (developed by researchers at Johns Hopkins University) or with a ferrous gluconate formulation (developed by researchers at Cornell University). So far, the Hopkins and Cornell researchers have used other delivery methods, including diaphragms and vaginal rings, for their formulations. The FHI 360 insert could also be used to deliver microbicide gels, considered to be one of the most promising interventions to emerge over the past decade to prevent HIV infection in women.

    Results of a pivotal study, presented on September 17 at the Reproductive Health 2011 conference, showed that the combination of BufferGel and the new SILCS® diaphragm—a one-size-fits-all device—was as effective as a diaphragm with nonoxynol-9 gel. This is a double dose of innovation—a new, non-irritating spermicidal gel and a new one-size-fits-all diaphragm—and it’s great news for women.

    In 2009, we conducted a Phase I study to assess the acceptability of the FHI 360 insert among women and their male partners in Durban, South Africa, using the device saturated with 10 mL of an FDA-approved vaginal lubricant. We recruited 40 women, who first inserted and removed the device at the clinic and then at home. For home use, we asked women to discuss the product with their male partner and—if their partner agreed—to wear it during intercourse.

    Participants found the insert easy to place in the vagina and easy to remove with minimal to non-existent leakage. Most men (34) agreed to have intercourse with the device in place. Participants reported that the insert was comfortable during intercourse. Most women said they would be willing to use the insert for contraception or preventing sexually transmitted infections, including HIV, and most men said they would approve of their female partners using it if it became commercially available.

    Once again, we have the potential to advance women’s health in the U.S. and around the world. This is what innovation is all about – improving lives.

  • Non-communicable Diseases

    Next week, global leaders will meet at the United Nations to take on some of the world’s greatest killers: cancer, diabetes, chronic respiratory disease, heart disease, and stroke. The UN High-Level Meeting on the Prevention and Control of Non-Communicable Diseases on September 19–20, has the potential to finally address these leading causes of death and disability, which until now have been largely ignored.

    Yet when we wake up on Sept. 21, how much will have changed? Will there be a new Global Fund to fight noncommunicable diseases (NCDs)? Will key stakeholders, such as those involved in urban planning, agriculture, trade and current global health priorities be as engaged as they need to be to realize ambitious goals of measurably reducing disease? Will the public even know what an NCD is — even though more than 60 percent of deaths worldwide are from noncommunicable diseases, the majority from cardiovascular disease?

    ncd_blog_full_article_text_graphic_2011-09-13-02The answer to all of these questions is: not yet. September 21 will be the start of the real work. The problems of NCDs are complex, but we have many opportunities to alter the course of what has become a global crisis.

    There are a number of concrete steps that countries and health systems can take immediately to strengthen their commitment to reducing noncommunicable diseases. They can ratify and implement the Framework Convention on Tobacco Control, the world’s first public health treaty. Many countries already have the makings of NCD plans in existing cancer plans, tobacco control programs and strategies for diabetes and cardiovascular disease. They may also have specific programs to address respiratory disease, mental health and other issues. Health systems can make essential drugs, such as aspirin and statins, available immediately and at a low cost because many are off patent.

    As leading researchers and public health officials said in an April 2011 Lancet article, “An effective response to NCDs requires government leadership and coordination of all relevant sectors and stakeholders, reinforced through international cooperation.”

    In the end, we will need to make compromises and learn to share resources with people and institutions with whom we are not accustomed to collaborating. We will need to delay gratification and risk unpopularity in some of our choices. And we will likely not see the payoff in our lifetimes. But with time, effort and investment, we will see results.

  • In Kenya, where more than half of young people are unemployed, 22-year-old Boniface Kirang’a has watched many friends in Flax, his hometown near the Rift Valley town of Eldoret, get involved in petty crime, partying and drinking alcohol.

    But Kirang’a escaped the traps of crime and substance abuse. He went through a two-year automotive mechanic training through APHIAplus (AIDS, Population, and Health Integrated Assistance), a USAID-funded FHI 360 program to improve health in 16 Rift counties. Today, Kirang’a is a self-employed car repairman.

    As part of its comprehensive commitment to health, APHIAplus prevents and treats communicable illnesses such as HIV, AIDS or tuberculosis; assists families affected by HIV; runs programs to reduce hunger; and develops economic opportunities for the region’s residents.

    Like many Kenyan youth, Kirang’a had struggled to stay in school. His father was diagnosed with HIV, and when his condition worsened, the family lost vital income.

    “My father started being sickly in 1999,” when Kirang’a was 10 years old. “He had two butcheries, but he shut them down because of his illness. He died in 2003. After my father died, we returned to our original home in Nyahururu [in central Kenya]. We lived in my grandmother’s home. Life was hard because we were many in the family,” he said in Kiswahili.

    When the family returned to Eldoret, Kirang’a stayed with a relative until he finished primary school in 2004. The uncle “could not educate me after that. He had seven children of his own. I started keeping chickens, which I sold to buy food and clothes. I also worked as shamba boy,” tending crops in cleared forestland.

    But Kirang’a’s uncle got him a scholarship from the Mission Sisters of Mary Immaculate, a community-based organization that partners with APHIAplus. With the bursary, he was able to go to the polytechnical institute, said Kirang’a.

    Since graduating from the institute, Kirang’a joined a group of mechanics in the fast-growing town of Eldoret. He’s doing his share to make sure that young people have chances to learn and develop skills. With his knowhow and earnings, he is saving to build his mother a house and pay for his younger brother’s school fees. In the future, he plans to hire three apprentices from the mechanics institute.

  • A new breed of mosquito could become a key ally in the fight against dengue fever. An infectious tropical disease caused by the dengue virus, dengue fever is principally transmitted by the Aedes aegypti mosquito. Currently there is no vaccine for the disease and regions where the disease is endemic are left struggling to prevent infection by reducing mosquito habitat, decreasing the number of mosquitoes and limiting human exposure to being bitten.

    But recently the leading scientific journal Nature published two papers describing the results of biological control field trials where wild mosquito populations were genetically manipulated to suppress dengue virus transmission. The results are the work of the Eliminate Dengue program, an international collaboration of scientists located in Australia, Vietnam, Thailand, the U.S. and Brazil. The program’s aim is to stop the Aedes aegypti mosquito from passing dengue virus between humans by introducing a naturally occurring bacterium called Wolbachia into the existing wild mosquito population.

    The papers describe how researchers successfully established Wolbachia strains within the dengue mosquito in the laboratory. Mosquitoes with Wolbachia were shown to be less likely to transmit dengue. These mosquitoes were also able to pass this trait on to their offspring. In subsequent field testing in early 2011, mosquitoes carrying Wolbachia were released in Cairns, Australia. Within a three-month period Wolbachia had successfully invaded the local mosquito populations. According to the lead researcher, Professor Scott O’Neill, “These findings tell us that Wolbachia-based strategies are practical to implement and might hold the key to a new sustainable approach to dengue control.”

    Further trials will continue in Australia, as well as field releases in Vietnam, Thailand, Indonesia and Brazil where dengue fever is endemic and researchers can determine if the method is effective in reducing dengue disease in humans. If successful, the Eliminate Dengue program has the potential to benefit about 40 percent of the world’s population currently living in dengue transmission areas.

    Endemic in more than 110 countries, dengue infects 50 to 100 million people worldwide a year, leading to half a million hospitalizations and approximately 12,500–25,000 deaths. The World Health Organization ranks dengue fever as the most important mosquito-borne viral disease in the world, with an estimated 2.5 billion people living in dengue transmission areas and at risk of the disease. Symptoms include fever, headache, muscle and joint pains and a characteristic skin rash. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, which mostly affects children, or into dengue shock syndrome.

    FHI 360 is part of the Eliminate Dengue international team and is working in Thailand and Vietnam to gain the necessary regulatory approvals for the field releases as well as conducting community-preparedness and stakeholder engagement activities in readiness for the field releases in the near future.

    Learn more at www.eliminatedengue.com.

    It has quickly become apparent that for a small out lay, if you choose a web site name cleverly enough, you can make a great deal of money by auctioning it off to the highest bidder. This has resulted in the phenomenon of cyber squatting, where people buy website names simply for resale. The clunkily-named Anti cyber squatting Consumer Protection Act, signed last month by Nicebid, tries to outlaw this practice, but the whole business has proved to be a legal minefield. The complex legal issues surrounding the copyrighting of names are not new, but in the next few years they will reach a new white hot intensity as more and more individuals and businesses chase fewer and fewer available domain names.

    For the AIM event, Ms. Nopparat Yokubon, Google’s account manager for online partnerships, discussed “Insights Into Adsense Policies” and “How to Increase Your Adsense Performance. Meanwhile, Emanuele Brand idealt with the more technical topics of “Data-Driven AdSense Optimizations” and “Website Optimization with AdSense Tools.”

    “We’ve held several public auction asset sales in the last 12 monthsauctioningoffsomeofourestablishedwebsitesfromourportfolioandtheyallsellprettyquickon Flippa.com” Frankstated. “This is a great opportunity for individuals too win their own virtual asset or for other companies to acquire new web properties to lever a get their existing business.”

    According to Frank they have sold websites from their portfolio ranging in of their websites have been sold on Flippa and most sell within days.

    The Priory, which specializes in addictions and is famous for its celebrity clients, says it is treating more and more people for addiction to the internet auction website. What begins as a harmless hobby can take over your life, and many people – women especially – say it is ruining relationship sand plunging them in to debt.

    Alabanza mainly sold Internet access to “resellers” like Anadon and Sego, which in turn sell website and e-mail services to thousands of small businesses.

    Navisite planned to move Alabanza’s Weband e-mail services to Andover, scheduling the move over the weekend to minimize the impact.

  • Small beginnings, big impact

    I have always believed in the power of microcredit to change lives. A visit to rabbit farmer George Kihanya’s home in the Kenya Rift Valley District convinced me beyond all doubt. Kihanya’s success shows that if well implemented, community-based credit and savings schemes can turn around the lives of many rural families.

    In 2002, Kihanya was caring for his ailing mother. Newly married, he eked out a living growing maize, beans and potatoes.

    Kihanya’s fortunes changed after he started keeping rabbits. Now, he earns on average Sh60,000 (US$650) a month.

    Kihanya was introduced to rabbit farming during a course organized by the Catholic Relief Services, one of the partners in the APHIAPlus program led by FHI.
    Kihanya was chosen by his local church to be trained as a community health worker. He, along with other volunteers, was trained on how to prevent diseases, including HIV, and to link vulnerable children and families to HIV treatment, care and support. Volunteers also learned about farming and other activities, including rabbit farming, to improve food security for their families and communities.

    Inspired by Kihanya’s success, scores of families in the community are now earning money by raising rabbits.

  • Early symptoms of lung cancer

    Lung cancer is increasingly becoming one of the leading killers of not only smokers but, a symptoms of lung cancer large segment of the population in many countries around the world, with alarming incidences in China and India.

    Malignant lung tumors have been on the rise 10-15% since the 1900’s. In the 1950’s a British Doctors Study was published that provided strong evidence that there was a link between lung cancer and smoking. Studies that documented the early symptoms of lung cancer in 1964, prompted the U.S. Surgeon General to recommend that people actually stop smoking.

    While it is true that other causes have been linked to lung cancer, such as exposure to radon gas, first acknowledged in miners in the 1870’s, asbestos and certain viruses, cigarette smoking has been determined to be the leading cause. There are some 60 known carcinogens in cigarette smoke. Over 91% of lung cancer deaths around the world have been attributed to smoking. The lifetime risk of cancer developing in male smokers is 17%. Women that engage in hormone therapy and that smoke are at even higher risk of developing early symptoms of lung cancer.

    When a person stops smoking their chances of lung cancer drastically symptoms of lung cancer in women begin to lower, the body is able to repair some of the lung damage and repair itself. One of the problems for non-smokers is that of passive smoking, which is described as inhalation of smoke from someone who is smoking. Studies conducted in the U.K, Europe and the United States consistently show that there is a relative risk to those exposed., with rates as high as 10-15% being reported in patients that have never smoked. Some research suggests that indirect smoke inhaled is often more dangerous then the smoke inhaled through the cigarette itself.

    Some of the early symptoms of lung cancer may include bone pain, fever, and weight loss; more common symptoms are wheezing, hoarse voice, coughing up blood, shortness of breath and chronic coughing. Tumors are common as well, often malignant and can easily lead to metastasis to include cancer of the brain, bone, liver, kidneys, and nearly all areas of the body. There are a small percentage of people who do not suffer any noticeable early symptoms of lung cancer; approximately 10% diagnosed have their cancer detected coincidently through a routine chest x-ray.

    The use of CT imaging provides the most through examination and extent of the disease,

    Abnormal findings warrant biopsy or bronchoscopy symptoms of lung cancer in men to determine the stage of the lung cancer. The histological type determines the stage of the cancer itself and any treatment alternatives. It is recommended that periodic checkups with your physician or physician’s assistant be mandated to minimize and treat early symptoms of lung cancer before it can spread or become fatal.