Sunday, October 24, 2010

Indians and Pakistanis Suffer Heavy Disease Burdens

Poverty, hunger, unsanitary or unsafe conditions and inadequate health care in South Asia's developing nations are exposing their citizens to high risk of a variety of diseases which may impact their intelligence. Every year, World Health Organization reports what it calls "Environmental Burden of Disease" in each country of the world in terms of disability adjusted life years (DALYs) per 1000 people and total number of deaths from diseases ranging from diarrhea and other infectious diseases to heart disease, road traffic injuries and different forms of cancer.

In the range of DALYs/1000 capita from 13 (lowest) to 289 (highest), WHO's latest data indicates that India is at 65 while Pakistan is slightly better at 58. In terms of total number of deaths per year from disease, India stands at 2.7 million deaths while Pakistani death toll is 318, 400 people. Among other South Asian nations, Afghanistan's DALYs/1000 is 255, Bangladesh 64 and Sri Lanka 61. By contrast, the DALYs/1000 figures are 14 for Singapore and 32 for China.

Recent research shows that there are potentially far reaching negative consequences for nations carrying high levels of disease burdens causing lower average intelligence among their current and future generations.

Published by the University of New Mexico and reported by Newsweek, new research shows that there is a link between lower IQs and prevalence of infectious diseases. Comparing data on national “disease burdens” (life years lost due to infectious diseases or DALYs) with average intelligence scores, the authors found a striking inverse correlation—around 67 percent. They also found that the cognitive ability is rising in some countries than in others, and IQ scores have risen as nations develop—a phenomenon known as the “Flynn effect.”

According to the UNM study's author Christopher Eppig and his colleagues, the human brain is the “most costly organ in the human body.” The Newsweek article adds that the "brainpower gobbles up close to 90 percent of a newborn’s energy. It stands to reason, then, that if something interferes with energy intake while the brain is growing, the impact could be serious and longlasting. And for vast swaths of the globe, the biggest threat to a child’s body—and hence brain—is parasitic infection. These illnesses threaten brain development in several ways. They can directly attack live tissue, which the body must then strain to replace. They can invade the digestive tract and block nutritional uptake. They can hijack the body’s cells for their own reproduction. And then there’s the energy diverted to the immune system to fight the infection. Out of all the parasites, the diarrheal ones may be the gravest threat—they can prevent the body from getting any nutrients at all".

Looking at the situation in South Asia, it appears from the WHO data that Pakistan is doing a bit better than India in 12 out of 14 disease groups ranging from diarrhea to heart disease to intentional injuries, and it is equal for the remaining two (Malaria and Asthma).

Source: Health Metrics and Valuation
 A detailed WHO report on World Health Statistics for 2010 assesses and compares its member nations on the basis of nine criteria including mortality and burden of disease, cause-specific mortality, selected infectious diseases, health service coverage, risk factors, health workforce-infrastructure, health expenditures and demographic and socioeconomic statistics. It shows that both India and Pakistan have some serious challenges to overcome to have any chance of meeting health-related Millennium Development Goals (MDGs 4, 5 and 6).

Related Links:

Haq's Musings

Infectious Diseases Kill Millions in South Asia
Infectious Diseases Cause Low IQ

Malnutrition Challenge in India and Pakistan
Hunger: India's Growth Story

WHO Report 2010 Blogger Analysis
Syeda Hamida of Indian Planning Commission Says India Worse Than Pakistan and Bangladesh

Global Hunger Index Report 2009

Grinding Poverty in Resurgent India
WRI Report on BOP Housing Market

Food, Clothing and Shelter For All

India's Family Health Survey
Is India a Nutritional Weakling?
Asian Gains in World's Top Universities

South Asia Slipping in Human Development


satwa gunam said...

Life expectancy in case of india is around 64 for both the sex where as it is 63 in case of pakistan. Both the countries were in the same slab in 1990 and 2000, but india has done relatively better than pakistan at 2008.

India has done better than pakistan in the following categories

Probability of child mortality by age one - Gap between india has increased from 22% to 38%

Pakistan Neo natal mortality in 2008 is higher than india by 43%

Probability of child mortality by age five - Gap between india has increased from 12% to 29%

However pakistan has done better in this category :

Probability of mortality of age group between 15 to 60 - It was in 8.39% more than pakistan in 1990 and it went up to 15% in 2000. But has come down to 4.23% in 2008

In the above categories, india has done better than pakistan. However in the following cases, pakistan has done better than india. [ pls refer data in url ]

Anonymous said...


Both India and Pakistan are roughly the same now wrt MDG.

HOWEVER India is investing $500 billion + per year in its economy and thus is more likely to be closer to MDG 2015 than Pakistan which is effectively in a negative per capita growth since 2008 vs 5-6% per capita income growth in India.

satwa gunam said...


Look at the size of population of india vs pakistan. Further the aid india get is minscular.

However india can work with small social network to assist people which i feel they are doing. It is like the gold saving with the asian families which are never counted as part of the country wealth as details are not available.

In the same note, pakistan is doing extremely well in control of diseases compared to india. i will be publishing those analysis in my site sooner.

Anonymous said...

Recent Statistics:
CBR--> 23.4 (21.76-->2009)
CDR--> 8 (6.23 --2009)
IMR--> 54 (2007)
IMR: 30.15 deaths/1,000 live births
Male: 34.61 deaths/1,000 live births
Female: 25.18 deaths/1,000 live births
Life Expectancy at birth -
Males - 62.3 (2005); 67.46 (2009)
Females - 65.3 (2005); 72.61 (2009)
Neonatal mortality rate : 37 per 1000 live births (2006); 34 per 1000 live births (2009)
Early neonatal mortality rate : 28 per 1000 live births (2006)
Under 5 mortality rate : 72 per 1000 (2007); 64 per 1000 (2009)
General fertility rate - 93.3 (2006)
General marital fertility rate - 111.7 (2009)
Total feritility rate - 2.72(2009)
GRR--> 1.3 (2006)
NRR--> 1.4
MMR--> 301/lakh Live Birth(2003); 2009 --> 254
CPR--> 58%
Sex ratio--> 933(2001); 927 (2009)
Least- Haryana
Least child sex ratio- Punjab
Population--> Rural(72%): Urban(28%)

I expect better stats in next census.....

satwa gunam said...

It could be observed from above that india is doing extremely bad in comparison to pakistan with regard to the handling of various diseases. But for respiratory infection, india has not control these disease even to the extent of what pakistan has achieved. India has to go long way in catching.

Most distrubing is that in many cases the gap is valley and it is high time that government opens up medical colleges / institutes in the rural areas of india.

Riaz Haq said...

Here's a piece by Eric Margolis on US-India ties titled "Welcome to India, Obama Sahib":

While the western media fulminates against Taliban’s or Iran’s treatment of women, a leading British medical journal reports an estimated 40,000 Indian women are burned alive each year by their in-laws to grab their dowries. Infanticide of female children is endemic. But few in the west seem to care.
India is a giant with feet of clay. A senior western diplomat in unhealthy Delhi told me that at any given time, half his staff is ill with serious maladies. India is plagued by grave health and environmental problems.
India is really two nations: modern, dynamic, high-tech urban India of about 100 million, and antique, timeless rural Mother India of 1.1 billion souls.
To China’s annoyance, President Obama proclaimed in Delhi that India should have a permanent seat on the UN Security Council. India is becoming a great power and deserves a seat among the world’s big boys. But so do Germany, Japan, Turkey and Brazil.

India and its people, long disparaged by British racist jokes, are delighted to be called equals by the great powers. In fact, nuclear-armed India sees itself very much as regional hegemon of the entire Indian Ocean extending from East Africa to Australia.

The Bush administration’s deal with Delhi to sanctify and facilitate India’s nuclear weapons programs was thought at the time a clever move. But it dismayed the rest of the world, made a mockery of non-proliferation, and outraged the entire Muslim world, which has been blasting the US for hypocrisy by threatening war against Iran, which is under UN nuclear inspection, while playing nuclear footsie with India, which rejected all UN inspection.

India’s leaders are no fools and will not be easily pushed or bribed into a stronger anti-China and anti-Iran stance by Washington – Delhi maintains cool but correct relations with Beijing, but behind the wintry, trans-Himalayan smiles lies growing rivalry over Chinese-occupied Tibet, Indian-ruled Ladakh and Kashmir, their long, poorly demarcated Himalayan border (another gift of the British Empire), strategic Burma, and their intensifying nuclear and naval rivalry.

India claims China is trying to surround it, using Pakistan, Sri Lanka, Bangladesh, and Burma. The two Asian superpowers have been locked in a strategic and conventional arms race for a decade. In 1999, this writer postulated that the two giants would one day clash over their contested borders.

India will follow its own strategic and diplomatic interests – which are not synonymous with those of the United States.

Delhi has a long record of clever diplomacy that has isolated Pakistan and kept the world and UN out of the burning Kashmir problem, where 40,000–80,000 Kashmiris have died in a long independence struggle against Indian rule.

But the United States is now slowly being drawn into the dangerous Kashmir dispute – which triggered the 2008 terror bombing in Mumbai. Just look for example at the embarrassing revelations that one of the men involved in the 2008 Mumbai massacre was working for the US Drug Enforcement Agency.

The more Washington backs and arms India, the more its relations with China will deteriorate. Japan is also quietly building up India against China, to Beijing’s mounting anger.

The US could even be drawn into an India-China regional conflict. So caution is advised to US diplomats as they charge into the murky, tangled, poorly understood geopolitics of South and East Asia.

We also wonder if President Obama was briefed on India’s growing strategic arsenal.Delhi already has enough medium-ranged Agni-series missiles to cover potential foe China. Why then is Delhi spending billions to develop a reported 12,000 km ICBM whose only targets could be North America, Europe or Australia? ..

Riaz Haq said...

India is emerging as diabetes epicenter, according to Bloomberg:

More than 50 million Indians are struggling with the same frightening predicament. The International Diabetes Federation in October 2009 ranked India as the country with the most diabetics worldwide. The umbrella group of more than 200 national associations estimates that the disease will kill about 1 million Indians this year, more than in any other country.

With 7.1 percent of adults afflicted, India is on a par with developed countries such as Australia, where 7.2 percent of adults suffer. India now fares worse than the U.K., where 4.9 percent are diabetic. In the U.S., where more than two-thirds of adults are overweight or obese, 12.3 percent have diabetes.

Doctors say a perverse twist of science makes Indians susceptible to diabetes and complications such as heart disease and stroke as soon as their living conditions improve. As a decade of 7 percent average annual growth lifts 400 million people into the middle class, bodies primed over generations for poverty, malnutrition and manual labor are leaving Indians ill- prepared for calorie-loaded food or the cars, TVs and computers that sap physical activity.

Researchers are finding the pattern begins before birth: Underfed mothers produce small, undernourished babies with metabolisms equipped for deprivation and unable to cope with plenty. Sonar’s mother, a widow who spent her life in a village and raised seven children by doing farm work, was active and healthy into her 70s, Sonar says.

Riaz Haq said...

India tops the world in TB cases, according to a recent WHO report:

With 2 million new tuberculosis cases in 2009, India carries the highest tuberculosis disease burden in the world, though the country’s NGOs and government have improved their intervention, according to a World Health Organization report.

In 2009, 1.3 million people died from TB in the world, reports. India’s TB deaths accounted for 280,000 lives. The mortality rate was higher in patients who had TB related to HIV/AIDS.

The WHO comprehensive report, dubbed the Global Tuberculosis Control 2010, says that while significant improvements were made in tackling the curable and deadly disease, multi-resistant TB strains are leading to more infections in countries like China, Russia and India.

“India has the highest TB burden in the world and despite spectacular interventions there were 2 million new cases in India,” Dr. Mario Raviglione, director of the Stop TB Department at the WHO, said, according to “The government and the private sector have remarkably scaled up their intervention to tackle TB and there have been significant advances in India.”

Raviglione said that 43 Indian labs have been strengthened for diagnosis of TB, but major challenges lie ahead for counteracting multi-resistant TB, especially in unhealthy and poor environments.

The report concludes that while the private sector of India is close to the biggest private source of TB medicines in the world, management of TB patients in the private sector may be of uneven quality.

“It is a fact that TB is not a disease exclusively of the poor as anyone, rich or poor, can get infected with active TB disease, but there is a well established and widespread association between poverty and TB” said Dr LS Chauhan, who is the National TB Program (NTP) Manager in India. India’s TB programme is called Revised National TB Control Programme (RNTCP). “A vicious cycle exists between TB and poverty” said Dr Chauhan, according to media reports.

Riaz Haq said...

Here is a Times of India report on India's rising TB disease burden:

NEW DELHI: India is saddled with highest burden of tuberculosis — with nearly 2 million new cases recorded in 2009. Out of an estimated 1.3 million people who died of TB in 2008, the nation alone accounted for 2.8 lakh lives.

India's case detection was around 67%, while the estimated number of TB cases that had become multi-drug resistant was 99,000 in 2009.

Even though the TB mortality rate has fallen by 35% since 1990, the disease claimed 1.7 million lives last year — of which 3.8 lakh were women.

According to World Health Organisation's annual report, "Global Tuberculosis Control 2010," around 4,700 die of TB daily. An estimated 9.4 million contracted the disease in 2009 — the same number as the previous year. However, the incidence of TB was stable, or falling in all 22 countries that have the highest burden of the disease except South Africa.

Six million lives are being saved annually as compared to 1995, thanks to improved detection and treatment. "There are still 1.7 million deaths a year from a disease that is perfectly curable in 2010. At this pace, it will take millennia to get rid of TB," said Mario Raviglione, director of the WHO's Stop TB unit.

However, "the biggest challenge of all" — as per the WHO — was an estimated 4.4 lakh multi-drug resistant (MDR) strains of TB a year, which are both hard to detect and treat.

"The main issue is in Russia, China and India, where most of the global (MDR) burden lies," said Raviglione. The global detection rate for MDR TB was about 5%.

WHO estimates that the largest number of new TB cases in 2008 occurred in the Southeast Asia Region, which accounted for 34% of incident cases globally. However, the estimated incidence rate in sub-Saharan Africa is nearly twice that of the Southeast Asia Region, which has recorded over 350 cases per 100,000. Among TB patients notified in 2009, an estimated 2.5 lakh had MDR-TB. Of these, slightly more than 30,000 (12%) were diagnosed with MDR-TB and notified.

The four countries that had the largest number of estimated cases of MDR-TB in absolute terms in 2008 were China (100,000), India (99,000), Russia (38,000), and South Africa (13,000). By July 2010, 58 countries had reported at least one case of extensively drug-resistant TB (XDR-TB).

Read more: 2m new TB cases in India last year - The Times of India

Anonymous said...

Calcutta may be heading towards a fever epidemic, says Jayanta Basu

Once the sahibs and memsahibs of Calcutta used to hold a party around mid-February every year to celebrate their survival for another year in a city where fever would wipe out thousands, as the numerous tombstones in Park Street symmetry bear witness. Fever, apparently, also had a role in the birth of the city as Job Charnock is said to have hopped on to the Calcutta side of the Ganges on being afflicted with malarial fever, when he was heading for Bator in Howrah, which was more developed.

Though parties may be more numerous today, the city has not changed much pathologically over the centuries. More than five million in the city and on its fringes are preyed upon by a range of fevers today; while malaria or dengue have turned into election issues, many of the fevers are attributed to “unknown causes”. Another “unknown fever” is now raging on the northern fringe of the city, in the Bagda, Gaighata and Baduria areas. The symptoms, almost like those of dengue, have followed a pattern: very high temperature, body ache, weakness, rashes. There have been rumours on how the fever is permanently damaging organs, if it is not killing its victims.

Some doctors feel that the fever is being caused by a weaker variant of the dengue virus. Other viral fevers are taking their toll. Some of these, with common cold and cough are said to be triggered by a combination of viral and bacterial infection. Typhoid fevers with gastrointestinal tract infections are common. Chikunguniya has invaded the Salt Lake area for the first time.

Though fevers can be treated if detected early, viral fevers and influenzas may get complicated with secondary infection. Dengue fever may become life-threatening if it is haemorrhagic (accompanied by rashes on body, bleeding from nose, gums etc).

According to the Calcutta Municipal Corporation (CMC), close to 6,70,000 people suffered from fevers due to malaria and dengue in the city in the last decade (1999-2009).

Private estimates say the number of fever patients in the city is several lakhs more than the CMC number.

Anonymous said...

“First, a large number of vector-borne diseases are not reported to the CMC. Second, in recent years the incidence of viral fever has spiralled. Many of the patients are treated by private doctors and the cases are not reported to the civic body,” says a state health official. “If all the fevers are taken into account, the number can go up to 20 lakh, which effectively means almost one in every three people in Calcutta suffers from fever,” he adds.

The unknown fever seems to be spreading most, at least among the city’s poor.

About a decade back, a joint study by the CMC and the Calcutta Metropolitan Development Authority (CMDA) along with an NGO claimed that fevers completely overshadowed other ailments among the slum population in Calcutta and most of them were of unknown origin.

Calcutta’s air seems to be thick with tiny, unstoppable mutating monsters.

“Malaria and dengue are still common, but viral fevers, especially during changing seasons, have become dominant and sometimes they are reaching epidemic proportions. In the absence of proper identification of the viral strains, we have no option other than symptomatic treatment,” says R.N. Chakrabarty, who has practised as a general physician for decades in north Calcutta.

“Children and the elderly are the worst sufferers,” says Arpan Choudhury, a general physician. Children are found to be affected mostly by the respiratory viruses triggering fevers and often such viral attacks act as triggers for asthma.

Riaz Haq said...

No wonder Calcutta has the distinction of a fever named after it. No wonder that Ronald Ross discovered the malarial parasite in the city.

But what makes the city so vulnerable to fever? The city provides the best possible environment for fever to thrive. “A very high population density, unplanned urbanisation, climate change leading to warming, allowing both the vectors and the causal organisms to thrive better and longer, largescale migration from all over the world, footpath dwellers, who are often carriers of germs… what more is required?” asks entomologist Debasish Biswas, a vector control officer with the CMC. But don’t all big Indian cities have similar constraints? They do, but they also have a far better counter mechanism.

The most important thing in case of an emergency is to have a proper control and command structure with roles clearly defined. This is completely lacking in the city, especially in case of health emergencies.

When something like avian flu or H1N1 strikes, Calcutta can only show a knee-jerk response. The facilities are ad hoc. In case of suspected H1N1 cases, blood samples had to be sent to Pune. The laboratories, apart from a few like the National Institute of Cholera and Enteric Diseases (NICED) in Beleghata, lack modern facilities. The quality of technicians in general is poor. There is no dependable database.

It is difficult to believe that Calcutta came up with a Fever Hospital Committee — and worked on the suggestions of its report — as far back as the 1840s.

Experts also blame global warming for the spread of viruses. “The attacks of viruses on Calcutta’s population are on the rise. I feel the change in the climate in the last few years, the warming up is making it conducive for the viruses to thrive as well as turn active from dormant conditions. The risk is definitely looming larger,” said Shekhar Chakrabarty, deputy director, NICED.

Paediatrician Subhomoy Mukherjee feels that limited medical knowledge often leads to abuse of antibiotics, thus making the viruses resistant to later medicine. Over-the-counter treatment does not help.

Some epidemiologists feel that the city may be heading towards an epidemic. But experts feel Calcutta is hardly ready to fight back if there is an epidemic. There is limited disease surveillance — both the CMC and state government have just an elementary monitoring structure in place. The absence of mechanisms to detect the ever-changing viruses quickly, insufficient awareness of its citizens and, above all, an overstressed and inadequate health delivery infrastructure make the condition worse.

It is very important to begin treatment at the earliest. “All fevers can be treated successfully if detected early,” says Tapan Mukherjee, officer on special duty at CMC.

“Viruses causing fevers in the city often remain unidentified and hence an epidemic triggered by any one of them cannot be ruled out,” says Chakrabarty of NICED. “It’s not that we completely lack infrastructure. Some of the institutes do have electron microscopy and other equipment required to identify viruses but we need a much more concerted efforts between these institutes.”

fever pitch

1923: Dengue fever
40 per cent of city population afflicted
--------------------------------------------------------------------- ---

1963: Haemorrhagic fever
About 100,000 afflicted
--------------------------------------------------------------------- ---

1983: Dengue fever
Thousands afflicted
--------------------------------------------------------------------- --

1999: Malaria
More than 100,000 afflicted
--------------------------------------------------------------------- --

2005: Haemorrhagic fever
More than 3,500 afflicted
--------------------------------------------------------------------- --

2009: Malaria
about 88,000 afflicted
--------------------------------------------------------------------- --

Source: CMC

Riaz Haq said...

Here is a little trivia in response to the worst of the right-wing caste-ist Hindu racists and bigots who claim higher levels of intelligence:

According to Lynn's worldwide IQ data published by Webster Online dictionary, Pakistanis avg IQ rose from 81 in 2002 to 84 in 2006, while Indians's avg IQ increased by just one point from 81 to 82.

A recent UNM study linking IQs and disease burdens can be the basis for rationalizing it.

Looking at the situation in South Asia, it appears from the WHO data that Pakistan is doing a bit better than India in 12 out of 14 disease groups ranging from diarrhea to heart disease to intentional injuries, and it is equal for the remaining two (Malaria and Asthma).

Poverty, hunger, unsanitary or unsafe conditions and inadequate health care in South Asia's developing nations are exposing their citizens to high risk of a variety of diseases which may impact their intelligence. Every year, World Health Organization reports what it calls "Environmental Burden of Disease" in each country of the world in terms of disability adjusted life years (DALYs) per 1000 people and total number of deaths from diseases ranging from diarrhea and other infectious diseases to heart disease, road traffic injuries and different forms of cancer.

In the range of DALYs/1000 capita from 13 (lowest) to 289 (highest), WHO's latest data indicates that India is at 65 while Pakistan is slightly better at 58. In terms of total number of deaths per year from disease, India stands at 2.7 million deaths while Pakistani death toll is 318, 400 people. Among other South Asian nations, Afghanistan's DALYs/1000 is 255, Bangladesh 64 and Sri Lanka 61. By contrast, the DALYs/1000 figures are 14 for Singapore and 32 for China.

Riaz Haq said...

Here's an excerpt from a paper by Professor J. Philippe Rushton on IQ variations across the world:

Classical anthropology often placed South Asians and North Africans in the same taxonomic group as Europeans and designated them both as Caucasoids. But modern genetic studies, such as those by L. L. Cavalli-Sforza, show the South Asians/North Africans are a surprisingly distinct "genetic cluster". They can be distinguished from Europeans to their north as well as from sub-Saharan Africans to their south and the other Asian groups to their east.

The evidence that the average IQ of the North Africans/South Asians is as low as 85 is extensive. Lynn reviewed 37 IQ studies from 16 countries such as India, Pakistan, Turkey, Iran, and Iraq and found an IQ range of from 77 to 96 with a median of 84. He reviewed 13 studies of immigrants from those countries in the UK and Australia and found a median IQ of 89. He reviewed 18 further studies of South Asians and North Africans in Continental Europe and found a median IQ of 84. He reviewed 9 studies of South Asians in Africa, Fiji, Malaysia, and Mauritius and found a median IQ of 88. Finally, Lynn reviewed 13 studies of select South Asian and North African high school and university students and found a median IQ of 92, eight points higher than that of general population samples.

Lynn’s finding of an average South Asian IQ of 85 has been corroborated by Jan te Nijenhuis and colleagues in Holland, who analyzed thousands of respondents including nationally representative samples. They found an average IQ of 81 for first generation Turks and Moroccans living in the Netherlands. They found an IQ of 88 for the second generation, who spoke Dutch and had been educated in the Dutch school system. They published their results in the 2004 European Journal of Personality.

Another finding of a low South Asian IQ came from a review of studies on the Gypsies (or Roma as they are now often called). This South Asian population migrated to southeastern Europe from northwest India between the 9th and 14th centuries and currently number between 4 and 10 million. Their average IQ in the Czech Republic and Slovakia, based on a review of 10 studies by Petr Bakalar, is below 80. His review was published in the 2004 Mankind Quarterly.

I too have confirmed the very low IQ for the Roma. This was in a study carried out in and around Belgrade, in Serbia. My colleagues and I individually tested 323 16- to 66-year-olds over a two-year period in three separate communities using the Raven’s Matrices, a widely-used, culture-reduced, non-verbal test of general intelligence, and four other tests usually given to children. On these tests, we found the Roma averaged at the level of Serbian 10-year-olds. (Our study was published in the January 2007 issue of Intelligence.)

Riaz Haq said...

There are reports that the use of gutka in India and Pakistan is causing growng incidence of oral cancer.

Businessweek has reported that India has the highest number of oral cancers in the world after a group of entrepreneurs known locally as “gutka barons” turned a 400-year-old tobacco product hand-rolled in betel leaves into a spicy blend sold for 2 cents on street corners from Bangalore to New Delhi. Sales of chewing tobacco, worth 210.3 billion rupees ($4.6 billion) in 2004, are on track to double by 2014, according to Datamonitor, a branch of the international research firm based in Hyderabad, India.

“Now you have an industrial version of a traditional thing” spurring demand, said Chaturvedi, who works at Tata Memorial Hospital in Mumbai, Asia’s largest cancer treatment center, and draws cartoons to warn of tobacco’s dangers in his spare time. “By the time you are experimenting with this product, you become the slave of the industry.”

India had almost 70,000 diagnosed cases of cancers of the mouth in 2008, the highest in the world ahead of the U.S. at 23,000 cases, according to statistics compiled by the World Health Organization’s International Agency for Research on Cancer.

Recent studies reported in Dawn on the subject show that Karachi has the highest incidence of oral cancer in the world. With the increasing number of oral cancer cases, the city may witness an epidemic in the coming years, medical experts believe.

A study conducted by the sociology department of Karachi University in 2006 found that 93 per cent children of 50 government and private schools in Saddar Town spent their pocket money on buying areca nut and seven per cent on betel leaf (paan) and gutka.

An Aga Khan University research titled, Socio-demographic correlates of betel, areca and smokeless tobacco use as high risk behaviour for head and neck cancers in a squatter settlement of Karachi, found that head and neck cancers were a major cancer burden in Pakistan.“They share a common risk factor profile, including regular consumption of products of betel, areca and tobacco. Use of paan, chhaalia, gutka, niswar and tobacco is acceptable in Pakistan and is considered a normal cultural practice.”

Riaz Haq said...

Here's a BBC report on pregnant women's deaths in Rajathan due to tainted UV fluids:

..The (three) doctors have been charged with negligence and irregularities in purchases of medicines.

The women died after they were given infected intravenous (IV) fluids at two hospitals in Jodhpur city.

Laboratory tests had confirmed that IV fluids supplied by a local company were "tainted", officials said.

The women died after severe haemorrhaging after they were administered with the IV fluids, authorities say.

India accounts for the highest number of maternal deaths in the world, with tens of thousands of women dying every year due to pregnancy-related problems.


Here's a Deccan Herald story on tainted medicines in India:

It is said that roughly 10 per cent of the medicines available in the market are counterfeit, contaminated or substandard. Profits are huge in the trade. This is a massive racket that involves not just illicit manufacturers but a long chain that includes distributors and then, of course, the shops and hospitals through which these spurious medicines are pushed. It is alleged that pharmacists selling counterfeit drugs profit from doing so. If manufactures are able to push their contaminated drugs easily, it is because hospital authorities are not vigilant. They prefer to purchase medicines from those who grease their palms rather than trusted manufacturers. The problem of contaminated medicines is not one that is confined to allopathic medicines. Testing of some samples of ayurvedic or homeopathic medicines has revealed presence of toxic metal.

Indian pharmaceutical companies export medicines to Africa and Latin America. Therefore, the manufacture of substandard drugs and contaminated fluids poses a grave public health threat that extends far beyond India’s borders. Stern action against those responsible for Jodhpur tragedy is welcome. But it must not stop there. The government must act against other manufacturers of counterfeit and contaminated medicines. The crime they are engaging in is not a minor one. It cannot be brushed aside as mere negligence as they are causing the death of people. They cannot be allowed to play with people’s lives. It is undermining the legitimacy of our medical system.

Riaz Haq said...

Here's a BBC report on resistant strains of TB growing in India:

On World Tuberculosis Day, health officials in the northern Indian state of Bihar are warning of an epidemic of a virulent form of multi drug-resistant TB unless cases are detected more quickly and accurately. The BBC's Geeta Pandey reports from the town of Hajipur, in Bihar, on a disease that kills two Indians every three minutes.

Kishori Rai, 42, looks emaciated and his entire body shakes when he coughs.

He stands in a corner of the dark and dingy hospital room, shifting uneasily from one foot to another, his mouth covered with a white handkerchief which has turned muddy with grime and blood.
Day labourer Kishori Rai is a classic TB patient. The search for work takes poor people like him to cities like Delhi where they are forced to live in cramped slums and shanties - a hotbed of infectious diseases like TB.

India gets nearly two million new TB cases every year - the highest in the world - and the disease, which is fully curable, kills at least 280,000 people annually.

"TB is the largest killer of Indians between 15 and 45 years," Dr Mannan says.

In the past decade, India has made major strides in bringing down the numbers of deaths by aggressively following DOTS or "directly observed treatment, short course" - a programme instituted by the WHO where patients must swallow their medicines every day, watched by health workers or volunteers, until they complete their treatment.

But the authorities admit that the disease remains a major public health challenge and an enormous drain on the economy.

And the huge number of drug-resistant cases is threatening to undo the progress made so far - in 2007, India reported 131,000 drug-resistant cases and that number is steadily rising.

Riaz Haq said...

Among inherited diseases, sickle cell is one reported mainly in Africa, India and the Mediterranean countries, according to an Emory University study:

Millions of people worldwide suffer from the affects of sickle cell anemia – especially those of African, Mediterranean and Indian descent. According to CDC, more than 70,000 people in the United States have sickle cell disease, mostly African Americans. Each year more than 1,000 babies are born with sickle cell disease.

The inherited disorder affects the blood’s hemoglobin, which produces stiff, misshapen red blood cells that deliver less oxygen and can disrupt blood flow, resulting in joint and organ damage and potential clots and strokes. The sickling of red blood cells is aggravated by infections, extreme hot or cold temperatures, poor oxygen intake, not drinking enough fluids and stress.

Eckman says his Center is a unique resource – the only place in the world where patients can be treated 24 hours a day, seven days a week for sickle cell. He notes that the Center functions with admissions, emergency room and short-stay center. A patient can be admitted in 10- to 15-minutes, versus three hours in an ER. Eckman says the more quickly you treat the pain, the more likely it is to be controlled.

Facts About Sickle Cell Anemia

* Sickle cell disease is an inherited disorder involving the chemical known as hemoglobin contained in red blood cells. Hemoglobin carries oxygen to all parts of the body. When sickle hemoglobin loses its oxygen, it forms long rods inside the red blood cells. This causes the red blood cell to lose its round, donut shape and form a hard, sickle, crescent shape.
* Unlike normal red blood cells that are disc-shaped and move easily through the blood vessels, sickle cells are stiff and sticky and tend to form clumps and get stuck in the blood vessels.
* The clumps of sickle cells block blood flow in the blood vessels that lead to the limbs and organs. Blocked blood vessels can cause pain, serious infections and organ damage.
* Sickle cell disease primarily affects individuals of African descent, but can affect people from Italy, Greece, Israel, India, Pakistan, Spain, Central America, the Caribbean and many other ethnic groups.
* Sudden pain throughout the body is a common symptom of sickle cell anemia. This pain is called a “sickle cell crisis.” Sickle cell crises often affect the bones, lungs, abdomen and joints.
* Early diagnosis of sickle cell anemia is very important. Children who have the disease need prompt and proper treatment.

Riaz Haq said...

Report in Hindustan Times says that "more new born babies die in India annually than in any other country, even though the number of neonatal deaths around the world has seen a slow decline, a new study by the World Health Organisation (WHO) has said".

New born deaths decreased from 4.6 million in 1990 to 3.3 million in 2009,
and fell slightly faster in the years since 2000, according to the study led by researchers from WHO, Save the Children and the London School of Hygiene and Tropical Medicine.

The study, which covers a 20-year-period and all the 193 WHO member states, found that new born deaths - characterised as deaths in the first four weeks of life (neonatal period) – account for 41 % of all child deaths before the age of five.

Almost 99 % of the newborn deaths occur in the developing world, with more than half taking place in the five large countries of India, Nigeria, Pakistan, China and Congo.

"India alone has more than 900,000 newborn deaths per year, nearly 28 % of the global total," WHO said, adding that India had the largest number of neonatal deaths throughout the study.

Nigeria, the world's seventh most populous country, ranked second in new born deaths – up from fifth in 1990. Three quarters of neonatal deaths around the world are caused by pre-term delivery, asphyxia and severe infections, such as sepsis and pneumonia.

WHO pointed out that two thirds or more of these deaths can be prevented with existing interventions.

Riaz Haq said...

The number of children under five who die each year has plummeted from 12 million in 1990, to 7.6 million last year, according to Child Mortality Report 2011 prepared by UNICEF and the World Health Organization.

About 21,000 children are still dying every day from preventable causes.

India leads the under-5 death toll with 1.7 million deaths, followed by Nigeria 861K, Dem Rep of Congo 465K, Pakistan 423K, China 315K, Ethiopia 271K and Afghanistan 191K.

In terms of deaths per 1000 live births, Pakistan is still at 87, compared with Bangladesh 48 and India 63.

Pakistan's rate of child mortality decline at 1.8% a year between 1990 and 2010 is among the slowest in the world, compared with 3% in India and an impressive 5.5% in Bangladesh.

Burkina Faso at 176 deaths per 1000 live births, Angola 161, Afghanistan 149, and Nigeria 143 are among the highest in the world.

Riaz Haq said...

Here's a story about a Lancet study of Pakistan's "Ladies Health Workers" treating child pneumonia:

LONDON, 14 November 2011 (IRIN) - Pakistan’s army of “Lady Health Workers” – some 90,000 strong – was never meant to diagnose and treat serious illnesses. Instead, these female community health workers (in Pakistan, men cannot visit families) were expected to teach good hygiene and nutrition, provide family planning advice, monitor pregnant women, weigh and vaccinate babies and treat minor ailments.

Yet a new study shows that these same women could hold the key to treating pneumonia – the world’s leading killer of young children.

The study, published by The Lancet medical journal and conducted by Save the Children US, funded by the US Agency for International Development and coordinated by the World Health Organization (WHO), found that children suffering from severe pneumonia were more likely to recover if treated at home by these women rather than in a health facility.
Sadruddin and his colleagues in Pakistan decided to see whether treatment could be given at home by the local Lady Health Worker. They ran a pilot project in Haripur district, in the south of Pakistan’s North West Frontier Province. Where the health workers identified severe pneumonia, with fever, rapid breathing and in-drawing of the lower chest, they were to give a full course of the WHO recommended antibiotic, liquid amoxicillin. “We wanted to see if they could do as well as conventional in-patient treatment. In fact, we found that they did better.”

The study followed 3,211 children, whose progress was checked six days after the start of treatment. Among those treated by their local health worker, only 9 percent failed to respond to treatment. In the control group, 18 percent failed to respond. The children visited at home started treatment sooner, and were sure to get the most suitable drug, while prescriptions in government and private clinics were far less consistent.

The Lady Health Workers taking part in the trial were carefully supervised. “These workers cannot just be left unsupervised after their training,” Sadruddin told IRIN. “They need ongoing support from their supervisors to attain their goals.”

The message was reinforced by the Elizabeth Mason, director of WHO’s Department for Newborn, Child and Adolescent Health.

“Supervision is absolutely critical, and it is one area that programmes have to ensure that they have well in place,” she told IRIN.

But she said WHO was extremely interested in the findings. “This is the kind of breakthrough research which is urgently needed. It is the first study of its kind and we will have to put it together with studies from other places. But I hope we may be able to review our guidelines to make treatment more accessible to poorer children and those living in remote communities, the ones who need it most.”

The programme also brought benefits to the women, elevating their status. In Haripur, when people saw that the women could treat seriously ill children and save their lives, their status rose dramatically, according to Sadruddin. By the end of the two-year trial, families were far more likely to make the Lady Health Worker their first port of call when their children were ill.

“When they started,” said Sadruddin, “the women themselves were not confident of their own abilities, and the community was also not confident. But when we went back, we found [so] much respect for the Lady Health Workers.”

Riaz Haq said...

US CIA's fake vaccine ploy to get bin Laden has hurt Pakistan's polio fight, reports the Wall Street Journal:

The United Nations says a reportedly fake vaccination campaign conducted to help hunt down Osama bin Laden has caused a backlash against international health workers in some parts of Pakistan and has impeded efforts to wipe out polio in the country.

A number of families across Pakistan refused vaccinations from July, when news of the reportedly fake campaign broke, to September, said Dennis King, chief of polio vaccinations in Pakistan for Unicef. "Following the early reports, some families in the provinces did refuse to have their children vaccinated citing the fake campaign as the cause," Mr. King said.

The refusals, he added, have declined since September due to vigorous campaigning by international and local health workers to ensure families they are working only to vaccinate against polio, a disease eradicated in most of the world but still prevalent in Pakistan.

Pakistan military intelligence in July detained a local doctor, Shakeel Afridi, on charges of involvement with the reportedly fake vaccination campaign, supposedly involving vaccine against hepatitis B. Pakistan officials believe the campaign was an attempt to get DNA samples from bin Laden's family to confirm his location in a house in Abbottabad.

In May, U.S. Navy SEALs raided the house, killing bin Laden. A Pakistani judicial committee has recommended Dr. Afridi be charged with treason, which carries the death penalty. He hasn't been made available to comment since his arrest.

The U.S. Central Intelligence Agency, which Pakistani officials say carried out the purportedly fake program, hasn't publicly commented. Officials familiar with the bin Laden operation say the CIA did indeed institute a mock vaccine program with a local doctor who had previously been an informant in the tribal areas. The plan was to obtain DNA from residents of the Abbottabad compound as they got a vaccine injection, helping confirm bin Laden's presence there....
Ghulam Rasool, a laborer from Khyber, found out in March that his 18-month-old son had polio after militants had warned off health workers.

"I know my child's future has been ruined, but I won't let it happen to my other kids," he says. "Now I have brought eight children of my extended family to Peshawar to get them vaccinated despite threats."

Senior Pakistani health officials condemn Mr. Afridi's role as unethical.

"Everybody in the medical profession resented his deceptive role. Defeating polio in Pakistan is challenging anyway, and this created negative associations," says Janbaz Afridi, deputy director at Khyber-Pakhtunkhwa's provincial health department in Peshawar.

Pakistan is one of the last significant polio reservoirs in the world, imperiling global eradication efforts, Unicef warns.

Riaz Haq said...

Here's a Businessweek story on fake medicines in Pakistan:

In Pakistan’s biggest market for wholesale medicines, it pays to be observant.

More than 2,500 stalls wedged along dirt lanes in Karachi’s busiest trading district offer everything from Pfizer Inc. (PFE) (PFE)’s cholesterol pill Lipitor to GlaxoSmithKline Plc (GSK)’s painkiller Panadol. Closer study of the remedies lining rickety shelves reveals the source of an unfolding medical crisis: Lipitor sold in obsolete packaging, Panadol packets missing tell-tale ribbing, and allergy medicine Zyrtec mislabeled as Zytrec.

Now, the free flow of fake medications channeled through the market for decades may soon be slowed. Lawmakers are poised to pass legislation in June creating an agency to quash the trade after 107 heart patients were killed this year by pills tainted with lethal amounts of an anti-malarial agent. That may help break the ring of counterfeiters in Pakistan, part of a wider network supplying what the World Health Organization estimates is a $431 billion global market for spurious drugs.

“The issue is serious, demanding serious steps,” said Salman Burney, chief executive of GlaxoSmithKline Pakistan Ltd. (GLAXO) in Karachi. “Better regulation will generate more investment in the pharmaceutical industry, which will mean better quality medicines.”

The problem spans national borders. Pakistan was one of the 10 largest sources of counterfeit goods seized in the U.S. last year, U.S. Customs and Border Protection said in January. Medicines accounted for 85 percent of the value of the Pakistani items obtained.

At least 30 percent of medicines bought in the country are either counterfeits or substandard, said Kulsoom Parveen, a lawmaker who chairs a Senate health committee. Pharmacies nationwide sell drugs without a doctor’s prescription, enabling the treatments to be taken without medical supervision.
’Exploiting Weaknesses’

Pakistan has 4,000 registered pharmacists and 25 times more merchants dispensing medicines illegally, the Pakistan Pharmacists Association said.

It’s no coincidence that fake and substandard drugs are flourishing in Pakistan, said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. The New York- based think-tank prepared six recommendations to fight the drug- safety crisis for consideration by the Group of Eight summit at Camp David, Maryland, today and tomorrow.

“Individuals that are exploiting weaknesses in global drug safety and regulation will base themselves in places where they know the system is fragile or nonexistent,” Garrett said in a telephone interview. “Pakistan is really struggling to keep its entire public health infrastructure alive.”
Damaging Brands

Protecting product integrity would also benefit makers of brand-name medicines. Pharmaceutical sales in Pakistan, with a population of 196 million, total $2 billion annually, compared with $12.4 billion in neighboring India, with 1.2 billion people.

GlaxoSmithKline Pakistan, based in Karachi, made 1.14 billion Pakistani rupees ($12 million) in profit on sales of 21.75 billion rupees last year. In India, Mumbai-based GlaxoSmithKline Pharmaceuticals Ltd. (GLXO) had net income of 6.3 billion Indian rupees ($118 million) and revenue of 23.9 billion rupees.

Prime Minister Syed Yousuf Raza Gilani’s government hasn’t had a federal health minister or a central drug regulatory agency since powers were handed to the country’s four provinces last year. A new bill, to be voted on by Pakistan’s senate next month, will strive to fill the void....

Riaz Haq said...

Pakistan become first South Asian nation to start pneumonia vaccination, reports Reuters:

Pakistan has become the first country in South Asia to introduce a vaccine against the deadly pneumococcal disease in children, with GlaxoSmithKline's Synflorix selected for the programme.

Worldwide more than 1.3 million children under the age of five are killed each year by pneumonia and in Pakistan it accounts for almost 20 percent of child deaths, according to the Global Alliance for Vaccines and Immunization (GAVI).

The move comes at a time when healthcare experts are still struggling to get polio vaccination accepted in parts of Pakistan, one of the few countries where it is still endemic.

The introduction of Synflorix in Pakistan, which began on Tuesday, is possible thanks to GAVI's advanced market commitment scheme, which provides incentives for drug companies to produce large quantities of vaccines for poor countries at low cost.

"In Pakistan, with a successful roll-out we can save tens of thousands of lives," GAVI's chief executive Seth Berkley told reporters at a briefing at its Geneva headquarters. "It will make a dramatic difference in life expectancy in the country."

GSK, Britain's largest drugmaker, said it would provide a minimum of 480 million doses of Synflorix to GAVI for programs against pneumococcal disease in 73 developing countries by 2023.

GAVI also has a similar global deal with Pfizer for its rival pneumococcal vaccine Prevnar. The agency chooses between the competing vaccines in each country.

GAVI is a public-private partnership backed by the Bill & Melinda Gates Foundation, the World Health Organisation, the World Bank, UNICEF, international donor governments and others. It funds bulk-buy immunization campaigns for poorer nations that can't afford vaccines at rich-world prices.

Berkley noted problems with Pakistan's polio eradication effort, which has been hampered by mistrust and rejection among local people, but said he expected the introduction of the pneumococcal vaccine to be smoother, and potentially helpful to the polio campaign in the longer run.

"The government of Pakistan assures us they will do everything they can to roll out this product," he said. "This is a vaccine that families understand, (along with) the importance of this disease and children dying, so it actually may help the effort."
Latest United Nations estimates show that pneumonia accounts for 18 percent of child deaths globally. In Pakistan more than 352,000 children die before they reach their fifth birthday and almost one in five of those deaths are due to pneumonia.

GAVI said that while pneumococcal vaccines cannot prevent every case of pneumonia they can prevent a significant proportion and have the potential to protect tens of thousands of children from preventable sickness and death.,0,5963496.story

Riaz Haq said...

Here's Kantawala in Friday Times on India's Dengue outbreak killing Yash Chopra:

I'm still not over Yash Chopra dying from Dengue disease. I just thought I'd throw that out there. Of course it's sad that the Rom Com Don passed away and I do hope he is running through heavenly wheat fields while singing love songs to clouds and backup singers, like the many dream sequences he inspired in us all. But I would never have thought of Dengue and Bollywood in the same sentence until now (or Dengue and anything, really. It's still not so much a reality as a morbid punch-line). It just reminded me of how good India is at PR. During last year's Succubus Summer Solstice, when Dengue Mosquitoes hit the Punjab like a wife beater with Daddy Issues, we lost over 2,000 people to the disease. Judges, trainers, workers, rich, poor, women, men. We covered it (forgive me) to death in newspapers, and the news of the world was gripped with yet another Pakistan catastrophe. For six months it really was like the end of a disaster movie called Infection or Gestation Period or something clinically unimaginative.
Last year, around this time, a water-based brain disease killed 500 children in a town in Northern India in one week. One week! It comes every year, it's just that that year was particularly bad. Now, how does a deadly, brain-eating, child specialist disease that may or may not have "come from Japan" not make it to the world's news? How? PR people. That's how. Get on that.

Here's NY Times on dengue fever in India:

NEW DELHI - An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world's nations.

"The global dengue problem is far worse than most people know, and it keeps getting worse," said Dr. Raman Velayudhan, the World Health Organization's lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India's capital, where areas of standing water contribute to the epidemic's growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.


"I'd conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations," said Dr. Scott Halstead, a tropical disease expert focused on dengue research...

Riaz Haq said...

Here's a News story on rising obesity in Pakistan:

KARACHI: The obesity is an emerging challenge to human well-being like other parts of the world, it was also on the increase in Pakistan.

The overweight and obesity are the fifth leading risk for global deaths.

The World Health Organization (WHO) estimates suggest that 26 percent of women and 19 percent of men in Pakistan are obese. Women are 2-3 times more likely to be obese.Childhood obesity is increasing with an estimated value of 10 percent.

This was stated by Prof Dr Muhammad Iqbal Choudhary, Director International Center for Chemical and Biological Sciences (ICCBS), Karachi University.

He was delivering a lecture on Wednesday at the 4th International Symposium-Cum-Training Course on Molecular Medicine and Drug Research being held at the International Center for Chemical and Biological Sciences (ICCBS).

Over 350 scientists, including 35 scientists from 24 countries, are attending the international event, organised by Dr Panjwani Center for Molecular Medicine and Drug Research (PCMD), University of Karachi.

Dr. Iqbal said that obesity had become a serious health problem worldwide, which is a result of an imbalance between energy intake and expenditure; the molecular cascade involves in obesity and associated disorders are not fully understood.

Proliferation of adipocytes plays an important role in the onset and progression of obesity, he added.

`Obesity has been linked to several serious health ailments like heart disease and stroke, high blood pressure, diabetes, cancer.

Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer; once considered a problem only in high income countries, overweight and obesity are now on the rise in low and middle-income countries.

Overweight and obesity are largely preventable; the intake of healthier foods, and regular physical activity are easiest ways to prevent obesity, he said.

There is an urgent need to have R&D programme in the field of anti-obesity drug discovery and development, he urged, saying that the fundamental causes of obesity are an increased intake of energy-dense foods that are high in fat, salt and sugars but low in vitamins, minerals and other micronutrients; and a decrease in physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation and increasing urbanization.

Talking about the multi-drug-resistant pathogens, he said that a rapid decline in research and development on new antibiotics coincides with increasing frequency of infections caused by multi-drug-resistant pathogens.

The key reason of bacterial resistance is the indiscriminate of suboptimal use of antibiotics. During the last three days of the symposium, various lectures of the national and international scientists were held on different scientific issues.

Riaz Haq said...

Here's a story of how Lahore fought dengue outbreak in 2011:

..“No one expected this kind of political commitment,” said Qutbuddin Kakar, who oversees programmes to combat malaria and dengue in Pakistan for the World Health Organization (WHO). “In this part of the world, at least, we had not seen this kind of response before.”

The anticipated 1,000-plus deaths did not occur, and since then, dengue fever cases have dropped - 200 in the province (Punjab) last year, without any reported deaths.


The results they collect are processed on site by specially-designed Android based applications on their smartphones, and uploaded to a centralized dengue prevention centre.

There, analysts match the entomological data with reports from hospitals showing where dengue patients are being treated. Based on the findings, a team is sent to fumigate areas where aedes mosquitos seem to be breeding and infecting people, or to identify and remove sources of standing water.

The key season for infections comes with monsoon rains, when the aedes aegyptus and aedes albopictus mosquitoes, which can carry the virus, begin to appear.

Chronology of an outbreak

In August 2011 heavy monsoon rain dumped 13 inches in a week, leaving parts of Lahore with large bodies of standing water, and raising immediate concerns about disease.

By mid-October, the provincial government in Punjab reported that more than 11,000 dengue cases were recorded by the provincial government.

“It was an exponential increase in number, and it really frightened the government,” said Faran Naru, a consultant hired by the provincial government to tackle the problem. “And the issue was resonating in the media... so it created a panic in the public which had to be contained.”

Most people infected with dengue recovered on their own, said Naru, but once media outlets began reporting on the extent of the outbreak, thousands showed up at hospitals and laboratories to get tested.

An initial team of 70 entomologists conducted 12,000 spot-checks to track where aedes mosquitos were present. By mid-October, this data had been mapped, along with the locations of 11,000 reported dengue patients.

The results surprised the scientists. The worst affected areas were some of the wealthiest neighbourhoods of Lahore: Model Town, Race Course, Mozang, and Gulberg.

“I saw that in Model Town there is a big park, and in Race Course there are two of Lahore's biggest parks… and I believe lots of breeding was happening there and mosquitoes were leaving from there and infecting people,” said Naru.

The mosquitoes need fresh water to lay their eggs, and the large puddles in Lahore's biggest public parks proved to be ideal homes.

Another hotspot was the Mozang neighbourhood, home to one of Pakistan's largest graveyards. The 150-acre area was found to be a major breeding ground for mosquitos. Gravediggers had dug large pits to hold water, which they used to soften the dirt when digging.

“It's fresh water,” said Naur, “from the tap, and there were 70 pits, and all of those were infected, full of larvae.”

Back in the hospital, dengue patients were separated into special areas for treatment. The home of each dengue patient was fumigated, along with 12 surrounding houses, three in each direction.

Sanitation workers unclogged sewers and drains in an effort to clear areas of rainwater; and parks, gardens, and cemeteries were also sprayed. Thousands of Mosquitofish and Garden Carp - fish species known to attack mosquito larvae - were also released into ponds and ditch canals.

Within a few weeks, entomologists detected far fewer aedes mosquitoes, and the prevalence of dengue cases rapidly decreased.

Riaz Haq said...

How #Pakistan’s National Health Insurance Program Will Work via @WSJIndia

Pakistan’s government launched a national health insurance program for its poorest households Thursday, marking the start of the most-ambitious public health project in the country’s history.

The Prime Minister’s National Health Program will from Thursday cover families that make less than $2 a day through a gradual rollout. In the first phase, over 3 million families will get health insurance in 23 districts, with the ultimate aim to cover 22 million households across the country, officials said.

“This is another step towards the welfare state that we promised to create when we came into power,”said Pakistani Prime Minister Nawaz Sharif.

The Pakistani government already subsidizes health care to varying degrees in public hospitals, but officials acknowledge these facilities are unable to handle the patient load or achieve public health targets.

The government said earlier this year that it wouldn’t be able to meet the United Nation’s targets for child and maternal mortality rates that formed part of the Millennium Development Goals, which had a deadline of 2015. Critics have blamed Pakistan’s low health spending and inadequate management as key factors in the poor health provision. Between July 2014 and March 2015, Pakistan spent just 0.42% of its GDP on health. The U.S. government spends about 8.3% of GDP on healthcare.

The new insurance program will cover treatment at both public and private hospitals. Private hospitals that sign up will then be offered loans on easy terms to upgrade their facilities, officials said, without providing further details about interest rates and conditions.

Saira Afzal Tarar, minister of state for health Services, regulations and coordination, said most Pakistanis pay out of pocket for treatment. “There is treatment at government-run hospitals, but there are long lines. Those who don’t have a recommendation have to wait months for treatment,” Ms. Tarar said at the launch ceremony in Islamabad. “With this [health insurance] card, you’ll be able to go to the hospitals where you weren’t allowed to even go to the front door. Now, you’ll be treated there with dignity and respect.” Ms. Tarar said.

The national health program, with an initial funding of 9 billion Pakistani rupees ($86 million) will pay for the treatment of the types of illnesses identified by the government as critical: heart disease, diabetes and related illnesses, cancer, kidney and liver diseases, complications from infections like HIV and Hepatitis, road accidents, and burn injuries. Officials said coverage can be extended to other conditions considered life-threatening.

The government said Thursday that the program will be run in partnership with provincial governments, which will share the financial burden. Beneficiaries will receive insurance cards, after selection from a database of low-income Pakistanis set up in 2008 for a separate cash support program.

The coverage includes 50,000 rupees for general treatment, and 300,000 rupees for serious illnesses. Mr. Sharif said on Thursday that the government is making arrangements for an emergency fund that would extend coverage to 600,000 rupees for cases that require longer treatment.

Officials on Thursday didn’t provide specific timelines for the rollout of the next phase, which is expected to cover another 3.3 million households. The finance ministry said earlier this year that the program aims to cover 22 million families.

The finance ministry, quoting World Bank data and 2008 population estimates, said last year that if living on $2 a day is taken as the poverty line, over 60% of the population would fall in that category.

Riaz Haq said...

A fatal disease lurks in #India's air, water, and soil. #Modi's #India is hotbed of deadly bacteria via @qzindia

Melioidosis, a highly contagious disease, is widely prevalent in India, according to a new report by researchers from the University of Oxford. If not treated in time, it can lead to death within just two days of contracting it.
However, diagnosing melioidosis is particularly difficult, causing the illness to largely go under-reported. The report, published in the Nature Microbiology journal, classified India as “endemic but under-reported” as a measure of its melioidosis pervasiveness.
“Some 44% of the total cases (165,000 annually) worldwide are from South Asian countries,” David Dance of the University of Oxford said at Manipal University in November 2015. India tops the list of countries that reported melioidosis deaths, with more than 50% share.

“We estimate there to be 165,000 melioidosis cases per year worldwide, from which 89,000 people die. Our estimates suggest that melioidosis is severely under-reported in the 45 countries where it is known to be endemic, and that melioidosis is probably endemic in a further 34 countries that have never reported the disease,” the report in Nature Microbiology said.
Burkholderia pseudomallei, the bacteria that causes melioidosis and breeds in water and soil, is commonly found in Southeast Asia and Northern Australia. The symptoms of the disease include fever, convulsions, and respiratory discomfort.
In India, rampant, large-scale construction has led to the disease spreading more easily. Besides water, the bacteria can be transported through dust or loose soil, common in construction sites.
“A patient will come with high fever, cough, chills, abscess in internal organs—especially the liver and prostrate—bone and joint ache and rigors, which is a sudden feeling of cold with shivering accompanied by a rise in temperature, often with copious sweating,” Chiranjay Mukhopadhyay, professor at the department of microbiology at Manipal University’s Kasturba Medical College, Karnataka, and head of the Indian Melioidosis Research Forum, told the Mid-day newspaper.
The disease still lacks a licensed vaccine. “Once you’ve got it badly, it is difficult to treat,” Dance said. Diabetic patients and those with chronic kidney diseases are more likely to contract melioidosis.

Riaz Haq said...

A #crowdfunding platform to solve #Pakistan's #healthcare woes. 200 surgeries funded to date …

Pakistan-based startup Transparent Hands is a crowdfunding platform which looks to address the problem of a lack of access to quality healthcare in the nation. Pakistan has a population of approximately 200 million people, yet its health indicators are abysmal. The government allocates only 0.67% of GDP on the healthcare sector; so the country’s public health infrastructure is almost non-existent.

While patients can receive access to quality healthcare facilities, it is very expensive. With a reported 58.7 million citizens living under the poverty line, this is simply not possible for a vast segment of the populace.

Transparent Hands, which was incubated at Lahore-based Plan9, launched operations in 2014 with the objective of bringing transparency to charitable donations in Pakistan. Founder Rameeza Moin says that the venture is entirely not-for-profit and came about after a thorough analysis of the existing healthcare segment in the country.

“There are many potential donors across the world who want to contribute, but they don’t know where and when to send their money or whether their donations will be utilized in a proper way. This is the main issue we’re trying to overcome,” she adds.
Transparency is at the core of the startup’s processes. Team members visit rural and semi-urban areas to find patients in need of critical medical care. Their cases are verified, both in terms of health and finances. The startup currently only works with patients who require surgery.

Since its launch, Transparent Hands has facilitated over 200 surgeries and has partner hospitals in four cities. Its next step is to expand into other major urban centers, as well as focus on other areas of service delivery – such as education.

Riaz Haq said...

Dailytimes | #ImranKhan to perform ground-breaking of #Karachi's cancer hospital on Dec 29 - #PTI via @Shareaholic

The ground-breaking ceremony of Shaukat Khanum Memorial Cancer Hospital and Research Centre in Karachi would be held on December 29, 2016.

Pakistan Tehreek-e-Insaf's chairman Imran Khan, who is also Chairman Board of Governors Shaukat Khanum Memorial Trust will lay the foundation stone.

In February this year, the then Chief of Army Staff General Raheel Shareef had granted a 20 acre plot for the construction of the cancer hospital in Defence Housing Authority located at the Karachi-Hyderabad Super Highway.

A statement of Shaukat Khanum Memorial Trust said, "The construction of a comprehensive cancer diagnosis and treatment facility in Karachi will not only provide the most modern cancer treatment to the people of Sindh, but will also help raise healthcare standards and provide training and employment opportunities in the region."

It is Shaukat Khanum Memorial Trust's third Cancer Hospital and Research Centre in the country. Trust has already established two hospitals - one in Lahore and the other is in Peshawar.

Riaz Haq said...

India world’s leprosy epicentre, despite its ‘elimination’ in 2005
Leprosy cases with severe deformities have increased by 50% increase in the past six years, indicating that many cases of the curable disease are being detected late. This rising trend of late diognosis is a cause for concern, especially after the government had declared leprosy had been eliminated from India in 2005. WHO norms say leprosy is eliminated if the prevalence of the disease is less than one case per 10,000 people.
According to the WHO, 60% of the 2,12,000 people detected with leprosy globally in 2015 were from India. WHO norms say leprosy is eliminated if the prevalence of the disease is less than one case per 10,000 population. In 2005, India achieved statistical elimination of leprosy with a national prevalence rate of 0.96. The prevalence rate declined to 0.66 in 2015-16. The next step is eradicating the disease, when not a single case is reported.

From the early 1960s on, Pfau helped lead the Marie Adelaide Leprosy Centre, transforming what was once a tiny makeshift dispensary into the hub for a system of 157 medical centers across the country, often in remote regions. With the partnership of the Pakistani government, Pfau developed the country's National Leprosy Control Programme and extended her efforts to include treatments for blindness and tuberculosis.

"We are like a Pakistani marriage," Pfau told the BBC of her occasionally strained collaboration with state officials. "It was an arranged marriage because it was necessary. We always and only fought with each other. But we never could go in for divorce because we had too many children."

But that partnership paid dividends. By 1996, the World Health Organization declared that leprosy had been controlled in Pakistan. The country's Dawn newspaper reports that last year, just 531 patients were in treatment for leprosy nationwide — down from 19,398 in the early 1980s.

For her efforts, Pfau earned the country's second-highest civilian honor, the Hilal-e-Imtiaz, in 1979. And she ultimately came to enjoy a celebrity in Pakistan on par with another nun known the world over for her work with the sick and the poor: Mother Teresa.

Riaz Haq said...

#UAE to build first ever #medical mall in #Islamabad, #Pakistan. The project will include therapeutic and recreational areas, a regional #Cardiology center, an orthopedic centre and 400-bed #university #hospital.

A prominent UAE-based MBF Group has announced to establish an integrated medical city that will also feature a first-ever medical mall of the country in Islamabad.

The agreement of MBF with Ibchez Housing and Nixon, according to the report, will include the construction of a hospital that will provide medical services at international standards.

The founder and owner of MBF Group Shaikh Mohammad Bin Faisal Al Qasimi ,in an interview with the Gulf news said the project will include a 400-bed university hospital that will offer the most advanced levels of healthcare services.

The medical city will also feature the country’s first medical mall, therapeutic and recreational areas, a regional cardiology centre, and an orthopedic centre, he added.

He noted that the city will include a nursing college and is expected to serve some one million patients and clients on a monthly basis.

There is a need for such advanced hospitals to serve Pakistan’s growing population, he stressed.

Shaikh Mohammad pointed out that the investment provided for the medical city has reached US$970 million (Dh3.52 billion), while noting that its land has been purchased, as well as the desire of all parties to complete the project on time, in a bid to answer the growing demand for medical services in Islamabad and provide specialist health services that are in short supply.

He informed that the group will manage the city’s 1,000 medical, technical and administrative staff, who will all be Pakistanis, and is responsible for providing medical equipment and beds.

Riaz Haq said...

Lancet Study: Non-infectious diseases cause early death in Pakistan

Pakistan has considerable control over infectious diseases but now struggles against cardiovascular diseases, diabetes and cancer as causes of early deaths, according to a new study published Thursday.

The Lancet Global Health, a prestigious British-based medical journal, reported that five non-communicable diseases — ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease — were among the 10 leading causes of early deaths in the impoverished Islamic nation.

However, the journal said some of Pakistan’s work has resulted in an increase in life expectancy from 61.1 years to 65.9 over the past three decades. The change is due, it said, “to the reduction in communicable, maternal, neonatal, and nutritional diseases.” That’s still 7.6 years lower than the global average life expectancy, which increased over 30 years by 8% in women and 7% in men.

The study says “despite periods of political and economic turbulence since 1990, Pakistan has made positive strides in improving overall health outcomes at the population level and continues to seek innovative solutions to challenging health and health policy problems.”

The study, which was based on Pakistan’s health data from 1990 to 2019, has warned that non-communicable diseases will be the leading causes of death in Pakistan by 2040.

It said Pakistan will also continue to face infectious diseases.

“Pakistan urgently needs a single national nutrition policy, especially as climate change and the increased severity of drought, flood, and pestilence threatens food security,” said Dr. Zainab Samad, Professor and Chair of the Department of Medicine at Aga Khan University, one of the authors of the report.

“What these findings tell us is that Pakistan’s baseline before being hit by extreme flooding was already at some of the lowest levels around the globe,” said Dr. Ali Mokdad, Professor of Health Metrics Sciences at IHME. “Pakistan is in critical need of a more equitable investment in its health system and policy interventions to save lives and improve people’s health.”

The study said with a population approaching 225 million, “Pakistan is prone to the calamitous effects of climate change and natural disasters, including the 2005 Kashmir earthquake and catastrophic floods in 2010 and 2022, all of which have impacted major health policies and reform.”

It said the country’s major health challenges were compounded by the ongoing COVID-19 pandemic and last summer’s devastating flooding that killed 1,739 people and affected 33 million.

Researchers ask Pakistan to “address the burden of infectious disease and curb rising rates of non-communicable diseases.” Such priorities, they wrote, will help Pakistan move toward universal health coverage.”

The journal, considered one of the most prestigious scientific publications in the world, reported on Pakistan’s fragile healthcare system with the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine. The study was a collaboration with a Karachi-based prestigious Aga Khan University and Pakistan’s health ministry.

The study also mentioned increasing pollution as one of the leading contributors to the overall disease burden in recent years. Pakistan’s cultural capital of Lahore was in the grip of smog on Thursday, causing respiratory diseases and infection in the eyes. Usually in winter, a thick cloud of smog envelops Lahore, which in 2021 earned it the title of the world’s most polluted city.