Tuesday, May 28, 2019

Pakistan's Latest Health Emergency: HIV/AIDS Outbreak in Sindh

Pakistan is dealing with a new health emergency with the HIV/AIDS outbreak. Nearly 700 people, most of them children, have so far tested HIV positive in Ratodero, Sindh, according to Pakistan's health officials. Authorities allege that this HIV outbreak started when local doctor Muzaffar Ghangharo, who has AIDS, infected patients in early April.

"Initial investigations reveal that used syringes are being repacked, which may not only grow significantly the number of HIV cases but also other diseases," said Federal Health Minister Zafar Mirza.

A joint 11-member rapid response team of health experts from the United States Centers for Disease Control (CDC) and the World Health Organization (WHO) have just arrived in Pakistan to support the emergency response to the nation's “biggest” outbreak of HIV infections in a southern district where more than 700 people, mostly children, have been diagnosed over the past month, according to Voice of America.

Minister Mirza believes that reported cases of HIV/AIDS in Pakistan are only the tip of the iceberg. He says that official estimates put the number of HIV/AIDS carriers in the country at around 163,000. “But only 25,000 of them are registered with our national and provincial HIV/AIDS treatment centers, and out of them, merely 16,000 visit the programs routinely to receive their medicine,” the minister was reported as saying.

 With questionable medical practices in private as well as public hospitals, Pakistan's health system is inadequate for dealing with serious health crises like the HIV/AIDS outbreak. However, the US CDC and WHO have had a lot of experience in fighting HIV/AIDS in sub-Saharan Africa where it continues to be the biggest contributor to disease burdens and premature deaths.

Pakistan needs to work with WHO and US CDC and use the opportunity to learn from their experience in terms of prevention and antiretroviral therapy for HIV/AIDS. Such learning could also help improve the overall health care practices and outcomes in the country. Right now, time is of the essence in identifying all current cases for quickly controlling further spread of the disease.

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Anonymous said...

A major factor that must be accounted for in the overall HIV transmission scenario is the rampant use of therapeutic injections, often with non-sterile injection equipment. There are an estimated 800 million therapeutic injections given annually in Pakistan or approximately 4.5 per capita. This is among the highest in the World.
A significant proportion of these are reused. This has led to the prevalence of Hepatitis C infection (which is nearly exclusively transmitted via blood exposures) to become >5% nationwide, although this seems to have stabilized at a national level. Conservatively this suggests around 150,000 new HCV infections annually, leading to the conclusion that HIV can also potentially spread via this route as well. Indeed recent community based outbreaks in Punjab suggest that the process may have already started.

Is this the tip of an iceberg?

Edhi F

nayyer ali said...

The practice of giving useless injections to patients to satisfy the perceived need for a treatment and to give the doctors additional revenue source has to stop. There needs to be a public education campaign about the uselessness of most injections and the extreme danger of reused needles. These victims, mostly children, were infected for no reason. The doctor here is to blame but his behavior is just an example of a major systemic problem.

Rks said...

This is just a tip of the iceberg..... given the taboo, most pakistanis would hide this disease and refuse to take tests.

Riaz Haq said...

Dr Zafar Mirza, Fed #Health Minister, visits Getz #Pharma, #Pakistan’s only WHO-accredited pharmaceutical company, gets assurance that Getz Pharma would help address the problems of shortages of #medicines for the treatment of #HIV #AIDS https://www.thenews.com.pk/latest/485535-dr-zafar-mirza-visits-getz-pharma-pakistans-only-who-accredited-pharmaceutical-company

KARACHI: Dr Zafar Ullah Mirza, State Minister for National Health Services, Regulations and Coordination (NHSRC), visited the only pharmaceutical company in Pakistan, whose manufacturing facility has recently been prequalified and accredited by the World Health Organization (WHO).

Getz Pharma, is also the largest exporter of medicines from Pakistan. The company has been awarded the Prime Minister’s highest export trophy in the Pharmaceuticals category for the past 14 consecutive years.

During the nearly three hours visit, the minister toured and reviewed company’s Manufacturing/Production Facility, Quality Control laboratories, Stability Area, and Technical/ Utility Areas.

Dr Zafar Mirza, who has 15-years of experience of working with WHO, appreciated the high standards of production and quality assurance of the company and congratulated the management for obtaining both the WHO prequalification as well as the PIC/S accreditation and putting Pakistan on the map of the select few countries whose facilities and products are prequalified by WHO.

The minister discussed with the management how to improve the availability of the Essential Medicines in Pakistan in general and the local production for the treatment of HIV.

The CEO assured the minister that Getz Pharma would help address the problems of shortages of Essential Medicines, especially the medicines for the treatment of HIV.

Dr Zafar Mirza exchanged views on the issues facing the pharmaceutical sector and brainstormed ideas to boost exports of medicines. He reiterated that the government is keen to transform the health and pharmaceutical sector and increase the exports of medicines from Pakistan.

The minster urged the pharmaceutical companies to increase their exports.

The company’s management shared their plans to increase their exports in the next few years.

Riaz Haq said...

#Pakistan's swift response to #HIV led by World Health Organization, #Sindh #AIDS Control Program, Aga Khan University, the Field Epidemiology and Laboratory Training Program, Dow Medical University in #Karachi, Microbiology Society of Infectious Disease. https://www.unaids.org/en/resources/presscentre/featurestories/2019/june/20190618_pakistan

UNAIDS is continuing its support to Pakistan in responding to the outbreak of HIV in Larkana, during which more than 800 people have been newly diagnosed with the virus. More than 80% of the new cases are among children aged under 15, with most among children aged under 5. By 17 June, 396 people had been referred to treatment.

At a press conference on June 14 the authorities presented the findings of a preliminary investigation into the outbreak. It concluded that poor infection control practices, including a lack of sterilization and the re-use of syringes and intravenous drips, are the most significant factors behind the rise in new infections.

“There is a huge amount of work that needs to be done to improve infection control and support the affected children and their families,” said UNAIDS regional director, Eamonn Murphy, during the press conference held in Karachi, Pakistan. “UNAIDS will continue to facilitate and coordinate within the United Nations system and with other partners to ensure that the required support is provided effectively and efficiently,” added Mr Murphy.

As well as improving infection control procedures, the preliminary investigation found that strengthening community education is critical to raise awareness about HIV prevention and to tackle stigma and discrimination. The conclusions of a rapid assessment on HIV-related knowledge presented at the press conference found that information about HIV is very limited among the affected communities. Many parents and caregivers learnt about HIV only on the day their children were diagnosed or because of media reports about the increase in cases. A lack of accurate information created panic and some families with children diagnosed with HIV have been shunned and isolated.

In response, UNAIDS in partnership with UNICEF, UNFPA, the World Health Organization and the JSI Research and Training Institute have been supporting national partners to develop a community response plan to promote health education and reduce stigma and discrimination. The Sindh AIDS Control Programme, together with UNAIDS and UNICEF, has started to train health workers on paediatric case management and health education sessions are being organized with the involvement of community led organizations and religious leaders. Training sessions for local media on responsible HIV reporting are also being carried out.

UNAIDS has been working closely with the federal and provincial governments to provide on-site technical support to help respond to the crisis and mitigate its impact. Sindh’s Ministry of Health has increased its efforts to prevent unlicensed and informal medical practices from operating and, as a result, 900 health clinics and unlicensed blood banks have been closed.

The preliminary investigation was led by the World Health Organization, in partnership with organizations including the Sindh AIDS Control Programme, Aga Khan University, the Field Epidemiology and Laboratory Training Programme, the Dow Medical University in Karachi, the Microbiology Society of Infectious Disease and UN agencies, including UNAIDS, UNICEF and UNFPA.

With 20 000 new HIV infections in 2017, Pakistan has the second fastest growing AIDS epidemic in the Asia Pacific region, with the virus disproportionately affecting the most vulnerable and marginalized, especially key populations. UNAIDS continues to work with the government and partners in Pakistan to strengthen the response in the countr

Riaz Haq said...

#Pakistan bringing services closer to communities affected by the #HIV outbreak. #UNICEF is refurbishing the pediatric HIV treatment centre at Taluka Headquarters hospital in Rotadero, #Larkana #Sindh https://www.unaids.org/en/resources/presscentre/featurestories/2019/july/20190703_Pakistan

A newly refurbished paediatric centre is to open in Ratodero, Pakistan, to serve families affected by the recent HIV outbreak in the district of Larkana. It is expected that the centre will be operational by mid-July.

Alia (not her real name), the mother of a two-year old girl, lives in the village of Mirpur Bhutto, in Ratodero Taluka in Larkana district. Alia’s world has been turned upside down since her family was caught up in the HIV outbreak in the area.

“My daughter was diagnosed with HIV just a few days ago, but she became so weak so quickly. She couldn’t eat anything we gave to her,” says Alia. After Sameera’s (not her real name) diagnosis, she was referred to Sheikh Zayed Children Hospital in Larkana to start antiretroviral therapy. The hospital is more than 50 kilometres away from the family home.

“I got these dispersible tablets for Sameera and some fever medicine, and since she started her treatment, I have seen some improvements in my daughter’s health. Her fever has gone and before there was diarrhoea from which she also recovered,” explains Sameera’s mother.

Alia’s husband is a farmer and earns less than two dollars a day. “We can hardly support our family of ten members,” she explains.

Poor road conditions and economic constraints make it difficult for Alia and her daughter to travel from their village to the district capital Larkana, currently the nearest health facility where her daughter can receive the treatment she needs.

Since the HIV outbreak was first reported in Larkana at the end of April, UNAIDS, UNICEF, the World Health Organization, the Sindh AIDS Control Programme and other partners have been calling for a new paediatric treatment centre in Ratodero to bring HIV services closer to the affected communities. As a result of these efforts and in the framework of the “Sindh HIV Outbreak Response Plan, May 2019-Apr 2020,” UNICEF is refurbishing the paediatric HIV treatment centre at Taluka Headquarters hospital in Rotadero, ensuring that treatment will be available in the area where Alia and her daughter live. When the new centre opens, HIV treatment services for Sameera will be less than 10 kilometres away.

“I know my Sameera will be fine and that she will get married and have children. This is what the doctor told me. For this to happen she must continue her treatment forever. I will follow the doctor’s instructions because this is what will save my daughter’s life,” says Alia.

By the end of June, 877 people had been newly diagnosed with HIV in the Larkana district. More than 80% of the new cases are among children aged under 15 years old. A total of 721 people had already been registered in care programmes and 482 people (365 of them children under the age of 15) were on treatment.

“UNAIDS is working closely with the government, civil society organizations, the association of people living with HIV, UN agencies and all other partners to ensure that both the immediate response to the HIV outbreak and longer-term programmatic measures will be implemented and sustained,” said Maria Elena Borromeo, UNAIDS Country Director for Pakistan and Afghanistan.

Riaz Haq said...

WHO mission in #Pakistan to help focus on #Infection Prevention Control (IPC) and patient #safety in #health facilities. #hospital after #HIV outbreak in #Sindh https://www.thenews.com.pk/latest/496060-who-mission-in-pakistan-to-help-transform-hospitals-into-patient-safety-friendly-facilities

On the request of federal health ministry, a seven-member mission of World Health Organization (WHO) has arrived in Pakistan to assist and support the country's federal and provincial health departments to develop National Quality Policy and Strategy (NQPS) and transform a few of public and private health facilities into patient-safety friendly hospitals through WHO’s flagship Patient Safety Friendly Hospital Initiative (PSFHI), health authorities said on Tuesday.

“On our request, a joint mission of WHO and the Eastern Mediterranean Regional Office (EMRO) of the WHO comprising seven international experts has arrived on a five-day visit to help us on patient safety strategy issues and to transform our facilities into patient safety friendly hospitals,” said Dr. Zafar Mirza, Special Assistant to Prime Minister on Health while talking to The News.

Ministry of National Health Services, Regulations and Coordination officials said the WHO mission is comprised of WHO Regional Advisor Dr. Letaief Mondher, Dr. Jamal Nasher, Dr. Zulfiqar Khan, Dr. Bassim Zayed, Dr. Donna Forsyth from National Health Services England, Dr. Mathew Neilsen and Ms Afifa Baloch. The international mission is tasked with identifying gaps of quality, patient safety and Infection Prevention Control (IPC) within the healthcare system of Pakistan.

“The joint WHO mission has been requested to visit six major hospitals in Pakistan which includes PIMS and Shifa International Hospital Islamabad in the capital, Lahore General Hospital and Shaukat Khanum Memorial Hospital in Lahore and Jinnah Postgraduate Medical Center (JPMC) and Aga Khan University Hospital (AKUH) in Karachi,” an official of the federal health ministry said while explaining details of scheduled engagements of the mission. These experts, he added, would also be holding meetings with federal and provincial health authorities before presenting their proposals to the government of Pakistan.

Special Assistant to the PM Dr. Mirza said the international team of experts would be meeting with local and as well as international agencies' health officials in Pakistan and provide full technical support to the country for launching its flagship Patient Safety Friendly Hospital Initiative at the selected hospitals in the federal capital and provincial headquarters.

Health authorities said they were pushed to invite international expertise for Infection Prevention Control (IPC) and patient safety after several leading international health experts associated with WHO, UNAIDS and UN’s other health agencies warned of more Larkana-like HIV outbreaks in other parts of the country if immediate measures were not adopted for patient safety, infection control, safe disposal of hospital waste, training of healthcare providers and awareness of masses regarding infectious diseases.

“We are facing huge health challenges ranging from HIV outbreaks to having largest number of viral hepatitis patients in the world. Anti Microbial Resistance (AMR) and Extensively Drug Resistant Typhoid, growing incidence of Multi-Drug Resistant (MDR) Tuberculosis, numerous water-borne diseases as well high incidence of non-communicable diseases including diabetes, Cardiovascular Disease (CVD) and hypertension are also causes of immense worry for us,” the NHS official conceded.

Health authorities said they were also seeking the support of local health experts from public and private health varsities and institutions in transforming major hospitals into patient friendly facilities while cooperation of provincial governments was also being sought to prevent future incidents like HIV outbreak in Sindh.

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.