Archive for category: Global Health

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Tuberculosis: A Major Health Problem in Bangladesh

Tuberculosis in BangladeshTuberculosis (TB) is an airborne disease; common symptoms include cough with sputum and blood in some cases, chest pains, weakness, weight loss, fever and night sweats. TB can lead to the death of an infected person when left untreated. According to the World Health Organization (WHO), TB has caused about 2 million deaths worldwide, and 95% of deaths were recorded in developing countries. Bangladesh ranked sixth among high TB burden countries. The National Tuberculosis Control Programme (NTP) has attained more than 90% treatment success and more than a 70% case detection rate. Despite these successes, tuberculosis in Bangladesh remains a serious public health problem.

Reasons for Higher Infection of Tuberculosis in Bangladesh

  1.  Delays in the Initiation of Treatment: Patients in Bangladesh often receive late treatment. Delays in treatment increase chances of negative treatment results, death and community transmission of TB. A study on 1,000 patients reported that, on average, there were 61 days of delay in the treatment of women and 53 days of delay in the treatment of men.
  2.  Role of Informal Health Practitioners: Most of the impoverished people in Bangladesh prefer to go to their local practitioners due to the ease of accessibility and low cost. A recent survey showed that approximately 60% of the Bangladesh population prefers to go to these uncertified doctors. However, such doctors typically lack formal training. This may lead difficulties in accurately diagnosing and treating TB.
  3. Lack of Awareness: Directly observed treatment short-course (DOTS) has been recognized as one of the most efficient and cost-effective approaches for treating TB. In 1998, the DOTS program became an integrated part of the Health and Population Sector Programme. The inclusion of the DOTS strategy in the Programme helped TB services transition from TB clinics to primary level health facilities. These health facilities typically incorporate GO-NGO (government-organized non-governmental organization) partnerships, and the NGOs have advocated for work on literacy, social awareness along and health care development. As part of the Health and Population Sector Programme, DOTS is freely available to the public. Unfortunately, many remain unaware of the treatment option.  As a result, detection of new TB cases has stagnated at around 150,000 cases per year since 2006.
  4. Poverty: A large portion of the country is still suffering from poverty. Poverty can often lead to overcrowding and poorly ventilated living and working conditions. People with less income also cannot afford food, leading to higher incidences of malnutrition. The culmination of these factors typically make the impoverished population more vulnerable to contracting TB.

The Effort to Combat TB

Tuberculosis is a major public health problem in Bangladesh. However, continuous efforts by the NTP and various NGO organizations have played an important role in decreasing the spread of the disease. DOTS, for instance, demonstrated a 78% cure rate in 1993. Due to its success, a phase-based treatment plan was implemented in 67 million rural populations in 1996.  Since implementation, the NTP has attained a 90% treatment success rate. Further efforts to combat the disease include development of the FAST program (Find cases Actively, Separate safely and Treat effectively). The program intends to detect active TB cases and decrease spread of the disease in healthcare facilities. However, despite efforts by the NTP and a number of NGOs, significant delays in care-seeking and treatment initiation still exist as major hindrances to the program’s goals. 

Challenges to TB Programs

Tuberculosis in Bangladesh kills more than 75,000 people every year. Despite free services like DOTS and other NTP programs, limited access to quality service, lackluster funding and insufficient screening prevent adequate detection and treatment of the disease. The lowest quartile of the population is still five times more likely to contract TB, potentially due to a lack of awareness of TB-treatment programs among the general public. Adding to the problems for TB programs, private health professionals are typically inactive in national programs. While NTP programs have made progress in addressing the disease, these challenges persist, and tuberculosis remains a major health problem in Bangladesh.

Solutions

To stop the growth of tuberculosis in Bangladesh, community organizations such as the Bangladesh Rural Advancement Committee (BRAC) have shown impressive results in lowering the percentage of those afflicted by TB. Effective treatment of TB includes investment in medicine, local health services and diagnostics. To ensure full recovery, social protection of patients is also required. Multidrug-resistant TB (MDR-TB), for instance, requires two months of drug treatment and a four month continuation period. If treatment programs can satisfy requirements investment and social protection requirements, the chance of curing TB patients reaches 92%. The application of a more successful method will help in curing the most complex TB cases, such as drug-sensitive TB, with improved results. With the implementation of proper and effective treatment strategies, we can eliminate tuberculosis in Bangladesh and the benefit even the poorest members of society.

– Anuja Kumari

Photo: Pixabay

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Technology Fights Tuberculosis in Tuvalu

Tuberculosis in Tuvalu
Tuberculosis (TB) is the world’s deadliest infectious disease, yet millions of people remain undiagnosed. TB diagnosis is a challenge for many island communities. In order to be diagnosed, patients usually have to go to the main island. This was the case for tuberculosis in Tuvalu.

Tuvalu is a remote Pacific island with a population of 11,500 and only one hospital. Travel to the hospital is difficult and increases the risk of transmission, especially when it includes a crowded boat full of people. TB rates are high in Tuvalu but are declining with only about 15 new cases each year since 2016 – a great improvement from the rate of 36 new cases each year in the 1980s. The death rate in 2017 was 19 per 100,000 people. Thanks to a couple of developments that have made diagnosis more achievable – namely GeneXpert machine, portable x-ray machines and training for health teams – Tuvalu is actively reducing rates of TB since 2018.

GeneXpert Machine

The United Nations Development Programme (UNDP) and the Global Fund have provided a GeneXpert machine to the government of Tuvalu. This machine reduces the duration of the TB test and allows for diagnosis of the drug-resistant strains, which are increasingly becoming a problem. Using the machine, the test only takes about two hours. Without this technology, the TB test takes at least two-six weeks.

It is a relatively new test that works on a molecular level to identify mycobacterium tuberculosis as well as rifampin resistance in a sputum sample. Another positive is that limited technical training is required to run the GeneXpert tests. These tests are being used around the world and prove to be an incredible feat of science.

Portable X-ray Machines

Because x-ray machines are now portable, more people can be reached and examined, including those on the outer islands. Mobile health teams travel to smaller islands and carry out chest x-rays for those presenting TB symptoms.

Thanks to portable x-ray technology, the number of TB diagnoses is increasing. Dr. Lifuka at the Tuvalu hospital said, “We can now actively find cases in the outer islands where there are no facilities, and we can assess everyone, even those who previously faced difficulties coming to the hospital.”

Training for Health Teams

Of course, none of this would be possible with the technology alone. Trained professionals are needed to help diagnose and treat people with tuberculosis in Tuvalu. They travel to patients’ houses and provide medication. Because of the stigma surrounding TB, patients won’t always get their treatments. This is why Tuvalu Red Cross community-based health promoters and other trained professionals treat patients at home.

Though TB rates remain rather high in Tuvalu, as well as throughout the Pacific, the new technology implemented in 2018 is promising. Technology will not be enough, however; system-wide approaches aimed at reducing poverty and development of infrastructure on the outer islands will also be needed in order to eradicate TB. Furthermore, Tuvalu needs to continue to improve TB surveillance in order to inform public health agencies of the strategies proven to be most effective. Hopefully, the new technology will help spread awareness of TB to all the members of the community. The change is already evident, as cases of tuberculosis in Tuvalu have declined consistently over the past 10 years, and detection has increased. In 2008, they were only able to diagnose eight cases a year. In 2017, there were 23. The new technology and training programs will continue to save lives on this small, isolated island.

– Fiona Price
Photo: Flickr

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7 Facts About Healthcare in the Maldives

Healthcare in Maldives
People know the Maldives internationally for its beautiful beaches and remote atolls. This south Asian nation has a unique healthcare system with a design specific for an island. Here are seven facts about healthcare in the Maldives.

7 Facts About Healthcare in the Maldives

  1. Universal Healthcare: The Maldives has universal health insurance that covers a plethora of primary care services. The country’s health scheme is called Husnuvaa Aasandha and the state-owned company Aasandha runs it. Husnuvaa Aasandha means “healthcare for all without a ceiling protection limit” according to the Aasandha website, and it receives funding from the Maldives’ government. Notably, the plan pays for citizens to go abroad for certain medical treatments if the treatments are not available in the Maldives.
  2. Tier-based System: The Maldives has a “tier-based” healthcare system. Every inhabited island, even the most sparsely populated, has a primary care facility. Every inhabited atoll, or island chain, has a secondary care facility. Larger urban areas also have tertiary care centers.
  3. Government Spending: According to a 2018 report from the World Health Organization (WHO), 9% of the Maldives’ GDP goes toward healthcare. The country spends a higher percentage of its GDP on healthcare than any country in Southeast Asia, where the average expenditure for the region is 3.46%.
  4. Operation: Primary medical facilities often struggle to operate effectively. A report from 2019 revealed that a lack of supplies and equipment is a major factor hampering the Maldives’ primary health facilities. These facilities also have high staff turnover rates and are expensive to operate.
  5. Medicine: Medicine can be unusually expensive in the Maldives. Importing pharmaceuticals is often costly, as the Maldives is a fairly remote island nation. Furthermore, an analysis from 2014 found that price controls on medicine did not experience enforcement. Some pharmaceuticals cost patients more than 100% of their importation costs.
  6. Disease: Noncommunicable diseases such as respiratory diseases, cancer, diabetes and cardiovascular diseases cause the most deaths in the Maldives. Noncommunicable diseases such as these cause almost 80% of deaths in the country according to a 2018 WHO report.
  7. Life Expectancy: The Maldives has an above-average life expectancy. The life expectancy in the Maldives was 78.6 years in 2019, while the world average the same year was 72.6.

Healthcare in the Maldives is rapidly improving, with the country having an above-average life expectancy and basic health services on all inhabited islands. However, some areas of the nation struggle to receive essential medical supplies and medicine can be expensive. Overall, these seven facts about healthcare in the Maldives show that the country is making progress a priority and heading towards promising results.

– Kayleigh Crabb
Photo: Pixabay

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8 Facts About Healthcare in Suriname

Healthcare in Suriname
The Republic of Suriname is an upper-middle-income country located on the northeastern coast of South America. Around 90% of the country’s population lives in urban or rural coastal areas. Healthcare in Suriname is accessible for both the public and private sectors. Here are eight facts about healthcare in Suriname.

8 Facts About Healthcare in Suriname

  1. Infant and Maternal Mortality: Suriname’s infant mortality rate in 2013 was around 16 deaths per 1,000 live births. The most prevalent reasons for mortality reported in children under 1 year of age were respiratory problems, fetal growth retardation, congenital diseases, neonatal septicemia and external causes. The maternal death ratio averaged 125 deaths per 100,000 live births from the years 2000 to 2013. For mothers, the most prominent causes included gestational hypertension and hemorrhage. In 2010, prenatal checkup coverage was around 95%, and more than 65% of pregnant women had had four prenatal checkups. In addition, almost 93% of births happened in a health center, and trained health workers carried out around 95% of births.
  2. Life Expectancy: In 2016, the average life expectancy of a male was 69, while the average life expectancy of a female was 75. These estimates are slightly below the average male and female life expectancies in the rest of South America.
  3. Mosquito-borne Illnesses: In late 2015, the preliminary issue of Zika virus was found in Suriname. The disease spread quickly throughout the country’s 10 districts, but there are no current outbreaks. Conversely, Suriname has eradicated malaria from all but one district of Suriname. However, the rate of new imported cases (principally among gold miners from French Guiana) increased by more than 70% in 2015.
  4. HIV and Tuberculosis: By 2014, Suriname’s human immunodeficiency virus (HIV) rate among the 15-49 age group was 0.9%. HIV/AIDS caused 22.4 deaths per 100,000 people in 2010, decreasing to 16.4 deaths per 100,000 people in 2013. From 2012 to 2014, the estimated tuberculosis diagnosis rate increased from 58% to 71%. To combat the disease, the country started the direct implementation of observed treatment, resulting in higher treatment success from 61% in 2010 to 75% in 2013.
  5. Government Contribution and Coverage: Suriname experienced vast economic growth from 2010 to 2014. During this period, healthcare in Suriname received increased funding for various services and facilities. It expanded and decentralized private laboratory diagnostic services, private primary care, dental care and paramedic practices. In 2015, vaccination coverage was almost 90% for DPT3 and above 90% for the trivalent vaccine (MMR1). In 2014, the total estimated health expenditure as a percentage of GDP was 6%. For health insurance, employees’  premium rate is 50%, and employers pay the other half. For low- or no-income citizens, the government subsidizes health coverage.
  6. Hospitals: Of Suriname’s five hospitals, two are private and three are public. The Academic Hospital in Paramaribo has recently renovated and expanded its facilities and invested in equipment and staff for specialty care like gastroenterology, oncology, intensive care, renal dialysis and more. In 2013, government and external funds also helped other hospitals invest in new facilities and healthcare worker training programs.
  7. Sanitation: Suriname’s lack of an integrated waste management policy has created illegal dumps and caused refuse to accumulate on roadsides and in open waters. This infrastructure problem results in health risks and environmental hazards. According to the Pan American Health Organization (PAHO), Suriname does not have facilities for storing or eliminating hazardous waste, nor does it regulate the safe use or storage of pesticides.
  8. Accessibility: In 2014, Suriname passed its national basic health insurance law. It provides access to a basic package of primary, secondary and tertiary care services for all Surinamese citizens. In 2013, all people under the age of 16, as well as people aged 60 and over, had the right to free health care that the government paid for. Universal access to healthcare for pregnant women and newborns remains a challenge for healthcare in Suriname.

Persistent voids in access to healthcare in Suriname are related to drawbacks in funding. The healthcare system has seen an expansion in the past decade, but there are still plenty of health challenges to confront and improve.

– Anuja Kumari
Photo: Flickr

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Tackling Tuberculosis in Botswana

Tuberculosis in BotswanaBotswana is a southern African country with just over 2 million residents living inside its borders. Every Batswana lives with the threat of tuberculosis, an infectious disease that remains one of the top 10 causes of death on the African continent. Tuberculosis has a 50% global death rate for all confirmed cases. Investing in tuberculosis treatments and prevention programs is essential. Botswana has one of the highest tuberculosis infection rates in the world with an estimated 300 confirmed cases per 100,000 people, according to the CDC. Preventative and community-based treatment shows promise in combating tuberculosis in Botswana.

Treating Tuberculosis in Botswana

Tuberculosis treatment cures patients by eliminating the presence of infectious bacteria in the lungs. The first phase of treatment lasts two months. It requires at least four separate drugs to eliminate the majority of the bacteria. Health workers administer a second, shorter phase of treatment to minimize the possibility of remaining bacteria in the lungs.

Early identification of tuberculosis is a crucial step in the treatment process and significantly reduces the risk of patient death, according to the Ministry of Health. Preventative treatment methods are vital because they inhibit the development of tuberculosis infection. They also reduce the risk of patient death significantly.

Health workers detect tuberculosis with a bacteriological examination in a medical laboratory. The U.S. National Institutes of Health estimate that a single treatment costs $258 in countries like Botswana.

Involving the Community

Botswana’s Ministry of Health established the National Tuberculosis Programme (BNTP) in 1975 to fight tuberculosis transmission. The BNTP is currently carrying out this mission through a community-based care approach that goes beyond the hospital setting. Although 85% of Batswana live within three miles of a health facility, it is increasingly difficult for patients to travel for daily tuberculosis treatment. This is due to the lack of transportation options in much of the country.

Involving the community requires the training and ongoing coordination of volunteers in communities throughout the country to provide tuberculosis treatment support. Community-based care also improves treatment adherence and outcome through affordable and feasible treatment.

The implementation of strategies such as community care combats tuberculosis. For example, it mobilizes members of the community to provide treatment for tuberculosis patients. The participation of community members also provides an unintended but helpful consequence. For example, community participation helps to reduce the stigmas surrounding the disease and reveals the alarming prevalence of tuberculosis in Botswana.

A Second Threat

In addition to the tuberculosis disease, the HIV epidemic in Africa has had a major impact on the Botswana population, with 20.3% of adults currently living with the virus. Patients with HIV are at high risk to develop tuberculosis due to a significant decrease in body cell immunity.

The prevalence of HIV contributes to the high rates of the disease. The level of HIV co-infection with tuberculosis in Botswana is approximately 61%. African Comprehensive HIV/AIDS Partnerships (ACHAP), a nonprofit health development organization, provides TB/HIV care and prevention programs in 16 of the 17 districts across the country in its effort to eradicate the disease.

Fighting Tuberculosis on a Global Scale

The World Health Organization (WHO) hopes to significantly reduce the global percentage of tuberculosis death and incident rates through The End TB Strategy adopted in 2014. The effort focuses on preventative treatment, poverty alleviation and research to tackle tuberculosis in Botswana, aiming to reduce the infection rate by 90% in 2035. The WHO plans to reduce the economic burden of tuberculosis and increase access to health care services. In addition, it plans to combat other health risks associated with poverty. Low-income populations are at greater risk for tuberculosis transmission for several reasons including:

  • Poor ventilation
  • Undernutrition
  • Inadequate working conditions
  • Indoor air pollution
  • Lack of sanitation

The WHO emphasizes the significance of global support in its report on The End TB Strategy stating that, “Global coordination is…essential for mobilizing resources for tuberculosis care and prevention from diverse multilateral, bilateral and domestic sources.”

– Madeline Zuzevich
Photo: Flickr

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10 Apps That Aid Healthcare in Developing Countries

Apps that aid in healthcare in developing countries It can sometimes be difficult for people in developing countries to access healthcare, specifically those living in poverty. In order to address this problem, healthcare apps are being used to provide greater access. Here are 10 healthcare aid apps that are impacting access in developing countries.

10 Apps That Aid Healthcare in Developing Countries

  1. Peek has its sights set on helping people with vision impairment issues and blindness, a problem exacerbated in developing countries by a lack of resources. Peek can identify people with vision problems. The app then works with healthcare providers to pinpoint an economically feasible way to supply the treatment they need, before allocating the appropriate resources. Currently, Peek is being used by the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine, which is administering a population-based survey of blindness and visual impairments in Cambodia.
  2. SASAdoctor focuses on making healthcare consultations more accessible in Kenya. In the country, only 12% of people are insured. About 8 million are reliant on the National Hospital Insurance Fund, leaving 35 million Kenyans uninsured. Available to all Kenyans with an Android smartphone or tablet (65% of Kenyans have one), SASAdoctor decreases the cost of an in-person consultation for the uninsured and makes it free for those with insurance. Patients will have their medical history, list of medications and other such medical notes in their ‘file’ on the app, so that whoever tele-consults with them will have the information they need to create an informed medical opinion. SASAdoctor can decrease the cost of uninsured visits with a doctor to Kes 495 (the equivalent of $4.66) for a projected 80% of Kenyans who are predicted to have smartphones in the next few years.
  3. iWander allows people to keep track of Alzheimer’s patients. Set with tracking technology that can be discretely worn by the patient, it offers whoever uses the app several options on how to deal with situations involving the patient. Solutions can range from a group calling session to making an emergency medical call or summoning a caregiver. iWander gives families more control over the care of a loved one, which can have a positive impact in countries where healthcare may be less accessible. In the US, the average cost of care for a single person is $174,000 annually. About 7 out of 10 individuals with dementia remain at home to receive care, where 75% of the costs fall to the family to pay. In helping families be proactive instead of reactive to crises, iWander can help in cutting these costs, especially in poorer countries, where many families are struggling to keep up with the high costs of at-home care.
  4. Kenek O2 allows the user to monitor their oxygen and heart rate while they sleep. Kenek O2, built for the iPhone, also requires a pulse oximeter which connects to the phone and retrieves the data to be stored in the app. Together, the cost for these two items is around $100, compared to the price of a regular hospital oximeter and other similar products, which could easily cost more than $500. Having effectively been used in North America, South America, Asia and Africa, Kenek O2 is currently working on developing a special COVID-19 device to watch for early signs of hypoxia, or the deficiency of oxygen reaching tissues.
  5. First Derm is an app that requires a smartphone-connected device, called a dermatoscope. This allows detailed pictures to be taken of skin conditions and lesions to better allow for remote, teleconsultations. In places where doctors are few and far between, and public transport is less reliable, this can make getting a second medical opinion much easier. So far, First Derm has helped in more than 15,000 cases from Sweden, Chile, China, Australia and Ghana, ranging from ages of just 3 days old to 98 years. Of these cases, 70% could be treated without a doctor, most often by over-the-counter treatments available at local pharmacies.
  6. Ada takes user-input symptoms and provides appropriate measures to take as a result, like a personal health assistant. It’s intended to assist those who don’t have the means to seek an in-person consultation right away. The app has been released in several languages, which makes it more accessible. Currently, 10 million people around the world are using Ada for symptom evaluation.
  7. Babylon is intended to mitigate the obstacle of going to see a doctor in person by allowing users to input symptoms or solve common health problems via teleconsultation with a doctor. Babylon specializes in non-emergent medicine, allowing patients to skip a trip to the doctor’s office entirely if their condition allows it. This is beneficial in places where doctors are sparse, or the patient lacks the financial means or a method of transportation in getting to the hospital. Babylon caters to users across the U.S., U.K., Canada, Rwanda and several countries across Asia-Pacific and the Middle East. The app aims to expand to more countries in the upcoming years.
  8. MobiSante, through its ultrasound device, allows versatility in diagnostic imaging by bringing the ultrasound to the patient. This allows quality, diagnostic imaging to be done outside the confines of a hospital or clinic. As a result, it provides more holistic and informed treatment where people may need it most but have previously struggled in accessing a healthcare center with the necessary technology. While having a computer at home with a desk is much less common in developing countries, the world’s increasing reliance on the internet is shifting the status of internet technology from a luxury to a basic necessity. This means that technology such as smartphones are becoming somewhat of a necessity in impoverished countries, making an app like MobiSante effective in using smartphones to make diagnostic imaging more accessible.
  9. Go.Data is a tool released by the WHO. It is specifically for collecting data during global health emergencies. During the Ebola outbreak in Africa, Go.Data was praised for tracing points of contact. The app also tracked infection trends and helped in arranging post-contact follow up.
  10. Mobile Midwife is a digital charting app that stores information in a cloud so that healthcare workers have access to all pertinent patient information. It works even in cases of power outages, or home births where internet connection may be less reliable. This app can help in areas where mother and infant mortality is higher, ensuring that healthcare providers can efficiently access patient information to ensure the best care. It can also cut the extra time it takes to find records that could otherwise make procedures more dangerous for both mother and child.

Bridging healthcare accessibility with smartphone apps isn’t a perfect solution, as it comes with accessibility issues of its own. However, these healthcare aid apps can help people without insurance, or who are physically unable to visit a physician, access health consultations. As a result, more people are provided access to healthcare, empowering a healthier (and more health-conscious) population.

– Catherine Lin
Photo: Flickr

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Top 3 Countries With the Most Cholera Cases

Countries with Cholera“Cholera is a disease of inequity that unduly sickens and kills the poorest and most vulnerable people – those without access to clean water and sanitation.” – Carissa F. Etienne, the Director of Pan American Health Organization.

Profuse vomiting, diarrhea and leg cramps, followed by intense dehydration and shock, are all symptoms of cholera. It is a highly contagious waterborne illness that can cause death within hours if left untreated. Cholera is mainly caused by drinking unsafe water, having poor sanitation and inadequate hygiene, all of which allow the toxigenic bacteria Vibrio Cholerae to infect a person’s intestine.

While cholera can be treated successfully through simple methods, such as replacing the lost fluid from excessive diarrhea, there are still many people around the globe struggling with the disease. There are 2.9 million cases and 95,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC).

The countries that have the greatest risk of a cholera outbreak are the ones that are going through poverty, war and natural disasters. These factors cause poor sanitation and crowded conditions, which help the spread of the disease.

Yemen

Yemen is known for being one of the countries with the most Cholera cases. The number of cholera cases in Yemen has been increasing since January 2018; the cumulative reported cases from January 2018 to January 2020 is 1,262,722, with 1,543 deaths. The number of cases in Yemen marked 1,032,481 as of 2017, which was a sharp increase from the 15,751 cases and 164 deaths in 2016. On a positive note, the numbers showed a decrease by February 19, 2020; 56,220 cases were recorded, with 20 associated deaths.

The Democratic Republic of the Congo (DRC)

The DRC is another country with a high number of Cholera cases. There were 30,304 suspected cases of cholera and 514 deaths in 2019. Although the number of 2019 cases was smaller than that of 2017 (56,190 cases and 1,190 deaths), the 2019 data showed an increase from 2018 (27,269 cases and 472 deaths). As of May 13, 2020, 10,533 cases and 147 deaths were reported; most of these reported cases originated from Lualaba regions, Haut Katanga and North and South Kivu.

Somalia

Somalia also stands as one of the countries with the most Cholera cases. From December 2017 to May 30, 2020, there were 13,528 suspected cholera cases and 67 associated deaths in Somalia. These reported cases are from regions of Hiran, Lower Shabelle, Middle Shabelle and Banadir.

Other than the three countries listed above, there are many others that are also going through Cholera outbreaks. Uganda reported a new Cholera outbreak in the Moroto district in May 2020; a month later, 682 cases and 92 deaths have been reported. Burundi also declared a new cholera outbreak this past March; 70 new cases were reported.

Helping Cholera Outbreaks

Many non-profit organizations like UNICEF are constantly working towards helping these countries and many more. A good example of a country that has shown a great decrease in cholera cases following external aid is Haiti.

Haiti experienced the first large-scale outbreak of cholera with over 665,000 cases and 8,183 deaths. After a decade of efforts to fight against cholera, the country recently reported zero new cases of cholera for an entire year. An example of how UNICEF helped Haiti is by supporting the Government’s Plan for Cholera Elimination and focusing on rapid response to diarrhea cases. However, the country still needs to keep effective surveillance systems and remain as a cholera-free country for two more years to get validation from the World Health Organization (WHO) of the successful elimination of the disease.

– Alison Choi
Photo: Flickr

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Morbidity and Inequity in Healthcare in Chile

Healthcare in Chile
Healthcare in Chile primarily comes from the state-funded insurance National Health Fund (Fondo National de Salud – FONASA) or from private companies collectively known as Las Instituciones de Salud Previsional (ISAPRE). According to a 2019 report from the Organization for Economic Cooperation and Development (OECD), 78% of the population participate in FONASA and around 17-18% enroll in ISAPREs, while 3-4% receive coverage from the armed forces insurance program. A number of newly implemented government reforms in Chile have challenged healthcare inequity to ensure universal healthcare for all.

Morbidity and Mortality

In the 1980s, a series of successful reforms decreased infant mortality rates (from 33 per 1,000 live births in 1980 to only eight per 1,000 in 2013) and improved communicable disease rates, nutrition and maternal and child health. While the health status of Chileans consistently fell below average among OECD nations in recent decades, the life expectancy in Chile in 2015 rose to 79.1 years in the last 40 years, nearly on par with its OECD peers. Determinants of health status include life expectancy, avoidable mortality rates, morbidity rates from chronic diseases and percentage of the population in poor health.

Non-communicable diseases (NCDs), such as high blood pressure, diabetes and heart diseases are identified as the burden of disease in Chile, accounting for 85% of all deaths. Key risk factors include high obesity rates, heavy tobacco use and increasing rates of alcohol consumption. The infant mortality rate is improving but remains high, as are mortality rates from cancer compared to cancer incidence.

Some Effective Government Measures

The Chilean government has undertaken effective measures to address the nation’s most urgent issues through a multi-intervention strategy that targets different population groups and settings:

  • Obesity: According to a 2016 WHO report, 39.8% of the Chilean population was overweight, and another 34.4% was obese. Childhood overweight and obesity rate is particularly problematic at 45%, with no reduction in prevalence over the past 15 years. Chile has implemented nationwide policies to tackle behaviors that cause obesity, especially inadequate physical inactivity and unhealthy diets. At the national level, mass media, such as websites, Twitter, TV and radio adverts, educates the public on healthy food choices and emphasizes the consumption of vegetables and fruits. The government has also mandated labels on packed foods that indicate high caloric content in salt, sugar and fat.
  • Tobacco Use: Tobacco consumption rates in Chile in 2016 stood at 37% (41% among men and 32% among women) of the adult population. Adult smoking rates have declined from 45.3% in 2003 and 39.8% in 2009, a percentage below average in comparison to other nations. Since joining the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2005, Chile has implemented various tobacco control policies, such as prohibiting smoking in public spaces, requiring health warnings on tobacco products and raising taxes on these products.
  • Cancer Care: The OECD projected that cancer could soon become the leading cause of mortality in Chile. Among men, prostate, stomach, lung, colorectal and liver cancer have the highest mortality rates. In women, breast, colorectal, lung, stomach and pancreas cancer account for high mortality rates. To lessen the burden of cancer, Chile has reinforced its cancer care system and launched nationwide programs focused on cervical and breast cancer and cancer drugs for adults and children. From 2011 to 2015, Chile reduced cancer by 4.1%.

Challenging Inequity

The establishment of the National Health System (NHS) in 1952, subsequent expansions and reforms together enabled Chile’s move towards universal coverage with more than 98% of the population having some kind of health insurance. However, inequality remains one of the main challenges in Chile’s two-tier healthcare system, mainly due to the unequal distribution of resources between the underfunded public facilities and the elitist private clinics. Equity monitoring shows less insurance coverage for less educated people, low-income quintiles, residents from rural areas and those with state insurance.

Significant inequalities due to socioeconomic position and residence area persist. According to a study that PLOS Medicine published, the infant mortality rate among the highest educated women was 2.3 times lower than the least educated, while the ratio was 1.4 between urban and rural residence. Risk factors like obesity, alcohol use disorders and cardiovascular risks also disproportionately affected the least educated segment of the population.

Moving Forward

Despite tremendous challenges, healthcare in Chile has improved thanks to the government’s effort to prioritize health reforms. In 2005, Chile launched Universal Access with Explicit Guarantees (AUGE) program that sought to improve access, timeliness and quality of care in the public sector. The OECD assessed that the system of healthcare in Chile is overall “well-functioning, well-organized and effectively governed,” with a particularly robust public healthcare program that operates efficiently on both the central and regional levels. Although challenges such as rising rates of certain NCDs and inequities between sectors and populations persist, the country’s ambitious reforms demonstrate its preparedness to tackle these issues.

– Alice Nguyen
Photo: Flickr

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Vaccines in Africa During COVID-19

Vaccines in Africa during COVID-19Medical progress in developing countries could unravel during COVID-19 because the global shutdown is preventing important vaccines from reaching Africa. In fact, global health organizations struggle to dispatch health care workers, make shipments, and store medical supplies and vaccines. Health care systems have halted vaccinations for cholera, measles, polio and other diseases in order to focus on stopping COVID-19. Also, parents are afraid of bringing newborns to get vaccines during the pandemic as many health care workers have been repeatedly exposed to COVID-19. Although the WHO says that children are not a high-risk category for COVID-19, the fear of exposure could perpetuate the vaccination gap and exacerbate the problem even as governments ease restrictions.

Effects of Halting Vaccine Distribution

The postponement of vaccines in Africa during COVID-19 could lead to a dramatic resurgence of measles, cholera and other diseases that have been decreasing worldwide. Children in countries with low-quality health care might not receive these vaccines. This inequality is a problem that many organizations are trying to combat. Experts are also recommending that leaders should track and trace unvaccinated children to administer the vaccines on a later date. These proactive measures could help prevent future outbreaks.

Measles Vaccinations

Measles cases have risen globally in recent years due to growing misinformation, low-quality health care and other cultural or societal issues. Coronavirus has stalled everyday life, international travel and vaccination campaigns. Because of the impact COVID-19 has had, it is now estimated that over 117 million children in 37 countries, in which the majority are located in Africa, will likely not receive their measles vaccine. The World Health Organization and other global health foundations have expressed concerns over this new problem. Data is now showing that deaths from other diseases will likely compare to COVID-19 deaths in Africa by a ratio of 100 to one because these preventable diseases will have been overlooked. 

What is Being Done to Help

Global health organizations such as UNICEF, the Gates Foundation and other private groups provide most vaccines. Most African health care systems are already not well equipped to handle basic care and disease management. The pandemic, as well as the threat of diseases becoming more prevalent, puts a strain on these health care systems. Organizations like the Gates Foundation have noticed this excess burden on the African health care system, so they are working to help improve Emergency Operations Centers and local disease surveillance and testing. The Gates Foundation is also focusing on providing routine care as that often goes overlooked during a pandemic. The foundation is working to build up their health care systems as a whole to fight other diseases.

Most world leaders are prioritizing the containment of COVID-19; however, global health organizations are encouraging governments to do more to prevent diseases that can be treated with vaccines. 

– Jacquelyn Burrer
Photo: Flickr

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Combating Tuberculosis in the Congo

Tuberculosis in the Congo
At the beginning of the 1990s through the early 2000s, the contraction and subsequent testing for HIV increased significantly in Africa. Within this time period, the World Health Organization (WHO) discovered that nearly 85% of Africans were HIV-positive. More recently, HIV numbers in Africa have reduced with a 38% drop in eastern and southern Africa since 2010. While Africa is getting a handle on HIV, tuberculosis is prevalent. It affects the entire African continent, but cases of tuberculosis in the Congo are the most significant.

Tuberculosis hit African nations forcefully, debilitating the economy, altering sociality and increasing mortality rates. In 2016, estimates determined that 417,000 Africans died due to the disease. This number constituted 25% of all tuberculosis cases present in the world at the time. Of the African deaths in 2016, 321 of them occurred in the DRC, which had one of the highest rates of TB in all of Africa during that time.

Although many have worked to combat TB and HIV within the DRC, the country is still suffering from preventable diseases. With internet access alone, individuals may support groups and companies who are already battling tuberculosis in the Congo and globally.

Important Organizations

The Global Fund is a group that has combated drug-resistant TB through “antimicrobial-resistant superbugs.”  Over the last 20 years, funding to find a cure for this type of tuberculosis has treated and saved 5 million people. Yet, its founder stated that “with more funding triple that number could have been saved.” He advised all to support The Global Fund by donating to its research on drug-resistant TB and by signing petitions to raise awareness.

Starting in 2011, the Management Sciences for Health (MSH) and USAID funded the Democratic Republic of Congo-Integrated Health Project (DRC – CIH) to educate people about the symptoms of tuberculosis in the Congo. This program also prepared healthcare professionals in ways to quickly identify and treat TB. Because of the efforts of this program, the detection rate for TB has raised from 12% to 86%. This program still needs support today, as funding is low and publicity has been scarce. Raising one’s voice in support of such a cause will only benefit the program and save more lives. Ciza Silva Mukabaha, a supporter of the MSH and the DRC – CIH called this program a “starting point” for change. He stated that, with more support from others, change is inevitable.

How to End Tuberculosis in the Congo

The End Tuberculosis Now Act recently entered Congress. Individuals in the United States can email or call their representatives and advocate to provide U.S.-government aid to combat multidrug-resistant TB and “support the fight to end tuberculosis” everywhere.

People can also aid the situation by staying informed and supporting local groups who are raising funds to combat TB. In 2018, healthcare worker Virginia Benhard started a personal fundraiser to fight tuberculosis in the Congo. She told The Borgen Project that the cause originally attracted her because of her visit to the Congo as a healthcare worker. She realized that community members consuming contaminated milk and meat caused them to contract tuberculosis. Since TB is an airborne illness, those who had tuberculosis would process the meats and then sell them, causing the infection rates to increase dramatically. Virginia “saw a need and responded,” and through local support she was able to raise over $1,000. She donated the proceeds for the building of a milk pasteurization factory in Kinshasa as well as a meat processing factory.

While this disease still rages on, there is much that individuals can do to help. One can sign a petition, donate, speak out for those who cannot speak for themselves and help those who cannot help themselves. Through small and simple acts, tuberculosis in the Congo should decrease.

– Alexis LeBaron
Photo: Flickr