Maternal health in Nepal Nepal, a landlocked country bordering India and China, has a population of approximately 30 million. In 2015, close to 41 percent of births occurred at home in Nepal. Of those home births, just under half were carried out without a trained professional. Due to the alarming rate of maternal deaths seen in the early 2000s, maternal health in Nepal has been a focal point for many years. Even though complications during births at health centers still occur, the presence of trained professionals during birth remains the best way to avoid preventable deaths. Many organizations have partnered with the Nepalese government and are working hard to bring these numbers down even further every year.

4 Facts About Maternal Health in Nepal

  1. Nepal’s maternal mortality rate decreased about 71 percent between 1990 and 2015. The decline is attributed to free delivery services and transport in rural areas, access to safe delivery services and medicines that prevent hemorrhaging. In rural parts of Nepal, it has historically been much more difficult to receive proper healthcare. Through the combined efforts of various organizations and the Nepalese government, the number of facilities in remote areas has increased. Additionally, the incentive to travel to these facilities has risen. In 2005, the government began giving stipends to pay for transportation costs. Four years later, the government passed the Safe Motherhood Programme, which allowed free delivery services to pregnant women. In 2011, the government continued to promote safe pregnancies by adding another incentive of $5 for attending antenatal checkups. Through these efforts, the government has had an enormous impact on the development of maternal health in Nepal.
  2. Midwifery is one of the most important services for maternal health in Nepal. Fast intervention and postnatal suggestions from a skilled midwife allows for better postnatal care for both mother and child. In Nepal, only about 27 percent of women receive care within 24 hours of giving birth. This increases risk of hemorrhaging and heavy-lifting related injuries shortly after giving birth. It also increases risk of possible complications for the baby during and directly after birth.
  3. Midwifery education ensures that midwives are up to date on the most current practices and procedures for successful pregnancy and birthing. Institutions have partnered with the United Nations Fund for Population Activities (UNFPA) to offer combined education for nursing and midwifery. In 2011, Nepal and the UNFPA committed to training 10,000 birthing attendants. However, in a report about midwifery authored by the UNFPA, midwives do not have specific legislation for their work. Midwives are not completely recognized under the law nor are they regulated, which results in issues with proper training and resources. Therefore, greater recognition and accessibility will allow midwives the resources, training and encouragement that they need for success.
  4. Women of lower socioeconomic status have more complications surrounding maternal health. The National Medical College Teaching Hospital in Nepal published an extensive report of the challenges surrounding maternal health in Nepal. A specific challenge mentioned in this report includes the socioeconomic influencers of maternal health. Due to poor nutritional health in women of lower economic status, issues such as anemia can cause mortalities. Additionally, rural areas record about 280 birth complications per day. Although there has been significant work since then to expand access to cesarean sections and birthing centers in rural areas, there are still around 258 women dying per 100,000 live births.

As maternal health in Nepal becomes more of a focus in the healthcare system, there are certain policies and programs that must be expanded upon. Midwifery education and access to services are the most important programs for successful maternal health in Nepal. Many experts in the field continue to push for individual programs that focus primarily on methods for successful midwifery education and overall increased care for maternal health in Nepal.

– Ashleigh Litcofsky

Photo: Flickr

Life expectancy in Hungary
Socioeconomic discrepancies and health issues, such as cardiovascular disease and cancer, have contributed to life expectancy in Hungary, a landlocked country in central Europe. Here are 10 facts about life expectancy in Hungary.

10 Facts About Life Expectancy in Hungary

  1. Life Expectancy: Life expectancy at birth in Hungary was approximately 76 years in 2017. Meanwhile, women had a mortality rate of approximately 80 per 1,000 female adults, whereas men had a mortality rate of about 168 per 1,000 male adults.
  2. Regional Differences: While individuals living in Eastern Hungary have higher GDP values, indicative of greater overall economic benefit, those in the western regions of the country are at a greater disadvantage. For example, for those living in Budapest, the GDP per capita was a little more than 5,000 forints per capita, whereas those living in Western Hungary, like Szabolcs-Szatmár-Bereg, had a GDP per capita of fewer than 2,000 forints per capita. Western Hungarian areas, like South Transdanubia, often experience worse economic conditions and poorer health, contributing to lower life expectancy. Men living in Budapest have four years higher life expectancy at birth than males in Szabolcs-Szatmár-Bereg. With regard to female life expectancy at birth, there is a gap of approximately 1.5 years between these two regions.
  3. Socioeconomic Effects: Socioeconomic discrepancies have influenced life expectancy trends in Hungary as well. In comparing the life expectancies of 25-year-old men and women residing in Hungary, those who had access to a university education had life expectancies that exceeded those of individuals who did not finish secondary education by nearly nine years.
  4. Risk Factors: In 2010, dietary risks, followed by high blood pressure, tobacco and smoking, were the leading risk factors of those living in Hungary. For those under the age of 5 and adults between 15 and 49 years old, iron deficiency was a leading risk factor, followed by alcohol use in 2010.
  5. Disease Prevalence: Cardiovascular disease and cancer account for approximately 75% of all deaths in Hungary. Analyzing the effects of these diseases more specifically, ischemic heart disease, lung cancer and stroke caused the majority of deaths and, ultimately, played a significant role in lowering life expectancy.
  6. Health Expenditure: Hungary spent approximately 6.88% of its GDP on health-related services and issues in 2017. This is lower than the worldwide average of approximately 9.896% in the same year.
  7. Quality of Care: With cancer being a leading factor in determining life expectancy, it is essential to examine what Hungary is currently implementing in order to curtail such a disease. Despite having the highest European cancer death rates, Hungary had instituted relatively poor screening programs to lower the prevalence of cancer. In 2015, only 47% of Hungarian women between the ages of 45 and 65 received screening for breast cancer in the previous two years, and the rate of screening for cervical cancer was even lower. In 2017, however, Hungary developed a voluntary colorectal screening to better address the development of cancer among populations.
  8. Hospitalization: A high amount of hospitalizations in Hungary have been the result of preventable health issues. Such a finding is indicative of primary care quality. In making improvements to primary care systems, the number of hospitalizations could decrease, resulting in greater prevention of deaths and potentially higher life expectancies.
  9. Influence of the Pharmaceutical Industry: Approximately 50% of all government funds have gone towards driving the development of the pharmaceutical industry. A readjustment of spending towards making improvements in public procurement practices and encouraging generic medical prescriptions instead would allow for effective means of slowing the development of health conditions that only serve to aggravate life expectancy.
  10. The Impact of Health Worker: With more and more health care workers leaving Hungary to practice in other countries, many communities inevitably experience less access to means of improving health. In order to address this issue, the Hungarian government developed a type of residence scholarship program, in which medical residents received a monthly raise if they committed to public sector work while attaining their specialization. In addition, health professionals who were already working within the system experienced an increase of 20% in their salaries.

With the wide range of issues negatively impacting life expectancy in Hungary, the World Health Organization (WHO) has offered multiple constructive solutions. Due to the fact that Hungary instituted a more hospital-centralized health system, duration of stay, together with preventable hospitalization, have increased in prevalence. This has been evident in the lower effectiveness of primary care providers and an absence of adequate addressing of health issues in communities. In order to prevent the consequences associated with such problems, WHO has emphasized the significance of both improving community health care accessibility and the methods of primary health care workers. Consequently, despite issues with health systems in Hungary, the implementation of such solutions could result in improved health conditions and, ultimately, higher life expectancies.

– Aprile Bertomo
Photo: Flickr

Health conditions in Brazil
Over the years, the Brazilian government has improved the provision of health care for citizens. However, challenges have persisted in terms of the quality of care provided. In response, the government and other NGOs have taken various steps to improve health conditions in Brazil. These steps include reaching more impoverished areas, offering affordable HIV/AIDS treatment and providing vaccinations.

Reaching the Favelas

Reaching urban slums, or “favelas,” is crucial to improving health conditions. These areas are stricken with poverty and the people experience harsh living conditions. Poor health often accompanies these conditions, heavily impacting the people in favelas.

The struggles those individuals face are not new to the Brazilian government or NGOs. One NGO working to improve health conditions in Brazil, specifically among the people living in the favelas, is the Brazilian Institute for Innovations in Social Healthcare, also known as Ibiss. Initiated in 1989, Ibiss now operates 62 projects with 600 employees. One project is leprosy-awareness because many leprosy cases are concentrated within the favelas.

Ibiss has increased awareness and care by helping favela residents to organize self-treatment programs. This is significant because the course of treatment is lengthy so many of the people with leprosy stop treatment, especially in favelas.

Affordability of HIV/AIDS treatment

Brazil provides one of the best programs to combat HIV/AIDS in the developing world, which has helped to improve health conditions in the nation. One way that HIV/AIDS treatment affordability has improved is through the implementation of legislation increasing access to universal antiretroviral treatments for citizens. Additional legislation has allowed Brazilian companies to produce a generic version of antiretroviral drugs to reduce high associated costs.

Statistics from 2018 show these legislative measures are improving health conditions in Brazil, specifically in HIV/AIDS patients. 66 percent of people in Brazil who had HIV and were receiving treatment.

Vaccines

In contrast, vaccine coverage in Brazil has been declining. Coverage for the first dose of measles/mumps/rubella has declined in two regions in Brazil since 2016. In Northeastern Brazil, coverage dropped from 55.8 percent to 41.9 percent. Further, in Northern Brazil, coverage dropped from 58.9 percent to 44.9 percent.

Vaccination must occur to improve health conditions in Brazil. Thankfully, the Brazilian government recently responded to an outbreak of measles in 2019 by doubling the purchase of MMR (measles/mumps/rubella) vaccinations from the previous year. The government purchased 60.2 million MMR vaccines.

Brazil also recently launched a massive campaign to deliver yellow fever vaccinations. The government implemented these vaccines in 77 municipalities within the states of São Paulo, Bahia and Rio de Janeiro. These particular municipalities were targeted because of the increased risk of an outbreak. As a result of this campaign, 53.6 percent of people were covered in São Paulo, 55.6 percent Rio de Janeiro and 55.0 percent in Bahia.

 

Despite the poor health conditions, efforts to improve health conditions in Brazil are being implemented. From new government legislation to NGO programs, improvements have been made in reaching more impoverished areas, offering affordable HIV/AIDS treatment and providing vaccinations. Moving forward, the development of a robust health system will continue to have a positive impact on the nation.

Jacob E. Lee
Photo: Flickr

Diabetes in Developing Countries
Type 2 diabetes results from the body’s ineffective use of insulin, a hormone that the pancreas makes and allows the body to either convert glucose into energy or store it. Insulin prevents one’s blood sugar from getting too high since it effectively removes glucose from the bloodstream. Diabetes is a major cause of blindness, kidney failure, heart attacks and stroke among other conditions. While there are many risk factors for diabetes, physical inactivity and excess body weight are two of the most significant contributors to type 2 diabetes across the globe. However, there is an increasing prevalence of type 2 diabetes in developing countries where investments in health care are often inadequate.

Diabetes in Developing Countries

Globally, the number of people with diabetes increased from 108 million in 1980 to 433 million people in 2019. Estimates determine that the global prevalence of diabetes is 9.3 percent, and about one in two people with diabetes are undiagnosed. The International Diabetes Federation projects that global prevalence will increase by 25 percent in 2030 and by 51 percent in 2045 if prevention methods and treatment programs remain unchanged.

Type 2 diabetes relates to obesity and overeating. Therefore, people in the past have associated it primarily with high-income countries, but this viewpoint is changing. The prevalence of diabetes in developing countries has been rising rapidly. In 2019, 79 percent of adults with diabetes were living in middle-low income countries.

Risk Factors of Diabetes in Developing Countries

A majority of type 2 diabetes cases are in advanced nations. However, the disease is becoming a serious problem in developing countries. Diabetes prevalence in low-middle-high SDI countries is 1.48, 3.74, and 3.42 percent, respectively. SDI refers to the Sustainable Development Index as an updated version of the human development index and measures the ecological efficiency of human development. Middle SDI countries also have the highest annual rate of increase in prevalence. The prevalence of diabetes in developing countries is growing with westernization and with the urbanization of rural areas. In Pakistan, for example, a recent study found that urban areas have a prevalence rate of 28.3 percent which was just higher than the rate of 25.3 percent in rural areas.

Obesity, a main contributor to the diabetes epidemic, is increasing rapidly in developing countries. This shift also connects with the nutrition transition. The nutrition transition results from changes in agricultural systems. Specifically, there is a decrease in fruit and vegetable consumption. There is also a rise in processed foods such as refined carbohydrates, added sweeteners, edible oils and animal products.

In many Asian populations, the risk of diabetes starts at a lower BMI than for Europeans. Additionally, increased intake of meat, oils, highly saturated ghee (a type of butter used in Asian cooking) and added sugar have also marked diet shifts in Asia. Before urbanization, physical activity counteracted the effects of high fat and sugar diets. Unfortunately, physical activity has also decreased as a result of the shift from agricultural labor to working in manufacturing services.

Preventive Methods

The current trends show that type 2 diabetes in developing countries will likely significantly increase, but these outcomes are preventable through lifestyle and dietary changes. Since treatments such as drugs and insulin are costly and developing countries have limited resources, people must prioritize prevention. It is crucial to raise awareness about the effects of lifestyle shifts on obesity and type 2 diabetes globally. Low-cost innovations include training non-medical health professionals and using mobile devices to spread awareness about type 2 diabetes prevention. In addition to technology, countries should develop solutions using networks of community health workers.

Accredited social health activist (ASHA) workers are an example of this type of intervention in Asia, where 70 percent of the population lives in rural areas with very limited access to health care facilities and skilled health workers. ASHA workers are health educators in their own communities and have the ability to care for patients at home while also providing guidance regarding diet and physical activity. Telemedicine and the use of technology support this system and keep the ASHA workers in touch with medical professionals. This intervention also offers employment to people with some medical knowledge. ASHAs are able to make money by charging low fees for their services and provide for their families.

Making cities more walkable or cyclable through urban planning can increase physical activity while taking some of the prevention weight off of health systems, especially in countries with limited health resources. Making healthy food more affordable through redesigning subsidies needs to be a priority. This is because industrialization makes processed food cheaper and more accessible. These actions require political will and an understanding of the negative implications of the growing diabetes prevalence. Such actions could make a significant difference in decreasing the epidemic globally.

Maia Cullen
Photo: Pixabay

Women's Health in Mexico
Mexico has seen its fair share of issues in women’s health over the years, including a lack of access to affordable healthcare and gender inequalities. Recently, Mexico has made significant progress in addressing women’s health, making it a priority for the country. Here are seven facts about women’s health in Mexico.

7 Facts About Women’s Health in Mexico

  1. Femicide: Femicide is defined as the murder of a woman for gender-based reasons. The rate of femicides in Mexico has nearly doubled since 2007. Citizens of Mexico, along with the government, now refuse to ignore the issue. In March 2020, millions of Mexican women went on a 24-hour strike to stand up against gender-based violence. Through these strikes, women aim to criminalize femicides nationally,  as opposed to states deciding for themselves.
  2. Affordable Healthcare: Annual fees for healthcare in Mexico are, at most, $500 per family, with participation costing $40 per month per person. Each major city in Mexico has a first-rate hospital, and the healthcare system is not based around profit. On average, prescription drugs cost between 30 to 60 percent less than the same drugs in the United States. Mexico’s status as a developing country makes this especially promising. 
  3. Improved Sex Education for Rural Regions: Though many indigenous women living in rural areas in Mexico do not have access to formal healthcare, nonprofit organizations throughout the country offer assistance. Mujeres Aliadas, a non-profit organization, has worked with over 9,000 women in 40 rural communities in central Mexico to educate them on sexual and reproductive health. The organization offers workshops, talks, and even safe spaces for women to give birth. With improved education, women can empower themselves and learn about their bodies.
  4. Fair Start in Life: “Fair Start in Life,” an initiative launched in 2001, was created to address maternal mortality and the health of young children. This program gave expecting mothers access to safe blood, nurses, necessary drugs and healthcare networks. The initiative also led to proper monitoring of maternal deaths and women of reproductive age. Between 2000 and 2006, maternal deaths dropped 2.7 percent.
  5. Emergency Contraception: After a discussion between hundreds of organizations and members of the public, emergency contraception was officially included in the essential drug list in July 2005. The office of the President of Mexico, as well as women’s rights advocacy groups, supported the initiative. Advocates stated that acknowledging the importance of emergency contraception would decrease unwanted pregnancy, disease and sexual violence. 
  6. National Center for Gender Equality and Reproductive Health (NCGERH): In 2003, the Ministry of Health (MOH) established the National Center for Gender Equality and Reproductive Health (NCGERH) in order to acknowledge the equality gap between men and women’s health in Mexico. This institution has the ability to suggest, monitor and evaluate sexual and reproductive national policies. The NCGERH also has the authority to monitor the quality of reproductive health services across the country. 
  7. Cervical Cancer Screening: Mexico has made a significant effort in preventing cervical cancer among Mexican women. In 2012, 48.5 percent of women ages 25-64 were screened for cervical cancer, an increase of more than 4 percent from 2006. The country has also given all girls access to the human papillomavirus (HPV) vaccine since 2008, which prevents a virus that causes various types of cancer in women. 

These seven facts about women’s health in Mexico highlight that although Mexican women have faced challenges in their healthcare, the country is working hard to make changes. Moving forward, it is essential that Mexico continues to prioritize women’s health, paving the way for more progress. 

– Alyson Kaufman
Photo: Pixabay

ENT Care in Zimbabwe Zimbabwe is a country in Sub-Saharan Africa with an estimated population of 14.2 million people. As a developing country struggling from political and civil issues, their Human Development Index is at 0.509. This places the country in the low human development category. Lacking effective medical care access, the country has long struggled with managing several pandemics. This includes malaria, HIV, tuberculosis and widespread maternal and childhood illnesses. A particular medical issue that needs attention in Zimbabwe is ear, nose and throat (ENT) care.

Challenges in ENT and Audiology Care in Zimbabwe

According to a survey of 22 Sub-Saharan countries in Africa, it has been observed that there has been an overall lack of progress in ENT and audiology care between 2009 and 2015. Although there has been an increase in ENT surgeons by 43 percent and audiologists by 2.5 percent, these numbers cannot adequately serve the 23 percent population growth that occurred during that time. Since 2015, there has been a steady decline in ENT physicians and audiologists in Sub-Saharan Africa. Additionally, U.K. respondents have noted that there is a lack of proper medical equipment for ENT care, training facilities and audiological rehabilitation.

Importance of ENT Care in Zimbabwe

With the lack of ENT care available in African countries, physicians wondered how they can also provide social support to patients that have suffered hearing loss, speech impediments and other traumas relating to ENT illnesses. Dzongodzaand Chidziva, an ENT surgeon who works in Zimbabwe, has explained that many Zimbabweans believe that a runny nose or snoring are minor issues. However, those same symptoms could be the precursor for devastating illnesses.

To demonstrate the dangers of these misconceptions, Chidziva found that a common issue among patients he treated was respiratory papillomatosis, caused by the papilloma virus, otherwise known as the Human Papilloma Virus (HPV). The illness causes growths to build up in the upper respiratory tract, constricting breathing and damaging vocal cords. If left untreated, it is life-threatening, especially for young children. Invasive care and surgery has to be taken immediately in order to dislodge warts. It is illnesses like these that make adequate and proper ENT care paramount.

Improvements to ENT Care in Zimbabwe

Despite setbacks and social misconceptions in the field, improvements are underway to bring proper ENT care in Zimbabwe. In March 2017, Zimbabwe opened its doors of the first pediatric otolaryngology clinic. This is a public clinic that has two operating rooms and a recovery room for in-patient care. Within that first year, thousands of patients traveled from all over Zimbabwe to receive treatment from the clinic. Only one other clinic such as this one existed in Africa at the time.

Following the clinic’s outstanding success, in May 2018 the first international symposium to promote the expansion of pediatric otolaryngology across Africa took place. The  PENTAfrica symposium resided in Victoria Falls, Zimbabwe that year. Health care physicians and otolaryngologists from North America, Europe and Africa engaged in these ENT discussions. The purpose of the conference was to create a long-term plan to further extend ENT care to various African countries.

Zimbabwe is one of many countries in Africa that is in dire need of ear, nose and throat care. The effects of leaving ENT illnesses untreated has left lasting effects, including deafness, on populations in Zimbabwe. However, after the opening of their first ENT clinic, more clinics and treatment are underway  to treat patients suffering from ENT illnesses.

Lucia Elmi 
Photo: Flickr

3D Printing in Impoverished Nations
3D printing is a technology that has existed since the 1980s. Over time, additive technology has increasingly progressed where various medical applications can use it. 3D printing in impoverished nations has several benefits specifically in medicine and medical services relating to the affordability for the general populous of these nations. 3D printing for medical applications is the process of utilizing a digital blueprint or digital model, slicing the model into manageable bits and then reconstructing it with various types of materials, typically plastic. Here are three examples of 3D printing in impoverished nations.

3 Examples of 3D Printing in Impoverished Nations

  1. Custom Surgical Elements: The use of 3D printing has significantly increased in the manufacturing of customized surgical elements, such as splints. Manufacturers can make these devices and components quickly at a relatively low cost, which would greatly reduce the price of sale to the consumer. The reason for the reduced cost of production compared to conventional manufacturing systems is primarily due to the additive nature of 3D printing. For example, 3D printing actually adds material onto each layer, rather than subtracting (cutting/slicing) and combining material. This results in smaller opportunities for error to occur and the wasting of fewer materials in the long run.
  2. 3D Printed Organs: Many know this particular field of 3D medical printing as bioprinting. According to The Smithsonian Magazine, bioprinting involves integrating human cells from the organ recipient into the “scaffolding” of the 3D printed organ. The scaffolding acts as the skeleton of the organ and the cells will grow and duplicate to support physiological function. Although this particular method is still in the experimental stages, there have been successful procedures performed in the past. Researchers at Wake Forest have found an effective method for bioprinting human organs; they have successfully implanted and grown skin, ears, bone, and muscle in lab animals. Further, scientists at Princeton University have 3D printed a bionic ear that can detect various frequencies, different than a biological, human ear. The researchers behind the creation of this bionic ear theorized that they could use a similar procedure for internal organs. Similar to surgical components, 3D printed organs would greatly reduce the cost of organ transplants. Additionally, it would increase the availability of organs, which are nearly impossible to find. Locating an appropriate match within a specific proximity of the patient has resulted in a global organ shortage. Whilst some have presented a solution in the form of international organ trade, WHO states that international organ trade could provide a significant health concern because of the lengthy trips the organs would experience. 3D printed organs may be a sustainable method to help impoverished nations with supply organs quickly and cheaply.
  3. Prosthetics: 3D printing in impoverished nations could also allow people to print custom prosthetics for those in need. The lack of access to current prosthetics creates a lot of obstacles for people living in impoverished nations. Creating prosthetics with 3D printing technology has the potential to provide a person the ability to accomplish basic, daily tasks in order to support a family. Not only are current prosthetics expensive, but they are also often inconvenient or they prohibit natural motion. For example, Cambodia treats a prosthetic hand as a cosmetic item, leading the majority of the population to refuse the prosthetic due to the lack of functionality. The Victoria Hand project is currently attempting to change this perspective by providing functional, 3D printed prosthetic hands to Cambodia and Nepal. The team has performed user trials, where the aim is to distribute the 3D printed hand to the general populace. Subsequently, the design will go to multiple fabrication services to maximize accessibility.

These three examples of 3D printing in impoverished nations show just how important 3D printing is and will continue to be to aiding those in need. With further development, 3D printing should allow people to receive prosthetics and organ transplants more easily.

– Jacob Creswell
Photo: Wikimedia

Health Care in Sudan
Sudan is rich in natural and human resources; however, it is poverty and conflict-stricken. Agriculture is an income provider for 70 percent of the populace. Due to a lack of resources and training availability, the health care sector of the country remains underfunded and understaffed. Here are ten facts about health care in Sudan.

10 Facts About Health Care in Sudan

  1. Approximately 14 percent of Sudanese do not have access to health care. This is largely due to the fact that Sudan has a critical shortage of health care workers. According to the World Health Organization, there are 23 qualified health care workers per 10,000 members of the population.
  2. Sudan’s maternal mortality rate has improved, but it varies by region. In 2015, the maternal mortality rate was 311 per 100,000 live births. This was a significant improvement from 744 per 100,000 live births in 1990. Unfortunately, these rates are not consistent across the country. While more recent data is not available, in 2006, the maternal mortality rate in Southern Kordofan was 503 per 100,000 live births. In the Northern state, however, the rate was only 91 per 100,000 live births.
  3. Approximately 32 percent of Sudan’s population is drinking contaminated water from untreated water sources. This is a result of chemical and bacterial contamination from industrial, domestic and commercial waste that degrades the water quality. There are acts at the state and national levels to help prevent this washing and injection; however, these acts need activation. UNICEF is working with the Sudanese government to increase access to basic treated water supplies for the people of Sudan, with a focus on women and children.
  4. Sudan suffers from outbreaks of cholera, dengue fever, Rift Valley fever (RVF), chikungunya and malaria. Increased outbreaks in 2019 were, in part, a result of heavy rainfall during the rainy season. Consequently, this rainfall left behind stagnant pools which were breeding grounds for mosquitos, contributing to the spread of infection. Government authorities and their humanitarian partners worked to respond to outbreaks across the country. The Kassala and North Darfur Ministries of Health launched weekly response task force meetings and developed state-level plans to mitigate the outbreak.
  5. Sudan has widespread micronutrient deficiencies. This is partially due to insufficient levels of crop growth. Only 14 percent of 208 cultivable acres are being cultivated. Drought, pests and environmental degradation also contribute to widespread malnourishment. However, vitamin A deficiency decreased due to repeated vitamin A supplementation given during National Immunization Day campaigns.
  6. Many Sudanese women and girls lack adequate health care and resources. Women and girls living in the rebel-held areas of Southern Kordofan or the Nuba Mountains of Sudan have very limited or no access to contraception. Human Rights Watch found most of the women interviewed did not know what a condom was and was unfamiliar with other common contraceptive practices. This lack of education and the low availability of condoms are why there are high percentages of women testing positive for hepatitis B. Consequently, gonorrhea and syphilis are on the rise in Sudan.
  7. The National Expanded Program on Immunization in Sudan supports an increase in routine immunization coverage. In addition, the government’s financial investment to EPI and polio eradication program is 15 million USD. Challenges the program faces include poor service delivery and a lack of resources and skilled staff.
  8. Sudan spends 6.5 percent of its gross domestic product and 8.3 percent of government spending on health care. Before the 1990s, receiving care at public health care facilities was mostly free. However, the structural reforms of 1992 introduced user fees. Now, out-of-pocket expenses for patients hover in the 70 percent range.
  9. There are 75 degrees and diploma-granting health institutions in Sudan. About 28 of these institutions offer diplomas and 47 of these schools offer degrees. There are 14 private institutions, while the others belong to agencies such as the Federal Ministry of Health and other government agencies. In 2001, the Federal Ministers of Health and Higher Education signed a Sudan Declaration and Nursing and Allied Health Workers in 2001. The goal of the declaration was to improve nursing and other health care education. The Academy of Health Sciences was established in 2005 to help implement this goal.
  10. The Sudanese government is working to rebuild and reform the health care system. A 25-year plan spanning from 2003 to 2027 was created in the early 2000s. This plan focuses on ensuring health care services are accessible and high quality, particularly for impoverished and vulnerable populations.

These ten facts about health care in Sudan illuminate some of the struggles the nation has faced, as well as improvement efforts by the Sudanese government and other humanitarian organizations. It is imperative that these efforts continue in order for health care to continue to progress in Sudan.

Robert Forsyth
Photo: Flickr

childrens health in Pakistan
Pakistan is a country that has had many years of strife regarding affordable and accessible health care, particularly for families. Many organizations seek to change this so that the country can improve the well-being of its children, the most vulnerable group. Below are seven facts about children’s health in Pakistan.

7 Facts About Children’s Health in Pakistan

  1. Immunizations: UNICEF has been supporting the Pakistani government in ensuring that children have access to routine immunizations. The Expanded Programme on Immunization (EPI) in Pakistan works to provide vaccinations to children in both urban and rural communities. In 2018, 75 percent of infants received a third dose of the Diptheria-Tetanus-Pertussis (DTaP) vaccine, compared to only 59 percent in 2000. Similarly, in 2018, 67 percent of children received a second dose of the measles vaccine, compared to only 30 percent in 2009.
  2. Pneumonia: Pneumonia is the number one cause of death among children in the world as well as in Pakistan. About 91,000 Pakistani children die from pneumonia each year. However, in 2012, Pakistan was the first nation in South Asia to introduce a pneumonia vaccine to children. Though the vaccine is expensive, international organizations such as the World Health Organization (WHO), Global Alliance for Vaccines Initiative (GAVI) and the Bill and Melinda Gates Foundation have begun to include this vaccine in the free immunization program for children.
  3. Child Health and Sanitation Week: Twice a year, Pakistan holds Child Health and Sanitation Week. UNICEF and the Government of Pakistan hold events and marches to raise awareness about children’s health. They provide free immunizations and deworming, and hold information sessions on breastfeeding and hydration. Children and families also learn about the importance of good hygiene and how to prevent certain diseases.
  4. Diarrhea: About 53,000 children die from diarrhea in Pakistan every year. Though diarrhea is another leading cause of death, UNICEF Pakistan supports the Global Action Plan for Pneumonia and Diarrhea (GAPPD). The GAPPD trains health care workers, researches causes of illness and provides supplies to help treat and prevent both conditions.
  5. Neonatal Deaths: The government of Pakistan Provides programs on EPI, family planning, maternal/neonatal and child health and primary health care and nutrition for women and children living in rural and remote areas of Pakistan. According to the National Institute of Health, these sorts of programs have the potential to prevent 20 percent of neonatal deaths, between 29 to 40 percent of deaths in children below the age of 5.
  6. Government Projects: The Government of Pakistan has initiated a wide variety of programs aimed specifically towards protecting the health of children and their mothers including the Maternal and Child Health Programme, National Program for Family Planning and Primary Health Care, National EPI Programme, Nutrition Project, Acute Respiratory Infections Control Project and the Integrated Management of Childhood Illnesses Strategy. These projects are able to assist areas of Pakistan that need treatment and prevention supplies for various illnesses in children.
  7. HIV: UNICEF is assisting the Government of Pakistan in preventing HIV cases in children. Though the amount of pediatric HIV cases has increased in Pakistan throughout the last few years, the Prevention of Parent to Child Transmission has been researching ways to change this and strengthen the care that infected children receive. The initiative is also working to educate adolescents on HIV prevention.

Pakistan has struggled with providing its families with accessible and affordable health care. However, with many new initiatives, specifically with immunizations, its children will be able to thrive. As the Government of Pakistan has shown, children’s health in Pakistan will continue to be among its priorities.

Alyson Kaufman
Photo: Wikimedia

Sanitation in Peru
Thanks to the government and various international organizations, Peru has made noticeable progress in regards to sanitation and clean water. However, there is still a large amount of room for improvement in the country. Here are 10 facts about sanitation in Peru.

10 Facts About Sanitation in Peru

  1. Access to Running Water: The water crisis in the suburbs of Peru is complex. Even in more urban areas, running water is still a rare commodity. In middle-class homes just outside of Lima, 3 million people still lack running water. Hand-dug wells are common sources of water in these areas and local citizens may travel miles in order to use the restroom. The country has made progress in the hopes of expanding access to running water. In 2014, the International Secretariat for Water Solidarity established a sustainable source of water in Cuchoquesera and followed this with a similar development in the town of Waripercca. Both communities now have running water.
  2. Sanitation in Schools: The Peruvian water crisis has heavily affected schools. Almost no rural schools have clean bathrooms or working sinks. A lack of proper restrooms and facilities can prevent academic progress. Luckily, sanitation officials in Peru have identified this issue and created a plan to increase infrastructure. This plan should provide suitable and sanitary bathrooms to Peruvian schools by 2030 and educate younger children on hygienic practices, however, donations and investments could speed up the process.
  3. Sanitation in Hospitals: In 2016, 18 percent of health care facilities reported having to operate without running water, leading to problems in water disposal, waste management and an overall inability to perform tasks as simple as cleansing the hands. According to a report from UNICEF and WHO, this can easily lead to life-threatening illnesses, especially for newborns that may be born in these facilities.
  4. Plumbing Systems: Even homes in the suburbs of Lima do not always have toilets. In Peru’s urban areas, about 5 million people do not have a working toilet in their homes. In places where these facilities do exist, the plumbing system is so fragile that flushing toilet paper could do serious damage to the system, or at the very least cause the toilet to clog or flood. The best solution to this less-than-perfect system is to invest more money in plumbing infrastructure or to utilize the “dry toilet” designs that are popping up around the world.
  5. Open Defecation: Despite having dropped since 2000, the percentage of the rural population practicing open defecation still measured around 19 percent in 2017. Experts cannot understate the negative health and sanitation effects of citizens experiencing exposure to human waste. The good news is that the portion of the urban population practicing open defecation is as low as 3 percent and both rates are in a steady decline.
  6. Untreated Drinking Water: Lima’s source of water and the surrounding areas is the Rio Rimac, a river heavily polluted by harmful microorganisms. One of these microorganisms is Helicobacter pylori, a dangerous bacteria that can affect the gastrointestinal tract of those unlucky enough to experience an infection. The good news is that water treatment is seeing a slow uptick in Peru, especially in urban areas. The number of people consuming untreated water has decreased by the thousands since 2000. Public health intervention has begun to focus on treating the water before distribution, partnering with organizations like the International Secretariat for Water Solidarity.
  7. Unsafe Water Affects More Than Drinking: While drinking unsafe tap water is a prominent issue, the problem becomes monumental when one considers everything else that people use water for. Fruit and vegetables that individuals wash in tap water may be dangerous for consumption, as well as drinks with ice and any foods kept on ice.
  8. Unsanitary Practices: While many of the sanitation problems in Peru come from lack of funding or infrastructure, another big problem comes in the form of unsanitary practices. This involves hand-fecal transmission and infection, which may lead to transmission to the face or other individuals in the community. During observation in 2014, 64 percent of those researchers observed potentially contaminated their face, hands or food within one hour of hand contamination. This can be detrimental to the health of Peruvians, as contamination can cause an array of enteric pathogens including salmonella and Escherichia coli. These practices are simply a result of the lack of running water in many parts of the country and lack of awareness of the diseases that fecal transmission can cause. Peru can eliminate this issue by educating Peruvians as children about sanitation and hygiene and by improving the running water system in Peru. There have been attempts to address these issues, including observation and correction of some of these behaviors.
  9. WaterCredit Program: Water.org’s WaterCredit program is quite possibly the jumpstart the nation needs in order to provide running water and sanitary conditions to all of its citizens. The WaterCredit program works with various donating partners to provide plumbing and similar infrastructure to countries that need it. Through this program, Water.org has been trying to reach people in urban areas, like Lima, and provide them with improved indoor bathrooms, sewage collection infrastructure and safe running water. It has reached an estimated 2.5 million people and hopes to reach more within the country in the future.
  10. Stray Dogs: One problem affecting sanitary conditions in Peru is the fact that stray animals, especially dogs, run rampant in cities like Cusco and Mancora. Sadly, due to lack of proper care, these animals can carry various infections that they can spread to humans through direct contact. These infections include rabies, norovirus, salmonella and brucella among others. These infections can have detrimental health effects on humans if contracted and the infected animals may show little to no symptoms.

While the conditions of sanitation in Peru are not yet acceptable, the country has made significant progress in the last decade. It is not an overestimation to say that Peru will continue this forward progress with the help of its citizens and various donating partners. With continued aid from international organizations, the sanitary conditions in Peru could see a significant increase in quality in the next few years.

Tyler Hall
Photo: Flickr