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State of Health care in Vietnam

Health care in VietnamVietnam’s public health system has faced significant challenges in recent years, from diseases including tuberculosis, HIV/AIDS and COVID-19. With the help of organizations including USAID and the CDC, however, Vietnam has also achieved a great deal of success in addressing these issues. Here are some important things to know about health care in Vietnam, and how foreign aid programs have contributed to its development.

The Centers for Disease Control and Prevention (CDC)

The CDC’s partnership with the Vietnamese government celebrates its 25th anniversary in 2023. Since 1998, the CDC has supported Vietnam in establishing programs to improve the treatment of diseases including TB, HIV and influenza. The number of HIV sentinel surveillance sites, for instance, which help Vietnam detect and monitor patterns of infection have doubled since 2003. Furthermore, a clinical trial for a new TB treatment conducted by the CDC in Vietnam reduced the length of treatment from six months to only four; it was the first new treatment regimen, in any country, for the disease in three decades. The CDC has also aided in the creation of five emergency operations centers to support the country’s health care system in times of crisis, such as the COVID-19 pandemic.

The World Bank

In 2013, the World Bank funded a $126 million project to protect and improve the public hospital system in 13 provinces in North Vietnam. The North East and Red River Delta Regional Health System Support Project aimed to solve the overcrowding problem that many Vietnamese hospitals were experiencing. It was a success — nearly half of the 74 hospitals included in the program were awarded the Vietnamese Ministry of Health’s upper hospital classification, and patient satisfaction rates experienced a marked increase, reaching 88.5% at the district level. Almost 5,000 local doctors received training from Vietnam’s top medical specialists, learning around 3,000 new techniques to use in their own communities.

USAID

In an effort to ensure an effective response to the COVID-19 pandemic, USAID provided Vietnam with $12 million in aid in 2020. This included $4.7 million in funding for laboratory systems, public health screenings, infection prevention in health care settings and 100 ventilators. USAID also provided $5 million in support of the country’s economic recovery.

Other programs financed by USAID that support health care in Vietnam include Erase TB. This initiative has improved the country’s ability to detect and treat tuberculosis, contributing to a decline in cases of the disease in Hanoi and Ho Chi Minh City. Additionally, USAID’s Local Assistance to Develop and Deliver Excellence, Resilience and Sustainability in Vietnam (LADDERS) program helps high-risk people living with HIV, often living in remote areas, to access testing and treatment services.

The World Health Organization (WHO)

The WHO has supported Vietnam with the goals set out at the ninth Global Conference on Health Promotion, held in 2016. These are:

  • Good governance – promotes an approach in which health care is central to government policy and policies that protect citizens’ health and wellbeing are prioritized
  • Health literacy – ensures that citizens have the information they need to make healthy choices and to access health care.
  • Healthy cities – reinforces the need for high-quality health care services and planning at the local level, to improve the state of the country’s overall health care system.

Vietnam’s 1,332 hospitals, alongside its community services and laboratories, have significantly improved patient access to higher quality health care in recent decades. The work done, and aid given, from both American and global organizations has been vital to this record of success and continues to help Vietnam improve the standard of care that its citizens receive. Health care in Vietnam is more effective thanks to the enduring partnerships established between these organizations and the Vietnamese government.

– Martha Probert
Photo: Flickr

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RSV in Developing Countries and the Need for a Vaccine

RSV in Developing CountriesAs of 2022, pandemics such as COVID-19 and tuberculosis are still rampant around the world. But there is another respiratory virus called the respiratory syncytial virus (RSV) that poses a risk, especially for those living in low-income countries and young children.

RSV in Developing Countries

RSV is a contagious virus that affects the lungs and breathing passages. The reason why RSV is not as well known is because its symptoms are the same as a cold. These include cough, a runny nose and fever. RSV can infect people of any age, but elderly people and children ages 2 and under are at the most risk of catching the virus. And much like the flu and COVID-19, it spreads when an infected person coughs or sneezes when around others and touches surfaces and objects.

People infected with RSV may even develop severe infections such as pneumonia or bronchiolitis which is the inflammation of the small airways in the lungs. Despite the danger, however, RSV is preventable. People can protect themselves from infections by simply washing their hands with soap and hot water for 20 seconds, covering coughs and sneezes, wiping surfaces that have been frequently touched and maintaining distance.

With these simple prevention methods, one might be asking just why is RSV so dangerous. While cases of RSV can be mild and clear on their own, a person can be infected multiple times in their lifetime. Furthermore, for those with severe symptoms who lack access to health care services, the outcomes can be devastating.

The Importance of Medical Care

“A seasonal virus that emerges during the winter months” causes RSV. Infants are more at risk for catching RSV since they do not have immunity compared to adults. Not only that, but in recent months the virus has been surging and that is ironically due to the prevention protocols against the COVID-19 pandemic.

Prevention methods such as social distancing, hand washing and mask-wearing during the COVID-19 pandemic helped to limit the spread of RSV. As a result, there have been no RSV infections over the past few years. That also means that there are two to three-year-olds who have no immunity to RSV. 

The situation is most worrisome when it comes to tackling RSV in developing countries. Many kids in low-income countries may also live in remote areas without access to medical assistance. “More than 95% of RSV deaths occur in low-income countries,” according to Bill and Melinda Gates Foundation. Unfortunately, a percentage of those who do survive may suffer from long-term health issues such as lung damage.

The Future

Currently, there is no known drug or vaccine for RSV. However, a vaccine to prevent RSV is in development by Pfizer who announced at the end of 2022 that its vaccine “showed an efficacy of 82% against hospitalization among infants under 90 days old and 69% among those younger than six months.”

The only challenge left is facilitating vaccine access to low-income countries. On that note, the Bill and Melinda Gates Foundation announced a grant to support the development of affordable multidose vials for delivery. The foundation is “optimistic that this vaccine could be available to low-income countries at an affordable price by 2024.”

– Aaron Luangkahm
Photo: Flickr

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3 Facts About Measles

About MeaslesMeasles is a communicable disease caused by a virus. Persian physician and scholar Abū Bakr Muhammad Zakariyyā Rāzī discovered the disease in the ninth century but it became a global term in the 16th century. In 1757, measles-infected blood was transmitted to healthy donors where Scottish doctor Francis Home discovered that a highly infectious bacterium causes measles. Measles only become a nationally recognized disease in the United States in 1912, when there were 6,000 deaths annually. To this day, measles is considered to be one of the world’s deadliest diseases, especially in developing nations, despite treatment efforts. Here are three facts about measles.

3 Facts About Measles

  1. In 2022, the creator of the measles vaccine Samuel L. Katz passed away at the age of 95. Before the development of the vaccine, almost every child had measles by the age of 15 and nearly 4 million people were infected every year. Five hundred people died from measles each year, there were 48,000 hospitalizations and 1,000 people had swelling of the brain due to the infection, according to the Centers for Disease Control and Prevention (CDC). In 1956, there was a disease breakout at a school in Boston, Massachusetts, where John F. Enders and Dr. Thomas C. Peebles collected blood samples from infected students and isolated the disease within David Edmonton’s blood. In 1963, they developed Edmonton’s virus into a vaccine and it officially received a license in the United States, where Maurice Hilleman and his research team further improved it in 1968.
  2. Before the vaccine, there was an epidemic every two to three years that caused around 2.6 million deaths each year worldwide, according to the World Health Organization (WHO). Even after the vaccine, in 2018, 140,000 people died from measles, most of which were children under 5. Unvaccinated children, pregnant women and non-immune people are most at risk of getting measles, though it is particularly common in developing nations, such as countries in Africa and Asia. In addition, more than 95% of deaths happen in low-income households and countries with underdeveloped health services, WHO reports. Once one has measles, there is no anti-treatment available. However, vitamin A can reduce the complications and risk of death from measles after taking two doses a day apart. The vaccine is a routine procedure in the U.S. and costs $1 per vaccine. However, many developing nations cannot afford the vaccine. This has led to 19.2 million infants not receiving a single dose in 2018. Around 6 million of these infants were from India, Nigeria and Pakistan, where the number of cases is significantly rising.
  3. According to the WHO, measles spreads through coughing, sneezing and being in close contact with infected patients. It can stay airborne and on infected surfaces for as long as two hours and can infect people four days before and after a rash occurs. The first symptoms of measles show 10 to 12 days after exposure to the virus, lasting for four to seven days. It initially has cold-like symptoms, such as a runny nose, cough, red and watery eyes and a fever. Patients also develop small white spots on their cheeks. This develops into a rash after 14 days, which could last for six days. Without treatment, complications could occur, such as blindness, brain swelling, diarrhea, dehydration and ear and respiratory infections. Though, complications occur more in malnourished children with a lack of vitamin A or those who have weak immune systems from other diseases.

Looking Ahead

In 2010, the World Health Assembly stated three targets to eradicate measles by 2015. First, to enable more first-dose vaccines during routine coverage to more than 90%. Second, to reduce case numbers to less than five cases per million annually. Third, to reduce measles-related deaths by at least 95%. Furthermore, in 2012, the World Health Assembly supported the Global Vaccine Action Plan of “eliminating measles in four WHO regions by 2015 and five regions by 2020,” the WHO reports. These goals were successful and as of 2018, mortality rates had decreased by 73% with the development of the vaccine coverage. The Measles and Rubella Initiative, founded in 2001 and the Gavi Vaccine Alliance also supported this by preventing 23.2 million deaths, where most of the deaths would have been in Africa and the countries that the Gavi Alliance support.

– Deanna Barratt
Photo: Flickr

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HIV/AIDs in Cameroon

HIV/AIDs in Cameroon
One of the most prominent challenges citizens in Cameroon are facing today is the prevalence of HIV/AIDs throughout the country. With the national infection rate being 3.7% in 2021, achieving epidemic control continues to be a constant battle. However, with the help of foreign aid, NGOs and the proactive efforts of the Cameroonian government, the country is making progress toward this goal. Here are the most important things to know about the history of HIV/AIDs in Cameroon and the state of the prevention effort.

History and Demographics

Like many countries in sub-Saharan Africa, there is a higher rate of individuals infected with HIV/AIDs in Cameroon than in most other parts of the world. The earliest reported case in Cameroon was in 1985 and by 1990 the country had an estimated 49,000 infected individuals. This number increased every year until it peaked at an estimated 520,000 cases in 2012. Since then, the annual rate has slowly but steadily declined to an estimated 500,000 cases in 2021.

Though many children have HIV/AIDs in Cameroon, people 15 years or older are by far the most common and represent an estimated 460,000 of the 500,000 currently infected, according to UNAIDS. Within the adult over 15 cohort, women are more than twice as likely to have HIV/AIDs than men.

Prevention and US Support

The first measure the government of Cameroon took to prevent the spread of HIV/AIDs was the establishment of the National AIDS Control Committee (NACC) in 1986. Its function was to facilitate cooperation between prevention efforts nationally. It expanded its efforts further in 2000 when it launched the first of three five-year plans to prevent the transmission of HIV/AIDs in the country.

There has also been a myriad of U.S.-backed efforts to help assist in the prevention effort. For example, in 2008 the U.S. Center for Disease Control and Prevention (CDC) partnered with Cameroon’s Ministry of Health as well as a host of NGOs to assist in the fight against HIV/AIDs. Through this collaboration the CDC aimed at “providing technical leadership on HIV epidemic control efforts within the country” but eventually expanded its operations to also include “direct clinical support” and help “scale-up access to HIV prevention and treatment services.”

Additionally, USAID has backed and helped execute a variety of HIV/AIDs prevention plans in Cameroon through the President’s Emergency Plan for AIDS Relief (PEPFAR). A few of these initiatives are The Continuum of Prevention, Care and Treatment (CoPCT) of HIV/AIDS with Most-at-Risk Populations in Cameroon (CHAMP), Reaching Impact, Saturation, and Epidemic Control (RISE) and Community-Led Monitoring (CLM).

In general, PEPFAR programs aim to mitigate the spread of HIV/AIDs in Cameroon through education, community outreach, reliable data collection and strengthening existing government and non-governmental healthcare agencies.

Looking Forward

Though it may seem like a sign of inefficacy that total infection numbers have only gone down by a small margin since 2012, it is important to remember that epidemics tend to grow exponentially and that the population of Cameroon has been increasing steadily at a high rate for the past several decades. With this in mind, a stagnated or only marginally decreased total infection figure is actually quite an accomplishment, as the government has to account for an enormous increase in population and the spread of infectious diseases is notoriously difficult to subdue.

Further, aid from countries like the U.S. was undoubtedly instrumental in achieving this feat and continued international support will be necessary as the national government continues to battle HIV/AIDs in Cameroon.

– Xander Heiple
Photo: Unsplash

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Diseases in Puerto Rico

Diseases in Puerto Rico
Chronic diseases in Puerto Rico have been on the rise in recent years. According to the Puerto Rico Report, more than half of the deaths reported on the island are due to chronic diseases. In 2010, 57% of deaths were due to heart disease, diabetes, cancer and strokes. The Puerto Rican Report also said more than one-third of Puerto Ricans have diabetes, more than 18% have arthritis and 17% have reported asthma throughout their adulthood.

Poverty and Chronic Diseases

Puerto Rico Report stated in an article that poverty has a connection with the increase of chronic diseases as households with an income of around $15,000 per year or less have higher chances of developing a chronic disease. Chronic diseases result in disabilities that can deteriorate the workforce and exacerbate the health care system. The CDC stated that 21% of Puerto Ricans have reported having serious mobility restrictions.

A study that the International Journal of Environmental Research and Public Health published stated that, compared to the general mainland population in the United States, chronic disease occurrence levels and mortality rates are higher for the people living in Puerto Rico. Around 44.3% of individuals who reported food insecurity in the study also reported that they perceived their health to be average or poor. The study also found that as of 2020, 5,000 doctors had left the island to work in the United States for economic reasons leaving the island, marking a 36% decline in medical staff on the island. Health care services in Puerto Rico currently face the risk of funding reduction in the Medicaid program that could lead to 1.5 million people losing health care coverage.

Financial Burdens

The Puerto Rico Report stated that citizens of the island are currently not eligible for Supplemental Security Income due to its status as a colony. The rising cost of pharmaceutical medicines and treatments has left the high levels of chronic disease to increase the financial burdens on the island. More than half of Puerto Rican residents are eligible for Medicaid. However, they do not receive enough funding to cover the cost of their disease’s treatment.

Solutions

In 2014, the Puerto Rican government released the “Puerto Rico Chronic Disease Action Plan” that focuses on collecting data, chronic disease self-management education, intervention plans within communities and increasing access to nutritious food and physical activity. The plan could strengthen the health care system on the island while increasing the economic position of Puerto Rico as the government looks to build medical manufacturing on the island to increase profit and medications. The plan is also looking to increase a clinical trial network within the island and develop local primary health.

The Puerto Rican government developed the model from the chronic model that the Pan American Health Organization/World Health Organization (PAHO/WHO) created and implemented in countries such as Brazil, Argentina, Colombia and the Dominican Republic. This model has reduced hospitalization rates due to diabetes, hypertension and other chronic conditions. It has also decreased the economic strain of the health care system in the different countries. “The model has six components: organization of care, community engagement, support for self-management, clinical information systems, design of service delivery systems, and support for clinical decisions,” PAHO stated.

The government has yet to release any update on the progress of the model due to the pandemic drawing attention away from the increasing risk of chronic diseases on the island. Chronic illnesses still present a big risk factor on the island from both the economic and health care perspective. However, many of the education sections of the model have increased health awareness on the island. As the island begins to move away from the COVID-19 pandemic hope increases for an increase in resources for chronic illness treatment.

– Nuria Diaz
Photo: Flickr

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How Epigenetics Predicts the Effects of Poverty

EpigeneticsEpigenetics is a recently developing branch of genetics that rose to prominence in the 21st century. Recent research has shown the biological effects of poverty through epigenetics. Epigenetics goes further than the genes a person inherits from their parents by showing how the individual’s genes react to their environment and other factors. One study that Molecular Psychiatry published concluded that children who grow up in families below the poverty line are “more prone to mental illness and alterations in DNA structure.” Since poverty brings numerous stressors such as poor nutrition and physical or psychological trauma, it can affect a child’s biological development, particularly in the brain. Epigenetics can help shape the future and bring to prominence that poverty can cause acute and chronic conditions.

What is Epigenetics?

The Centers for Disease Control and Prevention (CDC) defined epigenetics as “the study of how your behaviors and environment can cause changes that affect the way your genes work.” Epigenetics affects gene expression, specifically the process of protein creation. The environment and a person’s behaviors correlate with epigenetic changes; the connection becomes evident between a person’s genes, behaviors and environment.

There are three different mechanisms in epigenetics that can affect gene expressions, including DNA methylation, histone modification and non-coding RNA. DNA methylation turns the genes “off” and demethylation turns the genes “on.” More specifically, DNA methylation can directly inhibit the expression of genes. In this process, information from the gene becomes a functioning product such as proteins, which are essential molecules that help bodies function. Histone modification occurs with the adding or removal of chemical groups from histones. More specifically, it can also change if a gene is “on” or “off.” Finally, non-coding RNA is a biological function that helps control gene expression.

The Relationship Between Epigenetics and Poverty?

A 2019 article from Northwestern University explains that poverty can implement itself across genomes — “poverty leaves a mark on nearly 10% of the genes in the genome.” Previous research demonstrated that socioeconomic status is a significant determinant of human health and disease. For example, some factors such as lower educational attainment or lower-income increase the risk for heart disease, diabetes, different forms of cancers and other infectious diseases. Also, lower socioeconomic status is associated with other physiological processes that could “contribute to the development of diseases such as chronic inflammation, insulin resistance and cortisol dysregulation.”

In one recent study led by Dr. Adam R. Wende, researchers learned that end-stage heart failure patients had “cytosine-p-guanine, or CpG, methylation of the DNA in the heart.” This methylation was associated with race as the only variable between African Americans and Caucasians. In addition, researchers discovered through census tracking that African American patients lived in neighborhoods with higher racial diversity and poverty. This difference suggested to the researchers that “the underlying variable may be socioeconomic difference.”

Wende spoke about the impact of the study with UAB News. Wende stated that “we provide preliminary evidence that socioeconomic factors are likely associated with racial differences in cardiac DNA methylation among men with end-stage heart failure.”

Differences Between Children in Poverty and Higher Income Households

In another study published in 2016, scientists found that children who grew up in poverty had more DNA methylation than other children who came from higher household incomes. Researchers thought that this difference might have suppressed the impoverished children’s “production of serotonin transporter protein.” As a result, the kids in the impoverished households had less serotonin in the brain, which can lead to depression and other mental conditions.

Dan Notterman, a molecular biologist at Princeton University, found in his research that telomeres, the caps at the end of chromosomes, “[shorten] in children from impoverished families.” Research shows a link between telomere length, aging and poor general health, meaning that the shorter telomeres are, the worse a person’s health is and the faster the aging process is. In layman’s terms, poverty can cause children and adults alike to be more prone to mental and physical illnesses and hinder physiological processes at a genetic level.

Can Epigenetics Help Reverse Negative Health Outcomes?

Robert Philibert, a behavioral geneticist at the University of Iowa in Iowa City stated that “what this points out here is that if you really want to change neurodevelopment, alter the environment.” Epigenetics shows that the environment affects gene expression, and thus, the body’s biological functions.

Social determinants of health (SDH) are, as the World Health Organization (WHO) defines, “the conditions in which people are born, grow, work, live and age and the wider set of forces and systems shaping the conditions of daily life.” SDHs can influence health and gene expression through “income and social protection, education, food insecurity, social inclusion and nondiscrimination.” According to the WHO, SDH plays a significant role in 30-55% of health outcomes. Epigenetics shows people must address the systems that allow poverty to thrive in order to ensure people do not experience a disadvantage at the beginning of life.

– Gaby Mendoza
Photo: Flickr

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Initiatives Against HIV in Haiti

HIV in Haiti
With an estimated “2.2% of adults” noting an HIV-positive status in 2010, Haiti faces “the largest [HIV] epidemic in the Caribbean.” In 2020, 150,000 children and adults in Haiti lived with HIV. People older than the age of 15 made up 93% of this population. In addition, 20% of Haitians living with the disease are unaware that they are HIV-positive. To help reduce the prevalence of HIV in Haiti, several initiatives are currently underway, run by the Centers for Disease Control and Prevention (CDC), UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation.

CDC Initiatives

Since the CDC’s Division of Global HIV & TB opened its office in Haiti in 2002, the CDC has launched several initiatives to address the country’s HIV epidemic. The first aim is to strengthen health systems by training medical personnel, supporting staffing needs and strengthening the Haitian Ministry of Health’s governance. The CDC has also aided in the development of the iSanté national electronic medical record (EMR) software to better monitor and track HIV patient data. These innovative tools help inform evidence-based treatment for this disease. In 2018, iSanté, “along with two other EMR systems,” could monitor the data of “96% of HIV care and treatment sites.”

Another goal of the CDC office in Haiti helps improve laboratory resources. Through a collaboration with the National Public Health Laboratory and GHESKIO, a medical treatment, research and training center in Port-Au-Prince, Haiti, the CDC has helped develop and expand several HIV testing methods. In addition, the CDC assisted in developing “an external quality assurance program and a training curriculum” to support lab accreditation.

Community-led Monitoring

With support from UNAIDS, the Ministry of Public Health and Population and the U.S. government via the United States President’s Emergency Plan for AIDS Relief (PEPFAR), Haiti’s Civil Society Forum Observatory has initiated “community-led monitoring,” a program through which people living with HIV hold each other accountable throughout treatment. Community members are familiar with HIV patients from their community, and when patients do not follow through on treatments or follow-ups, community members know how to best communicate with them and encourage them to return. Community-led monitoring can provide valuable feedback on service delivery from a patient perspective, helping to improve on existing issues “to retain people in care.”

Community-led monitoring reveals the weaknesses of treatment plans for HIV in Haiti and brings corresponding solutions to light. For example, due to insight from community-led monitoring, the Civil Society Forum Observatory brings to light a need to increase the window of service hours and decrease patient wait times. It also recommends that stable HIV patients receive a six-month supply of antiretroviral medication. Through community-led monitoring and other resources, Haiti was able to allocate multiple months’ supplies of antiretroviral medicines to 88% of HIV patients during the COVID-19 pandemic.

Elizabeth Glaser Pediatric AIDS Foundation

The Elizabeth Glaser Pediatric AIDS Foundation strives to combat pediatric HIV worldwide through advocacy, research and initiatives for prevention and treatment. Although most HIV patients in Haiti are adults, 8,000 children younger than 15 lived with HIV in Haiti in 2020. Thus, addressing pediatric HIV in Haiti is an important health initiative.

Toward the latter part of 2020, the Foundation began its work in Haiti with the Delivering Technical Assistance Project. The project offers “cost-effective technical assistance (TA), capacity building and program implementation services” to HIV reduction programs. The technical assistance includes program management training, mentorship, consultations and workshops for health care workers.

These strategies, and many others throughout the country, are successfully helping lower HIV rates in Haiti. As organizations continue to implement HIV reduction plans, the severity of the HIV epidemic in Haiti may see a decline in the years to come.

– Aimée Eicher
Photo: Flickr

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HIV/AIDS in Ukraine

HIV/AIDS in UkraineUkraine has one of the highest rates of HIV/AIDS in the world, with an estimated 260,000 people living with the disease. Odessa, the third-most populous city in Ukraine, has “the highest concentration of HIV/AIDS of anywhere in Europe.” Poverty exacerbates HIV/AIDS in Ukraine and links to injected drug use, threats to government funding, lack of access to antiretroviral treatment and social discrimination.

Poverty and HIV/AIDS in Ukraine

In 2019, Ukraine and Moldova stood as the two most impoverished countries in Europe. The poverty rate in Ukraine increased during the COVID-19 pandemic, from 42.4% in 2020 to 50% as of February 2021. There is a strong connection between poverty and the spread of diseases; disease could be both a cause and a result of poverty.

HIV/AIDS causes conditions of poverty when working adults become ill and can no longer support their families. The disease becomes a result of poverty when the conditions of poverty put people at greater risk of contracting it. As an example, women and girls who live in poverty are more vulnerable to sexual exploitation. They are more likely to resort to working in the sex trade, which could put them at high risk of contracting HIV.

HIV/AIDS in Ukraine’s Women and Girls

UNAIDS estimates that out of all people with HIV/AIDS in Ukraine, 120,000 are women older than 15 and 2,900 are children aged 14 or younger. Gender inequality, poverty and violence against women and girls are significant factors in the spread of HIV. Women and girls who live in fear of violence may be reluctant to advocate for safe sex, receive testing or seek treatment for HIV and other diseases.

Gender inequality inhibits women’s access to resources for sexual and reproductive health. In rural Ukraine, where the poverty rate is highest, 36% of women do not participate in community or family decision-making. Only 46% of these women are competent with a computer or the internet. Furthermore, almost 48% do not have access to medical services.

The Lack of Access to Antiretrovirals

As Sky News reported, access to antiretrovirals is a major problem for many people living with HIV/AIDS in Ukraine. Although a law stipulates that antiretroviral therapy should be free to all citizens, limited national resources have resulted in restricted access.

Antiretrovirals are crucial for preventing the spread of HIV to children. The use of antiretrovirals during pregnancy and administered to an infant for four to six weeks after birth can result in a transmission rate of 1% or less. According to U.N. Women, the majority of women living with HIV/AIDS in Ukraine fell between 18 and 45 years old. Out of these women, 39% discovered that they were HIV-positive during pregnancy.

Social Discrimination Against People Living With HIV/AIDS

According to the World Health Organization (WHO), discrimination against people who use drugs and people living with HIV presents a serious challenge to identifying those who need treatment. Harsh drug laws, fear of HIV/AIDS and systematic police abuse undermine efforts to provide HIV information and services such as testing and safe needle exchanges. In addition, the law requires drug treatment centers in Ukraine to register drug users and share the information with law enforcement. This protocol keeps people who use drugs from seeking medical help, which subsequently prevents them from testing and receiving treatment for HIV/AIDS.

The War in Donbas

The war in Donbas has made it difficult for people to receive treatment in a region that previously had one of the highest rates of HIV/AIDS in the country and was home to nearly one-quarter of all antiretroviral recipients. When the war began in March 2014, it displaced 1.7 million people. To compound this, unsafe sex has resulted in an increase of HIV/AIDS within the military. Combined with ongoing military conflict and a shortage of antiretrovirals, Ukraine is experiencing a crisis: the government has failed to keep up with infection rates.

Solutions

In July 2021, Ukraine received a grant of $35.8 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. According to the Ukrainian government, the nation would use the funds to purchase personal protective equipment (PPE), reduce risks associated with COVID-19 and strengthen the health care system.

Ukraine is collaborating with the Centers for Disease Control and Prevention (CDC), USAID and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The country wants to implement prevention campaigns, increase access to antiretroviral treatment and target key risk groups, such as people who inject drugs, sex workers and men who have sex with men.

On September 1, 2021, President Biden announced that the United States would provide more than $45 million in additional assistance for Ukraine. The aid would help people facing the impacts of the COVID-19 pandemic and the war in Donbas. The U.S. is working with USAID-supported programs to provide supplies for Ukrainian health care centers, training for health care workers and psychosocial support for the most vulnerable populations.

– Jenny Rice
Photo: Flickr

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Mental Health in Guatemala 

Mental Health in Guatemala 
Between 1960 and 1996, Guatemala faced a civil war between the government of Guatemala and several leftist rebel groups, resulting in many deaths due to the destructive violence. This caused many mental health conditions to arise among the people residing in the country. Unfortunately, violence and public security continue to be a concern in Guatemala, which is deteriorating Guatemalan mental health.

The Importance of Mental Health

The Centers for Disease Control and Prevention (CDC) defines mental health as one’s emotional, psychological and social well-being, which affects how one experiences and performs in daily life. To add, mental health can help determine how people cope with stress and make choices. Mental health has significant links to physical health because poor mental health can lead to diseases, such as diabetes, heart disease and stroke.

Guatemalans Facing Mental Health Disorders

More than 3,250,000 people in Guatemala could experience a mental health illness in their lifetime. However, unfortunately, many of them do not seek the help they require. In fact, one in four people between the ages of 18 and 65 have suffered or continue to suffer from a mental health disorder, but only 2.3% took the initiative to consult a psychiatrist to address their mental health issues.

Many people are reluctant to talk about their mental health due to a lack of knowledge on mental health in general and the stigma surrounding mental health in Guatemala. Furthermore, Guatemala’s poverty rate increased from 45.6% to 47% in 2020. As a result, Guatemalans are at greater risk of developing mental health disorders because they endure more poverty-related stress and face many economic difficulties in their daily lives. The limited mental health sources available to them are insufficient to help alleviate the stress that socioeconomic disadvantages cause.

In the United States, most health care providers do not cover expenses for mental health care. Interestingly, Guatemala does not have a universal health care system, let alone dedicated mental health legislation. As a result, Guatemalans have difficulty seeking help because the nation has “0.54 psychiatrists available per 100,000 inhabitants,” according to the American Psychological Association, and only five of these mental health specialists are located outside of the main cities. Guatemala is a low-income country that does not have the resources to make mental health data available to the public, which is why there are few studies and limited public data regarding this issue.

Poor Mental Health Among Guatemalan Children

A study conducted by Rosalba Company-Cordoba and Diego Gomez-Baya analyzes the mental health of children in Guatemala. Interestingly, 50% of Guatemala’s total population is younger than 18 years old, meaning Guatemala is home to a significantly large portion of young people. A child’s mental health is valuable because mental health can have positive or negative long-lasting effects on development.

Unfortunately, Guatemala’s high poverty rate has led to increased levels of violence because of desperation and dire living conditions. Exposure to violence showed significant effects on a child’s mental health, such as depression and anxiety. Although childhood poverty is prevalent in many areas of Guatemala, the quality of life showed little significance in the study. These symptoms were more common in adolescents than in children because adolescents are more aware of their surroundings and environment. On the other hand, children exposed to low violence from urban areas with educated parents described higher qualities of life.

Violence rates have continued to increase with assaults, shootings, threats and robberies, causing many children to fear going to school. Almost 60% of Guatemalan students would prefer not to go to school due to fears of violence. Many students and teachers have received threats and experienced robberies or know victims of violence. Guatemala remains one of the most impoverished countries with high rates of violence, which poses a higher risk of a child developing mental health disorders.

Living in these socioeconomic disadvantaged areas can sway children to join gangs because there are few other options. The previously mentioned study showed the association between greater parental education level and higher income with lower food insecurity. However, many children do not attend higher education schooling because they have to work to help their families afford household essentials. The number of children living in urban areas is increasing, which leads to more children in unsanitary conditions and a high cost of living. Almost all children attend primary school, however, the completion rate is 15%, which leads to low enrollment rates for secondary school.

Solutions for Mental Health in Guatemala

Many people have taken action to improve the state of mental health in Guatemala, especially for children. First, many citizens are taking to the streets to protest against the continuation of violence. The implementation of the International Commission Against Impunity (CICIG) resulted in reductions in homicide rates. For example, there were fewer homicides per 100,000 people each year. The CICIG provided Guatemala with $150 million in international support to help reform its justice system, but President Jimmy Morales thought this violated Guatemalan authority. As a result, he removed the CICIG mandate in 2019, causing setbacks in progress.

Next, people are beginning to seek support for their mental health in Guatemala due to more specialized centers offering psycho-emotional support services to the public, such as Federico Mora National Hospital for Mental Health, for a low cost. According to the American Psychological Association, Guatemala has about seven psychologists for every 100,000 people, which is a number that continues to increase.

Lastly, schools are playing roles in fighting against gang violence to ensure the safety of children in Guatemala and other countries. With support from UNICEF and the Ministry of Education, schools created a Peace and Coexistence Committee. The idea is to promote an environment where schools do not tolerate violence, as Theirworld reported. The schools are trying to lead by example and show their students that violence is not the answer, noting fewer disputes among students.

Guatemala is working toward a better future by spreading awareness about mental health and fighting violent trends.

– Kayla De Alba
Photo: Unsplash

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3 Diseases in Nigeria

Diseases in Nigeria
Nigeria ranked 142 out of 195 countries in a 2018 global health access study. However, although Nigeria has a challenging health care system, the country has improved the infrastructure that has helped it fight diseases such as polio, measles and Ebola. Nigeria now has centralized offices called Emergency Operation Centers (EOCs) that serve as a base for government health workers and aid agencies to coordinate immunization programs and collect data. While there is progress, many diseases still plague Nigeria.

Cholera

Cholera is a water-borne disease that results in a quick onset of diarrhea and other symptoms such as nausea, vomiting and weakness. It is one of the many diseases impacting Nigeria in 2021. If people with cholera do not receive treatment, the disease may kill them due to dehydration. A simple oral rehydration solution (ORS) can help most infected people replace electrolytes and fluids. The ORS is available as a powder to mix into hot or cold water. However, without rehydration treatment, about half of those infected with cholera will die, but if treated, the number of deaths decreases to less than 1%.

In August 2021, Nigeria began to see a rise in cholera cases, especially in the north, where the country’s health care systems are the least prepared. The state epidemiologist and deputy director of public health for Kano State, Dr. Bashir Lawan Muhammad, said the rise in cases is due to the rainy season. It is also because authorities have been dealing with Islamist militants in the north. In Nigeria, 22 of the 36 states have suspected cholera cases, which can kill in hours if untreated. According to the Nigeria Center for Disease Control, 186 people from Kano have died of cholera since March 2021, making up most of the country’s 653 deaths.

Malaria

Malaria is another one of the diseases affecting Nigeria. Through the bites of female Anopheles mosquitos, parasites cause malaria and transmit it to humans. Globally, there were 229 million malaria cases in 2019, with 409,000 deaths. Children under the age of 5 years old are the most susceptible group, and in 2019, they accounted for 274,000 or 67% of worldwide malaria deaths. That same year, 94% of malaria cases and deaths occurred in the WHO African Region. Although the disease is preventable and curable, the most prevalent malaria-carrying parasite in Africa, P. Falciparum, can lead to severe illness and death within 24 hours.

The President’s Malaria Initiative (PMI), which USAID and the CDC lead, works with other organizations to help more than 41 million Nigerians. Despite the difficulties that COVID-19 presented in 2020, the PMI was able to assist Nigeria to distribute 14.7 million treatment doses for malaria, 8.2 million of which went to pregnant women and children. Besides that, the “PMI also distributed 7.1 million insecticide-treated mosquito nets (ITNs), provided 7.2 million rapid test kits, and trained 9,300 health workers to diagnose and treat patients” of malaria. Before the PMI, only 23% of Nigerian households had bed nets, but since 2010, that number has risen to 43%. The PMI also aims to improve health systems and the skill of health workers to administer malaria-related services.

HIV

HIV (human immunodeficiency virus) attacks the immune system, leading to AIDS (acquired immunodeficiency syndrome). One can control the virus with proper medical care, but there is no cure. The disease is prevalent in Africa because it originated in chimpanzees in Central Africa. The virus likely spread to humans when the animals’ infected blood came into contact with hunters. Over the years, HIV spread across Africa and other parts of the world, becoming one of the diseases impacting Nigeria today.

The CDC works with the Federal Ministry of Health (FMOH) and other organizations to create and sustain HIV response programs in Nigeria. The CDC’s “data-driven approach” and prevention strategies and treatment strengthen the collaborative system in Nigeria. These include HIV treatment, HIV testing, counseling, services to help prevent mother-to-child transmissions and integrated tuberculosis (TB) and HIV services. TB is the leading cause of death among people living with HIV.

From October 2019 to September 2020, nearly 200,000 Nigerians tested positive for HIV and began treatment. During the same period, over 1 million HIV-positive people tested for TB. More than 5,000 of those individuals tested positive and began treatment for TB. By the end of September 2020, nearly 25,000 orphans and other vulnerable children received HIV/TB services through the CDC. Not only that, but all facilities in Nigeria that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supports now use TB BASICS, which is a program that “prevents healthcare-associated TB infection.”

In 2021, Nigeria will face many diseases. On the other hand, great strides are occurring to educate the Nigerian population on diseases like HIV, malaria and cholera. Despite efforts, there is still much more necessary work to reduce illness in Nigeria.

– Trystin Baker
Photo: Flickr