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The State of Malaria in South-East AsiaAlthough Malaria remains at the forefront of global health issues, malaria in South-East Asia represents a success story in terms of mobilizing aid in the fight against the disease. In 2018, the World Health Organization (WHO) reported eight million malaria cases, a decline of 69% since 2010, marking the largest decline of all WHO regions.

Direct Aid Strategies

South-East Asia has been the target of hefty aid strategies from a variety of non-profits. The aid primarily comes from the WHO and the Global Fund to Fight AIDS, Tuberculosis and malaria. As the Global Fund puts it, “The fight against malaria is one of the biggest public health successes of the 21st century.” The multi-pronged strategies used by these non-profits begin with a tactic known as surveillance.

Surveillance involves testing, record-keeping and reporting malaria cases. Surveillance systems have become more efficient. As a result, health care systems maintain a much more refined picture of malaria cases in any given region. This eventually gains “near real-time individual case data in small areas.”

Vector control is limiting contact between people and the mosquitos that transmit the disease. It has also helped eliminate malaria in South-East Asia. One of the most effective means to achieve this has been the wide-scale distribution of insecticidal mosquito nets. So far, the Global Fund has donated 142 million nets, providing a simple means for those in rural and urban areas alike to keep themselves protected.

Strengthening Local Healthcare Systems

Besides direct aid, many non-profits also turn to bolster already-existing local healthcare systems in the fight against malaria in South-East Asia.

Malaria Consortium is a non-profit organization specializing in the disease. It began working in Myanmar in 2016 to train locals in rural areas to administer essential health services. Malaria Consortium also taught local health workers to treat malaria, working to close the gap in rural healthcare.

In one village, 13 healthcare workers were trained in the treatment of malaria and other diseases common to the area. These workers went on to teach local mothers and adolescents, expanding the web of healthcare knowledge even further. By the end of the program, 90% of trainees were able to diagnose malaria cases correctly. Trainees were also able to run malaria diagnostic tests and administer Artemisinin. Artemisinin is the most widely used drug to treat the disease.

Concerns with Treating Malaria

Aid has been successful in treating malaria in South-East Asia. However, a new drug-resistant strain on the rise reignites concerns around the disease. Artemisinin-resistant malaria has the potential to undermine malaria prevention and was first recorded in the Mekong River region of Vietnam, Thailand and Cambodia. In 2014 and 2015, studies conducted by Vietnam’s National Malaria Control Program found treatment failure rates ranging from 26% to 46%.

From the perspectives of non-profits and medical experts, the rise of this new Artemisinin-resistant malaria in South-East Asia means surveillance efforts must be bolstered to prevent global spread. Likewise, instead of merely treating already-present cases, the goal must be preventing transmission in the first place. According to Chris Plowe, the director of the Duke Global Health Institute, is using all the tools available to the institute to eliminate aggressive malaria in the Greater Mekong subregion.

Overall, direct aid, community mobilization and the bolstering of healthcare systems have transformed a region once fraught with malaria. As these efforts continue, malaria in South-East Asia moves closer toward its extinction.

Jane Dangel
Photo: Flickr 

Life Expectancy in Timor-Leste
Timor-Leste, also known as East Timor, is a nation that occupies the eastern half of the island of Timor in Southeast Asia. With a population of 1.26 million people, Timor-Leste is one of the least populated countries in Asia. The Portuguese originally colonized the country in 1520. After declaring independence in 1975, Indonesia invaded the nation, which occupies the western half of the island. The Indonesian invasion brought violence, famine and disease to Timor-Leste, resulting in a large loss in population. After a majority of the Timorese population voted to become independent in 1999, Indonesia relinquished control and Timor-Leste moved under the supervision of the United Nations. The nation officially became independent in 2002, making it one of the newest nations in the world. These 10 facts about life expectancy in Timor-Leste outline the rapid improvement the country has made since Indonesian occupation and the issues it still needs to overcome.

10 Facts About Life Expectancy in Timor-Leste

  1. Life expectancy in Timor-Leste increased from 32.6 years in 1978 to 69.26 years in 2018, matching that of South Asia. The consistent improvement in life expectancy in the past decade is primarily due to the Ministry of Health’s public health interventions. Such interventions include the reconstruction of health facilities, expansion of community-based health programs and an increase in medical graduates in the workforce.
  2. Life expectancy in Timor-Leste increased despite a drop in GDP, which decreased from $6.67 billion in 2012 to $2.6 billion in 2018. However, Timor-Leste’s GDP rose by 2.8% from 2017 to 2018. Continued improvement in GDP and economic progress in the nation will only serve to increase life expectancy by providing more opportunities for employment, education and improved quality of life.
  3. Tuberculosis was the highest cause of death in 2014, causing 14.68% of deaths. In 2014, estimates determined that Timor-Leste had the highest prevalence of tuberculosis in Southeast Asia, and 46% of people with tuberculosis did not receive a diagnosis in 2017. Maluk Timor, an Australian and Timorese nonprofit committed to advancing primary health care, provides a service through which team members visit Timorese households to locate undiagnosed patients and raise awareness about the severity of tuberculosis in the community. The organization collaborates with the National TB Program and aims to eliminate suffering and deaths in Timor-Leste due to diseases that Australia, which is only one hour away, had already eliminated.
  4. Communicable diseases caused 60% of deaths in 2006 but decreased to causing 45.6% of deaths in 2016. While diseases such as tuberculosis and dengue fever remain a public health challenge, the incidence of malaria drastically declined from over 200,000 cases in 2006 to no cases in 2018 due to early diagnoses, quality surveillance, funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria and support from the World Health Organization.
  5. The adult mortality rate decreased from 672.2 deaths per 1,000 people in 1977 to 168.9 deaths per 1,000 people in 2018. Additionally, the infant mortality rate decreased from 56.6 infant deaths per 1,000 live births in 2008 to 39.3 infant deaths per 1,000 live births in 2018. While public health interventions and disease prevention contributed to the decrease in the adult mortality rate, Timor-Leste needs to expand access to maternal health services in rural areas to continue to improve the infant mortality rate.
  6. Maternal mortality decreased from 796 deaths per 100,000 live births in 1998 to 142 deaths per 100,000 live births in 2017. The leading cause of the high maternal mortality rate is poor access to reproductive health services, as only 43% of women had access to prenatal care in 2006. While the Ministry of Health continues to expand access to maternal health care through mobile health clinics that reach over 400 rural villages, only 30% of Timorese women gave birth with a health attendant present in 2013. Even as access increases, challenges such as family planning services, immunization, treatment for pneumonia and vitamin A supplementation remain for mothers in rural communities.
  7. The violent crisis for independence in 1999 destroyed more than 80% of health facilities. Despite rehabilitation efforts to rebuild the health system, many facilities at the district level either have limited or no access to water. However, the number of physicians per 1,000 people improved from 0.1 in 2004 to 0.7 in 2017. The capacity of the health care system is also improving, as UNICEF supports the Ministry of Health in providing increased training for health care workers in maternal and newborn issues and in striving to improve evidence-based public health interventions.
  8. Timor-Leste has one of the highest malnutrition rates in the world. At least 50% of children suffered from malnutrition in 2013. Additionally, in 2018, 27% of the population experienced food deprivation. USAID activated both the Reinforce Basic Health Services Activity and Avansa Agrikultura Project from 2015-2020 to address the capacity of health workers to provide reproductive health care and the productivity of horticulture chains to stimulate economic growth in poor rural areas. Both projects aim to combat malnutrition by addressing prenatal health and encouraging a plant-based lifestyle that fuels the economy.
  9. Motherhood at young ages and education levels are key contributors to malnutrition, as 18% of women began bearing children by the age of 19 in 2017. Teenage girls are far more likely to experience malnourishment than older women in Timor-Leste, contributing to malnutrition in the child and therefore lowering life expectancy for both mother and child. As a result of malnutrition, 58% of children under 5 suffered from stunting in 2018. Additionally, findings determined that stunting levels depended on the wealth and education level of mothers. In fact, 63% of children whose mothers did not receive any formal education experienced stunting, while the number dropped to 53% in children whose mothers received a formal education.
  10. Education enrollment rates are increasing, as the net enrollment rate in secondary education increased from 40.5% in 2010 to 62.7% in 2018. Completion of secondary education links to higher life expectancy, especially in rural areas. Since 2010, Timor-Leste has increased spending on education. Additionally, local nonprofit Ba Futuru is working to train teachers to promote quality learning environments in high-need schools. After Ba Futuru worked with schools for nine months, students reported less physical punishment and an increase in innovative and engaging teaching methods in their classrooms. The organization serves over 10,000 students and provides scholarships for school supplies for hundreds of students. With more programs dedicated to increasing enrollment and the classroom environment, students are more likely to complete secondary education and increase both their quality of life and life expectancy.

These 10 facts about life expectancy in Timor-Leste indicate an optimistic trend. Although malnutrition, disease and adequate access to health care remain prevalent issues in Timor-Leste, the nation’s life expectancy has rapidly increased since Indonesian occupation and has steadily improved its education and health care systems since its founding in 2002. To continue to improve life expectancy, Timor-Leste should continue to focus its efforts on improving public health access and community awareness in poor rural areas, and particularly to emphasize maternal health services to reduce both maternal and infant mortality rates. Despite being one of the newest nations in the world, Timor-Leste shows promise and progress.

Melina Stavropoulos
Photo: Flickr

tuberculosis in KiribatiKiribati is one of the world’s smallest countries, located in the middle of the Pacific Ocean. The 30 plus islands that together form Kiribati may be small and house a population of a little more than 100,000 people, but Kiribati is modernizing every day. The country only became fully independent in 1979 after a history of colonialism, and it joined the U.N. in 1999. Today, one of the biggest threats it faces is tuberculosis (TB). Of all the neighboring pacific island countries, Kiribati has the highest incidence of tuberculosis with a report of 349 incidents per 100,000 in 2018. While tuberculosis is endemic in Kiribati, the situation is far from hopeless. New scientific approaches to diagnosing and treating tuberculosis are making it possible to eradicate the disease in the future.

Tuberculosis and Overcrowding

Tuberculosis is directly related to overcrowding. While there are 33 total islands of Kiribati, only 20 of these islands are inhabited. Moreover, almost all of these islands are very sparsely inhabited, with around 64,000 inhabitants living on the main atoll, Tarawa. Though the nation does not boast a large overall population, the population density of the country is one of the highest in the world. Tarawa has a population density on par with major cities, like Tokyo and Hong Kong. This high population density means that most households in Kiribati are vastly overcrowded, creating a greater likelihood of spreading tuberculosis. Oftentimes, the housing lacks proper construction or proper ventilation, which also impacts the spread of TB. On average, households in Tarawa have between eight and nine people in them.

Tuberculosis and Diabetes

Tuberculosis and diabetes are often co-morbid illnesses causing major concern in Kiribati, which has one of the top 10 highest rates of diabetes in the world. In Kiribati, between one fourth and one-third of adults have diabetes, so the likelihood of having tuberculosis and diabetes is quite high. In fact, one-third of citizens with tuberculosis are also diagnosed with diabetes. This is so prevalent because diabetes can impact the treatment of tuberculosis. As a result, most of the citizens with both diabetes and TB have the infectious form of TB. This means that they pose a greater risk of spreading the illness to other members of the community.

New Methods for Catching and Eliminating TB

While tuberculosis is a serious concern to citizens of Kiribati, there are groundbreaking efforts to speedily diagnose and treat tuberculosis. Addressing TB is one of the country’s top priorities. In conjunction with organizations like the Global Fund to Fight Aids, Tuberculosis and Malaria, Kiribati has managed to acquire modern diagnostic tools like portable X-ray machines. In recent years, another strategy that targets specific “hotspot” areas has proved incredibly useful in diagnosing TB in the early stages. This process focuses on areas known to have the greatest likelihood of TB by using patterns from past years to locate the most at-risk communities. After locating these communities, citizens of the area participate in screening for TB. In 2019, during a hotspot case study, healthcare workers screened 3,891 people for tuberculosis in less than two weeks. Over the course of the 11 days, they diagnosed seven new cases.

A More Positive Future

In the past few years, the general fear of tuberculosis in Kiribati has greatly diminished. With the new systems in place to screen, diagnose and treat TB, citizens have become more aware of how to prevent the spread of disease. The new systems also allow more citizens who may be living in poverty or isolated areas to access treatment. Healthcare workers go directly into the villages within each hotspot, allowing citizens to easily walk to clinics for screening. At these clinics, they receive prevention tips, pamphlets and a better understanding of how to care for themselves and those around them.

Despite overcrowding and comorbidity with diabetes, the future of tuberculosis in Kiribati is looking up. With only 323 cases in 2018 after 745 new cases in 2007, the numbers are slowly decreasing. With increased awareness and prevention tactics, along with modern technology and hotspot screening, it is hoped that this trend will continue.

– Lucia Kenig-Ziesler
Photo: Flickr

Leading Diseases in Sri Lanka
A 6-year-old boy cried from pain from a small room in an overcrowded ward. The small child had a fever and rash and pointed to the different parts of his body that hurt. Hannah Mendelsohn, a medical volunteer from Haifa, Israel, tried to distract the boy with games of tic-tac-toe and peekaboo.

The child displayed classic symptoms of dengue fever. Doctors diagnosed him with the virus at Karapitiya Teaching Hospital in Galle, Sri Lanka during the summer of 2015. “[The boy] had luckily gotten to the hospital when he was still in an earlier stage of the disease,” Mendelsohn told The Borgen Project. “There were a few times I heard doctors tell patients with dengue that there were no options for life-saving care.”

While non-communicable diseases are the main causes of death in Sri Lanka, many still consider certain infectious diseases, including dengue fever, threats to public health. Here are five leading diseases in Sri Lanka.

5 Leading Diseases in Sri Lanka

  1. Dengue Fever: Dengue is a mosquito-borne virus that is endemic to Sri Lanka. A person can contract dengue any time of year. However, the risk elevates during the monsoon season. This is the time of year when dengue-bearing mosquitos are most common, and severe storms often inhibit travel for care. The year 2019 saw double the cases when compared to the previous year with over 99,000 reported cases and 90 deaths. The World Health Organization (WHO) is currently working with Sri Lanka’s Ministry of Health, Nutrition and Indigenous Medicine to control the spread of dengue fever by enhancing dengue surveillance and training health care workers dengue case management and prevention. Among the suggested prevention strategies, WHO advises keeping neighborhoods clean and using mosquito netting and repellents to prevent bites.
  2. Acute Lower Respiratory Infections: Acute lower respiratory infections (ALRI) are leading causes of childhood mortality and morbidity in Sri Lanka; they are responsible for 9 percent of deaths of children under age 5. Poor access to health care, food shortages, lack of safe water and poor sanitation elevate the risk and disease burden. Fortunately, the political prioritization of public health has led to increased administration of vaccinations. This has reduced the impact of contracted ALRI. In 2014, Sri Lanka’s government enacted a national immunization policy which guarantees every citizen the right to vaccination. A separate line in the national budget aims to ensure the continuous availability of immunizations.
  3. Typhoid Fever: Typhoid is a bacterial infection that has a high mortality rate when a person does not receive treatment. Between 2005 and 2015, Sri Lank had 12,823 confirmed cases of typhoid fever. The risk of typhoid is related to overcrowding, food shortages and poor water quality. Sri Lanka’s prevention strategy has largely focused on disease surveillance and health education. Every medical practitioner has to notify the government of any typhoid fever diagnosis. Health education has involved the promotion of proper sanitation and immunization campaigns.
  4. Meningitis: Meningitis, a bacterial disease, was the 20th leading cause of premature death in Sri Lanka in 2010. Malnutrition, poor access to health care and poor sanitation are risk factors for infection and disease severity. Since 1990, the annual number of deaths due to meningitis in Sri Lanka has decreased. It was formerly the 16th leading cause of premature death. Experts largely attribute this to the growing accessibility of the Haemophilus Influenzae B vaccine.
  5. Tuberculosis: Tuberculosis was the 21st leading cause of premature death in Sri Lanka in 2010. The estimated number of cases has progressively increased from 10,535 in 1990 to 11,676 in 2007. The National Strategic Plan for Tuberculosis Control 2015-2020 states that Sri Lanka has successfully maintained a high treatment rate for tuberculosis. Because tuberculosis transmits from person-to-person, a high treatment rate reduces the risk of transmitting further infections. Additionally, Sri Lanka has received funding from the Global Fund for AIDS, Tuberculosis and Malaria. The funds are for raising awareness and increasing access to medication.

Non-communicable diseases currently represent a larger health burden. However, the continued incidence of infectious diseases ­­in Sri Lanka highlights the burden of poverty. For many of these five leading diseases in Sri Lanka, vaccinations are widely available and accessible in developed countries. Yet, reports of cases and fatalities in Sri Lanka still occur.

Still, for infectious diseases where vaccines remain elusive, poverty is a prominent risk factor for infection and severity of illness. Poverty affects the ability to receive adequate nutrition, sanitary housing, health care and more.

“Around the clock, patients died from diseases that are definitely preventable,” Mendelsohn said. “Coming from a developed country where medical care is among the best in the world, it was hard for me to accept that, just a continent away, people were still dying of infectious diseases to which the cures had already been found.”

– Kayleigh Rubin
Photo: Pixabay