Militancy, floods, ‘negligence’ hit fight against polio in Pakistan

Pakistan had looked to be winning its battle against polio until 2007 when 32 new cases were detected. Since then, things have deteriorated, with the president declaring a national emergency in January 2011, and describing the failure to eradicate the disease as “criminal negligence”.

The discovery of the polio virus in water samples obtained from five cities in February is believed to be just one of the reasons why the disease is spreading so rapidly in the country.

Pakistan had more polio infections in 2010 (144 cases confirmed) than any other country. Fifteen new cases have been recorded this year.

Whether or not negligence is involved is debatable. But there are many dimensions to what is a complex problem; lack of access for polio vaccination teams to certain areas of the country due to the activities of armed militant groups is one key factor.

According to media reports earlier this year, a worker for Pakistan’s Expanded Programme for Immunization (EPI) was kidnapped and later killed in the North Waziristan tribal agency on the Pakistan-Afghan border.

“The militants, and other orthodox elements, oppose vaccination for children. They say Allah alone decides about sickness or health and no one should interfere,” Jamila Bibi, a mother of three, told IRIN from the Khyber Agency, also along the western frontier. She said she and her husband had their children immunised “in secret” to avoid reprisals.

EPI deputy director Janbaz Afridi in the northwestern province of Khyber Pakhtoonkhwa told IRIN that for the latest campaign (in March) “more super visors” had been put in place to oversee the activities of field staff, and that the issue of “refusals was also being addressed”. “Refusals” refer to parents who decline their children to be vaccinated, usually on religious grounds.

The National Research and Development Foundation NGO is working on tackling this issue, and has said the services of 1,700 clerics, prayer leaders and religious scholars had been enlisted to help build opinion in favour of vaccination.

Other problems stem from the militancy issue. Due to security concerns in many tribal areas, female health workers in particular are reluctant to venture beyond main towns.

“We are afraid of kidnappings or other violence. So many times children outside big urban centres do not get immunized at all,” said a health worker who asked not to be named. She suggested villagers be trained to immunize children themselves.

Aziz Memon, chairman of the Pakistan Polio Plus Committee of Rotary International, told IRIN: “The problem of more cases in Pakistan really came up after the floods from July to September 2010. It was only after August that we had more cases reported from Sindh and the Punjab, mainly due to poor sanitation and unhygienic conditions from floodwater. Before then, new cases were being reported only from Khyber Pakhtoonkhwa and Balochistan, mainly due to inaccessibility issues.”

He said Pakistan planned to use the new bivalent vaccine in future to tackle the different strains of polio simultaneously and that the vaccine had proved highly successful in India.

“We are determined to reach every child,” the EPI’s Afridi said. But given the scale of the problem, this is still a tall order and it is still not certain the plan launched by President Zardari to quickly eradicate polio will work.

Ambulatory surgery and clinic launched at DHCC

Dubai Healthcare City (DHCC) has launched BR Medical Suites, a state-ofthe-art ambulatory surgery and day care centre providing clinical and diagnostic services across a wide range of disciplines.

BR Medical Suites aims to attract top medical professionals from around the globe by providing fully furnished clinical examination rooms, 21 fitted-out clinics, a diagnostic centre and four operating rooms with support staff.

Dr B. R. Shetty, chairman and managing director of BR Medical Suites, commented during the opening ceremony: “Stringent regulatory standards and the integrated concept of having multiple facilities and experts in one location make DHCC the ideal location for offering our services. We are looking forward to welcoming both national and international patients and providing state-of-the-art medical care.”

Leishmaniasis outbreak in Saudi Arabia

The Saudi Gazette reports (27 March 2011) that 30 workers of a cleaning company in Albadaye’a governorate of Qassim were found to have cutaneous leishmaniasis.

The company said the infected workers worked near farms and swamps. It said the unavailability of medication led to the disease spreading among the workers.

Infections can be treated in many ways if the sores do not heal on their own, which happens often, said Abdullah Al-Suqair, assistant general director of the Primary Healthcare department. He said the disease is transmitted by the 2 millimeter-sized sand fly from infected animals to humans. He said it “is hard to eradicate, but the healthcare efforts to combat the disease are continuing. The disease in the Kingdom can be found in the regions of Qassim, Madina and Riyadh. However, it is present particularly in Qassim, given the agriculture and grazing activities which can provide an environment for the parasites.”

He said infections in Qassim are determined annually by the weather because the sand fly is more active in hot and mild weather, and also because people are more involved in outdoor activities during these periods.

Dubai’s Canadian hospital opens specialist obesity clinic

Canadian Specialist Hospital (CSH), one of the largest private hospitals in Dubai, has opened an Obesity Clinic in the hospital’s Oud Metha branch. Around 20% of the population in the UAE is obese, according to the MoH. The clinic will help to address this worrying issue through counselling and surgery.

The clinic was established by Dr Ali Reza Eghtedari, consultant surgeon and one of the pioneers in laparoscopic surgery in the UAE under the guidance of Dr Karl Miller, president of the International Society of Obesity Surgery.

According to the hospital, the CSH Obesity Clinic offers a complete solution to obesity, and despite its reliance on surgical methods to achieving weight loss, each case is considered separately and recommendations are made based on the patient’s condition.

“CSH aims to help its patients to understand the surgical procedure to weight loss, its consequences, and the lifestyle practices that are involved,” a spokesperson for the hospital said.

“We believe that people need a space where they are comfortable to talk about their problem, while at the same time explaining that they might require medical attention for related problems like diabetes, cardiological conditions and blood pressure,” Dr Eghtedari explained.

UAE doctor calls for more osteoporosis screening

UAE doctors attending the recent integrated Osteoporosis Workshop have called for an increase in screening for the bone disease after a local audit revealed the Emirates has a comparatively low number of specialist screening machines which are under used.

The audit of Dual-Energy X-ray Absorptiometry (DEXA) machines that detect bone density was carried out by Dr Mustafa Ali Izzi, chairman of the Emirates Osteoporosis Society, as part of a global study by the International Osteoporosis Foundation (IOF).

The IOF recommends one DEXA machine per 10,000 head of population. The UAE audit found that the country has one machine per 100,000 of which many are under-utilised, suggesting that many with osteoporosis, which affects one in three women in a lifetime, are going undetected.

“All the osteoporosis societies all over the world fed into the IOF audit report. We calculated the UAE data and found that we have approximately one DEXA machine per 100,000 head of population which is well below than the one in 10,000 recommended by the IOF,” said Dr Al Izzi, who acted as co-chair of the workshop.

“Even the more developed Western countries do not meet the IOF’s recommendation, but what we also saw in the UAE was that the machines we do have are not used fully; so we are calling on women, especially those aged above menopause, to come forward to have their bone density measured so that we can determine if they are at risk of osteoporosis and bone fractures. Following this we can start early treatment to help prevent or slowdown the disease,” added Dr Al Izzi.

Emirates doctor appointed chair of Association of Clinical Research for GCC

The Association of Clinical Research, headquartered in North Virginia, US, has appointed Dr Satish Chandra as Chairman of the Association’s Gulf Cooperative Council (GCC) Chapter. Dr Chandra is Specialist and Head Clinical Research at Tawam Hospital, associated with Johns Hopkins Medicine, in Al Ain in Abu Dhabi, UAE. Tawam is an important referral centre of the Middle East, especially for cancer.

Dr Chandra is accredited with discovery of the first human Immunophilin gene and for avid binding of the hormone progesterone. He has published extensively in international peer reviewed journals and written two books in the field of molecular medicine.

Dr Chandra commented: “I am very honoured to be appointed as ACRP chairman of the GCC. There are some exciting, pioneering and much needed clinical research studies currently being conducted in the region and the GCC is emerging as an increasingly important location in terms of medical breakthroughs and clinical research. I hope that in this role I can support further growth and advancements.”

Established in 1976, the ACRP was founded to address the distinct needs of research doctors, researchers, nurses and others who support the work of clinical investigations.

Work starts on Middle East’s largest medical university

The Saudi Press Association reports that work has started on the largest medical college in the Middle East at King Khaled University in Abha, as part of its University City project in Abha’s Alfaraa area.

The Medical City will have more than 24 fully-equipped departments of medicine, pharmacology, dentistry, and applied medical science, along with a conference centre, central library and classrooms.

The contract is worth SR1.9bn (US$510 million). The Medical City will also include an 800-bed hospital.

This development is part of University City which is being developed in six phases. The first two phases have been awarded to contractors.

Meanwhile, the Saudi Gazette reports (30 March 2011) that the Ministry of Health has approached seven international firms to design five medical cities ordered by King Abdullah.

Dr Muhammad Kheshaim, Undersecretary for Planning and Development, was quoted as saying the medical cities would have to be operational in five years’ time.

He said beds in the ministry’s hospitals will be increased by 70% in the next four years, from 34,200 to 54,000 beds at more than 349 hospitals and 2,750 primary care centres.

Pampers, UNICEF launch tetanus vaccine campaign

Pampers and UNICEF launched the “1 Pack = 1 Lifesaving Vaccine” campaign in the Arabian Peninsula in February this year. The campaign, which has seen remarkable success in other parts of the world, is geared towards eliminating maternal and neonatal tetanus (MNT).

With the “1 Pack = 1 Vaccine” campaign, Pampers and UNICEF aimed to raise a further 5 million vaccines in February and March to be used towards eliminating MNT in Yemen.

Dr Arwa Baider, Child Health Officer at UNICEF in Yemen, said: “Most people had never heard of maternal and neonatal tetanus before this campaign was announced.

“MNT is a silent killer that kills a baby every nine minutes globally. Most of the deaths take place at home and occur among the hardest to reach, most vulnerable populations. Yet, the reality of MNT is that it’s easily preventable. That’s why we need, more than ever, to work together to reach those who are most vulnerable to this silent disease. It is unacceptable that thousands of babies are needlessly dying.”

Tetanus is caused by bacteria, which enters the body through open wounds. Poor hygiene and limited access to health services and vaccinations increase the risk of maternal tetanus, which, in extreme cases, can result in violent seizures, difficulty in breathing and death.

The disease can be transmitted from mother to child via the umbilical cord or when there is contact with broken skin. Babies born with tetanus may take three to 14 days to exhibit symptoms, after which irritability, failure to feed properly, convulsions and ultimately death by suffocation await for 70% of infected newborns.

Increasing tobacco taxes reduces consumption in Egypt, says report

According to a report released in Cairo 29 March 2011 about tobacco economics and tobacco taxes in Egypt, raising taxes on tobacco products is a very effective measure for tobacco control and has a strong impact on public health. This measure can save the lives of thousands of Egyptians as well as serve as a significant source of revenue for the government to supply many healthcare services.

The World Health Organisation emphasises the significant effect of high smoking rates on the large number of premature deaths, excessive healthcare costs and lost productivity in Egypt. Nearly 20% of Egyptians use some form of tobacco. Ninety per cent of all lung cancer cases in Egypt are attributed to tobacco use, and 44% of young people aged 13-15 years are exposed to deadly second-hand smoke in public places.

In addition to the detrimental impact of tobacco on the health of Egyptians, tobacco use exacts a high economic cost. The direct annual cost of treating tobacco-related diseases is estimated at three billion Egyptian pounds (about US$500 million).

“It is estimated that more than 170,000 Egyptians die each year from tobacco-related diseases. It is critical that the government remain vigilant and follow the recommendations in this report to save more Egyptian lives and generate additional revenues,” said Dr Ashraf Saleh, associate professor of Economics and Finance in the Arab Academy for Science, Technology & Maritime Transport. He added that “the revenue could be used for poverty alleviation programmes, tobacco cessation and prevention programmes, among other efforts to promote healthcare for the economically disadvantaged”.

Projections in the report show that the recent tax increase, which saw cigarette taxes rise to 65% of retail price, is estimated to have reduced cigarette consumption by 19%, while bringing in an extra 3.5 billion Egyptian pounds in tax revenue. This tax increase will prevent nearly 1.6 million Egyptians from smoking and can save more than 450,000 lives.

“If Egypt raises cigarette taxes by a further 5%, so they account for 70% of the retail price, cigarette consumption could be reduced by 25%, and total increase in revenues could reach 5.2 billion Egyptian pounds,” explained Dr Saleh. “This tax increase would prevent more than 2.1 million Egyptians from smoking and could save 600,000 Egyptians lives”.

Amman’s Istishari Hospital awarded JCI accreditation

Istishari Hospital, in Amman, Jordan has received JCI (Joint Commission International) accreditation. The prestigious US-based Joint Commission accreditation is used to measure and set exacting protocols for safety and quality of hospitals. Istishari Hospital undertook the accreditation programme with the financial assistance of the USAID Jordan Economic Development Program.

USAID Jordan Economic Development Program signed letters of support with seven Jordanian hospitals pledging to cover part of the JCI Accreditation fees as a means to increase medical tourism and facilitate continued economic growth. The investment seems to be paying off. A recent World Bank study placed Jordan first in the Middle East and fifth in the world for medical tourism.

Zahira Haram, chief marketing and experience officer at Istishari Hospital, said: “Each and every one of us is committed to a culture of service excellence, and the JCIA is only the first step in that direction for us. The JCIA mainly lays the foundation for providing safe standards of care, and we are proud to be a part of it.”

Other JCI accredited hospitals in Jordan include: Al Essra Hospital, Jordan Hospital & Medical Center, Jordan University Hospital, King Abdullah University Hospital, King Hussein Cancer Center and the Specialty Hospital.

Diabetic Foot Academy set up in Saudi Arabia

The Middle East’s first Diabetic Foot Academy (DFA), sponsored by Smith & Nephew and endorsed by the Saudi Arabia Ministry of Health, attracted 47 physicians from across the Kingdom for a three-day accredited event focusing on the disease and the latest advances in prevention and treatment. The DFA was timed to coincide with preparations for the launch in early 2012 of 20 new diabetes centres across Saudi Arabia and is part of the ‘train the trainers’ programme through which physicians attending the DFA will then train colleagues working in this new national network of diabetes centres.

Diabetic foot disease is a common and serious complication of diabetes, which is highly prevalent in Saudi Arabia and the region, and frequently results in foot amputations which are avoidable with good patient education and prevention protocols.

The DFA was led by one of the world’s leading experts, Professor Gerit D Mulder of the University of California San Diego, and was endorsed by the Saudi Arabia Ministry of Health. The DFA was chaired by Dr Khaled A. Abdulrahman Tayeb, Consultant Diabetologist & Endocrinologist, Director of Diabetes & Endocrinology Center, Al Nour Specialist Hospital, Makkah.

According to Dr Tayeb, patient education and a strategy to tackle the problem of foot amputation are our major priorities, and the DFA initiative will make an important contribution in this initiative.

HAAD launches premarital screening programme

The Health Authority - Abu Dhabi (HAAD) has launched a premarital screening and counselling programme to provide information and advice to couples about to get married, as part of it preventive healthcare initiative.

Couples will be screened for:

- infectious diseases including HIV/AIDS; hepatitis “B” and “C”; and syphilis

- genetic blood diseases including beta-Thalassemia, Mediterranean anemia, sickle cell hemoglobin and other hemoglobinopathies

Other preventive tests include blood type and Rhesus factor; and immunity against rubella in women.

Dr Farida Al Hosni, Section Head of infectious diseases at HAAD said: “To benefit from these services, we encourage couples to take these tests and get counselling as early as possible; the results usually appear in 2 to 3 weeks’ time.”

WHO calls for integration of eye care into primary health care

Significant progress has been made over the past three decades in physical, mental and social health, and this has reflected positively on economic outputs and in the remarkable increases in life expectancy in most countries of the world. These crucial human gains also offer enormous challenges, especially with regard to the lack of health equity both between and within countries. Perhaps one of the most obvious manifestations of health inequity is the unacceptable rise in prevalence of preventable blindness and eye diseases in many communities and countries, despite the availability of opportunities for prevention, and of affordable treatment, and the significant development in eye health care services during the past decade.

Within the context of the efforts directed at addressing this situation, and to ensure the maximum possible benefit from health progress for all countries, communities and population groups without economic, gender or ethnic barriers, WHO continues its collaboration with concerned partners to ensure The Right to Sight: Vision 2020, the international initiative aimed at elimination of preventable blindness by 2020. Partners in this initiative and representatives of countries from the Eastern Mediterranean Region held a workshop in United Arab Emirates in February, hosted by the government, and under the patronage of His Royal Highness Prince Abdel Aziz Bin Ahmad, regional director for the Eastern Mediterranean region (EMR) of the International Agency for the Prevention of Blindness (IMPACT).

The main objective of this workshop was the full integration of eye healthcare services at all levels of the healthcare services, especially primary health care and health financing. Integration will have a great impact on health care consumers through comprehensive coverage of services, and on health systems themselves.

“We have increasing evidence that the prevalence of eye disease is really high, and that this can be addressed through an integrated primary health care approach,” said Dr H Al Gezairy, WHO regional director for the EMR. “Many policy-makers may not realise the benefit of integrating eye health in primary health care and health systems.”

Blindness and visual impairment represent a significant problem, challenging development in affected countries. It has been noted that early detection of many eye diseases, such as cataract, trachoma and childhood blindness, and treatment within primary health care decreases the magnitude of this problem. Early detection can also improve care services and preventive opportunities.

According to the latest WHO estimates, almost 37 million people in the EMR suffer from visual impairment due to eye diseases or uncorrected refractive errors. Of these, 5.3 million suffers from blindness, 90% of them in low-income countries. It is unfortunate that 80% of cases of blindness in the world occur despite the fact that they can be prevented and treated at affordable cost.

WHO and its partners in Vision 2020 are calling for strengthened efforts in the 10 years remaining until the target date for achievement of the goal.


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