CNS

Hyderabad to Cape Town: Evidence driving medical research and health systems strengthening

Shobha Shukla and Bobby Ramakant, CNS

Prof Jimmy Volmink

"We develop medicines and other therapies which are based on very good research, but then we offer those therapies often in ways that are untested and have never been evaluated. So there is a natural progression from making sure that our treatments are evidence-based, to the next phase of ensuring that the way we offer those treatments to people is also evidence-based” said Professor Jimmy Volmink, Director of South African Cochrane Centre and Dean, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Chhatra Karki, CNS Correspondent
Situated at an altitude of 2,400 metres, Toplang, a village in the South West district of Dhading, Nepal, has been successfully maintaining its identity as an 'organic village' of the country. The village is merely an hour's drive along the Chandragiri hill from Kathmandu's Thankot pass.

Dr Pradeep K Srivastava

Kulsum Mustafa, CNS Correspondent
Every minute a child dies from malaria. According to the World Health Organization (WHO), half of world's population is at risk of malaria. "Mosquito borne diseases are a major health problem in India. Globally every year 3.4 billion people are at risk. Early diagnosis and prompt treatment of malaria prevent deaths," said Dr Pradeep K Srivastava, a well known 'scientoonist'. He advised that adequate preventive dose of malaria are a must when one is visiting a mosquito-prone place. Urging medical alertness and timely blood tests if fever persists beyond a day, Dr Srivastava said that timely detection of malaria and proper medication can help prevent death.

Overcoming roadblocks in translating evidence-based healthcare into public health gains

Shobha Shukla and Bobby Ramakant, CNS

Dr Prathap Tharyan, Director, SACNC
Photo credit: SACNC

Commendable progress has been made in the South Asian region to advance evidence-based healthcare and let evidence inform policy and programmes at different levels. But there have been roadblocks too that are slowing down the progress. Citizen News Service (CNS) spoke with Dr Prathap Tharyan, Director, South Asian Cochrane Network and Centre, who has led from the front on the cause of evidence-based healthcare in this region, and globally. Dr Tharyan is also the co-chair of the 22nd Cochrane Colloquium, which is taking place for the first-time ever in the South Asian region in Hyderabad, India.

Dr Matthew Varghese

Shobha Shukla and Bobby Ramakant, CNS
Corporate capture of healthcare in India has got much less attention than it should. Systematic weakening and dis-crediting of public health system, deepening roots of a bias towards private healthcare system, corporations chipping in with 'profit before people' principles, corruption and malpractices, shifting scales of public versus private medical education, strong influx of public healthcare experts in private sectors, sky-rocketing prices of medical care, drugs and diagnostics, and most importantly, less takers of evidence-based healthcare among doctors, policy makers and people at large, are just some of the reasons which are responsible for the state of healthcare in the country.

Evidence-based medicine is the basis of sound healthcare

Shobha Shukla and Bobby Ramakant, CNS

Dr Gordon Guyatt

Evidence based medicine (EBM) emphasizes the use of evidence from robust research in healthcare decision-making. It is the conscientious and judicious use of current available best evidence in making decisions about the care of individual patients. It integrates individual clinical expertise with the best available external clinical evidence obtained from systematic research and with the patient's values and expectations. It informs the doctor which drugs and procedures are best for treating diseases.

Shobha Shukla and Bobby Ramakant, CNS
For management of disasters and humanitarian crises, doing something is not enough—but doing the right thing at the right time is. Decision-makers need to know which interventions, actions and strategies would work, which would not work, and which, no matter how well-meaning, might be harmful. They need to make well informed choices and decisions and for this they need access to reliable evidence.

When natural disasters happen: do more good than harm!

Shobha Shukla and Bobby Ramakant, CNS

Whenever natural disasters and humanitarian crises occur, enormous amount of resources are spent on relief and aid services, albeit without knowing whether they will do more good than harm. At a pre-conference symposium organized by Evidence Aid, before 22nd Cochrane Colloquium opens in Hyderabad, India, the message was clear from those with experience in disaster management activities: despite best intentions, lot of interventions are happening without strong evidence that they actually do more good than harm.

Shobha Shukla, CNS Columnist
Well, any right-minded person would say NO. But the global, as well as the local media, has castigated India for not ratifying the Protocol of Amendment for the Trade Facilitation Agreement (TFA) at the recent World Trade Organization (WTO) negotiations in Geneva in July 2014, and for linking it to discussions for a permanent solution to the G-33’s Food Security Proposal. India’s refusal to tow the line of developed countries has caused worldwide uproar.

Nenet Ortega, CNS Correspondent, Philippines
A government hospital is usually the preferred facility to seek medical and clinical consultation by people in a rural community and they do come when they are already sick. Everyday hundreds of clients seek consultation. A review of the out patients census and data for the first two quarters of 2014 in a hospital in Philippines showed that the top three leading causes for which patients sought medical and clinical consultation were--TB, upper respiratory tract infection/asthma and pneumonia.

Dr Aparna Srikantam, LEPRA

Genital tuberculosis (TB) is one of the major causes of tubal infertility. Some studies show that only two per cent of women with genital TB have live births. Genital TB is usually asymptomatic so needs higher degree of clinical suspicion so that accurate and confirmed diagnosis of TB can be made and standard anti-TB treatment provided as early as possible. But the challenge is that current range of standard diagnostic tests are less likely to pick up every case of genital TB.

Shobha Shukla, CNS Columnist
Abused by her own family in childhood, Bela (name changed) was sold by a relative and trafficked to India. She eventually came out of her harrowing ordeal, turned her life around and became a peer counsellor and educator with Family Planning Association of Nepal (FPAN). She was supported for 5 years by the anti trafficking project of FPAN. But once the project got over she was once again left to fend for herself.

Eranga Isaac, CNS Correspondent, Nigeria
It has been established by health experts in Nigeria that indoor and outdoor environments are usually polluted by multifarious mixtures of gases and particles that are produced by combustion of various types of fuels. Sources of indoor pollution include cooking stoves, cigarettes smoking, burning of various fuels for indoor heating, burning of mosquito coils and burning of incense for religious purposes and defecating in the living room.

Babs Verblackt, CNS Correspondent, Belgium
Progress made in tuberculosis control is at risk of being undermined by the rapid rise of diabetes in regions where both diseases are prevalent, experts warn. Patients living with diabetes are especially vulnerable to catching the lung disease. Improved care and increased efforts to diagnose and treat both diseases are urgently needed.

Shobha Shukla
It has been one year since you left us. And yet not a day has gone by when your invisible, but all pervading, presence was not felt by us. You had touched the lives of not only your near ones but even those who had never met you personally and had heard about you through common friends.

Strangely, during this one year I never ever felt the urge to mourn your loss, rather your remembrance fills my mind with peace and an indescribable calm.

Chhatra Karki, CNS Correspondent, Nepal
The degradation of indoor air quality is a critical issue throughout the world today, which is convicted for causing severe impacts on human health. World Health Organization (WHO) reports that around 38 million of the global population is forced to face untimely death every year due to household air pollution. To aggravate the matter, indoor air pollution is catapulting the number of the people contracting maladies like pneumonia, stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD), lung cancer, and others.

Know your epidemic: First-ever national anti-TB drug resistance survey launched

Shobha Shukla and Bobby Ramakant, Citizen News Service – CNS

India took a historic step for control and management of multidrug-resistant tuberculosis (MDR-TB) when the Union Health and Family Welfare Minister of Government of India, Dr Harsh Vardhan formally launched the first-ever nationwide anti-TB drug resistance survey (2014-2015) on 6th September 2014 in New Delhi.

Diana Wangari, CNS Correspondent, Kenya
(First publish in The Star News, Kenya): Early in the morning, the scene in large areas of rural Kenya is that of women walking towards their kitchen, often situated in a separate structure next to their living quarters. Homestead after homestead, the woman gathers firewood beneath her three stone make shift cooker or begins the process of getting the coal on the jiko to light.

Owen Nyaka, CNS Correspondent, Malawi
People all over the world are living in homes with poor indoor air quality. This can have profound health impacts. According to the World Health Organisation, 4.3 million people die prematurely every year from illnesses attributed to household air pollution. These illnesses include pneumonia, stroke, ischaemic heart disease, chronic obstructive pulmonary disease (COPD), and lung cancer. There is also evidence of links between household air pollution and low birth weight, tuberculosis, cataract, nasopharyngeal and laryngeal cancers.

Shobha Shukla, CNS Columnist
Findings of the World Health Organization (WHO) confirm that, ‘Air pollution is now the world’s largest single environmental risk’. Globally, 7 million people die each year because of exposure to air pollution, which means that 1 in 8 deaths occurring worldwide are due to breathing dirty air. While outdoor air pollution is responsible for 3.7 million of these deaths, surprisingly more deaths — 4.3 million — are linked to indoor air pollution chiefly caused by use of solid fuels for cooking and heating. Add to this smoking tobacco and e-cigarettes, and you have a veritable inferno of deadly air circulating within closed doors.

Air Pollution: Does Height Matter?

Alice Tembe, CNS Correspondent, Swaziland

Photo credit: R Dwivedi/ CNS

Well the answer is yes-- the closer you are to the ground the more efficient is the inhalation of heavier airborne chemicals. Children are more vulnerable to the health hazards of these pollutants. Besides breathing a greater volume of air than adults relative to their body size, children being small and closer to the ground (as compared to adults) breathe in more of the heavier airborne chemicals than adults. They also have a higher heart rate, which allows substances that are absorbed into the blood to permeate tissues faster.

Rahul Dwivedi, CNS Correspondent, India
Pollution often refers to outdoor pollution of air, water, soil or other natural resources. But indoor air pollution within our homes is a serious health hazard for lung health which is often ignored. “Passive smoking and exposure to biomass cook stove smoke are also risk factors for developing active tuberculosis (TB) disease, especially in children. Biomass cooking fumes and tobacco smoke can also trigger asthma attacks. So the practice of using biomass fuel should be replaced by other safer and cleaner energy options” said Dr Surya Kant, Professor and Head, Department of Pulmonary Medicine, King George’s Medical University (KGMU).

Food Sovereignity And Sustainable Agriculture Go Hand In Hand To Reduce Poverty

Shobha Shukla, CNS Columnist

Despite rapid economic growth, income inequality is rising in India and structural inequalities have kept entire groups trapped in poverty. Although India has reduced absolute poverty by 14% in the last decade more than 400 million of its people still live in poverty. It is home to one third poor of the world as well as to 40% (217 million) of the world’s malnourished children. It also remains at the bottom of the group of mid income countries with a GDP per capita at $ 1410 in 2011.

Shobha Shukla, CNS Columnist
The threat of being evicted from ones home is a scary thought for anyone, more so for a woman. The fear of being ousted from her home forces her to live in an unsafe environment behind closed doors rather in the absence of a safe place that is rightfully her own. The Indian tradition of a daughter being ‘paraya dhan’ (her husband’s property) smacks of a patriarchal setup that implies denial of property rights to her. A land or a house which a woman owns legally is an asset which gives her the confidence and courage to fight life’s odds.

Call to link sustainability with post-2015 development goals

Bobby Ramakant, CNS Special Correspondent

Ashish Kothari, Kalpavriksh

One of the drawbacks of millennium development goals (MDGs) which countries aspired to meet by 2015 was that sustainability was missing. There was no sustainability indicator in place to assess development in MDG framework. With intense rounds of post-2015 Strategic Development Goals (SDGs) going on around the world, one positive sign is that sustainability is getting increasing attention in development discourses.

Shobha Shukla, CNS Columnist
The deadline for the realization of the eight Millennium Development Goals (MDGs) by countries of the world is drawing to a close in 2015. The progress on MDGs might have been with mixed results, but lot of lessons need to be learnt while we frame new set of development goals and targets after 2015. The post-2015 discussions have been taking place since last one and a half years to address the issues of unsustainability, poverty, climate change, and global cooperation, with a view to integrate the economic, social and environmental aspects of global governance.

Debate: What do post-2015 strategic development goals mean to us?

Bobby Ramakant, CNS Special Correspondent

In the year 2000, countries of the world had agreed to meet the 8 Millennium Development Goals (MDGs) by 2015. Numerous consultative processes have been taking place around the world on what should be the development goals post-2015. A draft list of 17 Strategic Development Goals (SDGs) and 168 targets for post-2015 is expected to be presented before the UN General Assembly in September 2014 to agree on modalities and inter-governmental negotiations might begin from January 2015 onwards.

From CNS archives dated February 2013: Old news but more alarming today
This is an appeal from a person in her own words who urgently needs support for her healthcare needs. She is a brave woman who is a living example of the oft-quoted adage - 'When the going gets tough, the tough gets going...' Read her story in her own words -a real-life experience, full of grit, courage and determination, to continue living and spreading light despite seemingly insurmountable challenges.
(CNS has met and interviewed Payel and strongly supports her efforts to exercise her right to health. Please consider supporting her personal fight against Von Hippel Lindau (VHL) Syndrome and multidrug-resistant tuberculosis (MDR-TB). Kindly find her contact details or ways to support below)

Photo credit: R Dwivedi/CNS

Isaac Eranga, CNS Correspondent, Nigeria
Two billion people — one-third of humanity — carry a latent TB infection. The vast majority of those infected latently live their whole lives without becoming sick with TB or spreading the infection. The body’s immune defenses seal the invading TB germs within a tiny capsule at the infection site, thus preventing them from multiplying. When the body’s immunity is compromised, like through HIV, the capsule containing the TB germs weakens and breaks.

Photo credit: R Dwivedi/CNS

Shobha Shukla - CNS Columnist
(This article is based upon a podcast from TB Alliance (Global Alliance for TB Drug Development), which is online here). The first estimates of the global burden of TB in children given by the WHO in 2012, suggested that there might be 530,000 children suffering from it. Subsequently there has been an uptake in the research in this field. A recent mathematical modelling study on the burden of childhood TB in 22 high-burden countries, (published in the Lancet) has revealed that there may be 650,000 annual cases of TB in children. Are these figures at odds with the estimate of 530,000 previously made by WHO?

Chhatra Karki, CNS Correspondent, Nepal
‘HIV does not kill people, but the stigma does’. Stigma and discrimination refers to the prejudice and misbehavior with people living with HIV (PLHIV), further adding to their woes. Who else would know it better than 33 years old Tuka Devi (name changed), of Dadeldhura district in west Nepal.

Shobha Shukla, CNS Columnist
We know that nearly one third of the 35 million people living with HIV (PLHIV) have tuberculosis (TB), and 13% of 8.6 million new TB cases every year are HIV positive. Also 1 in 5 HIV associated deaths are due to TB. Moreover PLHIV are 21-34 times more likely to develop active TB disease than persons without HIV. So it becomes imperative to establish an effective collaboration between two vertical programmes and provide point-of-care services for both the infections through policies that promote effective screening for HIV among TB patients and provide early antiretroviral therapy (ART) to those who are confirmed to be HIV positive.

Chhatra Karki, CNS Correspondent
TB co-infection in people living with HIV (PLHIV) has remained alarmingly high all over the world. Studies have revealed that the risk of developing TB is 21-26 higher in PLHIV as compared to those who are HIV negative. Also, about one in five AIDS-related deaths in 2012 were attributed to TB. This poses a great challenge to many governments worldwide, since they have not yet taken integrated steps for its effective control.