Wednesday, October 20, 2010

Priorities? Whats Gone Wrong?

Have we got our priorities right?

Is hygiene a matter for concern?

Is home science taught to children especially girls?

Is dengue the biggest problem?

Can pure politicians decide on health issues?

Are our doctors trained sufficiently in Public Health?

Are our hospitals (both Public and Private) disease factories?

I can answer the last question easily.
Yes our hospitals are disease factories, there is no doubt about it.
If a patient is taken to a hospital he invariably acquires a new disease if he stays more than 48 hours.
That is why our mothers are discharged as soon as possible after child birth.

I am not going to get involved in any political arguments except saying that 30.000 (may be 40 thousand) children die every day due to poor hygiene and improper education worldwide.
One of the first lessons we have to teach undergraduates is hand hygiene when they enter university. But within 4 weeks they go back to bad habits and the cycle perpetuates itself
Majority of them have studied in tutories and not in school and the tutors never teach hygiene in their cramped up classes.

Below is some relevant samples and I have no editorial control over them or any connections.

Science Daily (Mar. 24, 2010)
A new study suggests that hand sanitizers containing ethanol are much more effective at removing rhinovirus from hands than washing with soap and water. Sanitizers containing both ethanol and organic acids significantly reduced recovery of the virus from hands and rhinovirus infection up to 4 hours following application.
The researchers from the University of Virginia School of Medicine, Charlottesville and Dial Corporation, Scottsdale, Arizona detail their findings in the March 2010 issue of the journal Antimicrobial Agents and Chemotherapy.
Rhinovirus is the known cause of approximately 30 to 35% of common cold cases in adults. Hand-to-hand contact is one of the main avenues of transmission contributing to the spread of rhinovirus infections. In the study researchers compared the effects of hand washing with soap and water and an ethanol-based hand sanitizer by contaminating the fingers of healthy volunteers with rhinovirus and then randomly grouping them and administering one of six hand treatments.
The experiments ranged from a control group who had no treatment, several groups who washed their hands for differing amounts of time (some with soap, some without), and several who used varying amounts of hand sanitizer. Results showed that the ethanol hand sanitizer removed approximately 80% of detectable rhinovirus from hands and was much more effective than no treatment, water alone, or soap and water. Soap and water removed rhinovirus from 31% of hands.

Science Daily (July 10, 2008)
Washing hands with soap and water before delivering a newborn infant is associated with a lower rate of neonatal deaths in developing countries, according to a report in the Archives of Pediatrics and Adolescent Medicine.
"Although major achievements have been made in reducing mortality in children younger than 5 years, less progress has been made in reducing neonatal mortality," according to background information in the article. It is estimated that there are approximately 4 million neonatal (newborn) deaths each year, with more than 99 percent occurring in low- and middle-income countries. "About half of these deaths occur at home where mothers receive little or no perinatal care. These neonatal deaths are attributable primarily to infections, prematurity and birth asphyxia [suffocation]."
Victor Rhee, M.H.S., of Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues obtained data in an observational study of 23,662 newborns through 28 days of life in rural southern Nepal from 2002 to 2006. Mothers of the infants were given questionnaires the day after delivery and two weeks later to identify maternal and birth attendant hand-washing practices.
More than 90 percent of births occurred at home or outdoors while the mother was being transported to a facility. Birth attendants washed their hands before the delivery of 59.2 percent of live births, while only 14.8 percent of mothers washed their hands with soap and water or antiseptic before handling their newborn. The overall mortality rate was 32.1 per 1,000 live births.

Science Daily (May 29, 2005)
The most accurate estimates of the causes of child deaths to date, published in the March 26, 2005 of THE LANCET, reveal that worldwide more than 70% of the 10.6 million child deaths that occur annually are attributable to six causes: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal sepsis or pneumonia (10%), preterm delivery (10%), and asphyxia at birth (8%).

Robert Black (Johns Hopkins Bloomberg School of Public Health, Baltimore, USA) and colleagues in an independent group on child health epidemiology, along with those from the World Health Organisation (WHO), analysed available data from publications and ongoing studies in 2000 to 2003 to obtain new estimates for mortality by cause in children younger than age 5 years. They found the four communicable disease categories account more than half (54%) of all child deaths. Infection of the blood or pneumonia in newborn babies and pneumonia in older children constitute 29% of all deaths. Undernutrition is an underlying cause of 53% of all deaths in children aged younger than 5 years. The investigators also calculated the total numbers and proportional distributions of deaths in children younger than age 5 years by cause for the six WHO-defined regions. Among deaths in children, 42% occur in the WHO Africa region, and an additional 29% occur in the south-east Asia region.

For many years, Chief physician Birger Forsberg has been working with international health issues, and has a particular interest in diarrhoea diseases children in low and middle-income countries. Although diarrhoea-related death amongst children has declined in the past thirty years, diarrhoea is still thought to be the cause of several million child deaths every year.
"Research shows that around 1.5 million children suffering from diarrhoea can be saved every year with the right treatment," says Dr Forsberg.
Back in the 1980s the WHO started a special programme to reduce diarrhoea-related child mortality. The organisation estimated that about two thirds of all deaths from diarrhoeal diseases were attributable to violent, watery diarrhoea and acute dehydration. It therefore promoted the greater use of rehydration solutions with sugar and salt additives and increased fluid intake. The recommendations were incorporated in most countries' national health programmes and active information campaigns were run through the WHO, UNICEF and national authorities. The use of the recommended treatments (rehydration or increased fluid intake) has increased but not as much as desired.

The review, led by Regina Ejemot of the University of Caliber, in Nigeria, shows that teaching people about hand washing can reduce the incidence of diarrhea by up to 30 percent and might have as great an affect as providing access to clean water.
“Our review specifically assessed the effects of interventions to promote hand washing and not the effectiveness of improving sanitation,” Ejemot said. “However, common sense would suggest that there has to be water for hand washing to happen, regardless of community awareness of benefits or willingness to wash hands.”

WHO estimates that diarrhea is responsible for over 2.2 million deaths annually, especially in children under the age of five. It is an important cause of malnutrition in resource-poor countries and, if persistent, can contribute to decreased resistance to infection and hamper children’s growth and development.

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