Category Archives: Global Health
Child Mortality Rates Improve in Many Developing Countries
The child mortality gap has narrowed between the poorest and wealthiest households in a majority of more than 50 developing countries, according to a new study by researchers at the Stanford University School of Medicine. And the rates have dropped fastest among the poorest families. The researchers found four common factors in countries with a narrowing child-mortality gap: Government effectiveness, rule of law, control of corruption and regulatory quality. Read more on global health.
State Level Heart Disease Data from CDC Can Help Improve Interventions
New state heart disease specific data compiled and evaluated by researchers at the U.S. Centers for Disease Control and Prevention (CDC) provide information at the state level for the first time, a key tool for creating targeted intervention programs, according to the agency. Nearly 800,000 people die each year from heart disease, making it the leading cause of death in the United States. Although heart disease has continued to decline during the past 40 years, the rates of decline vary significantly by state. Factors, and interventions that can impact heart disease—and its successful prevention and treatment—include hypertension, smoking, high blood cholesterol, diabetes, overweight/obesity, physical inactivity and little consumption of vegetables and fruits. Read more on heart and vascular health.
New Study Finds Cigars as Risky as Cigarettes
Many smokers think cigars are less likely than cigarettes to cause cancer and other diseases and rates of cigar smoking doubled between 2000 and 2011. However, a new study in the journal Cancer Epidemiology, Biomarkers & Prevention finds that cigar smoke—just like cigarette smoke—emits toxic chemicals. The researchers say this is an important study because cigar smoking has increased among kids and teens, who often think that cigars don’t pose the same health risk as cigarettes. Read more on tobacco.
Just about every think tank, school of public health and infectious disease association has held a conference on Ebola in the last few weeks, but two coming up are still absolutely worth tracking.
Now that New York City has seen is first diagnosis of Ebola, an already scheduled conference next week at Columbia University’s Mailman School of Public Health has taken on added importance. Presenters include ABC News Chief Health and Medical editor and former acting U.S. Centers for Disease Control and Prevention director Richard Besser, MD, as well as Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University's Earth Institute. While the conversation surrounding the Ebola cases in Dallas focused on the need for health care workers to receive better guidance and training, hours into the first case in New York City the focus is on the challenge of containing the disease in a huge urban setting—a topic the presenters will discuss at length.
And on November 7, the White House Office of Science and Technology Policy will host a simulcast workshop together with Texas A&M, the Worcester Polytechnic Institute and the University of California, Berkeley to discuss proposals to dispatch robots to aid in the care of Ebola patients and people who have succumbed to the disease. The idea is to augment — and not replace — health workers. Robots could spray disinfectant, respond to commands given by health workers in a remote location and even help bury the dead.
The conference will include not just engineers, but also public health officials and health care personnel who can speak to the human needs that need to be considered when design the robots. For example, Texas A&M engineering students are working on a robotic attachment that would pick up a dead body in movements that mimic compassion, rather than in another way that may be efficient but does not show sensitivity for the dead and their families.
>>Bonus Link: Read an interview with the conference conveners.
In the wake of the Ebola outbreak in West Africa and cases diagnosed in the United States, NewPublicHealth has been looking at the toll of other infectious diseases in need of new prevention and treatment efforts. Earlier this week, the Kaiser Family Foundation released a series of infographics that compare Ebola to twelve other infectious diseases, including SARS, malaria and HIV, which are all current public health challenges.
The infographics are an important teaching tool for explaining how Ebola is spread and for reminding public health professionals about the need for vigilance when it comes to other diseases.
The series of infographics touch on topics including:
- Transmission routes
- Vaccines, treatments and cures
- Fatality rates
- Key characteristics such as immunity after infection and number of cases worldwide each year
Below is one of the Kaiser Family Foundation’s infographics. Click through to view the additional educational tools.
Over the weekend, NewPublicHealth conducted an email interview with Tarik Jasarevic, a spokesperson for the World Health Organization (WHO), on Ebola efforts on the ground in West Africa and the impact on the global effort of the cases recently diagnosed in the United States.
NewPublicHealth: Is there concern among global health leaders that the attention on a handful of cases is taking away attention from the thousands of cases in West Africa?
Tarik Jasarevic: While countries need to be vigilant and prepared for a possible case of Ebola, we need to focus on getting all possible resources—trained health workers, medical facilities with beds and money—to the affected countries in West Africa.
NPH: Several weeks ago global health leaders had a checklist of things, including money and personnel, needed to stem the outbreaks in the various countries. Where do things stand now, and what is still needed?
Jasarevic: We need a lot of resources if we’re going to get the virus under control. WHO and partners constructed 12 Ebola Treatment Centers in Liberia, 15 in Sierra Leone and 3 in Guinea—30 out of the 50 that are needed. These facilities contain more than 1,100 beds for patients, out of the more than 4,000 needed. There are more than 2,500 beds becoming available in the next few weeks, but we still need more. We also need international health workers to come work alongside national health workers to manage and run the health facilities. WHO has set up “training academies” in each of the affected countries to train more local health workers, but more are needed.
NPH: What is the current fatality rate?
Jasarevic: The fatality rate for this particular outbreak has always been approximately 70 percent. We are seeing higher numbers of cases and deaths because of the geographic spread of the disease, from urban city centers to rural, hard to reach villages. There is also significant under reporting of cases in the three countries, especially Liberia.
In light of the ongoing Ebola outbreak, NewPublicHealth recently launched an in-depth look at the current state of several infectious diseases and efforts to stem Ebola and other outbreaks. Tomorrow night the PBS documentary series Frontline will air “The Trouble with Antibiotics” (10 p.m. EST), taking a look at antibiotic use on American farms and the death of a patient being treated at the National Institutes of Health (NIH) three years ago who succumbed to a superbug the NIH was unable to treat.
According to the program’s correspondent, David Hoffman, a former journalist with the Washington Post, 70 percent of U.S. antibiotics are used on farms and are linked to at least some of the two million people who become ill and the more than twenty thousand people who die of antibiotic resistance each year.
NewPublicHealth recently spoke with Hoffman about the project.
NewPublicHealth: What made you interested in the topic of antibiotic resistance?
David Hoffman: In 2012, the Clinical Center at the National Institutes of Health disclosed the details of an outbreak of resistant bacteria in the hospital during 2011. It was a remarkable story in which advanced genomics from an NIH institute were used to unravel the mystery of how the organism had spread, and the hospital took extraordinary measures to combat it. This led to a 2013 Frontline film about the growing problem of resistance in human health, “Hunting the Nightmare Bacteria.” While working on “Hunting.”’ we heard a lot about antibiotics in animal agriculture. But the issues were complex and needed time for serious examination. We decided to devote our next film to answering some of the questions and that process took about a year.
Tomorrow, the U.S. Centers for Disease Control and Infection (CDC) will hold a conference call for medical personnel. The call will review and underline safeguards needed to help protect health workers who will be called on to help with care for U.S. Ebola patients, should more cased be diagnosed.
The first patient diagnosed with Ebola in the United States died in Dallas last week; a second, a nurse who looked after that patient, was confirmed yesterday by the CDC to have the virus. She is in isolation in a Dallas hospital.
CDC director Tom Frieden, MD, MPH, said the infected nurse may have contracted the disease through a “breach in protective gear protocol.” However, Ezekiel Emanuel, MD, a bioethicist and professor at the University of Pennsylvania, said this morning on MSNBC that he thought the problem was not so much a breach as the need for greater implementation. Medical checklist guru Atul Gawande, MD, agrees. In a short piece titled “Ebola is Stoppable” in The New Yorker last week, Gawande wrote “The main challenge is taking off the protective personal equipment—that’s when it is easiest to contaminate yourself.”
Public health experts are assessing what changes to make to reduce the chance of transmission without making suiting up so cumbersome that health workers are tempted to skip steps. At yesterday’s press conference, Frieden said that there have been reports out of West Africa of health workers who contaminated themselves when they pricked themselves with a clean needle that came in contact with contaminated gloves. For now, the procedures laid out in posters from the CDC on how to don and remove protective clothing remain in place.
>>Bonus Link: Over the weekend, an article in the Los Angeles Times questioned a key component of assessing people who may be infected with Ebola—assuming that they are not contagious if they don’t have fever. The study, funded by the World Health Organization and published online last month in the New England Journal of Medicine, analyzed data on 3,343 confirmed and 667 probable cases of Ebola, finding that thirteen percent did not have a fever. U.S. public health experts told the Times that they continue to view fever as the key indicator that the virus is transmissible to other people.
EBOLA UPDATE: Obama to Commit as Many as 3,000 Troops to Epidemic Response
(NewPublicHealth is monitoring the public health crisis in West Africa.)
President Obama will today announce an expansion of military and medical resources that could send as many as 3,000 people to West Africa to help combat the ongoing Ebola outbreak. According to The New York Times, the United States will help train health workers and build as many as 17 Ebola treatment centers, which will house approximately 1,700 treatment beds. The U.S. Department of Defense will also open a joint command operation in Liberia in order to coordinate an international response to the outbreak. Read more on Ebola.
Report: 1 in 9 People Worldwide are Chronically Undernourished
An estimated 805 million people in the world are chronically undernourished, according to a new report, The State of Food Insecurity in the World 2014, from the Food and Agriculture Organization of the United Nations. While that means that approximately one in every nine people are undernourished, the number is down more than 100 million over the past decade and 209 million since 1990-1992. In the past two decades the prevalence of undernourishment has also dropped from 23.4 percent to 13.5 percent in developing countries. According to the health agency, the eradication of hunger requires a sustained political commitment that emphasizes food security and nutrition. Read more on global health.
SAMHSA: Percentage of Youth Using Illegal Drugs is Down Over the Past Decade
The percentage of U.S. teens using illegal drugs is down over the past decade, according to a new study from the Substance Abuse and Mental Health Services Administration’s (SAMHSA). The report, the 2013 National Survey on Drug Use and Health, found that the rate of illicit drug use in the past month for adolescents ages 12-17 was 8.8 percent, down from 9.5 percent in 2012 and 11.6 percent in 2002. From 2002 to 2013, the percentage of youth in that age group with a substance abuse or dependence problem dropped from 8.9 percent to 5.2 percent. “This report shows that we have made important progress in some key areas, but that we need to rejuvenate our efforts to promote prevention, treatment and recovery to reach all aspects of our community,” said SAMHSA Administrator Pamela S. Hyde, in a release. “The real lives represented by these statistics deserve our protection and help from the ravages of substance use disorders. Through a comprehensive, national effort we can help people avoid, or recover from substance use problems and lead, healthy, productive lives.” Read more on substance abuse.
Almost every day brings reports of new cases of Ebola, the often-fatal virus now impacting multiple countries in West Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak is the largest Ebola outbreak in history. Spread of the disease to the United States is unlikely—although not impossible—and efforts are underway to find vaccines and cures, including scale-ups of drug development and manufacturing, as well as human trials for vaccines both in the United States and around the world. However, in West Africa the epidemic is impacting lives, economies, health care infrastructure and even security as countries try a variety of methods—including troop control—to get citizens to obey quarantines and other potentially life-saving instructions.
Late last week, NewPublicHealth spoke with Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. Garrett has written extensively on global health issues and was on the ground as a reporter during the Ebola outbreak in Zaire in 1995.
NewPublicHealth: What are your key concerns with respect to the current Ebola outbreak?
Laurie Garrett: My main concern has been about the nature of the international response, which could be characterized as non-response until very recently. And now that the leadership of the international global health community has finally taken the epidemic seriously, it’s too late to easily stop it. We’ve gone through the whole list of all the usual ways that we stop Ebola and every single one of them was initiated far too late with far too few resources and far too few people—and now we’re in uncharted territory. We’re now trying to tackle a problem that has never reached this stage before and we don’t know what to do. The international response is pitiful, disgusting and woeful.
NPH: How do you account for such a poor response?
Garrett: First of all, the World Health Organization (WHO) is a mere shadow of its former self. When I was involved in the Ebola epidemic in 1995 in Kikwit, Zaire, the WHO was recognized worldwide as the leader of everything associated with outbreaks and infection, and it acted aggressively. It didn’t have a huge budget, but it still was able to take the problem very seriously and the resources that were needed were available, and more importantly a very talented leadership team combining the resources of the U.S. Centers for Disease Control and Prevention; WHO; Medicin San Frontiers (Doctors Without Borders); and the University of Kinshasa, Zaire, came together. They respected each other. They were on board together. They worked very closely with the local Red Cross, and they were able to conquer the problem pretty swiftly.
Ebola Update: U.S. Doctor Being Treated for Ebola Expected to Be Released from the Hospital Today
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Reuters and other news outlets are reporting that Kent Brantly, MD, who contracted Ebola in Liberia where he was treating patients for the disease, has recovered from the virus and is expected to be released from Emory University Hospital in Atlanta today. An update on the condition of Nancy Writebol, a health worker who also contracted Ebola in West Africa, is also expected today. Since the start of the current outbreak in West Africa, more than 1,350 people have died of the disease. In an effort to reduce the spread of the disease, officials in Monrovia, the densely populated urban capital of Liberia, began a quarantine to stem the disease outbreak, sparking clashes between residents and troops. Read more on Ebola.
Many Older ER Patients Show Signs of Malnutrition
A new study in the Annals of Emergency Medicine found that many patients over age 65 who go to the emergency room for medical care are also found to be malnourished or at risk of malnourishment. The study authors say the reasons behind the insufficient nutrition include dental problems that make it difficult to eat, depression and lack of access to food. The study suggests that all older patients be assessed for malnutrition during emergency room visits. Read more on aging.
Free Online Search Tool from DOT Lets Consumers Check Vehicle Safety
The U.S. Department of Transportation has released a free, online search tool—accessible at www.safercar.gov—that consumers can use to find out whether a vehicle, including a motorcycle, has been recalled by using the Vehicle Identification Number (VIN). Consumers can find their vehicle identification number by looking at the dashboard on the driver’s side of the vehicle, or on the driver’s side door where the door latches when it is closed. After entering the VIN number into the search tool, a message indicating whether the vehicle was recalled will appear, which will let users choose not to buy or rent the car, or if they own it or are planning to buy it, to have it fixed according to the recall specifics. The National Highway Traffic Safety Administration is working with the National Automobile Dealers Association to make sure that the VIN tool is used by all U.S. car dealerships. Read more on safety.
The worst Ebola outbreak in history has now claimed 1,145 lives, according to the World Health Organization (WHO). In the two days to August 13, 76 people died and there were 152 confirmed, probable and suspected new cases in Guinea, Liberia, Nigeria and Sierra Leone. NewPublicHealth has been following the outbreak in West Africa closely. You can read our ongoing coverage of the Ebola epidemic here. Below is a look at the latest news on the outbreak:
- While stating its belief that the magnitude of the outbreak has been “vastly” underestimated, WHO continues to partner with individual countries, disease control agencies, agencies within the United Nations system and other organizations to combat the Ebola epidemic. “Practical on-the-ground intelligence is the backbone of a coordinated response,” the global health organization said in an update, noting that the U.S. Centers for Disease Control and Prevention (CDC) is providing computer hardware and software that should enable real-time reporting and analysis. The World Food Programme is also delivering food to the more than one million people living in quarantine zones; the food shortage has been compared to a “wartime” situation.
- The medical charity Médecins Sans Frontières (MSF) estimates that it will take public health officials at least six months to bring the Ebola outbreak under control. "In terms of timeline, we're not talking in terms of weeks, we're talking in terms of months,” said MSF President Joanne Lui, according to the BBC. “We need a commitment for months, at least I would say six months, and I'm being, I would say, very optimistic."
- Kent Brantly, MD, one of two U.S. aid workers infected in Liberia who received an experimental Ebola treatment, continues to improve and hopes to be “released sometime in the near future.” He is being treated at Emory University Hospital in Atlanta, Ga. The family of Nancy Writebol, a missionary from Charlotte, N.C., said she also continues to improve and doctors remain optimistic.
- The U.S. Department of State has ordered family members of staff members at the U.S. embassy in Freetown, Sierra Leone, to evacuate the country, announcing the order as part of reconfiguring of resources to better respond to the Ebola outbreak. The order stated: “We remain deeply committed to supporting Sierra Leone and regional and international efforts to strengthen the capacity of the country’s health care infrastructure and system—specifically, the capacity to contain and control the transmission of the Ebola virus, and deliver health care.”