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Women Health: Pregnancy: a woman’s burden?

March 08, 2009

By Fawad Ali Shah

KARACHI: Lying unconscious in bed, Zuhra, 17, is unaware of her surroundings at Civil Hospital Karachi’s Intensive Care Unit.

The heart rate monitor beeps as the crests and troughs on the screen show her heart rhythm. Not even out of her teens, the young girl has given birth to a baby girl. “Doctors have told us that she is weak after delivering and it will take her a while to recover,” her sister-in-law, Zareena tells Daily Times as she squats on the floor beside Zuhra’s bed. However, duty nurses regard the condition of both, the mother and the newborn, as critical.

Zuhra is one of the thousands of women who have never seen the inside of a health care centre or hospital. Their health suffers even more when they end up pregnant while unable to afford the basic healthcare costs during the crucial pregnancy period. Relying on traditional and home remedies, many a times these women end up in a worse physical and mental condition and this fate is passed on to their young children.

A woman is considered to play an important role in the development of her children but somehow things are different in reality as health issues mar their physical development.

Scholars claim that the mental growth, creativity and physical fitness of children are dependent on the behavior and physical health of mothers but no one cares about the health of a mother. In rural areas of Sindh, even bringing an infant female to a doctor for treatment is considered a taboo.

It is often said that there is a need to educate men about the importance of the health of female members, be it their mothers, sisters, wives, daughters, in order to ensure the happiness of their families.

Early child development is largely dependent on the physical health of a mother. An infant’s mental development, which at the end decides physical development, is decided by how well they are fed, what kind of environment they are given and on sensory stimulations.

Doctor Zulfiqar Bhutta at the Aga Khan University Hospital (AKUH) is an expert in women and child health. He says that 70 percent of pregnant women in Sindh suffer from iron deficiency called anemia. “The ratio is pretty dangerous and if a mother herself is not physically fit, how will her child be?” questions Bhutta.

He says that during pregnancy, which is an important phase in the development of a child, only one out of five women gets proper medical treatment while adding that nothing is being done to redress the issue.

“Research in interior Sindh has shown that parents bring boys to health care centres while denying the same opportunity to their daughters. Right from the beginning, girls end up suffering from health problems and in response they then mistreat their own children,” he adds.

AKUH Rector Dr Camer Vellani says, “Medical research has proved that the human brain develops very early, even before birth and the first three years of life, when development is dependant on nutrition, sensory stimulation, health and the social environment, are considered a crucial growth period, in which it is the mother who takes care of the child.” Vellani went on to say on to say that if we want a healthy nation we will have to educate and provide health facilities to women in our society so in turn they give birth to healthy citizens. “Child nurture needs considerations well before conception, through pregnancy and childhood to enable development of the brain and ensure the child reaches full genetic potential,” Vellani goes on to say.

As the world celebrates International Women’s Day, Zuhra is running out of energy. While the doctors give her a blood transfusion, her newborn daughter cries at full pitch because of hunger, oblivious to her mother’s agony. For now it seems, their fates are entwined as they stand in limbo.
 
TB remains rampant in population

The disease kills 4,400 people per day, two million people annually worldwide

Tuesday, March 24, 2009
Muhammad Qasim

Islamabad

Tuberculosis (TB), the second leading cause of death from infectious diseases in the world, remains a major health challenge in Pakistan.

Even though Pakistan has achieved 100% DOTS (Directly Observed Treatment, Short Course) coverage, 80% case detection rate and 87% treatment success rate, the country still ranks 8th globally among the 22 high burden countries, and contribute 43% of the disease burden towards the Eastern-Mediterranean Region of World Health Organisation. In Pakistan, nearly 1.5 million people suffer from TB where as more than 300,000 new cases add up to the country’s escalating TB burden every year. The TB incidence in Pakistan is reported at 181 per 100,000 persons.

Health experts say that every year, thousands of people die of a disease, which is completely preventable, and 100 per cent curable. A large number of people, though infected with the TB bacilli, do not get diagnosed, either because of poverty, or lack of awareness about the seriousness of the disease, they say.

World TB Day falling on March 24 each year is designed to build public awareness that tuberculosis remains an epidemic in most part of the world, causing deaths of several millions people each year, mostly in the third world. ‘TB Se Nijaat, Naujawanon Key Saath’ (Getting rid of TB with the help of youth) has been devised slogan for the year 2009, along with 2008 slogan, ‘I Am Stopping TB’ to sensitise the younger generation to make efforts against eradication of the disease.

“Youth are the prime target of TB control in Pakistan where 70% of new TB patients belong to productive age group between 14 to 49 and 30% belong to the age group 14-24,” said Head of Community Medicine at Islamabad Medical & Dental College Professor Dr Muhammad Ashraf Chaudhry while talking to ‘The News’ Monday in connection with World TB Day. He added that 63 per cent of total population of Pakistan consists of young people aged less than 25.

According to WHO estimates, one third of world population is infected with TB. Someone in the world is newly infected with TB bacilli every second. Every year nine million people develop TB worldwide, more than 95% of which are in the developing countries. TB kills two million people annually, or 4,400 people per day. TB is the leading cause of death among people living with HIV.

Dr Ashraf said that there is a dire need to increase awareness among general public and especially among youth through mass media, TB weeks and advocacy seminars and to spread the message that TB is preventable and curable. “The WHO is working out to cut TB prevalence rates and deaths to half by 2015,” he said adding multi-drug resistant TB (MDR-TB), extensively drug-resistant TB (XDR-TB), HIV-associated TB and weak health systems are major challenges being confronted by countries in third world including Pakistan.

According to official data, women and children are most vulnerable to Tuberculosis. In 2001, the government of Pakistan declared TB a national emergency. If left untreated, one person with active TB might infect 10 to 15 people during one year.

Dr Ashraf said that TB is a disease of poor. “Malnourished, diabetics, smokers, prisoners, elderly, HIV infected individuals, healthcare workers, alcoholics and close contacts of infectious TB patients are at high risk to develop TB,” he said and added that general public should be educated that TB is spread from person to person through air. When infectious TB patients cough, sneeze, talk, spit, they propel TB germs into the air. When healthy persons inhale the air, they become infected. TB is not spread through casual contact, utensils, eating together, shaking hands, sharing clothes, bed sheets, books, furniture, marital relations and it is not an inherited disease, he said.

The main symptoms of disease are persistent cough for more than three weeks, low grade fever (evening pyrexia), coughing up blood, night sweats, loss of appetite, loss of weight and feeling of tiredness all the time. “If somebody has these symptoms, he/she should report to the nearest Health Centre/Government Hospital or TB centre and get his sputum tested free of cost,” said Dr Ashraf adding if somebody is diagnosed with TB, he/she should not get upset, because TB is now 100 percent curable. “TB should be cured in order to stop TB.”

He added that patient should take anti-TB drugs as advised by the doctor under the supervision of health worker/some responsible person for eight months without interruption. The anti-TB drugs can be obtained free of cost from any healthcare centre, government hospital or TB Centre. Free diagnostic and treatment services are available at 5,000 public health establishments throughout the country.

To a query, Dr Ashraf said that patient should not leave treatment without advice from a qualified doctor. “During anti-TB treatment, mother can also breastfeed her child. Patients should not be stigmatised and must receive full support from family and community. TB patient can lead an active normal life after receiving full course of treatment,” he said adding, however, current default rate in Pakistani TB patients is still 11%, which leads to Multi-drug resistant TB (MDR-TB) and in some cases extensively drug-resistant TB (XDR-TB), the most dangerous form of TB with no treatment. “Remember! Complete TB treatment is the most effective means of TB prevention.”

On preventive measures, he said it can be prevented by BCG (Bacille Calmette Guerin) vaccination and by awareness raising campaigns on mass scale. “TB patients should be advised to cover mouth while sneezing or coughing and not to spit on different spots. Newborn infants must be immunized against TB with BCG vaccine immediately after birth.”

It is important that National TB Control Programme (NTP) has engaged 500,000 youth volunteers and students all across country to spread the basic information about various aspects of the disease.

Dr Ashraf like many other health experts believe that fighting TB means fighting poverty, treating patients so that they can resume work, reducing stigma, ensuring affordable access to drugs and promoting advocacy so that patients can have a voice. “With the will, the funds and the action, together we can Stop TB!” concluded Dr Ashraf.
 
Pakistan mobilises against swine flu

* Medical staff at air and seaports put on high alert
* No swine virus testing facility in country, says expert


Staff Report
April 29, 2009

ISLAMABAD/LAHORE: The Ministry of Health has alerted medical staff at entry points, including air- and seaports, to check any suspected cases of swine flu, which has become a pandemic in many countries of the world, Director General (Health) Professor Rashid Juma told Daily Times on Tuesday.

Professor Juma told Daily Times on Tuesday that health officers deputed at air- and seaports have been put on high alert to screen all suspected cases.

Health department officials appointed at Lahore airport told Daily Times that there are four doctors and six paramedics, under the supervision of Dr Rubina Naz, working in three shifts round the clock to examine the passengers coming into the country.

Professor Juma, when asked about the availability of the diagnostic facilities in the country, said two types of facilities were needed for proper diagnosis of swine flue, antibody testing and virus testing. The facility for the former is readily available in Pakistan, while samples would have to be sent to other countries for analysis for the latter.

The ministry has also summoned an emergency meeting of all concerned departments including the World Health Organisation, provincial health departments, livestock and food departments, representatives of federal government hospitals today (Wednesday) to analyse the situation. He said no suspected case has been reported anywhere in the country yet.

Dr Waseem Khawaja, spokesman for the Pakistan Institute of Medical Sciences (PIMS), said that an isolation ward with proper staff had already been reserved in the hospital in the wake of a possible threat.

Dr Khwaja said the swine flu virus is curable if treated quickly with antiviral medicine, yet no one is naturally immune. He said human-to-human infections could occur in the same way the human seasonal flu virus is transmitted – through coughing, sneezing and coming in contact with a person or object harbouring the virus. Symptoms of swine flu are similar to those of the regular human influenza virus, which include fever, lethargy, lack of appetite and severe coughing. Some who have been infected with the swine flu have also reported to having a runny nose, sore throat, nausea, vomiting and diarrhea, he added
 
Stopping swine flu

Wednesday, August 12, 2009

The DG health has confirmed the first case of swine 'flu in the country. The health minister has told the National Assembly the patient has indeed been 'cured' and virtually foolproof measures taken to prevent the virus spreading. The good minister told the house that airports, seaports, border-entry points and, astoundingly, even bus stops were being monitored to prevent the entry of infected persons. While we must commend this vigilance, it is pertinent to ask whether such steps are realistic or indeed if any such screening exists beyond ministerial imagination. Certainly, even at airports, there is no evidence of checks for swine flu. The health officials posted at counters some weeks back have vanished long ago. The notion of scrutiny at bus stops is ludicrous. The minister now says thermal scanning equipment is to be set up at airports to detect swine flu cases.

Any plan to spend big sums of money on this should be challenged. There are many far more urgent priorities in the health sector. It is true Pakistan faces a threat from swine flu. So does every other nation in the world. What we need most of all is to create awareness, and not panic. Swine flu can be a grave illness, but in most cases it is little more than a nuisance and often indistinguishable from ordinary flu. People need to be educated about good hand washing routines and other precautions to prevent the spread of infections. However, there seems to be no sense in creating unnecessary fear or making unrealistic claims. Perhaps someone would do us all a service by informing the minister or this.
 
World Sleep Day: To sleep or not to sleep?

Sunday Magazine Feature
By Sumaiya Lakhani
Published: March 22, 2011

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Sleep isn’t a luxury that can be cut back on to make time for other “more important” daily activities without serious consequences. ILLUSTRATION: JAMAL. K

We’ve all heard of World Aids Day, World Cancer Day and the usual Father’s Day and Mother’s Day. Well, here comes another day many of us would want to observe with great enthusiasm…World Sleep Day. I would be surprised if your first reaction isn’t “Excuse me…is this for real?” because that certainly was my first reaction. Despite its seemingly insignificant and somewhat ridiculous name, World Sleep day has a point…and I’m going to make it. Just give me till the end of this article.

We’re all living the 21st century lifestyle; where we’re busy with work, studies, kids etc. all of which causes us to neglect our physical needs.

It is sad but true. As human beings, we’re almost programmed to think short-term and of all the items on our agendas, a good night’s sleep is one item that never gets checked off our to do list. There’s always something more important; whether it’s spending time with your loved ones, catching up on your favourite soaps or, for the workaholics out there, just catching up on work and doing some in advance if there is time.

Psychologist and sleep expert David F. Dinges, Ph.D., mentions in his work Sleep, Sleepiness and Performance that irritability, moodiness and slow reflexes are some of the first signs of sleep deprivation. According to him, if a sleep-deprived person doesn’t sleep after the initial signs, the person may then start to experience apathy, slowed speech and flattened emotional responses, impaired memory and an inability to be novel or multitask.

There is more to catching a few winks than meets the eye…literally. Lack of sleep doesn’t only give you bags under your eyes; the consequences can be a lot more severe than you’d like to imagine. Sleep deprivation can result in lowering the effectiveness of the immune system, decreasing the release of growth hormones and causing heart rate variability. In short, not getting enough sleep can make you sick. Seriously sick.

Dr Michelle Miller, from the University of Warwick, says: “Chronic short sleep produces hormones and chemicals in the body, which increase the risk of developing heart disease and strokes, and other conditions like high blood pressure and cholesterol, diabetes and obesity.”

And this is exactly why we should all be enthusiastic about World Sleep Day that was observed worldwide on March 18 this year. The whole point of having such a day is to create awareness as far as the importance of sleep is concerned because most people world over tend to neglect their basic biological needs. So now that I have (hopefully) convinced you, you can get to work on trying to convince your respective bosses to be as enthusiastic about letting you practically implement what the day symbolically signifies. Good luck and happy sleeping! ☺


Interesting fact

Leonardo Da Vinci credited most of his achievements to his sleeping habits, which were rather unique to say the least. He slept for 10 to 20 minutes for every four hours that he stayed awake. Result: more time, more dreams and a greater control our the body.

Some common sleeping disorders:

Sleeping disorders are many and their intensity varies from individual to individual. The following are some common sleeping disorders.

• Bruxism

It is a disorder in which the sleeping individual grinds or clenches his/her jaw during sleep. Symptoms include pain in the jaw and headaches but are not always detectable. It can lead to facial pain and chronic headaches.

• Narcolepsy

It is a neurological sleep disorder that results in the individual falling asleep at random times. This type of sleep is less restorative than normal sleep and therefore these people experience more sleepiness. Symptoms include sleep paralysis and hallucinations.

• Somiloquy

It is a disorder which causes an individual to talk in his/her sleep. The frequency and volume of the speech varies from individual to individual.

• Sleep apnea

This sleeping disorder involves intervals in breathing activity during sleep. The time period of each occurrence is long enough so that one or more breaths are missed and this occurs repeatedly throughout the sleep. Symptoms are difficult to detect and the disorder may result in the individual feeling tired and sleepy.
 
Dengue season: 10-day operation begins to combat mosquitoes

By Sher Khan
Published: April 20, 2011

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LAHORE: The Public Health Engineering Department started a 10-day operation against the dengue virus on Tuesday.

According to a department official, the operation had to be started before the peak season for the disease owing to the unpredictable changes in the weather, which were encouraging the breeding of the mosquitoes that carry the virus.

“The seasonal changes are unexpected,” Dr Tariq Ramazan, a public health district officer. “We have instituted a city-wide plan to ensure that the breeding mosquitoes are unable to survive before the peak season for the virus arrives between August and October,” he added. Dr Ramazan said that the dengue virus control, instituted as a round-the-year campaign, used indoor residual spray (IRS) and thermal fogging to eliminate the mosquitoes.

He said that the department was facing constraints regarding the budget. He said he had met with the DCO, who allocated Rs7.8 million to carry the campaign through the rest of the year.

The Public Health Engineering Department has estimated the cost of the 10-day operation against dengue virus at Rs150,000 per day, including the cost of insecticide and petrol oil lubricant for thermal fogging.

Dr Ramazan said that the department was also facing transport issues. The Public Health Engineering Department, he said, did not have its own vehicles to carry the thermal fogging equipment and had to borrow them from other departments.

He said that it was not the first time the department was facing this issue.

“Transport has always been a challenge, but the government found ways to work around it. Inspectors are assigned towns to supervise the fumigation process effectively,” he said.

Reported cases

Dr Ramazan told The Express Tribune that out of the five cases reported in the city, only one had been confirmed.

He said the patient was a King Edward Medical College student who had been affected during a stay in Rawalpindi. He had carried the virus to Lahore.

He hoped that the entire city would be fumigated in the 10 days of the campaign.

Department report for DCO

A Public Health Engineering Department report, prepared for the DCO, said that the department had fumigated 28,123 houses, 1,336 schools and 3,673 mosques in Lahore with IRS spray since December 2010. It stated that six rounds of fogging had been completed and a seventh round was underway, covering 1,003 ditches and 89 drains in each round.

The effects of the sprays on human health were also discussed in th+e report. It said that the presence of insecticide and diesel in the spray solvent had hazardous effects on asthma patients. People were therefore advised to stay inside while their area was being sprayed. The IRS sprays, however, were harmless, it said.
 
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