K Shehzad
FULL MEMBER
- Joined
- May 18, 2019
- Messages
- 134
- Reaction score
- 0
- Country
- Location
When a doctor in southeastern Pakistan sounded alarm bells in April about children mysteriously testing positive for HIV, health officials decided to offer screening to his entire town. What they found, the World Health Organization said, was unprecedented.
Over six weeks of testing, more than 600 children in the town, most of them between 2 and 5 years old, tested positive for the virus that causes AIDS, while nearly all their parents tested negative. Authorities have begun screening people in nearby towns, and the number of cases is expected to rise.
Test ResultsOf over 26,000 people screened recently forHIV in Ratodero, 2.8% tested positive, many ofthem small children.Recent HIV cases, by ageSource: Directorate General Health Services SindhHyderabadNote: Cases screened from April 25-June 4
57419135117200-1 years2-5 years6-15 years15-45 yearsOver 45years
Before the tests, just over 1,000 children were registered as HIV positive in the entire country, the WHO said. Those earlier cases were a mix of mother-child transmission and blood transfusions and many involved high-risk groups such as the children of sex workers.
A WHO-led delegation is investigating the cause of the outbreak in the town of 330,000 people and expected to present its findings on Friday. “We cannot say for sure what caused it,” said Maryam Yunus, a WHO spokeswoman in Pakistan.
Babies who tested positive for HIV were admitted for treatment at a hospital in Ratodero. PHOTO: PPI/ZUMA PRESS
Police last month arrested a local pediatrician, Muzaffar Ghangro, and said the virus spread when his clinic in Ratodero reused infected syringes. Dr. Ghangro, one of few licensed physicians in the town, has been charged with unintentionally causing deaths, said his lawyer, who said his client isn’t guilty.
Organizations that are part of the WHO-led delegation expressed doubt that a single doctor could be responsible for all the newly discovered cases. The crisis, they said, exposes Pakistan’s weak health-care system and raises questions about how widespread the problem could be.
Pakistan has one of the world’s lowest rates of health-care spending as a proportion of gross domestic product. It is outspent by countries such as Afghanistan and Iraq, among others, World Bank figures show.
Care GapPakistan has one of the world’s lowest ratesof health-care spending.Current health expenditure (% of GDP)Source: World Bank
%U.S.ChinaIndiaPakistanBangladesh2000’05’10’15024681012141618
With private health care out of reach for many in Pakistan and few government facilities available for children, people typically seek treatment from unlicensed professionals at inexpensive local clinics. Policing of these unqualified providers is spotty.
Health authorities in Sindh, a province of roughly 48 million people that includes Ratodero, shut down over 500 clinics run by unlicensed doctors after the outbreak surfaced, said Sikander Memon, the head of the province’s AIDS control program. More than 170 of the clinics were in the district where Ratodero is located, he said, adding that authorities also closed three unregistered blood banks in the district.
“Many clinics don’t follow proper sterilization processes, they don’t dispose of syringes, they reuse IV drips,” said Eamonn Murphy, the regional director in Asia for UNAIDS, which is part of the WHO delegation to Pakistan.
Malnutrition, dehydration and diarrhea are common among children in Ratodero, and drips are used to administer treatment.
Clinics also rampantly overuse syringes, health experts said. “We find in developing countries that if people go to a medical practitioner for a problem and don’t get an injection, they feel like they haven’t received a proper service,” Mr. Murphy said.
Out of the more than 26,000 people who volunteered for HIV screening in Ratodero, 761 had tested positive as of Saturday, Mr. Memon said. Of the infected, 623 were children and most under 5.
Doctors are assessing how many of the cases were new infections and how many had gone undetected because of a lack of awareness and screening.
“It’s just the tip of the iceberg. I suspect infections are in the thousands, not hundreds,” said Imran Akbar Arbani, the doctor who diagnosed the first case.
It was the illness of a 9-month-old girl in Ratodero that led to the discovery of the infections. In November, Syed Nazeer Hussain Shah sought treatment for his daughter’s diarrhea and fever from Dr. Ghangro.
But her condition worsened over the next few months, according to Mr. Shah, who continued seeing Dr. Ghangro. The infant developed blisters in her mouth, suffered chest pains and pneumonia and dramatically lost weight. “She became so weak that her veins jutted out,” said Mr. Shah.
Police last month arrested a local pediatrician, Muzaffar Ghangro, and said the virus spread when his clinic reused infected syringes. A lawyer for Mr. Ghangro says he isn’t guilty. PHOTO:RIZWAN TABASSUM/AGENCE FRANCE-PRESSE/GETTY IMAGES
In February, he approached Dr. Arbani, a local urologist. Dr. Arbani wasn’t a pediatrician, but he was a friend, and had some renown for his role in setting a Guinness World Record, having extracted the heaviest kidney stone from a patient in 2008.
“So many prescriptions, so many medicines—I couldn’t understand why nothing worked,” Dr. Arbani said.
Dr. Arbani suspected an immunodeficiency and ordered an HIV test. The result came back positive.
Mr. Shah said it was impossible because no one in the family had HIV. He traveled 300 miles to Karachi to have his daughter, now 16 months old, tested again at Aga Khan University Hospital. The result, in March, confirmed the diagnosis.
Within weeks, as word of the diagnosis spread in Ratodero, parents whose children showed similar symptoms began pouring into Dr. Arbani’s clinic. More than a dozen children tested HIV positive, the doctor said. A local television reporter broke the news of the infections after a relative’s son, who Dr. Arbani had diagnosed as positive, died.
As news of Dr. Arbani’s findings spread, officials set up testing centers across the town.
“You had hundreds of panicked, distressed parents rushing at the gate,” said Fatima Mir, a pediatrician at Aga Khan who was present when the screenings began and is helping the government to administer care. “There was so much misinformation. The one thing everyone was saying was that HIV kills.”
Gulbahar Shaikh, a journalist in Ratodero, also reported the outbreak—his 2-year-old daughter tested positive at the government screening. The girl had sought treatment from Dr. Ghangro for a chest infection that wasn’t improving, Mr. Shaikh said. Like Mr. Shah, he decided to take her to Aga Khan, selling his wife’s jewelry for $650 so he could pay for treatment.
Pakistani villagers pushed to enter a hospital for HIV testing in a village near Ratodero on May 16.PHOTO: FAREED KHAN/ASSOCIATED PRESS
The daughters of Mr. Shaikh and Mr. Shah have responded well to treatment.
For the mostly poor residents of the district where Ratodero is based, there is no treatment center for children. The government plans to open one this month, said Mr. Memon, the AIDS-control official.
Pakistan doesn’t have enough antiretroviral drugs to address the sudden increase in cases, said Mr. Memon. Supplies are expected to arrive from India in the coming days, he said. The WHO and other international organizations have pledged funds for medicines until next year, after which the government is expected to foot the bill.
Dr. Mir said the long-term challenge is making sure children adhere to antiretrovirals, whose course would run for life.
“We’re in it now with our sleeves rolled up,” she said. “If we don’t take serious action and create sustainable strategy now, we’ll be in much deeper trouble a few years later.”
Parents who are getting their children tested are getting screened, too, though the number of adults infected is low. Those infected face the risk of being ostracized, social workers say.
In a nearby village called Wazir Rind, a 28-year-old mother of four was diagnosed as HIV positive, said Waheed Mangi, a police officer in the area. Her husband asked her to leave and go live with her parents. She refused. A day later, she was found strangled to death, according to Mr. Mangi. Police arrested her husband suspecting him of murder. It couldn’t be determined if he had been charged.
Over six weeks of testing, more than 600 children in the town, most of them between 2 and 5 years old, tested positive for the virus that causes AIDS, while nearly all their parents tested negative. Authorities have begun screening people in nearby towns, and the number of cases is expected to rise.
Test ResultsOf over 26,000 people screened recently forHIV in Ratodero, 2.8% tested positive, many ofthem small children.Recent HIV cases, by ageSource: Directorate General Health Services SindhHyderabadNote: Cases screened from April 25-June 4
57419135117200-1 years2-5 years6-15 years15-45 yearsOver 45years
Before the tests, just over 1,000 children were registered as HIV positive in the entire country, the WHO said. Those earlier cases were a mix of mother-child transmission and blood transfusions and many involved high-risk groups such as the children of sex workers.
A WHO-led delegation is investigating the cause of the outbreak in the town of 330,000 people and expected to present its findings on Friday. “We cannot say for sure what caused it,” said Maryam Yunus, a WHO spokeswoman in Pakistan.
Babies who tested positive for HIV were admitted for treatment at a hospital in Ratodero. PHOTO: PPI/ZUMA PRESS
Police last month arrested a local pediatrician, Muzaffar Ghangro, and said the virus spread when his clinic in Ratodero reused infected syringes. Dr. Ghangro, one of few licensed physicians in the town, has been charged with unintentionally causing deaths, said his lawyer, who said his client isn’t guilty.
Organizations that are part of the WHO-led delegation expressed doubt that a single doctor could be responsible for all the newly discovered cases. The crisis, they said, exposes Pakistan’s weak health-care system and raises questions about how widespread the problem could be.
Pakistan has one of the world’s lowest rates of health-care spending as a proportion of gross domestic product. It is outspent by countries such as Afghanistan and Iraq, among others, World Bank figures show.
Care GapPakistan has one of the world’s lowest ratesof health-care spending.Current health expenditure (% of GDP)Source: World Bank
%U.S.ChinaIndiaPakistanBangladesh2000’05’10’15024681012141618
With private health care out of reach for many in Pakistan and few government facilities available for children, people typically seek treatment from unlicensed professionals at inexpensive local clinics. Policing of these unqualified providers is spotty.
Health authorities in Sindh, a province of roughly 48 million people that includes Ratodero, shut down over 500 clinics run by unlicensed doctors after the outbreak surfaced, said Sikander Memon, the head of the province’s AIDS control program. More than 170 of the clinics were in the district where Ratodero is located, he said, adding that authorities also closed three unregistered blood banks in the district.
“Many clinics don’t follow proper sterilization processes, they don’t dispose of syringes, they reuse IV drips,” said Eamonn Murphy, the regional director in Asia for UNAIDS, which is part of the WHO delegation to Pakistan.
Malnutrition, dehydration and diarrhea are common among children in Ratodero, and drips are used to administer treatment.
Clinics also rampantly overuse syringes, health experts said. “We find in developing countries that if people go to a medical practitioner for a problem and don’t get an injection, they feel like they haven’t received a proper service,” Mr. Murphy said.
Out of the more than 26,000 people who volunteered for HIV screening in Ratodero, 761 had tested positive as of Saturday, Mr. Memon said. Of the infected, 623 were children and most under 5.
Doctors are assessing how many of the cases were new infections and how many had gone undetected because of a lack of awareness and screening.
“It’s just the tip of the iceberg. I suspect infections are in the thousands, not hundreds,” said Imran Akbar Arbani, the doctor who diagnosed the first case.
It was the illness of a 9-month-old girl in Ratodero that led to the discovery of the infections. In November, Syed Nazeer Hussain Shah sought treatment for his daughter’s diarrhea and fever from Dr. Ghangro.
But her condition worsened over the next few months, according to Mr. Shah, who continued seeing Dr. Ghangro. The infant developed blisters in her mouth, suffered chest pains and pneumonia and dramatically lost weight. “She became so weak that her veins jutted out,” said Mr. Shah.
Police last month arrested a local pediatrician, Muzaffar Ghangro, and said the virus spread when his clinic reused infected syringes. A lawyer for Mr. Ghangro says he isn’t guilty. PHOTO:RIZWAN TABASSUM/AGENCE FRANCE-PRESSE/GETTY IMAGES
In February, he approached Dr. Arbani, a local urologist. Dr. Arbani wasn’t a pediatrician, but he was a friend, and had some renown for his role in setting a Guinness World Record, having extracted the heaviest kidney stone from a patient in 2008.
“So many prescriptions, so many medicines—I couldn’t understand why nothing worked,” Dr. Arbani said.
Dr. Arbani suspected an immunodeficiency and ordered an HIV test. The result came back positive.
Mr. Shah said it was impossible because no one in the family had HIV. He traveled 300 miles to Karachi to have his daughter, now 16 months old, tested again at Aga Khan University Hospital. The result, in March, confirmed the diagnosis.
Within weeks, as word of the diagnosis spread in Ratodero, parents whose children showed similar symptoms began pouring into Dr. Arbani’s clinic. More than a dozen children tested HIV positive, the doctor said. A local television reporter broke the news of the infections after a relative’s son, who Dr. Arbani had diagnosed as positive, died.
As news of Dr. Arbani’s findings spread, officials set up testing centers across the town.
“You had hundreds of panicked, distressed parents rushing at the gate,” said Fatima Mir, a pediatrician at Aga Khan who was present when the screenings began and is helping the government to administer care. “There was so much misinformation. The one thing everyone was saying was that HIV kills.”
Gulbahar Shaikh, a journalist in Ratodero, also reported the outbreak—his 2-year-old daughter tested positive at the government screening. The girl had sought treatment from Dr. Ghangro for a chest infection that wasn’t improving, Mr. Shaikh said. Like Mr. Shah, he decided to take her to Aga Khan, selling his wife’s jewelry for $650 so he could pay for treatment.
Pakistani villagers pushed to enter a hospital for HIV testing in a village near Ratodero on May 16.PHOTO: FAREED KHAN/ASSOCIATED PRESS
The daughters of Mr. Shaikh and Mr. Shah have responded well to treatment.
For the mostly poor residents of the district where Ratodero is based, there is no treatment center for children. The government plans to open one this month, said Mr. Memon, the AIDS-control official.
Pakistan doesn’t have enough antiretroviral drugs to address the sudden increase in cases, said Mr. Memon. Supplies are expected to arrive from India in the coming days, he said. The WHO and other international organizations have pledged funds for medicines until next year, after which the government is expected to foot the bill.
Dr. Mir said the long-term challenge is making sure children adhere to antiretrovirals, whose course would run for life.
“We’re in it now with our sleeves rolled up,” she said. “If we don’t take serious action and create sustainable strategy now, we’ll be in much deeper trouble a few years later.”
Parents who are getting their children tested are getting screened, too, though the number of adults infected is low. Those infected face the risk of being ostracized, social workers say.
In a nearby village called Wazir Rind, a 28-year-old mother of four was diagnosed as HIV positive, said Waheed Mangi, a police officer in the area. Her husband asked her to leave and go live with her parents. She refused. A day later, she was found strangled to death, according to Mr. Mangi. Police arrested her husband suspecting him of murder. It couldn’t be determined if he had been charged.
