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Limiting the spread of antibiotic resistance in India: overuse, underuse, or lack of access to life-saving drugs

September 30, 2011 Leave a comment

DR. RAMANAN LAXMINARAYAN
Earlier this month, a meeting of health ministers representing the member states of the World Health Organization’s South-East Asia Region recognized antimicrobial resistance as a major global health issue. The Jaipur Declaration issued on 6 September 2011 is an important step forward in coordinating a global response to the problem of antibiotic resistance, or the ability of bacteria to withstand antibiotic treatments. Importantly, it sets the tone and serves a model for other countries to follow.

We already have evidence of the effects of antibiotic resistance in India. A 2009 World Health Organization study found that 58.7 percent of pathogenic E.coli samples in Delhi were resistant to the common antibiotic ciprofloxacin1. In intensive care units in India, the rate of vancomycin-resistant enterococcus (VRE), a hospital acquired infection, is five times the world average.

Why does it matter? When treatment with first-line antibiotics fails, patients have to turn to more powerful, more expensive drugs. In addition, sometimes these drugs fail, too. Antibiotic resistance leads to higher treatment costs, longer hospital stays, and in some cases, death. For example, our rough estimate is that 119,000 of the one million children who die each year in India within the first four weeks of life die from sepsis, or a bacterial infection that overwhelms the blood stream. Of these sepsis deaths, over 30% are attributable to antibiotic resistance.

Resistance is driven by antibiotic use, and antibiotic overuse speeds its development. In India, we see numerous examples of such overuse. India is behind many other countries in regulating the use of antibiotics in livestock, as there are currently no laws prohibiting the use of antibiotics in food animals. Additionally, people often take antibiotics when they are not needed. Between 45 and 80 percent (depending on where they live and the type of practitioner they visit) of patients in India with symptoms of acute respiratory infections and diarrhoea are likely to receive an antibiotic, even though it will not be effective if they have a viral illness.

But, it is important to recognize that India is not only facing a situation of antibiotic overuse – there is also, paradoxically, evidence of underuse, or lack of access to life-saving drugs. In India, bacterial pneumonia is responsible for an estimated 410,000 deaths each year and is the number one killer of children. In developing countries, antibiotic resistance restricts access to treatment, as more expensive, second-line drugs may be out of reach for the poorest of the population. In a country where eighty percent of healthcare expenditures are borne out-of-pocket and a large proportion of these costs are related to pharmaceutical purchases, higher antibiotic costs are a serious problem.

The kinds of challenges facing the developing world inspired the creation of the Global Antibiotic Resistance Partnership (GARP), hosted at the Center for Disease Dynamics, Economics & Policy (CDDEP). GARP working groups develop actionable policy solutions in low-resource settings to address antibiotic resistance while expanding access to treatment to those who currently are not reached.

Research conducted by the GARP-India working group shows that there is much that India can do to address antibiotic resistance. Recommendations include limiting the use of antibiotics in livestock, strengthening hospital infection control, and educating health practitioners and the public about the dangers of antibiotic misuse. The findings of GARP working groups from India, Kenya, South Africa, and Vietnam will be presented at the 1st Global Forum on Bacterial Infections, 3-5 October, at the India Habitat Centre, New Delhi.

The Jaipur Declaration is a promising acknowledgment of antimicrobial resistance as a serious public health issue. But the problem will continue to grow, rapidly, if we don’t build on this first step. Now is the time to adopt meaningful policies within India to preserve life-saving drugs and reduce the burden of bacterial illnesses. … Read More

via Limiting the spread of antibiotic resistance in India

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Indian cities experiencing ‘acute’ respiratory problems: WHO

September 27, 2011 Leave a comment

Cities in India and China drowned in a sea of automobiles are experiencing maximum health issues, like “acute” as well as “chronic” respiratory problems and lung cancers, due to air pollution, a United Nations body has said.

The rising population of SUVs (sports utility vehicles), cars and two-wheelers in Indian cities where it is a status symbol for middle classes to posses the latest automobiles are having a deathly impact on people, the global body said.

The World Health Organisation (WHO) estimates that around 1.34 million premature deaths from respiratory diseases and cancers were caused due to polluted air in 2008.

Rapidly industrialising cities in China, India, and other growing developing countries are the epicentre for the lung diseases.

“If the WHO guidelines had been universally met, an estimated 1.09 million deaths could have been prevented in 2008,” said Maria Neira, WHO Director for Public Health and Environment.

In its latest report, data on air quality data was compiled from 1,100 cities across 91 countries. It did not rank cities according to the highest pollution.

The report said categorically that countries which are experiencing maximum growth and industrialisation, particularly “China and India,” are experiencing the maximum health problems due to polluted air.

“Yes, cities in India and China are facing air pollution that is threatening public health,” said Ms. Neira. “Lack of clean air is causing ‘acute’ as well as ‘chronic’ respiratory problems in these countries,” she said, arguing that these countries would experience highest number of heart, lung, cancer and asthma and acute lower respiratory infections if the air quality is not improved on a war footing.

“The largest contributions to urban outdoor air pollution include motor transport, small scale manufacturers and other industries, burning biomass and coal for cooking and heating, as well as coal-fired power plants.”

“PM10 particles, which are particles of 10 micrometres or less, which can penetrate into the lungs and may enter the bloodstream, can cause heart disease, lung cancer, asthma, and acute lower respiratory infections,” said Ms. Neira, adding that there is a growing need for public awareness.

Most of the cities compiled in the WHO’s report have breached the global health body’s air quality guidelines for PM10 which is 20 micrograms per cubic metre as an annual average.

But cities in China and India should average PM10 to the order of 300 micrograms per cubic meter. There is growing awareness of the problem in both China and India, said Carlos Dora, WHO co-ordinator for interventions for Health Environments. … Read More

via The Hindu

BRMS, 3.5-yr rural medical study not mini-MBBS degree

September 27, 2011 1 comment

The planning commission has backed the Bachelor of Rural Medicine and Surgery degree but clarified that it was not a mini-MBBS but rather a unique training programme aimed at the basic healthcare needs of its target population.

According to the Union health ministry, vulnerable populations in rural, tribal and hilly areas are extremely underserved. In 2006, only 26% of doctors in India resided in rural areas, serving 72% of India’s population. Another study found the urban density of doctors is nearly four times that in rural areas, and that of nurses also three times higher.

As of March 2010, undue delays in recruitments resulted in high vacancies even in available posts at health centres—over 34% of male health workers are not in position, while 38% of radiographer posts, 16% of laboratory technician posts, 31% of specialist posts, 20% of pharmacist posts, 17% of ANM and 10% of doctor posts are vacant.

Overall, human resources in health shortfalls range from 63% for specialists to 10% for allopathic doctors. The past few decades have also seen the disappearance of certain cadres-—village health guides and traditional birth attendants, first instituted in 1986. “They have now decreased to a point of nonexistence,” the report said.

The panel said, “The BRMS degree should be linked to state health sciences universities. BRMS students should be taught in local settings where they live and work and the faculty should be drawn both from existing teaching institutions and retired teachers. The faculty should include non-physician specialists from the fields of public health and social sciences.” … Read More

via BRMS not mini-MBBS degree

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A doctor’s touch: a powerful, old-fashioned tool

September 26, 2011 Leave a comment

Abraham Verghese: A doctor’s touch, a powerful, old-fashioned tool
Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.

Categories: health, News, Opinion

Theme for 2011 Voluntary Blood Donation Day, “SAVE FOUR UNKNOWN LIVES”

September 25, 2011 1 comment

“Blood donation is the greratest gift to mankind. Without much efforts, one can save four unknown people with the little gift one shares from one’s body. One unit of blood having four different components of Red Blood Cells, White Blood Cells, Platelets and Plasma can save four different people who are in need of these components. So, this year’s theme for Voluntary Blood Donation Day which falls on 1st October 2011 is “Donate Blood, Save Four Lives” – Writes Seram Neken
A blood donor has to meet the following criteria:
(as per Drugs and Cosmetics Act. 1940)
Age: between 18 to 60 years.
Body weight: 45 kg and above.
Pulse rate: 60 to 100 per minute and regular
Blood Pressure: Systolic 100 to 140, Diastolic 70 to 100.
Hemoglobin: minimum 12.5gm/100ml of blood.
Oral temperature: not exceeding 37.50C.
There are also persons who should not donate blood. They are those:
who are feeling unwell.
who are anaemic.
who are either pregnant or breast-feeding.
who have heart disease, high or low blood pressure, epilepsy, diabetes.
who are taking anti-biotics
who are immunized with live vaccines.
who are being treated for Malaria during last 3 months.
who received blood during the preceding 3 months.
who had major operations during last 6 months. … Read More

via SAVE FOUR UNKNOWN LIVES

Recruitment of Medical Officers and Dental Surgeons in Department of Health, Manipur Health Services

September 25, 2011 1 comment

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World Alzheimer’s Day 2011

September 22, 2011 Leave a comment

Every year 21st September is observed as World Alzheimer’s Day. Year 2011’s theme is “FACES OF DEMENTIA”.

Alzheimer’s disease is the commonest type of dementia named after Alois Alzheimer, a German psychiatrist and neuro-pathologist who had first described the disease in the year 1906. Clinical presentation of Alzheimer’s disease is similar with other types of dementia.
“Our goal in the management of dementia is basically to enhance quality of life, by slowing down disease progression, maximising function, improving cognition, mood and behaviour.”
Read More

via The Sangai Express