Molyneux D.,Center for Neglected Tropical Diseases |
Hallaj Z.,WHO EMRO Eastern Mediterranean Regional Office Consultant |
Keusch G.T.,Boston University |
McManus D.P.,Queensland Institute of Medical Research |
And 14 more authors.
Parasites and Vectors | Year: 2011
Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock. © 2011 Molyneux et al; licensee BioMed Central Ltd.
Das D.,West Bengal Pollution Control Board |
Das D.,City Center |
Sengupta P.P.,National Institute of Technology Durgapur
Environment, Development and Sustainability | Year: 2011
The developing countries i.e., the non-Annex-I countries (parties to the Kyoto Protocol but not responsible to any reduction target yet) in the Kyoto Protocol whose economies are in transition are also allowed to reduce GHG emissions. Among these, the countries that have accepted the Kyoto Protocol may be benefited from CDM projects to promote sustainable development. The developed countries i.e., the Annex-I countries (that have signed the Kyoto Protocol & are responsible to have specific GHG emission reduction target) or the investing countries, in return, have privilege to purchase CER credits (in units equivalent to one tonne of CO2 gas emission reduction) to meet the emission target as specified in the Kyoto Protocol. The key step in understanding about CDM is to grasp the concept of "baseline" and "additionality". The "Baseline" is the emissions level that would have existed if a CDM project had not happened. The feature of an approved CDM project is that the planned reductions would not occur without the additional incentive provided by emission reduction credits; this concept is known as "Additionality". According to environmental additionality concept, baseline emission minus project emission is equal to emissions reduction. "Investment Additionality," ultimately rejected during negotiation of the "Marrakech Accords" and "Financial Additionality," are the two important concepts. The concept of trading of CER matches to the idea of Pigovian tax (equal to the negative externality and which is considered one of the "traditional" means of bringing a modicum of market forces) in Economics, making pollution more costly to the polluter, as the polluters have negative cost since they save money by polluting; hence, there are supposed negative externalities associated with the market activity. Economic theory predicts that in an economy where the cost of reaching mutual agreement between parties is high and where pollution is diffuse, Pigovian tax will be an efficient way to promote the public interest and will lead to an improvement of the quality of life measured by the Genuine Progress Indicator and other human economic indicators, as well as higher gross domestic product growth. We can seek a level of pollution such that the marginal savings (MS) to one polluting unit from pollution (-MC) is equal to marginal damage (MD) from pollution over the entire population, since pollution is a public bad i.e., MS (x*) = ∑MDi (x*) where ∑Di (x) is the total damage. Though the responsibility of reduction in emission does not lie on the non-Annex-I countries, still effort of maintaining global emission balance can be expected equally from developed and developing countries. The responsibilities of Kyoto Protocol are (a) to reduce global GHG emissions, (b) to bring about sustainable development in the developing countries lie on above two groups since its effect on February 16, 2005. Different polluters have different costs of pollution control. The least costly way of controlling pollution from various sources that reflects different costs of pollution control making the set of environmental regulations to achieve the emission target at the lowest cost makes the regulation cost-effective. Though efficiency is not attainable for many regulations, cost-effectiveness is attainable. © 2011 Springer Science+Business Media B.V.
Msyamboza K.P.,World Health Organization |
Msyamboza K.P.,City Center |
Phiri T.,Ministry of Health |
Sichali W.,Mzimba North District Hospital Office |
And 2 more authors.
BMC Public Health | Year: 2016
Background: Malawi has the highest cervical cancer incidence and mortality in the world with age-standardized rate (ASR) of 75.9 and 49.8 per 100,000 population respectively. In response, Ministry of Health established a cervical cancer screening programme using visual inspection with acetic acid (VIA) and treatment of precancerous lesions with cryotherapy. This paper highlights the roll out, integration with family planning services and HIV ART Programme, uptake and challenges of VIA and Cryotherapy programme. Methods: We analyzed program data, supportive supervision, quarterly and annual reports from the National Cervical Cancer Control Program. We evaluated the uptake and challenges of screening services by age, HIV serostatus and trends over a five year period (2011-2015). Results: Between 2011 and 2015, number of cervical cancer screening sites, number of women screened and coverage per annum increased from 75 to 130, 15,331 to 49,301 and 9.3 % to 26.5 % respectively. In this five year period, a total of 145,015 women were screened. Of these, 7,349 (5.1 %) and 6,289 (4.3 %) were VIA positive and suspect cancer respectively. Overall 13,638 (9.4 %) were detected to be VIA positive or had suspect cancer. Of the 48,588 women with known age screened in 2015; 13,642 (28.1 %), 27,275 (56.1 %) and 7,671 (15.8 %) were aged 29 or less, 30-45, 46 years or more. Among 39,101 women with data on HIV serostatus; 21,546 (55.1 %) were HIV negative, 6,209 (15.9 %) were HIV positive and 11, 346 (29.0 %) status was unknown. VIA positivity rate and prevalence of suspect cancer were significantly higher in HIV positive than HIV negative women (8.8 % vs 5.0 %, 6.4 % vs 3.0 %); in women aged 30-45 years than women aged 29 years or less (5.6 % vs 2.3 %, 2.6 % vs 1.2 %) respectively, all p <0.05). The main challenge of the programme was failure to treat VIA positive women eligible for cryotherapy. Over the five year period, the programme only treated 1,001 (43.3 %) out of 2,311 eligible women and only 266 (31.8 %) of the 836 women with large lesion or suspect cancer who were referred, received the health care at the referral centre. The reasons for failure to provide cryotherapy treatment were stock out of gas, faulty/broken cryotherapy machine (usually connectors or probes) or no cryotherapy machine at all in the whole district. For women with large lesion or suspect cancer; lack of loop electrosurgical excision procedure (LEEP) machine or inadequate gynaecologists at the referral centre, were the major reasons. Cancer radiotherapy services were not available in Malawi. Conclusions: This study provided data on VIA positivity rate, prevalence of suspect cancer, failure rate of cryotherapy and challenges in the provision of cryotherapy and LEEP treatment in Malawi. These data could be used as baseline for monitoring and evaluation of Human Papillomavirus (HPV) vaccination programme which the country introduced in 2013, the linkage of cervical cancer screening and women on HIV ART and the long term effect of ART, voluntary male medical circumcision on the prevalence and incidence of cervical cancer. © 2016 The Author(s).
Msyamboza K.P.,World Health Organisation |
Msyamboza K.P.,City Center |
Mawaya L.R.,Ministry of Health |
Kubwalo H.W.,World Health Organisation |
And 5 more authors.
BMC International Health and Human Rights | Year: 2012
Background: Although leprosy was eliminated globally in 2000, the disease continues to be the significant cause of peripheral neuropathy, disability and disfigurement in some developing countries. However, recent population-based prevalence data are lacking to inform evidence-based renewed commitment for the final push for leprosy elimination at national and sub-national levels. Methods. Community camp-based cross-sectional descriptive study was conducted in four selected districts. World Health Organisation guidelines and tools for leprosy elimination monitoring were used to evaluate the Malawi National Leprosy Programme. Results: A total of 6,338 people (60% females, 35% children aged less than 15years) were examined for leprosy and other skin diseases. Prevalence of skin diseases was 18%, the commonest being fungal (9%), eczema/dermatitis (3%) and leprosy (1%). Of the fungal skin conditions, pityriasis versicolor and Tinea capatis were the commonest (22% and 21% respectively) then Tinea corporis (9%), Tinea cruris (6%) and Tinea pedis (2%). A total of 66 leprosy cases were detected out of 6,338 people screened giving a prevalence of 104.1 per 10,000 population (range by district 67.1 to 194.1). Of the leprosy cases, 37 were new, 6 were defaulters and 23 were on treatment, 30 were females and 9 were children aged less than 15years old. Of the 37 new leprosy cases, 9 (24.3%) were children, 25 (67.6%) had 1-5 leprosy lesions and 8 (21.6%) had grade 2 disability. The most frequent location of leprosy lesions was the head and neck (24.1%), arms (24.1%), chest (17.2%), legs (13.8%), back (13.8%) and abdomen (7.0%). Between 2006 and 2011, trends of leprosy prevalence and detection increased, prevalence/detection ratios were over 1 and cure rates by cohort analysis of 2009 multibacillary and 2010 paucibacillary cases were 33% and 63% respectively far below the expected 80% although the national prevalence remained at less than 1 case per 10,000 population. Conclusion: Leprosy was still an important public health problem in Malawi. Improving knowledge and skills of health workers, registration and recording of data, contact tracing, decentralisation and integration of treatment to health centres and introduction of leprosy awareness days and community-based surveillance could help to improve early detection, treatment, case holding and prevention of disabilities. © 2012 Msyamboza et al.; licensee BioMed Central Ltd.
Msyamboza K.P.,World Health Organisation |
Msyamboza K.P.,City Center |
Dzamalala C.,University of Malawi |
Mdokwe C.,Ministry of Health |
And 4 more authors.
BMC Research Notes | Year: 2012
Background: Cancer is a leading cause of morbidity and mortality worldwide with a majority of cases and deaths occurring in developing countries. While cancer of the lung, breast, colorectum, stomach and prostate are the most common types of cancer globally, in east and southern Africa these are less common and comprehensive data to inform policies are lacking. Methods. Nationwide cancer registry was conducted between September and October 2010 in Malawi. New cancer cases registered from 2007 to 2010 were identified from hospital and clinic registers of 81 out of 84 health facilities providing cancer diagnosis, treatment or palliative care services. Demographic and cancer data were extracted from registers and case notes using a standard form. Results: A total of 18,946 new cases of cancer were registered in Malawi from 2007-2010. Of these 55.9% were females, 7.2% were children aged less than 15 years, 76.5% were adults aged 15-59 years and 16.4% were elderly aged 60 years or more. Only 17.9% of the cases had histologically verified diagnosis, 33.2% were diagnosed clinically and 49.6% based on clinical and some investigations. Amongst females, cancer of the cervix was the commonest accounting for 45.4% of all cases followed by Kaposi sarcoma (21.1%), cancer of the oesophagus (8.2%), breast (4.6%) and non-Hodgkin lymphoma (4.1%). In males, Kaposi sarcoma was the most frequent (50.7%) then cancer of oesophagus (16.9%), non-Hodgkin lymphoma (7.8), prostate (4.0%) and urinary bladder (3.7%). Age-standardised incidence rate per 100,000 population for all types of cancer in males increased from 31 in 1999-2002 to 56 in 2007-2010. In females it increased from 29 to 69. Kaposi sarcoma and cancer of the oesophagus, cervical cancer and Kaposi sarcoma were the main causes for the increased incidence in males and females respectively. It was estimated that, annually at least 8,151 new cases of cancer (all types) occur in Malawi. Conclusions: This study provided data on common types and trends of cancer that could be used to focus prevention, treatment and control interventions in the context of limited resources. The problem of under-reporting and misdiagnosis of cancer cases has been highlighted. © 2010 Msyamboza et al; licensee BioMed Central Ltd.
Kissin D.M.,Centers for Disease Control and Prevention |
Mandel M.G.,Centers for Disease Control and Prevention |
Akatova N.,City Center |
Belyakov N.A.,City Center |
And 9 more authors.
BMC Infectious Diseases | Year: 2011
Background: The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.Methods: Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ2or Cochran-Armitage tests.Results: Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs) decreased from 62% in 2004 to 41% in 2008 (P < 0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all P < 0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (P < 0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (P for trend <0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged.Conclusions: Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy. © 2011 Kissin et al; licensee BioMed Central Ltd.
Msyamboza K.P.,City Center |
Msyamboza K.P.,University of Malawi |
Mvula C.J.,Ministry of Health |
Kathyola D.,Ministry of Health
BMC Endocrine Disorders | Year: 2014
Background: Previously considered as a disease of the affluent, west or urban people and not of public health importance, diabetes mellitus is increasingly becoming a significant cause of morbidity and mortality in sub-Saharan Africa. However, population-based data to inform prevention, treatment and control are lacking. Methods: Using the WHO STEPwise approach to chronic disease risk factor surveillance, a population-based, nationwide cross-sectional survey was conducted between July and September 2009 on participants aged 25-64 years. A multi-stage cluster sample design and weighting were used to produce a national representative data for that age range. Detailed findings on the magnitude of diabetes mellitus and impaired fasting blood glucose are presented in this paper.Results: Fasting blood glucose measurement was conducted on 3056 participants (70.2% females, 87.9% from rural areas). The age- sex standardised population-based mean fasting blood glucose was 4.3 mmol/L (95% CI 4.1-4.4 mmol/L) with no significant differences by age, sex and location (urban/rural). The overall prevalence of impaired fasting blood glucose was 4.2% (95% CI 3.0%-5.4%). Prevalence of impaired blood glucose was higher in men than in women, 5.7% (95% CI 3.9%-7.5%) vs 2.7% (95% CI 1.6%- 3.8%), p < 0.01. In both men and women, prevalence of raised fasting blood glucose or currently on medication for diabetes was 5.6% (95% CI 2.6%- 8.5%). Although the prevalence of diabetes was higher in men than women, 6.5% (95% CI 2.6%-10.3%) vs 4.7% (95% CI 2.4%-7.0%), in rural than urban, 5.4% (95% CI 2.4%-8.4%) vs 4.4% (95% CI 2.8%-5.9%) and in males in rural than males in urban, 6.9% (95% CI 2.8%-11.0%) vs 3.2% (95% CI 0.1%-6.3%), the differences were not statistically significant, p > 0.05. Compared to previous estimates, prevalence of diabetes increased from <1.0% in 1960s to 5.6% in 2009 (this study).Conclusion: High prevalence of impaired fasting blood glucose and diabetes mellitus call for the implementation of primary healthcare approaches such as the WHO package for essential non-communicable diseases to promote healthy lifestyles, early detection, treatment and control. © 2014 Msyamboza et al.; licensee BioMed Central Ltd.
Madhivanan S.,Aarupadai Veedu Medical College & Hospital AVMCH |
Jain R.K.,Aarupadai Veedu Medical College & Hospital AVMCH |
Jain R.K.,City Center
Indian Journal of Surgery | Year: 2016
A previously healthy 40-year-old woman presented with a right groin swelling for the last 2 years. Diagnosed preoperatively as uncomplicated, irreducible epiplocele of right femoral hernia, later per-operatively was diagnosed as hydrocele of femoral hernial sac also known as “femorocele”; ultrasound abdomen and groin demonstrated as a cystic mass right groin with no precise origin. All other basic line investigations within normal limits, except anemia 7 gm %, corrected to 10 gm %, by preoperative transfusions of 2 units of complete fresh blood. After low approach incision, excision of hydrocele sac, and feormal hernia repair were done with approximation of iliopectineal ligament to inguinal ligament, patient was discharged on 5th postoperative day with satisfactory wound healing and uneventful hospitalization. © 2015, Association of Surgeons of India.
Pandey S.,University of Burdwan |
Barai P.K.,City Center |
Maiti T.K.,University of Burdwan
Journal of Environmental Biology | Year: 2013
Three bacterial strains, a cadmium resistant Ochrobactrum sp. designated as CdSP9 and two strains of Bacillus sp. named PbSP6 and AsSP9 resistant to lead and arsenate, respectively were characterized here with respect to their oxidative enzyme activities. The bacterial strains were grown in basal medium supplemented with 50 ug ml-1 of respective elements to determine the changes in the level of oxidative enzymes. The superoxide dismutase activity increased in all three isolates, but the catalase activity and malondialdehyde concentration were relatively more in CdSP9 than PbSP6 and AsSP9. The glutathione peroxidase, however, remained almost uninduced in CdSP9 but was enhanced in PbSP6 and AsSP9. A possible role of these enzymes in metal tolerance is evident from these results. © Triveni Enterprises, Lucknow (India).
PubMed | University of Burdwan and City Center
Type: Journal Article | Journal: Journal of environmental biology | Year: 2014
Three bacterial strains, a cadmium resistant Ochrobactrum sp. designated as CdSP9 and two strains of Bacillus sp. named PbSP6 and AsSP9 resistant to lead and arsenate, respectively were characterized here with respect to their oxidative enzyme activities. The bacterial strains were grown in basal medium supplemented with 50 microg ml(-1) of respective elements to determine the changes in the level of oxidative enzymes. The superoxide dismutase activity increased in all three isolates, but the catalase activity and malondialdehyde concentration were relatively more in CdSP9 than PbSP6 and AsSP9. The glutathione peroxidase, however, remained almost uninduced in CdSP9 but was enhanced in PbSP6 and AsSP9. A possible role of these enzymes in metal tolerance is evident from these results.