Friday, April 27, 2012
Impatient Optimist: All women and men should have the power to plan for their lives and give their children the chance at a healthy and productive future.
All women and men should have the power to plan for their lives and give their children the chance at a healthy and productive future.
APRIL 26, 2012
The Case for Contraception on the Global Agenda
MELINDA GATES
April 26, 2012
I have learned a lot from following the reaction to the talk I gave at TedxChange two weeks ago. My talk was about the uncontroversial idea that all women and men should have the power to plan for their lives and give their children the chance at a healthy and productive future. One of the ways they can get that power is through access to birth control, and I tried to make the case for why the world should put birth control back on the global health agenda.
Because I’m so passionate about the issue, I’m excited to see so many people talking about it online. The more people talk, I think, the more they’ll realize how much agreement there is around the basic argument that birth control saves lives and helps families build a better future.
I believe in giving women the methods they want to use so they can do what’s best for themselves and their families.
In my talk, I spoke a little bit about my own Catholicism and how it fits in to my advocacy around this issue, since the Catholic Church officially prohibits the use of modern contraceptives. Many people have asked whether I support natural family planning methods like the rhythm method that the Church supports.
The answer is, unequivocally, yes. I support putting options and power in the hands of women and their husbands, period. While available evidence indicates that modern contraceptives—for example, pills, injectables, implants, and intrauterine devices—are more effective, I realize that there are families that are not comfortable using modern contraceptives for religious reasons or other matters of conscience. That is their right, I respect it deeply, and I believe they should have access to the most appropriate education and tools to follow through on their plans for their children.
The large majority of women do want to use modern contraceptives, and I also support giving them options that are right for them.
I believe in giving women the methods they want to use so they can do what’s best for themselves and their families. In some cases, that means natural family planning. In many cases, it means modern contraceptives. I hope we can agree that there really is no controversy around this idea.
DETAILS
CATEGORYHealth
TOPICSFamily Planning
TAGSContraception, TEDxChange
Monday, April 2, 2012
Malaria and Me - By Liam Fox
ELIZABETH JACKSON: Living in exotic places often means exposure to exotic illnesses.
Before setting out for Papua New Guinea Liam Fox was vaccinated for all kinds of diseases.
But there's no vaccination for malaria, only short-term preventative medication.
Liam had managed to avoid the disease for three years but sadly his luck finally ran out.
LIAM FOX: It was 2am and I was standing under a steaming hot shower but couldn't stop shaking with cold.
Several hours earlier a wave of fatigue had hit me like a bullet train.
Not long after that my whole body began to ache.
Shivering under the shower I thought something is really wrong here.
Sleep was impossible.
When the sun came up I said to my wife 'I think I've got malaria'.
A quick search on the internet confirmed the symptoms: shaking chills, tiredness and muscle aches.
While malaria is common throughout PNG, the risk of contracting the mosquito-borne disease in Port Moresby is thought to be low. Few residents take preventative medication.
The side effects of taking anti-malarials over an extended period of time can range from an upset stomach, to sensitivity to sunlight, to a severe neuropsychiatric reaction.
Some large multi-national companies require their workers to take the drugs and carry out tests to make sure they do.
But most expats are pretty blasé about it, me included, and most locals couldn't afford the drugs even if they wanted them.
Moresby's been home for three years and a few friends have had malaria in that time. But despite many, many mosquito bites I had avoided it, until now.
I hauled my aching body down to the local clinic and the friendly doctor said it looked to be a case of malaria and ordered a blood test.
It came back negative but the doctor said that wasn't unusual and could be because I was in between attacks.
The more likely cause of the negative result he said was because the lab technician examining my blood sample wasn't paying close attention.
He diagnosed malaria, prescribed me two kinds of drugs and sent me on my way.
The shaking chills didn't return and the aches soon went away, but the intense fatigue persisted for several days.
Despite the initial sickness I was pretty lucky. I had quick access to medical care and the money to pay for it.
It's a different story for most Papua New Guineans, who live outside the major cities and towns where health care is rudimentary at best, non-existent at worst.
According to the World Health Organisation nearly 10 per cent of all children who died before reaching the age of five in PNG were lost to malaria.
There has been some promising news in the fight against the disease recently.
Last week Australian researchers announced a PNG trial of a new drug cut rates of infant malaria by 30 per cent.
But the disease remains a fact of life, and death here, and will do for some time.
And it could still be factor in my life as well. People who've been infected with can have additional attacks after months, even years without symptoms.
That's because the parasites that cause the disease can remain dormant in a person's liver.
So even when I return to Australia, I could bring a little piece of PNG with me.
This is Liam Fox in Port Moresby for Correspondents Report.
Severe imported malaria in an intensive care unit: a review of 59 cases
Severe imported malaria in an intensive care unit: a review of 59 cases
Research
Lurdes C Santos, Candida F Abreu, Sandra M Xerinda, Margarida Tavares, Raquel Lucas and Antonio C Sarmento
For all author emails, please log on.
Malaria Journal 2012, 11:96 doi:10.1186/1475-2875-11-96
Published: 29 March 2012
Abstract (provisional)
Background
In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU).
Methods
Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011) and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS), malaria score for adults (MSA), simplified acute physiology score (SAPSII) and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12.
Results
Fifty nine patients were included in the study, all but three were adults; 47 (79,6%) were male; parasitaemia on admission, quantified in 48/59 (81.3%) patients, was equal or greater than 2% in 47 of them (97.9%); the most common complications were thrombocytopaenia in 54 (91.5%) patients, associated with disseminated intravascular coagulation (DIC) in seven (11.8%), renal failure in 31 (52.5%) patients, 18 of which (30.5%) oliguric, shock in 29 (49.1%) patients, liver dysfunction in 27 (45.7%) patients, acidaemia in 23 (38.9%) patients, cerebral dysfunction in 22 (37.2%) patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2%) patients, hypoglycaemia in 18 (30.5%) patients; 29 (49.1%) patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were not associated with death in this cohort.
Conclusion
Severe malaria cases should be continued monitored in the ICUs. SAPS II and the WHO score are good predictors of mortality in malaria patients, but other specific scores deserve to be studied prospectively.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Monday, September 5, 2011
New Discovery Gives Hope For Malaria Treatment and Vaccines
An investigation into the mysterious inner workings of the malaria parasite has revealed that it survives and proliferates in the human bloodstream thanks in part to a single, crucial chemical that the parasite produces internally.
Ellen Yeh, MD, PhD, a pathologist from Stanford Medical School, and UCSF biochemist Joseph DeRisi, PhD, have made a fundamental discovery about malaria parasites that gives new hope for future drugs and vaccines.
According to scientists at the University of California, San Francisco (UCSF) and Stanford Medical School, reporting today in the journal PLoS Biology, this insight immediately provides a powerful new tool for discovering and designing drugs to treat malaria, which infects hundreds of millions of people around the world each year and claims about a million lives – mostly children.
Ellen Yeh, MD, PhD, a pathologist from Stanford Medical School, and UCSF biochemist Joseph DeRisi, PhD, have made a fundamental discovery about malaria parasites that gives new hope for future drugs and vaccines.
The work also gives researchers a hypothetical new vaccine to test: a weakened version of the parasite, which the scientists grew in the test tube by supplying it with the chemical it needed to live while at the same time treating it with drugs to eliminate its ability to produce that chemical on its own.
“It’s as if we designed a ticking time bomb inside the parasite that’s ready to go off – and when it does, the parasite dies,” said Joseph DeRisi, PhD, a Howard Hughes Medical Institute investigator at UCSF and vice chair of the Department of Biochemistry and Biophysics, who led the work.
In theory, health officials could inoculate people living in areas where malaria is common with a similar “attenuated” form of the parasite. If it works, the modified parasite would not make those people sick but would give them resistance to the pathogen if they were later exposed to it – although that approach would need to be tested in clinical trials to determine whether it would work.
“It is an intriguing possibility that must be explored,” said Ellen Yeh, MD, PhD, the co-author of the study. Yeh is a postdoctoral researcher at UCSF and also on the faculty of the Pathology Department at Stanford University.
Slow, Brutish and Incomplete: A Short History of Malaria Control
Few diseases in history have been as widely spread, poorly understood and fruitlessly fought as malaria. The name itself evokes centuries of misunderstanding – a misnomer that comes from an old Italian construction that means “bad air.” People once thought it was caused by swamp gasses, since it seemed to be prevalent in wet, marshy places.
Progress Fighting Malaria:
A Timeline
Since the dawn of modern microbiology research, beginning in the 19th century, scientists have known that the disease is actually caused by a microscopic parasite called Plasmodium, which is spread by mosquitoes common to wet, marshy places. Two of the earliest Nobel prizes went to the scientists who made these basic discoveries, and at the dawn of the 20th century, the situation had never seemed brighter. The possibility that malaria would be eliminated or eradicated was exciting and real then. History proved otherwise.
Full malaria eradication was a major public health effort in the first half of the 20th century and was intensively pursued after World War II. Since that effort was launched, 108 countries have eliminated malaria from within their borders, with another 39 countries en route to that goal. Despite those efforts, malaria remains a major cause of illness in many parts of the world. Today almost half the world’s population lives in places where the disease is common.
According to the Centers for Disease Control and Prevention, about 1,500 cases of malaria still occur in the United States each year, but most are imported when people travel abroad. The real problem exists in several Asian and sub-Saharan African countries, where malaria is both a major leading cause of death and a significant drain on the economy. The World Health Organization estimates that the disease eats up nearly half of all public health expenditures and measurably lowers the gross domestic product of countries where it is common.
Several new approaches to controlling malaria have become available in the last few decades, like insecticide-treated bed nets, but there remains a dire need for new drugs and for effective vaccines to control it.
Hope for Vaccine Lies in the Parasite Itself
The Plasmodium parasite leads a strange and complicated life, crisscrossing between two “host” species – humans and mosquitoes. Within the short span of just a few weeks, the organism cycles through a half dozen radically different sizes and shapes and alternatively makes its home in the human liver, a person’s bloodstream, the insect stomach, and a mosquito’s spit.
For years scientists knew that the most fruitful way to fight the parasite would be to target the form in which it exists in the bloodstream, since that is where the majority of clinical symptoms occur. Existing drugs, like quinine and artemisinin, both target the parasite in the blood.
About 15 years ago, scientists discovered a potential new source of drug targets in a tiny, factory-like enveloped organelle called an apicoplast that exists within the parasite. It was unlike anything found normally in the human body, which suggested that drugs designed to interfere with it might kill the parasite while essentially leaving people unharmed.
“It was a very exciting discovery,” DeRisi said, “but in the years since, the prospect of finding drugs to target it has been frustrating and disappointing in many respects.”
In the last decade, the evolutionary history of this strange organelle has unfolded. The apicoplast is the strange remnant of collisions between competing cells far back in evolutionary history. Scientists reason that through the course of evolution, the apicoplast arose from its origin as a standalone bacterium into its current form through a series of at least two endosymbiotic events, in which one cell engulfs and permanently acquires genetic material and cellular machinery of another for its own benefit.
The discovery of this strange organelle in modern Plasmodium immediately suggested that there might be ways to target it with new drugs. However, even after extensive research revealed the genes of this apicoplast, efforts to raise new drugs against it were mostly fruitless – largely because nobody knew what the organelle actually did while the parasite was inside the human bloodstream.
Now DeRisi and Yeh have shown that the sole essential function of the apicoplast while the parasite is in the blood is to produce a single chemical known as isopentenyl pyrophosphate (IPP), a necessary building block the parasite uses to construct a variety of other molecules.
They discovered this by growing samples of Plasmodium falciparum within red blood cells in the test tube. If they treated the parasite with antibiotic drugs that kill the apicoplast, the parasites would all die. If they fed the parasites IPP at the same time, they lived – even though the parasites lost the organelle completely over time.
The work provides a new tool for probing the basic biology of the Plasmodium parasite, and it also suggests a new way of discovering promising new drugs to fight malaria. While many previous drug-screening efforts have identified multitudes of compounds that appear to inhibit growth of the parasites, most are without a known target within the parasites. Knowing the target of a drug greatly enables the necessary process of medicinal chemistry, in which the compound is optimized with respect to the target. Now, DeRisi and Yeh’s discovery has provided a simple tool to determine whether any particular drug candidate targets the apicoplast.
The attenuated form of the parasite also provides an intriguing hypothetical vaccine candidate – and one that would be relatively cheap to produce, DeRisi said. However, he cautioned, the history of malaria control is filled with failed efforts, and several past vaccines have fallen short. Only time and clinical trials will tell if this is a viable solution to the problem.
“This parasite has clearly evolved to be an immune system escape artist,” DeRisi said. “It’s no surprise that the simple approaches have not worked.”
The article, “Chemical Rescue of Malaria Parasites Lacking an Apicoplast Defines Organelle Function in Blood-stage P. falciparum” by Ellen Yeh and Joseph L. DeRisi appears in the August 30, 2011 issue of the journal PLoS Biology. After 5:00 p.m. ET on 8/30/2011, the article will be available at http://dx.doi.org/10.1371/journal.pbio.1001138
This work was funded by the Howard Hughes Medical Institute.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
Photo by Jason Bardi
Slideshow by Kevin Eisenmann
Ellen Yeh, MD, PhD, a pathologist from Stanford Medical School, and UCSF biochemist Joseph DeRisi, PhD, have made a fundamental discovery about malaria parasites that gives new hope for future drugs and vaccines.
According to scientists at the University of California, San Francisco (UCSF) and Stanford Medical School, reporting today in the journal PLoS Biology, this insight immediately provides a powerful new tool for discovering and designing drugs to treat malaria, which infects hundreds of millions of people around the world each year and claims about a million lives – mostly children.
Ellen Yeh, MD, PhD, a pathologist from Stanford Medical School, and UCSF biochemist Joseph DeRisi, PhD, have made a fundamental discovery about malaria parasites that gives new hope for future drugs and vaccines.
The work also gives researchers a hypothetical new vaccine to test: a weakened version of the parasite, which the scientists grew in the test tube by supplying it with the chemical it needed to live while at the same time treating it with drugs to eliminate its ability to produce that chemical on its own.
“It’s as if we designed a ticking time bomb inside the parasite that’s ready to go off – and when it does, the parasite dies,” said Joseph DeRisi, PhD, a Howard Hughes Medical Institute investigator at UCSF and vice chair of the Department of Biochemistry and Biophysics, who led the work.
In theory, health officials could inoculate people living in areas where malaria is common with a similar “attenuated” form of the parasite. If it works, the modified parasite would not make those people sick but would give them resistance to the pathogen if they were later exposed to it – although that approach would need to be tested in clinical trials to determine whether it would work.
“It is an intriguing possibility that must be explored,” said Ellen Yeh, MD, PhD, the co-author of the study. Yeh is a postdoctoral researcher at UCSF and also on the faculty of the Pathology Department at Stanford University.
Slow, Brutish and Incomplete: A Short History of Malaria Control
Few diseases in history have been as widely spread, poorly understood and fruitlessly fought as malaria. The name itself evokes centuries of misunderstanding – a misnomer that comes from an old Italian construction that means “bad air.” People once thought it was caused by swamp gasses, since it seemed to be prevalent in wet, marshy places.
Progress Fighting Malaria:
A Timeline
Since the dawn of modern microbiology research, beginning in the 19th century, scientists have known that the disease is actually caused by a microscopic parasite called Plasmodium, which is spread by mosquitoes common to wet, marshy places. Two of the earliest Nobel prizes went to the scientists who made these basic discoveries, and at the dawn of the 20th century, the situation had never seemed brighter. The possibility that malaria would be eliminated or eradicated was exciting and real then. History proved otherwise.
Full malaria eradication was a major public health effort in the first half of the 20th century and was intensively pursued after World War II. Since that effort was launched, 108 countries have eliminated malaria from within their borders, with another 39 countries en route to that goal. Despite those efforts, malaria remains a major cause of illness in many parts of the world. Today almost half the world’s population lives in places where the disease is common.
According to the Centers for Disease Control and Prevention, about 1,500 cases of malaria still occur in the United States each year, but most are imported when people travel abroad. The real problem exists in several Asian and sub-Saharan African countries, where malaria is both a major leading cause of death and a significant drain on the economy. The World Health Organization estimates that the disease eats up nearly half of all public health expenditures and measurably lowers the gross domestic product of countries where it is common.
Several new approaches to controlling malaria have become available in the last few decades, like insecticide-treated bed nets, but there remains a dire need for new drugs and for effective vaccines to control it.
Hope for Vaccine Lies in the Parasite Itself
The Plasmodium parasite leads a strange and complicated life, crisscrossing between two “host” species – humans and mosquitoes. Within the short span of just a few weeks, the organism cycles through a half dozen radically different sizes and shapes and alternatively makes its home in the human liver, a person’s bloodstream, the insect stomach, and a mosquito’s spit.
For years scientists knew that the most fruitful way to fight the parasite would be to target the form in which it exists in the bloodstream, since that is where the majority of clinical symptoms occur. Existing drugs, like quinine and artemisinin, both target the parasite in the blood.
About 15 years ago, scientists discovered a potential new source of drug targets in a tiny, factory-like enveloped organelle called an apicoplast that exists within the parasite. It was unlike anything found normally in the human body, which suggested that drugs designed to interfere with it might kill the parasite while essentially leaving people unharmed.
“It was a very exciting discovery,” DeRisi said, “but in the years since, the prospect of finding drugs to target it has been frustrating and disappointing in many respects.”
In the last decade, the evolutionary history of this strange organelle has unfolded. The apicoplast is the strange remnant of collisions between competing cells far back in evolutionary history. Scientists reason that through the course of evolution, the apicoplast arose from its origin as a standalone bacterium into its current form through a series of at least two endosymbiotic events, in which one cell engulfs and permanently acquires genetic material and cellular machinery of another for its own benefit.
The discovery of this strange organelle in modern Plasmodium immediately suggested that there might be ways to target it with new drugs. However, even after extensive research revealed the genes of this apicoplast, efforts to raise new drugs against it were mostly fruitless – largely because nobody knew what the organelle actually did while the parasite was inside the human bloodstream.
Now DeRisi and Yeh have shown that the sole essential function of the apicoplast while the parasite is in the blood is to produce a single chemical known as isopentenyl pyrophosphate (IPP), a necessary building block the parasite uses to construct a variety of other molecules.
They discovered this by growing samples of Plasmodium falciparum within red blood cells in the test tube. If they treated the parasite with antibiotic drugs that kill the apicoplast, the parasites would all die. If they fed the parasites IPP at the same time, they lived – even though the parasites lost the organelle completely over time.
The work provides a new tool for probing the basic biology of the Plasmodium parasite, and it also suggests a new way of discovering promising new drugs to fight malaria. While many previous drug-screening efforts have identified multitudes of compounds that appear to inhibit growth of the parasites, most are without a known target within the parasites. Knowing the target of a drug greatly enables the necessary process of medicinal chemistry, in which the compound is optimized with respect to the target. Now, DeRisi and Yeh’s discovery has provided a simple tool to determine whether any particular drug candidate targets the apicoplast.
The attenuated form of the parasite also provides an intriguing hypothetical vaccine candidate – and one that would be relatively cheap to produce, DeRisi said. However, he cautioned, the history of malaria control is filled with failed efforts, and several past vaccines have fallen short. Only time and clinical trials will tell if this is a viable solution to the problem.
“This parasite has clearly evolved to be an immune system escape artist,” DeRisi said. “It’s no surprise that the simple approaches have not worked.”
The article, “Chemical Rescue of Malaria Parasites Lacking an Apicoplast Defines Organelle Function in Blood-stage P. falciparum” by Ellen Yeh and Joseph L. DeRisi appears in the August 30, 2011 issue of the journal PLoS Biology. After 5:00 p.m. ET on 8/30/2011, the article will be available at http://dx.doi.org/10.1371/journal.pbio.1001138
This work was funded by the Howard Hughes Medical Institute.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
Photo by Jason Bardi
Slideshow by Kevin Eisenmann
Saturday, August 13, 2011
Timor-Leste Introductory Briefing: For Newly Arrived HCPs
Timor Leste – A Briefing for Newly Arrived Health Practitioners
Introduction –
This guide is designed to inform the visiting health practitioner of the key issues in Timor Leste, to enable ethical and informed practice and to facilitate culturally sensitive health care for the East Timorese.
Background
The Democratic Republic of Timor-Leste comprises four islands and a population of approximately 1.1 million. Indonesian occupation since 1975 and subsequent recognition of self-determination by the United Nations in 2002 has left this small yet determined nation struggling with post-crisis development difficulties in the twin contractionary economic realities of the inflationary oil crisis and the global economic downturn.
https://www.cia.gov/library/publications/the-world-factbook/maps/maptemplate_tt.html
The islands of Timor-Leste lie in the tropical maritime of South-East Asia making them susceptible to the blood disease, malaria. Globally, malaria causes more than 300 million acute illnesses and one million deaths annually.[i] In Timor-Leste, 100% of the population resides in areas endemic to malaria. The disease is responsible for >40% of deaths annually and it is the largest public health concern in the country.[ii]
Timor-Leste was a Portuguese colony from the middle of the 16th century until 1975, when independence was gained from Portugal. However nine days later, Indonesian forces aggressively invaded and occupied Timor. In 1976, forced integration with Indonesia was met with hostility and between 100,000 - 250,000 people were killed in the two decades that followed. In 1999, a referendum sponsored by the United Nations returned an overwhelming vote for independence from Indonesia. However prior to the arrival of the U.N. peacekeeping force, anti-independence militia, organised and equipped by the Indonesian military, destroyed much of Timor-Leste in a vengeful act of retribution. 1400 Timorese were killed and 300,000 people were forcibly made refugees in Western Timor.[iii] From homes to schools, hospitals, water and electrical supply, the majority of Timor-Leste’s infrastructure was destroyed. Much respect is due the Timorese for their unceasing fight against subjugation and pacification at the hands of the Indonesians.
There is ongoing sensitivity regarding the role of the U.N and its failure to supply peacekeeping at the required time. Australia shares a 50 year development zone agreement with Timor-Leste in place of a maritime boundary and while Australia is regarded well for its twice utilized peacekeeping role, there remain some border areas that are unresolved and an undercurrent of tension and sometime instability for the fledgling nation.
As a developing country ravaged by war and the struggle for independence, health care by western standards, is scantily provided in Timor-Leste. The magnitude of maternal mortality is very high, with one in thirty-five women having a lifetime risk of obstetric death. Inequalities in health exist as a function of social, cultural and contextual factors, extending past health services to policy making, education, economics and beyond.
Key Issues In Timor-Leste
Key issues in Timor-Leste revolve around poverty and equity. They have been exacerbated by the war for independence and ongoing instability, and the difficulties of developing a new country in a challenging economic climate. Timor-Leste faces many health issues and barriers to be overcome.
Cultural Issues
The culture of Timor-Leste is a synergy of its many influences including colonizing country of Portugal and its accompanying religion of Roman Catholicism, Malaysian culture, and the indigenous cultures of Austronesia and Melanesia. Craftsmanship, weaving and poetry are highly valued and widespread throughout the country.[iv] Cultural perceptions affect penetration of available health services in Timor-Leste and further complicate service provision. Many perceive the use of medical facilities for child birth for example as constituting failure on behalf of the mother. Consequently, Timorese women do not routinely seek essential obstetric care and only seek emergency obstetric care when in a critical condition.
Ethnic and Religious Issues
There are three main ethnic groups in Timor-Leste: Austronesian (Malayo-Polynesian), Papuan, and a small Chinese minority. Of the religions practiced in Timor-Leste, Roman Catholicism is dominant with 98% of the population being Catholic. During Indonesian occupation, participation at churches grew supporting the development of a resistance movement. Minority religions include Muslim at 1%, Hindu at 0.5%, Buddhist at 0.1% and Protestant at 1% (2005).[v] Despite the dominance of Roman Catholicism, animist traditions exist within this demographic and continue to have an effect on the culture of Timor-Leste.
Consideration should be made of contraceptive and family planning advice with regard to the religions of Timor-Leste. For many years, contraception has been contrary to the teaching of the Catholic church and may still be regarded distastefully by the Catholic community. Muslim women who wear the hijab will not attend a male clinician and many will require the authorization and presence of their husbands or fathers when medical treatment is required. Furthermore, the persisting influence of the former Portuguese society still dominates and results in unempowered and marginalised women in Timor-Leste.
Gender Issues
Gender inequalities exist is the form of non-prioritised health services for women, women of remote areas, and women of low educational status. The disempowerment of women means women seek health care, food and entitlements last. Little to no political power or influence over policy direction consolidates this position at an individual, community and national level.
Maternal mortality is an issue of serious concern in Timor-Leste. Reduction in the maternal mortality rate has been identified as a key development goal and accordingly targeted by the government of Timor-Leste and the United Nations in the Millennium Development Goals set down for member nations.
The average life expectancy in Timor-Leste is sixty years for males and sixty-two years for females,[vi] however statistical data for Timor-Leste is rudimentary at best. With only one tertiary level health facility and poor primary health care, there is a critical lack of Essential Obstetric Care and Emergency Obstetric Care service. This has led to an extremely high Maternal Mortality Rate (MMR) estimated to be 660 deaths per every 100,000 births.[vii]
The prevailing causes of maternal mortality in Timor-Leste include haemorrhage, sepsis, unsafe abortion, obstructed labour and hypertensive diseases of pregnancy. Indirect causes include increasing incidence of teenage pregnancy and early marriage, geographic isolation, poor reproductive health, low maternal literacy/education rates, prevalence of acute infectious diseases such as malaria, and chronic disease states such as malnutrition and anaemia.[viii] All are exacerbated by the many social, economic, geographic and political factors underpinning and in some cases, obstructing change.
The East Timorese Ministry of Health is addressing several key areas of deficit that directly relate to the provision of essential obstetric care and maternal health outcomes. They are the reduction of maternal and infant mortality, the improvement of reproductive health, equity of access to health services, provision of a regulated minimum healthcare service, increased health literacy for women, (including access to information), and improvement in the nutritional status of mothers and children.[ix]
According to the Timor-Leste Health Statistics Report, skilled health personnel attend only 27.2% of all births. Use of modern methods of contraception is very low.
Rural isolation means inequitable and problematic access to antenatal care, skilled birth attendants, essential obstetric care and emergency obstetric care for many Timorese women. The population resides primarily on one half of the major island, East Timor, however there are also residents on three other remote islands who receive little to no health care services. Access and equity issues are central to reducing the MMR and to providing better coverage and service provision.
Health Equity Issues
Health literacy is poor throughout the community in Timor-Leste and attempts to improve health literacy have been overly didactic, poorly targeted and have failed. The existing disease surveillance programme has failed to identify and evaluate routine disease.
Much of the population of Timor-Leste continues to reside in areas unserviced by health-care facilities and diagnostic laboratories. Organised activities designed to change behaviour have been fragmented, erratic and ineffectual. Despite the creation of a new faculty for the training of Health Care Professionals, human health care resources remain limited. According to The Democratic Republic of Timor-Leste Health Profile, August 2002, the following distribution of health professionals provides services to the people of Timor-Leste: 47 physicians (12 national and 35 international), 624 nurses and 226 midwives.
Health Services - Physical Infrastructure
The physical infrastructure for health services delivery is extremely limited throughout Timor-Leste. The only tertiary level referral hospital, located in Baucau, provides 114 beds and has the capacity to provide surgery with general anaesthesia. Four regional hospitals of 24 beds serve the districts of Cavalima, Bobonaro, Oecusse and Ainaro. Basic inpatient services are provided. Surgery is not yet available. All other districts provide community centres with the capacity to offer basic health services and to deploy mobile clinics. These centres are termed ‘level one’ health facilities and cover a four to eight kilometre radius. They provide basic non-diagnostic curative consultation, antenatal and postnatal care, immunization, infant growth monitoring, and health promotion. [x]
Community health centre facilities (level two) exist at the sub–district level for the provision of health promotion, prevention, and out-patient curative consultations. Services are supported by a simple laboratory. Level three healthcare facilities are located in the districts bordering Dili, Aielu and Liquica. This level of healthcare facility has the additional capacity of basic Emergency Obstetric Care (EmOC), with procedures such as forceps or vacuum assisted delivery, manual removal of placenta, and treatment of other obstetric complications. [xi]
Inpatient facilities for up to 20 beds are located in five districts, providing level 4 services such as minor surgery not requiring general anaesthesia. These facilities provide diagnostic medical consultation and referral where appropriate, medical pathology and other support diagnostics.[xii]
Resource Allocation Issues
In Timor-Leste, the provision of primary health care has been problematic. Accessibility barriers exist due to prohibitive geographical isolation; only 22 percent of Timorese live in urban areas with the remainder living in rural villages. Annually, government total health expenditure is significantly low per capita, ranking 141st lowest out of the 193 World Health Organisation member nations, 2009.[xiii] The Purchasing Power Parity (PPP) for health expenditure as a function of GDP illustrates indicative per capita expenditure of US$109 per annum. Total health expenditure as a percentage of GDP is 17.7%. Such severely constrained expenditure despite high proportion of GDP allocation directly correlates with low income per capita and low Gross Domestic Product (GDP).[xiv] The number of trained health care professionals (HCPs) is insufficient for the population, and the distribution is highly concentrated to urban centres leaving the majority of East Timorese who live in rural villages without access to health care.
The Government of Timor-Leste has extensive partnership arrangements with several donor organisations to increasingly fund selective primary health care programmes that meet with the Millennium Development Goals objectives. Donor organisations include AusAid, USAID, ACT Malaria, and the World Health Organisation, working in partnership with charitable NGOs such as Rotary International, Care International, and private philanthropic organisations such as The Bill and Melinda Gates Global Fund. In particular, large amounts of funding is targeted to reduce the burden of malaria by 30%, by 2015. (There is an estimated 150,000 clinical cases of malaria per annum in Timor-Leste).
Tax revenue insufficiency linked to low GDP per capita means a meagre base from which to redistribute wealth. Public goods such as health care receive too few dollars to address needs. A policy re-prioritisation matched by adequate funding will make the difference in the short term. For increased capacity and long term change, economic growth, stewardship and outsourcing are required.
Health Economics In Timor-Leste
Existing healthcare financing does not meet the needs of the Timorese. Policy changes are warranted to provide responsible and informed economic management by the government of Timor-Leste that recognize that as a public good, health care has associated externalities and failures that need to be addressed. This is a key role of government – to provide essential services where the allocative power of competitive markets fails. In collaboration with partner organisations, (NGOs and donor funding), the reliance on out of pocket funding as a dominant source of health financing can be minimised. This is especially important for Timor-Leste as the burden of out of pocket costs falls heaviest on the poor, and serves as a barrier and disincentive to consumption of health care services.
Given that healthcare the world over is predicated on the problem of infinite need and scarce resources, the use of evidence based investment is critical. Policy grounded in the criteria of efficiency, equity and effectiveness must be paramount if dollars and morals are not to be squandered. The current capacity of the government of Timor-Leste to respond to public health concerns is minimal and as a result, initiatives and development in public health, particularly health policy reform, is limited in its application and effectiveness.
Internally Displaced Persons (IDP) Issues
The ongoing problem of refugees in Timor-Leste persists. Itinerant populations provide particular problems in health care service delivery. They are difficult to reach for educational and preventative care purposes and provide ongoing primary and antenatal care difficulties due to the nomadic behaviour of internally displaced persons (IDP). Issues of equitable distribution are poorly addressed and becoming more important as IDPs return to their pre-war homes. Their migration brings an increase in service demand in remote areas and staffing these areas is problematic with health care professionals reluctant to service communities without utilities and basic infrastructure such as communications. Approximately 100,000 IDPs remain as a legacy of the independence war.
Nutritional Resources
Timor-Leste is not a food resource poor country. It has good annual rainfall and a bountiful supply from the sea. None-the-less, there is a high percentage of malnutrition, due in part to poor nutritional practices and also from poverty that leads to general lack of food security and poor nutritional outcomes.
Ethical Issues
Ethical issues for the visiting health care professional in Timor-Leste stem from ‘Western style’ paternalism and attitudes of superiority. It is important to remain cognizant of history and the resilience of the Timorese and to respect them as capable and intelligent people. Much respect is due the Timorese and their culture in and of its own right. It is not to be assumed that ‘Western’ practices are superior to local practices. All health care professionals should include the patient and local people as partners in their own health care development, provision and management. Informed consent in East-Timor is not the same as in Western cultures as issues of health involve all members of the family and community and are discussed as broadly.
It is recommended that the new health care professional observe closely for the usual practices of the community in which they are based and work within the boundaries of that community with sensitivity and respect for cultural differences. Culture shock is to be expected at first and quiet reflection time and sensitive discussion with colleagues can help to reduce the sense of dislocation for the visiting practitioner while improving cultural understanding and tolerance.
Conclusion
Successful practice in Timor-Leste relies on the recognition and management of many culturally sensitive key issues related to religion, history, culture, gender, equity and resource constraints. Fellow health care professionals can ensure ethical and informed practice by relying on the capacity of the clinician to respect, observe and learn the traditional Timorese ways, while also recognizing the importance of minimising unethical and paternalistic behaviour.
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OECD (November 2009), OECD Health Data 2009 - Frequently Requested Data, Organisation for Economic Co-operation and Development. http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html Accessed 23.3.10
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Post Graduate Subject Reading Lists:
Maternal and Child Health in Developing Countries (2010)
Curtin University
Ethics In International Health (2011)
Curtin University – Centre for International Health
International Health and Primary Health Care (2010)
Curtin University
Economics of Health Financing (2011)
Curtin University
[i] Malaria Basic III, pg1.
[ii] The Global Fund, Funding Document Round 7 (2009), Passim.
[iii] CIA The World Fact Book https://www.cia.gov/library/publications/the-world-factbook/geos/tt.html
[iv] East Timor: a bibliography, a bibliographic reference, Jean A. Berlie, (2001)
[v] CIA The World Fact Book https://www.cia.gov/library/publications/the-world-factbook/geos/tt.html
[vi] Source United Nations – Timor-Leste Millennium Development Goals
[vii] Timor-Leste: Health Statistics Report, 2006.
[viii] Source Family Health International http://www.fhi.org/en/Topics/maternalmort.htm
[ix] Source Democratic Republic of Timor-Leste Health Profile, August 2002.
[x] Source Democratic Republic of Timor-Leste, Health Profile, August 2002.
[xi] Source Democratic Republic of Timor-Leste, Health Profile, August 2002.
[xii] Source Democratic Republic of Timor-Leste, Health Profile, August 2002.
[xiii] OECD (November 2009). "OECD Health Data 2009 - Frequently Requested Data". Organisation for Economic Co-operation and Development.
[xiv]WHO (May 2009). "World Health Statistics 2009". World Health Organization.
[xiv] List of countries by total health expenditure (PPP) per capita, World Health Organisation (2006, 2009)
Introduction –
This guide is designed to inform the visiting health practitioner of the key issues in Timor Leste, to enable ethical and informed practice and to facilitate culturally sensitive health care for the East Timorese.
Background
The Democratic Republic of Timor-Leste comprises four islands and a population of approximately 1.1 million. Indonesian occupation since 1975 and subsequent recognition of self-determination by the United Nations in 2002 has left this small yet determined nation struggling with post-crisis development difficulties in the twin contractionary economic realities of the inflationary oil crisis and the global economic downturn.
https://www.cia.gov/library/publications/the-world-factbook/maps/maptemplate_tt.html
The islands of Timor-Leste lie in the tropical maritime of South-East Asia making them susceptible to the blood disease, malaria. Globally, malaria causes more than 300 million acute illnesses and one million deaths annually.[i] In Timor-Leste, 100% of the population resides in areas endemic to malaria. The disease is responsible for >40% of deaths annually and it is the largest public health concern in the country.[ii]
Timor-Leste was a Portuguese colony from the middle of the 16th century until 1975, when independence was gained from Portugal. However nine days later, Indonesian forces aggressively invaded and occupied Timor. In 1976, forced integration with Indonesia was met with hostility and between 100,000 - 250,000 people were killed in the two decades that followed. In 1999, a referendum sponsored by the United Nations returned an overwhelming vote for independence from Indonesia. However prior to the arrival of the U.N. peacekeeping force, anti-independence militia, organised and equipped by the Indonesian military, destroyed much of Timor-Leste in a vengeful act of retribution. 1400 Timorese were killed and 300,000 people were forcibly made refugees in Western Timor.[iii] From homes to schools, hospitals, water and electrical supply, the majority of Timor-Leste’s infrastructure was destroyed. Much respect is due the Timorese for their unceasing fight against subjugation and pacification at the hands of the Indonesians.
There is ongoing sensitivity regarding the role of the U.N and its failure to supply peacekeeping at the required time. Australia shares a 50 year development zone agreement with Timor-Leste in place of a maritime boundary and while Australia is regarded well for its twice utilized peacekeeping role, there remain some border areas that are unresolved and an undercurrent of tension and sometime instability for the fledgling nation.
As a developing country ravaged by war and the struggle for independence, health care by western standards, is scantily provided in Timor-Leste. The magnitude of maternal mortality is very high, with one in thirty-five women having a lifetime risk of obstetric death. Inequalities in health exist as a function of social, cultural and contextual factors, extending past health services to policy making, education, economics and beyond.
Key Issues In Timor-Leste
Key issues in Timor-Leste revolve around poverty and equity. They have been exacerbated by the war for independence and ongoing instability, and the difficulties of developing a new country in a challenging economic climate. Timor-Leste faces many health issues and barriers to be overcome.
Cultural Issues
The culture of Timor-Leste is a synergy of its many influences including colonizing country of Portugal and its accompanying religion of Roman Catholicism, Malaysian culture, and the indigenous cultures of Austronesia and Melanesia. Craftsmanship, weaving and poetry are highly valued and widespread throughout the country.[iv] Cultural perceptions affect penetration of available health services in Timor-Leste and further complicate service provision. Many perceive the use of medical facilities for child birth for example as constituting failure on behalf of the mother. Consequently, Timorese women do not routinely seek essential obstetric care and only seek emergency obstetric care when in a critical condition.
Ethnic and Religious Issues
There are three main ethnic groups in Timor-Leste: Austronesian (Malayo-Polynesian), Papuan, and a small Chinese minority. Of the religions practiced in Timor-Leste, Roman Catholicism is dominant with 98% of the population being Catholic. During Indonesian occupation, participation at churches grew supporting the development of a resistance movement. Minority religions include Muslim at 1%, Hindu at 0.5%, Buddhist at 0.1% and Protestant at 1% (2005).[v] Despite the dominance of Roman Catholicism, animist traditions exist within this demographic and continue to have an effect on the culture of Timor-Leste.
Consideration should be made of contraceptive and family planning advice with regard to the religions of Timor-Leste. For many years, contraception has been contrary to the teaching of the Catholic church and may still be regarded distastefully by the Catholic community. Muslim women who wear the hijab will not attend a male clinician and many will require the authorization and presence of their husbands or fathers when medical treatment is required. Furthermore, the persisting influence of the former Portuguese society still dominates and results in unempowered and marginalised women in Timor-Leste.
Gender Issues
Gender inequalities exist is the form of non-prioritised health services for women, women of remote areas, and women of low educational status. The disempowerment of women means women seek health care, food and entitlements last. Little to no political power or influence over policy direction consolidates this position at an individual, community and national level.
Maternal mortality is an issue of serious concern in Timor-Leste. Reduction in the maternal mortality rate has been identified as a key development goal and accordingly targeted by the government of Timor-Leste and the United Nations in the Millennium Development Goals set down for member nations.
The average life expectancy in Timor-Leste is sixty years for males and sixty-two years for females,[vi] however statistical data for Timor-Leste is rudimentary at best. With only one tertiary level health facility and poor primary health care, there is a critical lack of Essential Obstetric Care and Emergency Obstetric Care service. This has led to an extremely high Maternal Mortality Rate (MMR) estimated to be 660 deaths per every 100,000 births.[vii]
The prevailing causes of maternal mortality in Timor-Leste include haemorrhage, sepsis, unsafe abortion, obstructed labour and hypertensive diseases of pregnancy. Indirect causes include increasing incidence of teenage pregnancy and early marriage, geographic isolation, poor reproductive health, low maternal literacy/education rates, prevalence of acute infectious diseases such as malaria, and chronic disease states such as malnutrition and anaemia.[viii] All are exacerbated by the many social, economic, geographic and political factors underpinning and in some cases, obstructing change.
The East Timorese Ministry of Health is addressing several key areas of deficit that directly relate to the provision of essential obstetric care and maternal health outcomes. They are the reduction of maternal and infant mortality, the improvement of reproductive health, equity of access to health services, provision of a regulated minimum healthcare service, increased health literacy for women, (including access to information), and improvement in the nutritional status of mothers and children.[ix]
According to the Timor-Leste Health Statistics Report, skilled health personnel attend only 27.2% of all births. Use of modern methods of contraception is very low.
Rural isolation means inequitable and problematic access to antenatal care, skilled birth attendants, essential obstetric care and emergency obstetric care for many Timorese women. The population resides primarily on one half of the major island, East Timor, however there are also residents on three other remote islands who receive little to no health care services. Access and equity issues are central to reducing the MMR and to providing better coverage and service provision.
Health Equity Issues
Health literacy is poor throughout the community in Timor-Leste and attempts to improve health literacy have been overly didactic, poorly targeted and have failed. The existing disease surveillance programme has failed to identify and evaluate routine disease.
Much of the population of Timor-Leste continues to reside in areas unserviced by health-care facilities and diagnostic laboratories. Organised activities designed to change behaviour have been fragmented, erratic and ineffectual. Despite the creation of a new faculty for the training of Health Care Professionals, human health care resources remain limited. According to The Democratic Republic of Timor-Leste Health Profile, August 2002, the following distribution of health professionals provides services to the people of Timor-Leste: 47 physicians (12 national and 35 international), 624 nurses and 226 midwives.
Health Services - Physical Infrastructure
The physical infrastructure for health services delivery is extremely limited throughout Timor-Leste. The only tertiary level referral hospital, located in Baucau, provides 114 beds and has the capacity to provide surgery with general anaesthesia. Four regional hospitals of 24 beds serve the districts of Cavalima, Bobonaro, Oecusse and Ainaro. Basic inpatient services are provided. Surgery is not yet available. All other districts provide community centres with the capacity to offer basic health services and to deploy mobile clinics. These centres are termed ‘level one’ health facilities and cover a four to eight kilometre radius. They provide basic non-diagnostic curative consultation, antenatal and postnatal care, immunization, infant growth monitoring, and health promotion. [x]
Community health centre facilities (level two) exist at the sub–district level for the provision of health promotion, prevention, and out-patient curative consultations. Services are supported by a simple laboratory. Level three healthcare facilities are located in the districts bordering Dili, Aielu and Liquica. This level of healthcare facility has the additional capacity of basic Emergency Obstetric Care (EmOC), with procedures such as forceps or vacuum assisted delivery, manual removal of placenta, and treatment of other obstetric complications. [xi]
Inpatient facilities for up to 20 beds are located in five districts, providing level 4 services such as minor surgery not requiring general anaesthesia. These facilities provide diagnostic medical consultation and referral where appropriate, medical pathology and other support diagnostics.[xii]
Resource Allocation Issues
In Timor-Leste, the provision of primary health care has been problematic. Accessibility barriers exist due to prohibitive geographical isolation; only 22 percent of Timorese live in urban areas with the remainder living in rural villages. Annually, government total health expenditure is significantly low per capita, ranking 141st lowest out of the 193 World Health Organisation member nations, 2009.[xiii] The Purchasing Power Parity (PPP) for health expenditure as a function of GDP illustrates indicative per capita expenditure of US$109 per annum. Total health expenditure as a percentage of GDP is 17.7%. Such severely constrained expenditure despite high proportion of GDP allocation directly correlates with low income per capita and low Gross Domestic Product (GDP).[xiv] The number of trained health care professionals (HCPs) is insufficient for the population, and the distribution is highly concentrated to urban centres leaving the majority of East Timorese who live in rural villages without access to health care.
The Government of Timor-Leste has extensive partnership arrangements with several donor organisations to increasingly fund selective primary health care programmes that meet with the Millennium Development Goals objectives. Donor organisations include AusAid, USAID, ACT Malaria, and the World Health Organisation, working in partnership with charitable NGOs such as Rotary International, Care International, and private philanthropic organisations such as The Bill and Melinda Gates Global Fund. In particular, large amounts of funding is targeted to reduce the burden of malaria by 30%, by 2015. (There is an estimated 150,000 clinical cases of malaria per annum in Timor-Leste).
Tax revenue insufficiency linked to low GDP per capita means a meagre base from which to redistribute wealth. Public goods such as health care receive too few dollars to address needs. A policy re-prioritisation matched by adequate funding will make the difference in the short term. For increased capacity and long term change, economic growth, stewardship and outsourcing are required.
Health Economics In Timor-Leste
Existing healthcare financing does not meet the needs of the Timorese. Policy changes are warranted to provide responsible and informed economic management by the government of Timor-Leste that recognize that as a public good, health care has associated externalities and failures that need to be addressed. This is a key role of government – to provide essential services where the allocative power of competitive markets fails. In collaboration with partner organisations, (NGOs and donor funding), the reliance on out of pocket funding as a dominant source of health financing can be minimised. This is especially important for Timor-Leste as the burden of out of pocket costs falls heaviest on the poor, and serves as a barrier and disincentive to consumption of health care services.
Given that healthcare the world over is predicated on the problem of infinite need and scarce resources, the use of evidence based investment is critical. Policy grounded in the criteria of efficiency, equity and effectiveness must be paramount if dollars and morals are not to be squandered. The current capacity of the government of Timor-Leste to respond to public health concerns is minimal and as a result, initiatives and development in public health, particularly health policy reform, is limited in its application and effectiveness.
Internally Displaced Persons (IDP) Issues
The ongoing problem of refugees in Timor-Leste persists. Itinerant populations provide particular problems in health care service delivery. They are difficult to reach for educational and preventative care purposes and provide ongoing primary and antenatal care difficulties due to the nomadic behaviour of internally displaced persons (IDP). Issues of equitable distribution are poorly addressed and becoming more important as IDPs return to their pre-war homes. Their migration brings an increase in service demand in remote areas and staffing these areas is problematic with health care professionals reluctant to service communities without utilities and basic infrastructure such as communications. Approximately 100,000 IDPs remain as a legacy of the independence war.
Nutritional Resources
Timor-Leste is not a food resource poor country. It has good annual rainfall and a bountiful supply from the sea. None-the-less, there is a high percentage of malnutrition, due in part to poor nutritional practices and also from poverty that leads to general lack of food security and poor nutritional outcomes.
Ethical Issues
Ethical issues for the visiting health care professional in Timor-Leste stem from ‘Western style’ paternalism and attitudes of superiority. It is important to remain cognizant of history and the resilience of the Timorese and to respect them as capable and intelligent people. Much respect is due the Timorese and their culture in and of its own right. It is not to be assumed that ‘Western’ practices are superior to local practices. All health care professionals should include the patient and local people as partners in their own health care development, provision and management. Informed consent in East-Timor is not the same as in Western cultures as issues of health involve all members of the family and community and are discussed as broadly.
It is recommended that the new health care professional observe closely for the usual practices of the community in which they are based and work within the boundaries of that community with sensitivity and respect for cultural differences. Culture shock is to be expected at first and quiet reflection time and sensitive discussion with colleagues can help to reduce the sense of dislocation for the visiting practitioner while improving cultural understanding and tolerance.
Conclusion
Successful practice in Timor-Leste relies on the recognition and management of many culturally sensitive key issues related to religion, history, culture, gender, equity and resource constraints. Fellow health care professionals can ensure ethical and informed practice by relying on the capacity of the clinician to respect, observe and learn the traditional Timorese ways, while also recognizing the importance of minimising unethical and paternalistic behaviour.
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Official Government Portal of Timor-Leste, http://timor-leste.gov.tl/?lang=en
Accessed 1-31 October, 2010.
SEARO
http://www.searo.who.int/en/Section13/section2364.htm
Accessed October, 2010.
Post Graduate Subject Reading Lists:
Maternal and Child Health in Developing Countries (2010)
Curtin University
Ethics In International Health (2011)
Curtin University – Centre for International Health
International Health and Primary Health Care (2010)
Curtin University
Economics of Health Financing (2011)
Curtin University
[i] Malaria Basic III, pg1.
[ii] The Global Fund, Funding Document Round 7 (2009), Passim.
[iii] CIA The World Fact Book https://www.cia.gov/library/publications/the-world-factbook/geos/tt.html
[iv] East Timor: a bibliography, a bibliographic reference, Jean A. Berlie, (2001)
[v] CIA The World Fact Book https://www.cia.gov/library/publications/the-world-factbook/geos/tt.html
[vi] Source United Nations – Timor-Leste Millennium Development Goals
[vii] Timor-Leste: Health Statistics Report, 2006.
[viii] Source Family Health International http://www.fhi.org/en/Topics/maternalmort.htm
[ix] Source Democratic Republic of Timor-Leste Health Profile, August 2002.
[x] Source Democratic Republic of Timor-Leste, Health Profile, August 2002.
[xi] Source Democratic Republic of Timor-Leste, Health Profile, August 2002.
[xii] Source Democratic Republic of Timor-Leste, Health Profile, August 2002.
[xiii] OECD (November 2009). "OECD Health Data 2009 - Frequently Requested Data". Organisation for Economic Co-operation and Development.
[xiv]WHO (May 2009). "World Health Statistics 2009". World Health Organization.
[xiv] List of countries by total health expenditure (PPP) per capita, World Health Organisation (2006, 2009)
Monday, July 25, 2011
MSF Fight Measles Epidemic In Malawi
FIGHTING MEASLES IN THE DEVELOPING WORLD
MEASLES
Every minute a child dies of measles. Even though a safe and effective vaccine exists, outbreaks occur in many parts of the world because routine immunisation programs are not in place or efficient. In many places Médecins Sans Frontières (MSF) teams are confronted with outbreaks and have to organise emergency immunisation campaigns, which represent a complex logistical challenge.
According to the World Health Organisation (WHO), out of the 30 million children affected by measles every year, about half a million die. Most of those deaths occur in Africa and Asia. This contrasts sharply with the Western world where measles cases have become extremely rare thanks to universal routine immunisation. This leads many people to forget that measles is a major killer.
Measles is highly contagious. Symptoms like runny nose, cough, eye infection, and rash appear about 10 to 14 days after exposure to the virus. There are different levels of severity, and deaths following measles infection are usually due to measles-related complications like diarrhoea, dehydration, and respiratory infections (pneumonia, croup). Those deaths can occur weeks after the acute disease and are not always attributed to measles. Mortality can reach 5 percent to 20 percent of measles cases. Initial health condition, access to health care, and proper treatment provision are factors influencing mortality.
2011 International Symposium on Reducing Child Mortality: Thinking outside the hospital for effective medical care
15/07/2011
In the lead-up to the 7th World Congress of the World Society for Paediatric Infectious Diseases held in Melbourne, Australia, Médecins Sans Frontières and Epicentre are hosting a one-day satellite symposium to re-think...
Category: Upcoming Events (Events), Lectures & Seminars
Médecins Sans Frontières welcomes initiative by UNICEF to make vaccine prices public
31/05/2011
Geneva, 27 May 2011— In a bid to increase transparency and stimulate competition to bring down the prices of vaccines needed in the developing world, UNICEF has decided to publish the prices it pays to vaccine manufacturers.
Category: Press releases
Zambia: Measles vaccination campaign underway to immunise 600,000 children
24/05/2011
Mansa, Zambia – Médecins Sans Frontières teams are currently working alongside the Zambian health authorities to carry out a measles vaccination campaign with a target of almost 600,000 children. Médecins Sans Frontières launched...
Category: Field news
Treating measles in a remote province of the Democratic Republic of Congo
17/05/2011
In March, the measles epidemic that has raged in the Democratic Republic of Congo (DRC) for more than six months reached the remote province of Maniema. Despite the logistical challenges, Médecins Sans Frontières teams are...
Category: Field news
Medical and humanitarian emergency continues as violence persists in Ivory Coast
27/04/2011
21 April 2011: The medical and humanitarian emergency in Ivory Coast persists as violence rages in several neighbourhoods in Abidjan, and security in the west of the country remains critically unstable, with populations hiding in...
Category: Field news
28/03/2011
Over the past six months a measles epidemic has been sweeping through the Democratic Republic of Congo (DRC). Médecins Sans Frontières is raising the alarm and calling for concerted action to halt the spread of the disease.
Category: Press releases
Sunday, July 24, 2011
Research Summary: AMEDEO Parasitic Diseases, 25 July, 2011.
1. AMEDEO Parasitic Diseases
http://www.amedeo.com
2011-07-25
1. DOS SANTOS AO, Costa MA, Ueda-Nakamura T, Dias-Filho BP, et al.
Leishmania amazonensis: Effects of oral treatment with copaiba oil in mice.
Exp Parasitol. 2011.
http://amedeo.com/p2.php?id=21771592&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
2. TAFAGHODI M, Eskandari M, Khamesipour A, Jaafari MR, et al.
Alginate microspheres encapsulated with autoclaved Leishmania major (ALM) and
CpG-ODN induced partial protection and enhanced immune response against murine
model of leishmaniasis.
Exp Parasitol. 2011.
http://amedeo.com/p2.php?id=21767536&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
3. EL-LAKKANY N, Seif El-Din S, Ebeid F.
The use of pentoxifylline as adjuvant therapy with praziquantel downregulates
profibrigenic cytokines, collagen deposition and oxidative stress in experimental
schistosomiasis mansoni.
Exp Parasitol. 2011.
http://amedeo.com/p2.php?id=21762692&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
4. DE ALMEIDA ME, Steurer FJ, Koru O, Herwaldt BL, et al.
Identification of Leishmania spp. by Molecular Amplification and DNA Sequencing
Analysis of a Fragment of the rRNA Internal Transcribed Spacer 2 (ITS2).
J Clin Microbiol. 2011.
http://amedeo.com/p2.php?id=21752983&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
5. DESQUESNES M, Kamyingkird K, Vergne T, Sarataphan N, et al.
An evaluation of melarsomine hydrochloride efficacy for parasitological cure in
experimental infection of dairy cattle with Trypanosoma evansi in Thailand.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21767438&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
6. CARMELO E, Gonzalez G, Cruz T, Osuna A, et al.
Characterization of monomeric DNA-binding protein Histone H1 in Leishmania
braziliensis.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21767437&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
7. NEAL AT.
Male gametocyte fecundity and sex ratio of a malaria parasite, Plasmodium
mexicanum.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21756426&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
8. JACINTO DS, Muniz HD, Venancio TM, Wilson RA, et al.
Curupira-1 and Curupira-2, two novel Mutator-like DNA transposons from the
genomes of human parasites Schistosoma mansoni and Schistosoma japonicum.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21756422&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
9. KIHARA J, Mwandawiro C, Waweru B, Gitonga CW, et al.
Preparing for national school-based deworming in Kenya: the validation and
large-scale distribution of school questionnaires with urinary schistosomiasis.
Trop Med Int Health. 2011 Jul 18. doi: 10.1111/j.1365-3156.2011.02829.
http://amedeo.com/p2.php?id=21767334&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
10. XUE Z, Gebremichael M, Ahmad R, Weldu ML, et al.
Impact of temperature and precipitation on propagation of intestinal
schistosomiasis in an irrigated region in Ethiopia: suitability of satellite
datasets.
Trop Med Int Health. 2011 Jul 18. doi: 10.1111/j.1365-3156.2011.02820.
http://amedeo.com/p2.php?id=21767333&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
We have screened the following journals for you:
Acta Cytol
Am J Gastroenterol
Am J Trop Med Hyg
Antimicrob Agents Chemother
Br J Dermatol
Br J Haematol
Clin Infect Dis
Epidemiol Infect
Eur J Immunol
Exp Parasitol
Infect Immun
Int J Parasitol
J Clin Microbiol
J Eukaryot Microbiol
J Exp Med
J Immunol
J Infect Dis
J Parasitol
JAMA
Lancet
N Engl J Med
Nat Med
Nature
Neurology
Parasite Immunol
Parasitology
Proc Natl Acad Sci U S A
Science
Trop Med Int Health
http://www.amedeo.com
2011-07-25
1. DOS SANTOS AO, Costa MA, Ueda-Nakamura T, Dias-Filho BP, et al.
Leishmania amazonensis: Effects of oral treatment with copaiba oil in mice.
Exp Parasitol. 2011.
http://amedeo.com/p2.php?id=21771592&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
2. TAFAGHODI M, Eskandari M, Khamesipour A, Jaafari MR, et al.
Alginate microspheres encapsulated with autoclaved Leishmania major (ALM) and
CpG-ODN induced partial protection and enhanced immune response against murine
model of leishmaniasis.
Exp Parasitol. 2011.
http://amedeo.com/p2.php?id=21767536&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
3. EL-LAKKANY N, Seif El-Din S, Ebeid F.
The use of pentoxifylline as adjuvant therapy with praziquantel downregulates
profibrigenic cytokines, collagen deposition and oxidative stress in experimental
schistosomiasis mansoni.
Exp Parasitol. 2011.
http://amedeo.com/p2.php?id=21762692&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
4. DE ALMEIDA ME, Steurer FJ, Koru O, Herwaldt BL, et al.
Identification of Leishmania spp. by Molecular Amplification and DNA Sequencing
Analysis of a Fragment of the rRNA Internal Transcribed Spacer 2 (ITS2).
J Clin Microbiol. 2011.
http://amedeo.com/p2.php?id=21752983&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
5. DESQUESNES M, Kamyingkird K, Vergne T, Sarataphan N, et al.
An evaluation of melarsomine hydrochloride efficacy for parasitological cure in
experimental infection of dairy cattle with Trypanosoma evansi in Thailand.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21767438&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
6. CARMELO E, Gonzalez G, Cruz T, Osuna A, et al.
Characterization of monomeric DNA-binding protein Histone H1 in Leishmania
braziliensis.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21767437&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
7. NEAL AT.
Male gametocyte fecundity and sex ratio of a malaria parasite, Plasmodium
mexicanum.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21756426&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
8. JACINTO DS, Muniz HD, Venancio TM, Wilson RA, et al.
Curupira-1 and Curupira-2, two novel Mutator-like DNA transposons from the
genomes of human parasites Schistosoma mansoni and Schistosoma japonicum.
Parasitology. 2011.
http://amedeo.com/p2.php?id=21756422&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
9. KIHARA J, Mwandawiro C, Waweru B, Gitonga CW, et al.
Preparing for national school-based deworming in Kenya: the validation and
large-scale distribution of school questionnaires with urinary schistosomiasis.
Trop Med Int Health. 2011 Jul 18. doi: 10.1111/j.1365-3156.2011.02829.
http://amedeo.com/p2.php?id=21767334&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
10. XUE Z, Gebremichael M, Ahmad R, Weldu ML, et al.
Impact of temperature and precipitation on propagation of intestinal
schistosomiasis in an irrigated region in Ethiopia: suitability of satellite
datasets.
Trop Med Int Health. 2011 Jul 18. doi: 10.1111/j.1365-3156.2011.02820.
http://amedeo.com/p2.php?id=21767333&s=pad&pm=0da2afd4a82ab52
ABSTRACT available
We have screened the following journals for you:
Acta Cytol
Am J Gastroenterol
Am J Trop Med Hyg
Antimicrob Agents Chemother
Br J Dermatol
Br J Haematol
Clin Infect Dis
Epidemiol Infect
Eur J Immunol
Exp Parasitol
Infect Immun
Int J Parasitol
J Clin Microbiol
J Eukaryot Microbiol
J Exp Med
J Immunol
J Infect Dis
J Parasitol
JAMA
Lancet
N Engl J Med
Nat Med
Nature
Neurology
Parasite Immunol
Parasitology
Proc Natl Acad Sci U S A
Science
Trop Med Int Health
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