Wednesday, December 29, 2010

Rabies Outbreak in Bali: Update from Australian Chief Health Officer

Rabies alert - Bali

Rabies has been diagnosed in dogs on the Indonesian island of Bali. Previously Bali was considered to be rabies free, hence this presents a new risk to Australians visiting Bali.





The Indonesian media have also reported that several people with rabies-like clinical signs and symptoms have died after being bitten by dogs. The diagnosis of rabies in these people has not yet been confirmed.
Although rabies has previously been known to be present on other Indonesian islands, this is the first report of an outbreak of rabies on Bali. There is at present no indication that the disease has spread to animals other than dogs. However, any animal should be considered to pose a potential risk.


Rabies is a disease primarily of animals and is transmitted to humans via a bite or scratch from an infected animal. Person-to-person transmission is extremely rare. Rabies is an almost invariably fatal disease of the brain with an average incubation period of three to eight weeks. Without medical intervention, patients die from respiratory paralysis. Although rabies in travellers is rare, such cases do occur. Travellers to rabies-endemic areas should be informed of the risk and advised to avoid contact with wild and domestic animals.


Authorities in Bali have taken steps to control the situation, including implementing a program of culling and vaccination in dogs and vaccination of people in the villages affected.


Visitors to Bali are strongly advised to avoid direct contact with all dogs and cats (including pets), monkeys and other animals. If bitten or scratched by any animal, they should immediately wash the wound thoroughly with soap and water, apply an antiseptic containing povidone-iodine, and seek immediate medical attention. 


The Department advises that any patient who has returned to Australia with bites and/or scratches from an animal in Bali since 1 August 2008 should receive rabies immunoglobulin (RIG) and commencement of the rabies vaccine post exposure prophylaxis (PEP) schedule as soon as possible after the exposure. For the details of management of patients potentially exposed to rabies, please refer to the Australian Immunisation Handbook 9th Edition 2008.
Rabies vaccination should also be considered in those planning travel to Bali.


DHS funds RIG and rabies vaccine for individuals warranting rabies PEP. If you require RIG and/or rabies vaccine for PEP, or to replenish stocks you have used for such a purpose, please call DHS on 1300 882 008 or fill out the attached order form and fax it to 1300 768 088 and DHS can organise for them to be sent to you.
Please call DHS on 1300 882 008 if you require further information about this situation.


Yours sincerely,


Dr John Carnie



Chief Health Officer
Victoria, Australia.


Source: http://www.health.vic.gov.au/chiefhealthofficer/alerts/rabies.htm#

Tuesday, December 28, 2010

Malaria Eradication (WHO Bulletin)

Bulletin of the World Health Organization (BLT)






Malaria eradication back on the table

Marcel Tanner a, Don de Savigny a

After a lapse of almost 40 years, malaria eradication is back on the global health agenda. Inspired by the Gates Malaria Forum in October 2007,1,2 key organizations are starting to debate the pros and cons of redefining eradication as an explicit goal of malaria control efforts. Attempts to eliminate malaria in southern Africa3 and Pacific Island states,4 and WHO’s Global Malaria Programme agenda and field manual for malaria elimination,5,6 foreshadow this movement towards another global attempt at eradication.
When marking 60 years of WHO’s commitment to fighting malaria, we must ask what has been achieved, but also what can we learn from the past. We now know so much more about the biology of parasite-host responses, the determinants of endemicity and transmission dynamics, the social, economic and cultural implications of malaria at household, community and national levels, and the demands made upon health systems in endemic countries. We do not yet know how to synthesize and integrate this knowledge to achieve elimination in different settings.
Regional malaria elimination campaigns were first conducted in the late 1940s, preparing the ground for the Global Malaria Eradication Program in 1955. This campaign succeeded in eliminating malaria from Europe, North America, the Caribbean and parts of Asia and South-Central America.7 But no major success occurred in sub-Saharan Africa, which accounts for 80% of today’s burden of malaria.8 When the aspiration of global eradication was abandoned in 1969, the main reasons for failure were technical challenges of executing the strategy especially in Africa.
The post-eradication era from 1969 to 1991 focused on technical issues, and research and development for new tools, leading to advances in drug and vaccine development, vector control and insecticide-treated nets. These decades also brought a better understanding of the social, economic and cultural dimensions of malaria. There was little global support provided specifically for malaria control in the newly independent states of Africa that were struggling to establish broad-based health systems and primary health care. By 1992, the combination of a worsening malaria situation and promising technical developments led to renewed global focus on malaria control.
The Roll Back Malaria initiative, launched by WHO in 1998, led to the Abuja Declaration in 2000, which defined progressive intervention coverage targets for control designed to eliminate malaria as a public health problem, while emphasizing that this could only be achieved through vastly strengthened local health systems.9 Increased resources through the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank’s Booster Program, the US President’s Malaria Initiative and many others has meant that this page is finally beginning to turn as intervention coverage is rising.10
It is against this background that we hear this call for elimination/eradication. The challenges remain formidable. We all know that elimination in Africa is not possible with current tools. But efforts must focus beyond simply developing better tools, to include how existing and future tools can be strategically combined for maximum synergistic effectiveness when integrated into different health and social systems prevailing in endemic areas. Aiming at elimination and eradication further implies the need for effective surveillance strategies to monitor progress (again a challenge for health systems). This in turn requires a better understanding of malaria transmission heterogeneity in a globalized world with rapidly changing dynamics in environment, climate, migration and transnational cooperation.
Maintaining long-term momentum in the face of success in regional elimination while waiting to achieve final eradication will be a major challenge. Shrinking the map by starting on the malaria margins with the “easy-to-eliminate” settings will boost morale initially but may bring marginal benefits to such areas at the expense of those where the burden of malaria is highest. Any strategic plan – and here we learn again from the past – needs to be a synchronous global effort, locally adapted in all endemic areas.
Although we lack sufficient knowledge, systems and tools to eradicate malaria today, we do have a window of political will and financial resources to refocus on the goal of effective control through universal coverage of appropriate interventions. The prerequisites for a successful start are: (i) a process of inclusive discourse to agree on global vision, goals and strategy; and (ii) a global plan for all endemic areas describing how, where and when we move from control towards elimination. What must distinguish the new era, especially in Africa, is a real rather than rhetorical emphasis on health systems. ■

References

Affiliations

  • Swiss Tropical Institute, Socinstrasse 57, 4002 Basel, Switzerland.

Monday, December 27, 2010

The Millennium Development Goals In Action: Part V - Improve Maternal Health

The Millennium Development Goals In Action: Part VI

Combat HIV/AIDS, Malaria and other Diseases

The Millennium Development Goals in Action: Part V


Improve Maternal Health

We hear much about the Millennium Development Goals (MDGs) but just exactly what are they and what are some real life examples?


Our eight part series, The MDGs in Action, looks at real life examples of each goal and the people working to achieve them.


MDG Goal 5: Improve Maternal Health

A Programme In Action: UN fundraising for Maternal Health Programmes

Your Action: Support UNHCR , 'Like' on Facebook, Tweet or Donate.


MDG 5 – Improve Maternal Health


Improving Maternal Health
Millennium Development Goal number five (MDG 5) aims at improving maternal health.  This is to be done by minimising mortalities that result from complications, associated with pregnancy and childbirth.
MDG 5 aims firstly to reduce the maternal mortality rate between 1990 and 2015 by three quarters, and secondly to achieve universal access to reproductive health by 2015.  The UN has identified 68 priority countries where maternal health standards are the lowest.  These 68 priority countries, account for 98 per cent of all maternal mortality.
Family Planning and Antenatal Care
Family planning improves maternal health through increased education and access to contraception.  It is estimated that family planning is one of the most effective ways of decreasing maternal mortality. Unfortunately there has been little progress in this area.  During the 1990’s the use of contraceptives did increase, however since 2000 very little change has occurred. A major setback for the development of family planning has been insufficient funding.  Since 2001 the percentage of aid going towards family planning has decreased.
Access to antenatal care has progressed.  Between 1990 and 2008 Northern Africa, Southern Asia and Western Asia saw significant increases in the number of women who received at least one antenatal visit.  Promisingly 67 per cent of women in the developing world attended the recommended four antenatal visits.   While there is still global disparity in terms of antenatal care, progress since 1990 has been encouraging.
Two worlds
Alarmingly, most maternal deaths which occur could be easily avoided with modern medicines and education.  The disparity which exists between maternal health in the developed and the developing worlds, is phenomenal. MDG 5 aims at closing this gap by creating universal access to healthcare and education to women, not only during pregnancy and childbirth but also pre-conception.
Preventable Deaths
Deaths occurring during childbirth are unacceptably high in the developing world.  Haemorrhaging, for instance, accounts for more than thirty per cent of annual maternal mortality.  This is despite the fact that it can most often be overcome if a health care professional is present during childbirth.
While it remains that there is an insufficient number of supervised births in the developing world, progress has occurred. The number of attended births has increased by over 60 per cent in both North Africa and South-Eastern Asia.  The 2010 MDG’s report, states that since 1990, the number of births attended by trained personnel in developing countries rose by 10 per cent.   Despite these achievements, improvement is essential in Southern Asia and sub-Saharan Africa, where less than half of all births are assisted.
While the world has seen some progress over the past ten years, extreme inequity still exists.  In order to reach MDG 5 targets, rapid change must occur over the next five years with the instigation of further strategies.
Article written by Elyce Behrsin

A Maternal Health Programme in Action:ow

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For refugee women, pregnancy and childbirth can be fraught with risk. Those living in impoverished and isolated settlements may have no access to basic antenatal services or emergency obstetric care.
 
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Overview:

For refugee women, pregnancy and childbirth can be fraught with risk. Those living in impoverished and isolated settlements may have no access to basic antenatal services or emergency obstetric care. Refugee mothers are more likely to be poorly nourished and suffer from debilitating conditions like malaria-induced anaemia, a blood disorder which greatly increases the risk of miscarriage and post-natal haemorrhage. Even those with a tradition of homebirth may lack the simple means to make their birth environment clean, exposing themselves and their newborns to the risk of post-natal infection.





How We Help:

UNHCR oversees the operation of maternity clinics in refugee camps and encourages women to access these services before, during and after childbirth. We train and equip midwives and, where possible, provide all pregnant and breastfeeding mothers with extra nutrition and anti-malarial medication.

Where home birth is the norm and sanitation is poor, we distribute our Clean Delivery Kit - a plastic bag containing a clean blade, a plastic sheet, soap, string for the baby's cord, a swaddling cloth and information using simple pictures. These simple kits have dramatically reduced birth-related deaths and infections in a number of impoverished refugee communities.

Donate now to save the life of a refugee mother and her baby.

News from UNHCR:

Sarah-Jane Clarke announced as Ambassador

28 April 2010

sass & bide co-founder joins Australia for UNHCR to raise awareness of refugee mother and child health needs and other global refugee relief efforts
Australia for UNHCR, the UN Refugee Agency's charity in Australia, today announced that noted co-founder of sass & bide, Sarah-Jane Clarke, had come on board as an ambassador to help raise awareness of the plight of refugees around the world.
Sarah-Jane Clarke commences her role in support of the charity's Safe Mother & Baby Appeal, which is raising funds to send hygienic baby delivery packs to refugees in some of the world's poorest countries including Chad, Nepal, Bangladesh and Somalia in an effort to reduce high maternal and infant mortality rates.
Coinciding with Mother's Day, these special lifesaving gift packages can be purchased for $26 for a pack of 10, to be sent on behalf of Australian mothers at www.worldsbiggestpackage.com.
The Safe Mother & Baby appeal will be officially launched at the annual Australia for UNHCR Mother's Day Lunch, which is being held at Sydney's Ivy Ballroom on Friday, 7th May, and is being attended by special guests, Sarah-Jane Clarke, and Julie McCrossin as MC.
Commenting on her support of the charity, Sarah-Jane said, "Like any mother, a campaign like the Safe Mother & Baby Appeal is close to my heart. Knowing that $2.70 is the difference between life and death for a mother and her child makes this an extremely important message to send. A safe and healthy birth is a basic human right, and this kit will make that possible for refugee women around the world.
"Australia for UNHCR is an inspiring organisation that I strongly believe in and feel honoured to be an Ambassador for," she said.
National Director of Australia for UNHCR, Naomi Steer, said, "We're delighted to have SarahJane on board. Her passion for the issues will help make a real difference to raise awareness and funds to help refugees across the globe, 80% of whom are women and children."
Ms Steer recently returned from a charity trek up Mt Kenya and visit to Nakivale refugee camp in Uganda.
"My visit to Nakivale once again brought home the issues facing female refugees in the world's poorest countries, where maternal and infant mortality is 155 times higher than in Australia. While I was encouraged to see the amazing difference that funding from Australia for UNHCR has made, the trip has also made me very aware of how much work remains to be done.
"The Safe Mother & Baby Appeal will go a long way towards improving the lives of refugee women and children around the globe, so I really hope that our Australian supporters dig deep," she said.
About Australia for UNHCR

Australia for UNHCR was established in 2000 as part of UNHCR's global fundraising network. Its mission is to provide life changing humanitarian support to refugees and other displaced and stateless people who come under the care and protection of the UN Refugee Agency.
More than 42 million people are forcibly uprooted by conflict and persecution worldwide with 80 per cent of these being women and children. Globally, UNHCR provides and coordinates international relief for these people, offering them protection and assistance at every stage of their ordeal.
As well as providing emergency shelter, food, water and medical care, UNHCR strives to improve refugees' quality of life and future opportunities, providing infrastructure, schools and income generating projects in established refugee camps and communities.
About the Safe Mother & Baby appeal: the issues:
  • Globally, an estimated 529,000 women die during pregnancy and childbirth from preventable causes every year
  • One in 12 Somali mothers will die in childbirth in their lifetime
  • Only 9% of all births in Somalia are attended by skilled health personnel A woman in Somalia is 155 times more likely to die in childbirth than a woman in Australia.