Ensuring women’s health is challenging issue -Nepal Earthquake

The earthquake on 25^th April 2015 in Nepal has killed more than 8,800 people and injured more than 23,000. More than 4, 50,000 people were displaced & leaving many homeless with more than 5, 00,000 houses including entire villages flattened in many earthquake-affected areas in the country. The earthquake has triggered intense physical, economical, socio-cultural, impact on different sectors including the tourism sectors in more than twenty districts.

In Nepal existing patriarchal society is major risk factors for higher morbidity & mortality rate of women .In addition to above fact, the earthquake has triggered intense women’s & girls health damage which is further aggravated by poor women empowerment in terms of poor literacy rate, lack of accessibility & affordability to health services, gender based violence, restriction of social participation and lack of decision making role. The deleterious health effects on women are further described under specific areas below:

A.     Physical Health: The rate of functional impairment, injuries, permanent disability & deaths has increased. According to data published by Nepal Police, 55% of the causality were women & children.

B.     Mental & psychological Health:  The burden of psychological stress & trauma, loss of self esteem, anxiety and threat in people has tremendously increased. There may be increasing risk taking behavior including post traumatic stress disorder (PTSD).The situation is even more critical for girls and women. The possible reasons are loss of family members including husband &children and loss of physical properties due to poverty.

C.     Maternal Health: Maternal and child health issues including nutritional demand, antenatal care services, delivery care and postnatal care for women are emerging problems.  In Nepal 75% of population affected are either women or children, and similarly 25% of the population at risk are women of reproductive age, of them 20% likely to pregnant.  Decreased access to obstetric care increases risk of maternal & neonatal death. Others possible causes responsible for poor maternal health are poor communication & transportation, inadequate trained health-workers, health infrastructural damage and disintegrated community & family life.

D.     Reproductive & sexual health: The UNFPA estimated that approximately 50,000 pregnant women were affected from earthquake.  Lack of family planning devices at temporary shelters has triggered increasing risk of unwanted pregnancy & unsafe abortion. Other possible consequences are uterine prolapse, fistula, chronic infections, pregnancy complications, pelvic inflammatory diseases etc. Some newspapers have reported that there has increased using rate of emergency contraception in order to prevent from possibility of having abnormal birth outcome. There may be possibility of increasing sexual abuse on women & girls at temporary shelter due to mix population, loss of guardian & unsafe shelter etc. There may be also possibility of occurring sexual abuse, harassment, rape, unsafe sexual relations etc. and consequences may be transmission of HIV & sexual transmitted diseases (STI) at higher rate.

E.      Unhealthy behavior: This includes smoking, alcohol & drug use, sexual risk taking, physical inactivity, overeating etc.

F.      Social health:  This includes homeless, disintegrate from community etc.

G.     Others: There may be possibility of increasing rate of femicide, suicide, girl trafficking of girls & women, domestic violence etc.

What should we do to ensure women’s health?

- Preparedness for reproductive health in crisis in terms of technical support, advocacy, collaboration, coordination etc.

-Gather information (basic demographic info, RH, morbidity and mortality, available services, socio-cultural issues related to RH)

-Identify resource needs and order essential supplies (condoms, post-rape & obstetric emergencies, clean delivery kits)

-Recruit and train staff

-Plan for camp set-up (coordination among organizations, gender concerns site and layout concerns

Minimize risk of gender-based violence)

What tools we have?

•       Minimum Initial Service Package (MISP) (set of activities)

•       Inter-agency Field Manual

•       RH Kit for Emergency Situations (UNFPA)

What is beneficences of Minimum Initial Service Package (MISP) ?

•       Prevent and manage the consequences of sexual violence

•       Reduce HIV and STI transmission

•       Prevent neonatal and maternal morbidity and mortality

•       Plan for integrating comprehensive RH Services in Primary health care as soon as possible (Resume services)

Prevent and manage the consequences of sexual violence
-   Plan camp design, & food & other distributions
-   Medical response (trauma care, emergency
     contraception, pregnancy test, STI treatment, HIV)
 -  Awareness raising in the community
-  Referral to legal, social and other services
-  Ensure confidentiality

•       Reduce HIV transmission

-Universal precautions (safe handling of sharps,

Cleaning disinfecting and sterilization, gloves &

–      Protective clothing…)

–      Free condoms

–      Safe blood transfusions

•       Prevent neonatal and maternal morbidity and mortality

–      Clean home deliveries [ Shelter homes]

–      Clean and safe deliveries at health facility

–      Referral for obstetric emergencies

Plan for comprehensive RH services, integrated into PHC, as soon as possible

•       Assess needs and resources (staff, sites, equipment)

•       Design program & seek funds

•       Order supplies

•               Train staff

•       Block 1. Kits serving the needs of 10 000 people for 3 months  

•       Kit 0: Administration/training supplies

•       Kit 1: Condoms

•       Kit 2: Clean delivery, individual

•       Kit 3: Post rape treatment

•       Kit 4: Oral and injectable contraception

•       Kit 5: Treatment of sexually transmitted infections

•       Block 2. Kits serving the needs of 30 000 people for 3 months

•       Kit 6: Clinical delivery assistance

•       Kit 7: Intrauterine device

•       Kit 8: Management of miscarriage and complications of abortion

•       Kit 9: Suture of tears (cervical and vaginal) and vaginal examination

•       Kit 10: Vacuum extraction delivery

•       Block 3. Kits serving the needs of 150 000 people for 3 months

•       Kit 11: Referral level kit for reproductive health 32

•       Kit 12: Blood transfusion

http://www.ekantipur.com/2015/05/19/top-story/earthquake-55-pc-of-dead-are-women-children/405428.html

http://www.ekantipur.com/2015/04/29/national/around-50000-pregnant-women-affected-from-earthquake-unfpa/404628.html (accessed WRITE DATE)

http://www.ekantipur.com/the-kathmandu-post/2015/05/10/news/quake-hit-susceptible-to-diseases/276124.html

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960963-1/fulltext#.VYMM8jrywhU.facebook

Lymphatic Filariasis:- Painful story from Nepal

Key Learning Reflections from Nepal Earthquake

Nepal is among the high-risk countries (ranked 11^th most risk in the world) in term of earthquake occurrences. The earthquake on 25^th April 2015 in Nepal has killed more than 8,800 people and injured more than 23,000. More than 4, 50,000 people were displaced & leaving many homeless with more than 5, 00,000 houses including entire villages flattened in many earthquake-affected areas in the country. The earthquake has triggered intense physical, economical, socio-cultural, impact on different sectors including the tourism sectors in more than twenty districts. Nepal has suffered economic loss of up to $10 billion. The preliminary estimated cost for the reconstruction of the quake-ravaged country is to $ 5 billion as mentioned by government of Nepal.

The burden of psychological stress, trauma and threat in people has tremendously increased. The situation is even more critical for girls and women with possibility of increasing sexual abuse on women & ladies in temporary shelter areas.  Maternal & child health issues including nutritional demand, antenatal care services, delivery care and postnatal care for women are emerging problems.

Despite of huge loss triggered by earthquake, there are so many positive lesson learns from earthquake. Nepal will have to rebound after this suffering and should come stronger; the positive lesson learned is summarized below:

"Nepal Will Bounce Back symbolized by Dharahara"

·         The constitution drafting process was very much stagnant since 2006 AD, but after the devastating earthquake, leaders have realized the need for a committed role for unification of Nepal through building up consensus for conflicting issues in constitution. Thus after a long wait consensus has been made to draft new constitution;

·         During the time of crisis it was noteworthy that it was the common Nepalese around the country who responded to the one in need. The role of youth and those helping hands in relief and recovery initiative is highly praiseworthy. It has one way or other tighten the social bond of humanity, 

·         Many people have realized that maintaining quality and standards of housing is mandatory and must for safety reasons;

·         Concerned authorities  have realized the value of “disaster preparedness” before crisis and have enforced them on  strengthening  the disaster preparedness system;

•  It is great opportunity for mobilization of “community medical team” during disaster  so the concept of “emergency medical  mobilization” during disaster has put into action & lesson are learned by medical professionals;
•  Government realizes  the concept of quality standards on housing and also urge for  regulatory mechanism on housing;
•  Ministry of health and Population has realized that there should be further strengthening of “Community medical mobilization team” during disaster;
•   Many international helping hands were  mobilized during the disaster period showing solidarity of Nepalese people thus many people from around the world knew more about Nepal;
• Many international technologies were applied during rescue, e.g., in medical, construction sectors, so it was an opportunity to be familiar with foreign technologies.
• http://en.wikipedia.org/wiki/April_2015_Nepal_earthquake
• http://www.ibnlive.com/news/world/nepal-suffered-up-to-10-billion-loss-in-earthquake-government-990938.html
• http://eq.nitc.gov.np/
• https://docs.google.com/presentation/d/155HstWvSu5-H0SjO5u32vTNpDeklxlMo_cEcZop5C1M/pub?start=false&loop=false&delayms=3000&slide=id.p8
• 
  

Health System Facts in Nepal

• The Ministry of Health & Population(MoHP) was established in 1954 A.D.
• The first allopathic medicine was prescribed at Bir hospital.
• The Department of Health Services(DoHS) was established in 1933 A.D before establishment of MoH.
• Constitution of Nepal 272 B.S has mentioned "Right to Health" on right number- 35.
• "Performance appraisal" system was started in fiscal year 1998/99 A.D, under health system it was functioned in FY 2001/002 A.D.
• The concept of regional health directorate was established in five developmental regions in 1987 A.D.
• The Ministry of Health and Ministry of Population was merged to become MoHP on 27/July/2005. Recently they have separated again.
• "Compensation based citizen character" was started under health system on 13/Feb/2014
• The Leprosy elimination was declared on 19/Jan/2010.
• "Kidney transplantation service" was started in Tribhuvan University Teaching Hospital(TUTH) on 08/Aug/2008.
• The sampling method was started for population studies in 1975 A.D.
• Polio free status has declared by WHO in South -East Asia region including Nepal on 27/March/2014.
• Health insurance program has piloted at Sunsari, Baglung & Kailali districts of Nepal.
• World Hepatitis day was started to celebrate in 2008 A.D.
• Free maternity services was initiated on 14/Jan/2009.
• Second National Health Policy-2014 has approved by government on 17/July/2014 and published by MoHP on 08/Aug/2014.
•  "Modified De Jure" method was applied on National Population Census-2011 A.D.
• The last polio case to be diagnosed on 30/Aug/2010 A.D.
• Smoking was banned at public place on 07/Aug/2011.
• "Ebola desk" was established under Ministry of Health on 18/Aug/2014.
• "Tobacco control Act" was endorsed in 2011 A.D.
• 90% graphic health warning on tobacco packs was endorsed on 15/May/2015.
• Government of Nepal has committed to declare open defecation free Nepal by the year 2017 A.D.
•  Nepal ranked 146th rank among 188 countries in human development index report (HDI)-2015.
• First Dengue case was diagnosed at Kathmandu on 26/June/2014.
• "Oral Health Policy" was endorsed in 2013 AD.
• "Mental Health Act" was endorsed in 2006 AD.
• National Population Policy was endorsed in 2014.
• Primary Health Care- Revitalization division under DoHS was established in 2009 AD.
•  National census day is celebrated on  "1st Ashad.
• According to National Population Census-2011, the % of female having ownership on property is 19.71.
•  According to National Population Census-2011, the % of families having no access to toilet  is 38.17.  
• The highest population growth(2.62%)was reported during 8th National Population Census-1981 A.D.
• The inactivated polio vaccine(IPV) has first introduced in Nepal among South-East Asia region.
• The Female Community Health Volunteer(FCHV) is must successful  program under national health system,Nepal.
• The concept of "sustainable development" was included during 8th periodic five-years plan.
• The concept of environment policy and programs were included during 6th periodic five -years plan.
• ISO-14000 is related to "Environment Management"
• Agenda-21 is related to "Environment & Development"
• EURO-1 is related to  criteria on "vehicle emitted pollution"
•  In Nepal, annual temperature growth rate is 0.06 degree Celsius.
• In Nepal, annual deforestation rate is 0.4%.
• The concept of environmental impact assessment (EIA) was introduced during 12th periodic five-years plan.
• The interim constitution 2063 B.S declared "health as a fundamental human right".

www.mohp.gov.np

www.cbs.gov.np

MERS virus- Possibility of big threat for Nepal

            The current "MERS" virus epidemic in South Korea is public health emergency for the world. According to report updated by World Health organization (WHO) there is total 169 cases & 26 deaths has recorded in South Korea. The index case has just reported in Thailand and China has developed new diagnostic technology to identify MERS in 15 minute test. The case fatality of MERS is above 40%. 

            There is big possibility of transferring MERS virus from South Korea to South East Asia region including Nepal due to geographical closure. There is also fact that more than thousand of Nepalese people have mobilized from South Korea for the purpose of foreign employment & those who emigrated from South Korea to Nepal may pose to MERS infection.

The Ministry of Health & Population (MoHP), Nepal still hasn't drafted proper plan regarding MERS prevention program. There should be established mechanism to prevent possibility of MERS outbreak in Nepal; otherwise it will be big threat for Nepal in future.

What is role of MoHP to prevent possible outbreak of MERS in Nepal?

• There should be establishment of MERS-desk at international transits & borders;
• Program should be targeted to health service providers especially at hospital settings  in order to establish MERS prevention & management system;
• For public awareness, developing IEC(information, education & communication) materials about MERS virus;
• Establishment of isolation system for MERS cases if necessary.

Key Facts-

• Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (MERS‐CoV) that was first identified in Saudi Arabia in 2012.
• Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS).
• Typical MERS symptoms include fever, cough and shortness of breath. Pneumonia is common, but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported.
• Approximately 36% of reported patients with MERS have died.
• Although the majority of human cases of MERS have been attributed to human-to-human infections, camels are likely to be a major reservoir host for MERS-CoV and an animal source of MERS infection in humans. However, the exact role of camels in transmission  of the virus and the exact route(s) of transmission are unknown.
• The virus does not seem to pass easily from person to person unless there is close contact, such as occurs when providing unprotected care to a patient.

Symptoms-

The clinical spectrum of MERS-CoV infection ranges from no symptoms (asymptomatic) or mild respiratory symptoms to severe acute respiratory disease and death. A typical presentation of MERS-CoV disease is fever, cough and shortness of breath. Pneumonia is a common finding, but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported. Severe illness can cause respiratory failure that requires mechanical ventilation and support in an intensive care unit. Approximately 36% of reported patients with MERS-CoV have died. The virus appears to cause more severe disease in older people, people with weakened immune systems, and those with chronic diseases such as cancer, chronic lung disease and diabetes.

Source of the virus-

MERS-CoV is a zoonotic virus that is transmitted from animals to humans. The origins of the virus are not fully understood but, according to the analysis of different virus genomes, it is believed that it originated in bats and was transmitted to camels sometime in the distant past.

Transmission-

Non-human to human transmission: The route of transmission from animals to humans is not fully understood, but camels are likely to be a major reservoir host for MERS-CoV and an animal source of infection in humans. Strains of MERS-CoV that are identical to human strains have been isolated from camels in several countries, including Egypt, Oman, Qatar, and Saudi Arabia.

Human-to-human transmission: The virus does not appear to pass easily from person to person unless there is close contact, such as providing unprotected care to an infected patient. There have been clusters of cases in healthcare facilities, where human-to-human transmission appears to be more probable, especially when infection prevention and control practices are inadequate. Thus far, no sustained community transmission has been documented.

The virus appears to be circulating throughout the Arabian Peninsula, primarily in Saudi Arabia, where the majority of cases (>85%) have been reported. Several cases have been reported outside the Middle East. Most of these infections are believed to have been acquired in the Middle East, and then exported outside the region. No secondary or only limited secondary transmission has been reported in countries with exported cases.

Prevention and treatment-

No vaccine or specific treatment is currently available. Treatment is supportive and based on the patient’s clinical condition.

As a general precaution, anyone visiting farms, markets, barns, or other places where camels and other animals are present should practice general hygiene measures, including regular hand washing before and after touching animals, and should avoid contact with sick animals.

The consumption of raw or undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms that might cause disease in humans. Animal products that are processed appropriately through cooking or pasteurization are safe for consumption, but should also be handled with care to avoid cross contamination with uncooked foods. Camel meat and camel milk are nutritious products that can continue to be consumed after pasteurization, cooking, or other heat treatments.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. These people should avoid contact with camels, drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

Health-care facilities

Transmission of the virus has occurred in health‐care facilities in several countries, including from patients to health‐care providers and between patients in a health care setting before MERS-CoV was diagnosed. It is not always possible to identify patients with MERS‐CoV early or without testing because symptoms and other clinical features may be non‐specific.

Infection prevention and control measures are critical to prevent the possible spread of MERS‐CoV in health‐care facilities. Facilities that provide care for patients suspected or confirmed to be infected with MERS‐CoV should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health‐care workers, or visitors. Health‐care workers should be educated and trained in infection prevention and control and should refresh these skills regularly.

Travel

WHO does not recommend the application of any travel or trade restrictions or entry screening related to MERS-CoV.

WHO response

WHO is working with clinicians and scientists in affected countries and internationally to gather and share scientific evidence to better understand the virus and the disease it causes, and to determine outbreak response priorities, treatment strategies, and clinical management approaches. The Organization is also working with countries to develop public health prevention strategies to combat the virus.

Together with affected countries and international technical partners and networks, WHO is coordinating the global health response to MERS, including: the provision of updated information on the situation; conducting risk assessments and joint investigations with national authorities; convening scientific meetings; and developing guidance and training for health authorities and technical health agencies on interim surveillance recommendations, laboratory testing of cases, infection prevention and control, and clinical management.

The Director‐General has convened an Emergency Committee under the International Health Regulations (2005) to advise her as to whether this event constitutes a Public Health Emergency of International Concern (PHEIC) and on the public health measures that should be taken. The Committee has met a number of times since the disease was first identified. WHO encourages all Member States to enhance their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia cases.

Countries, whether or not MERS cases have been reported in them, should maintain a high level of vigilance, especially those with large numbers of travellers or migrant workers returning from the Middle East. Surveillance should continue to be enhanced in these countries according to WHO guidelines, along with infection prevention and control procedures in health-care facilities. WHO continues to request that Member States report to WHO all confirmed and probable cases of infection with MERS-CoV together with information about their exposure, testing, and clinical course to inform the most effective international preparedness and response.

http://www.who.int/mediacentre/factsheets/mers-cov/en/?utm_source=Twitter&utm_medium=Social&utm_campaign=MERS%20fact%20sheet

Beneficence of optimum salt consumption

आयोडिनयुक्त नुनबारे स्वास्थ्य सन्देश-

उच्च रक्तचापको कारण बिश्व र दक्षिण एसियामा धेरै मानिसहरुको मृत्युदर बढ्दो छ । अत्यधिक नुन य़ा सोडियमको सेवन नै उच्च रक्तचापको प्रमुख जोखिम तत्व (risk factor) हो । अत्यधिक नुन सेवनको मात्रलाई कम गर्ने हो भने उच्च रक्तचापको दर घट्न जान्छ फलस्वरूप मुटुको रोग तथा मस्तिस्कघात हुनबाट जोगिने सम्भावना धेरै हुन्छ। अत्यधिक नुन सेवनको  दरलाई कम गर्ने रणनीति जनताको स्वास्थ्यमा सुधार गर्ने एउटा cost-effective intervention को रुपमा प्रमाणित भएको छ ।

किन हामीले नुनको सेवन गर्दा होसियार हुने त?

•  उच्च रक्तचापको कारण बिश्व र दक्षिण एसियामा धेरै मानिसहरुलाई  मुटुको रोग, मस्तिस्कघात तथा विकलांग भै करिब 90 लाख जति  मानिसको बर्षेनी मृत्यु हुने गरेको छ ;
• दक्षिण एसियामा  प्रति चार जना मनिसमा उच्च रक्तचापको समस्या छ ;
• दक्षिण एसियामा औसत रुपमा दैनिक नुन सेवनको परिमाण 9-12 gm छ जुन विश्व स्वास्थ्य संघगठनले निर्धारण गरेको भन्दा दोब्बर मात्राको सेवन हो ;
• अत्यधिक नुन सेवनको मात्रा कम गर्नाले विश्वमा 2025  सम्म नसर्ने रोगबाट  हुने  थप 25% मृत्युदर घटाउने  लक्ष्य प्राप्त गर्न अति आवश्यक हुन्छ ।

दैनिक औसत नुन सेवनको मात्रा कति त?
विश्व स्वास्थ्य संगगठन(WHO) अनुसार प्रति व्यक्ति नुनको सेवन पाँच ग्राम(< 5 gm/per person) भन्दा कम हुनु पर्दछ ।

हामीले नुन सेवनमा नियन्त्रण गर्न कस्तो उपाय अपनाउने त ?

• खाना पकाउँदा कम नुनको प्रयोग गर्ने ;
• बजारमा पाइने तयारी खानाहरु (Junk Food) जसमा धेरै नुन मिसिएको हुन्छ जस्तै चाउचाउ, तयारी अचार, नुनिलो परिकार आदिको सेवनमा नियन्त्रण गर्ने ;
• आयोडिनयुक्त नुनको मात्र सेवन गर्ने ;
• प्रसस्त फलफूलको सेवन गर्ने जसमा पोटासियमको मात्रा धेरै हुन्छ जसले रक्तचाप घटाउन सहयोग गर्दछ ।

स्वास्थकर्मीको भूमिका के हुन सक्छ?

• समुदायलाई आयोडिनयुक्त नुन सेवनको सहि मात्रा बारे जनचेतना जोगाउने;
•  उच्च रक्तचाप भएका बिरामी तथा उनीहरुका परिवारलाई सहि मात्रामा नुनको प्रयोग गर्न सुझाब दिने; 
• स्वास्थ्य नीति निर्माणकर्ता लाई नुनको उपयुक्त प्रयोग गर्ने बारे सुझाब दिने तथा स्वमं सहभागी हुने; 
• नुनको उपयुक्त प्रयोग गर्ने बारे स्वास्थसंस्था/कार्यस्थलमा वकालत गर्ने ।