Public Health Perspective (PHP) Newsletter August 2012 Issue

Public Health Perspective
the first online public health newsletter of Nepal Vol. 2 Issue 8 August 2012

Editorial: The Status of Implementation of the Global Strategy for Infant and
Young Child Feeding in Nepal
On the auspicious occasion of Non-breastfed children are wealthiest households were
World Breastfeeding Week considered to be fed in ac- more likely than their coun-
Inside This Issue (August 1- 7), we are cele- cordance with the minimum terparts to receive foods from
brating the successes and standards if they consume four or more food groups.
achievements Nepal has made milk or milk products, are
in Infant and Young Child fed four food groups Seventy-eight percent of
National News 2&4 Feeding (IYCF) practices and (including milk products), breastfed children were fed
trying to present national and are fed at least four the minimum number of
World Breastfeeding work at global arena with this times a day. times in the previous 24
3 piece of writing. hours preceding the survey.
Week According to the Nepal The combined percentage of
Global Strategy for IYCF was Demographic and Health children who fall in both cate-
World Humanitarian
3 introduced by WHO and the Survey (NDHS) 2011, only gories (given foods from four
Day UNICEF in 2002. It provides one-fourth of children age 6- or more groups and fed the
advice on ways to protect, 23 months are fed appropri- minimum number of times
Global Health 5 promote, and support exclu- ately based on recommended per day) is 25 percent. Over-
sive breastfeeding for the first IYCF practices in Nepal. The all, 24 percent of Nepalese
six months, complementary percent of children aged less children are fed in accordance
Journal Watch 6 than six months who are with the three recommended
feeding practices with the
start of six months and con- exclusively breastfed is 70 IYCF practices.
Services of Public tinued breastfeeding for two while the percent of children
years or beyond. aged six to eight months old In the past one year, the GoN
Health, With Climate 7
(breastfed and non- has done various activities for
Change examples breastfed) who are given
IYCF is one of the programs the protection and promotion
implemented by the Govern- complementary foods at an of IYCF counseling. It has
ment of Nepal (GoN) to ad- appropriate time is just 66. carried out training on IYCF
Being Healthy 8 dress the nutrition problems counseling in seven districts
in young children. As a result, The survey further states namely Doti, Bardiya, Dang,
promotion of IYCF via public that, the majority of children Nuwakot, Morang, Mahottari,
WHO Publications 9 awareness is one of the spe- are still breastfeeding at the and Sankhuwasabha. Simi-
cific strategies to control pro- age of two years (93 per- larly, in four districts (Humla,
tein energy malnutrition in cent). The percentage of Jumla, Kalikot, and Dolpa) it
New Subscribers 10 Nepal. In Nepal, the IYCF children under six months has integrated IYCF commu-
status is assessed by the per- who are predominantly nity promotion program with
Public Health Important centage of children aged less breastfed (exclusively child grant. For promotion of
than two living with their breastfed children and those IYCF, the Ministry of Health
Day (August) who receive breast milk and and Population (MoHP) has
mothers and who are fed ac-
cording to three IYCF prac- only plain water or juice) is linked it with micronutrient
tices, by breastfeeding status. 80%. Only six percent of supplementation program in
These practices include; the children aged less than two six districts.
number of food groups con- years are bottle fed.
sumed by the child (food di- The majority of malnutrition
versity), the number of times As per the NDHS 2011, related deaths among chil-
the child is fed (feeding fre- among breastfed children dren under five years of age
quency), and consumption of age 6-23 months, 28 percent are linked with inappropriate
breast milk or other types of were given foods from four feeding practices, which occur
milk or milk products. or more food groups in the during the first year of life.
24 hours preceding the sur- Thus there is a need to pro-
With reference to these prac- vey. Greater percent of chil- tect, promote, and support
tices, breastfed children are dren living in the hilly area IYCF practices by breastfeed-
considered to be fed within (36 percent) were given ing infants within one hour of
the minimum standards if foods from four or more food life, exclusively breastfeeding
they consume at least four groups than from children for six months, with timely
food groups and receive food residing in the Terai (21 per- introduction of adequate, safe
other than breast milk at least cent). Similarly, children and properly fed complemen-
twice a day in the case of in- living in the Western region tary foods while continuing
fants 6-8 months and at least and Western hill sub-region, breastfeeding for up to two
three times a day in the case children of mothers with years of age or beyond.
of children 9-23 months. grade ten and higher educa-
tion, and children from the Amrit Banstola

August 2012
Public Health Perspective (PHP) Page 2

National News
KATHMANDU, JUL 26 - and one of the largest, hospi- the rural areas and lack of re-
Policy against random
medical referrals on
T he government’s pub-
lic health hotline, put into
practice six months ago, is
tal.

Relatives have accused the
sources at the health facilities.
Almost every year during the
monsoon, many hill districts in
receiving a slew of phone calls nurses of not attending to the the region face the onslaught of
cards from people needing informa- 27-year-old, behaving rudely communicable diseases like viral
tion and doctors’ suggestions toward him and often using fever, diarrhea, cholera and
KATHMANDU, JUL 23 – on health conditions. Based at harsh words. They said that jaundice. However, the lack of

I n an attempt to check the the telemedicine centre on the the care-givers were unkind to doctors and other health work-
ongoing trend of haphaz- premises of the Patan Hospi- their ailing kin, fearing that ers has added to the suffering of
ardly referring patients from tal, Lagankhel, the number the HIV virus he is suffering the people in the region. Re-
one health institution to oth- can be reached, toll-free, from might spread to those cently, seven people from rural
ers often for no proper rea- from all over the country. The attending him. Bhandari has areas of Doti lost their lives due
sons, the Ministry of Health calls are received by the hos- been awaiting an appendicitis to diarrhea. Local people claimed
and Population (MoHP) has pital’s resident doctors, who surgery at the hospital for four they died for want of treatment.
started preparations for a answer queries to the best of days. “One of the doctor said Many newborn babies are even
national referral policy. Such a their abilities. “People inquire that the nurses were trainees deprived of basic vaccinations as
policy, which is likely to be about problems ranging from and he would talk to them. the health service in the region
finalized in August, will incor- an itch in the throat to a Source: ekantipur.com is limited to a few areas, owing
porate medical referrals as stone in their gall bladder,” to the limited number of medical
well as mechanisms for recep- said Dr Kishan Mainali. “In Lack of staff affects personnel.
tion, said Dr Tirtharaj Burla- response, we suggest over- health service in Far
koti, chief of the Curative Ser- the-counter drugs for short- Chief of Baitadi District Hospital,
vice Division at the MoHP. “To term relief and also ask them West Dr Gunaraj Awasthi, said 22
date, there is no mechanism to visit the nearest doctor if health workers, including a doc-
for referring patients so peo- the case is severe.” KATHMANDU, AUG 02 - tor, were transferred out from
ple are often referred to
other health institutions and Dr Mainali said people from
the 17-21 age groups and
H ealth facilities in the Far
West are struggling to
provide proper medical ser-
the district and the vacancies
are yet to be filled. Eleven
doctors haphazardly,” said Dr health workers were transferred
Burlakoti. “For instance, a also those in their late forties vices due to a lack of human from different health facilities of
patient referred by a senior were frequent callers. Bimal resources. According to a data Bajura, also without any re-
doctor from a zonal hospital Gautam, an official looking provided by the Far Western placement. Providing medical
will be received by an MBBS after the telemedicine service Regional Health Directorate services with limited resources
doctor at a central level hospi- at the hospital, said the num- (FWRHD), 39 out of 76 posts and health workers in the region
tal. ber of calls per day is on the of doctors are vacant in the with worse hygiene and sanita-
rise, with a current average of region. Similarly, 128 out of tion situation is never going to
There is no point in using this 60 calls per day. He claimed a 885 posts for paramedics are ensure good health and well-
haphazard referral method to plan to run the phone service yet to be filled. The Mahakali being of the people there. Con-
supposedly get better treat- round the clock was stalled Zonal Hospital in Kanchanpur cerned health officials said it is
ment in this kind of situation: after some officials lodged a is providing service to a large high time for the government to
it has resulted in patients suf- complaint at the Supreme number of patients with only come up with a concrete plan to
fering regularly.” Burlakoti Court against appointment of one doctor. The hospital has improve health service in the
said that the present referral a medical officer for the 24- 18 posts for doctors. Similarly region. Source: ekantipur.com
system is a trend and repre- hour service. Once the case is at the Seti Zonal Hospital,
resolved at the Court, doctors eight out of 20 posts for doc-
sents a way for doctors to
hopefully will be advising pa- tors are still vacant.
World Breastfeeding
shun responsibilities.
“Currently, it seems as if the tients round the clock, Gau- A dearth of doctors has also Week: ‘The number of
tam said. Source: ekanti- hit hospitals and health facili-
job of the referring doctor is
pur.com ties in other districts, including
exclusively breastfed in-
done when they send the pa-
tient elsewhere for treatment. Doti, Achham and Bajura, in fants increases in Nepal’
The new policy will have
HIV-infected faces Bir the region.
mechanisms for proper identi- nurses’ ‘neglect’ KATHMANDU, AUG 05 -

T
fication of the type of physi- Health officials said mass he government organized
cian who should receive the KATHMANDU, JUL 30 - transfer of doctors and health various programs from Au-
referred patient. And after
treatment, we will make sure B ir Hospital nurses have
reportedly discriminated
against a patient suffering
workers from the hill districts
like Bajura, Achham, Bajhang,
Darchula, Baitadi, Doti and
gust 1-7 to mark the World
Breastfeeding Week under the
that the patients visit their theme of “Understanding the
referring doctor for follow-up.” from jaundice and appendici- Dadeldhura to urban areas Past - Planning the Future.”
Source: ekantipur.com tis upon knowing that he is has made the matter worse.
HIV positive. Ramesh Bhan- Quality and accessibility of The programs, including coun-
Are you facing any dari from Nuwakot district health services in the Far West seling, interactions and distribu-
(name changed) and his care- is already dismal due to the
health problems? Dial takers said they have been factors like a limited number
tion of posters and pamphlets to
health centers across the coun-
1115. facing ill-treatment from of health posts to cater timely try, are being organized as per
nurses at the country’s oldest, services to the people from Continued on page 4

August 2012

World Breastfeeding Week
World Breastfeeding Week is celebrated every year from August 1-7 in more than
170 countries to encourage breastfeeding and improve the health of babies
around the world. Twenty years ago, the World Alliance for Breastfeeding
Ac- tion (WABA) launched its first World Breastfeeding Week (WBW)
campaign with the theme: "Baby-Friendly Hos-
pital Initiative". The week is set aside to en-
courage breastfeeding and commemorate UNI-
CEF and WHO’s Innocenti Declaration on the
protection, promotion and support of breast-
feeding worldwide.

Breastfeeding is the best way to provide new-
borns with the nutrients they need. WHO recommends exclusive breastfeeding until a baby is
six months old and continued breastfeeding with the addition of nutritious complementary
foods for up to two years or beyond.

The theme of this year’s World Breastfeeding Week is ‘Understanding the Past, Planning the Future’ a relevant reference to
the lessons learnt and the achievements over the past 20 years on infant and young child feeding (IYCF), and is a call to action
to bridge existing gaps in policies and programs supporting breastfeeding and IYCF.

Breastfeeding plays a great role in countering malnutrition which is tied to approximately one third of deaths amongst children
under five; yet, the global exclusive breastfeeding rate of infants 0-6 months is just under 40% (WHO 2012). Over two third of
those deaths, often associated with improper feeding practices, occur during the first year of life. By providing infants with the
right amount of protein, sugar, fat and most vitamins, breastfeeding is key to healthy child development and is also beneficial to
mothers as it reduces risks of breast and ovarian cancer later in life, helps women return to their pre-pregnancy weight faster,
and lowers rates of obesity. >>Source: who.int

World Humanitarian Day
Natural disasters, conflicts and other emergencies threaten the
lives and health of millions of people every year. In the middle of
such crises, thousands of dedicated humanitarian workers strive to
care for those who have been affected and support local authori-
ties to deliver assistance. On World Humanitarian Day, WHO and
other international bodies are highlighting the roles performed by
humanitarian workers, and remembering aid workers who have
been killed or injured while performing their vital roles. It is a time
to recognize those who face danger and adversity in order to help
others. In 2008, the UN General Assembly designated 19 August
World Humanitarian Day to raise public awareness of humanitarian
assistance worldwide, recognize people who risk their lives to help
people in need, wherever they are, to mark 2003 bombing of the
United Nations headquarters in Baghdad, Iraq, which killed 22 UN
staff.

This year’s theme "I Was Here" is about making a mark by doing
something good, somewhere, for someone else. “This year’s World
Humanitarian Day presents an historic opportunity to bring to-
gether one billion people from around the world to advance a powerful and proactive idea: People Helping People.

This year, International star Beyoncé, the UN and humanitarian aid organizations have launched a global campaign website –
www.whd-iwashere.org which will provide members of the public with an opportunity to unite and share their individual acts of
good. On the Day itself, which falls on 19 August, the campaign aims to reach one billion people in a day with a single message
to shine a spotlight on humanitarian work and encourage people around the world to get involved by doing something good for
others.

World Humanitarian Day offers the chance:
 for the public to learn more about the humanitarian community, what aid workers do and the challenges they face;
 for nongovernmental and international bodies and UN agencies, to demonstrate their humanitarian activities;
 to pay respect to those who have died or been injured in the course of their humanitarian work.

World Humanitarian Day is a global day to celebrate humanity and the spirit of people helping people.
>> Source: >>un.org; unocha.org; who.int

August 2012

National News (cont…)
Continued from page 2 whether they should be called a hospital.” KATHMANDU, AUG 08 -

the Global Strategy for Infant and Young
Child Feeding endorsed by the member
The report has also shown that the gov-
ernment hospitals are also in very poor
condition. Lack of human resources, dilapi-
T he first national summit on drinking
water and sanitation concluded on
August 7 with a Kathmandu Declaration
states of the World Health Organization and dated and poorly managed buildings, ma- urging the concerned actors to work
the UNICEF executive board in 2002. Ne- jority of the equipment in a dysfunctional together to achieve the national target
pal, as a WHO member state, has adopted state and poor management among other of universal access to sanitation by
a strategy to promote exclusive breastfeed- factors have affected services of the gov- 2017. The two-day meet was jointly
ing—the practice of keeping a child on a ernment hospitals, it said. The majority of organized by the Federation of Water
steady diet of nothing but mother’s milk the buildings of the government hospitals and Sanitation Users’ Nepal
right from birth up until six months of built years ago, the study stated, needs to (FEDWASUN) and various government,
age—as defined by the WHO. All WHO be retrofitted and many private hospitals non-governmental and donor agencies
member states have recognized breast- run inside the city areas are operating in working in the sector. The declaration
feeding as the single most effective means the buildings initially meant for residential stresses the need to work together and
of reducing under-five infant mortality. purpose. In a blow, the inspection process strengthen the coordination in areas
in the hospitals of the Kathmandu Valley such as participatory policy-making,
The government has envisioned the promo- was halted. According to Surya Acharya, capacity enhancement of
tion of breastfeeding along with various joint-secretary of the MoHP and also the the sanitation user groups, institutional
awareness campaigns to inspire mothers coordinator of the inspection team inside development of FEDWASUN, and imple-
and families about breastfeeding through the Valley, lack of budget stood in the way mentation of the programs and services
the National Nutrition Policy and Strategy and the program will be continued in this through the users’ network. Promotion
2004. Stepping up its policy and strategy, fiscal year. The report, which did not in- of social campaigns on sanitation and
the government certified seven hospitals in clude Kathmandu, Lalitpur, Bhaktapur, cleanliness, and documentation of vital
the country as Baby Friendly Hospital Ini- Sankhuwasabha, Bhojpur among others, achievements in the sector are among
tiatives (BFHI), whose prime focus would has been submitted to Minister Mahato. other priorities of the declaration.
be promoting breastfeeding. However, re- Source: ekantipur.com
cent reports have shown that none of the According to the statistics provided by
hospitals have followed the BFHI guide-
Free blood for pregnant women the Department of Water Supply and
lines. “We are working hard to implement Sewerage (DWSS) under the Ministry of
the BFHI effectively,” said Dr Shyam Raj KATHMANDU, AUG 08 - Physical Planning and Works in 2010,
Upreti, director of the Child Health Divi- still around 57 percent of the total
sion. According to Nepal Demographic and
Health Survey (NDHS)-2006, the number T he Family Health Division (FHD), under
the Ministry of Health and Population
(MoHP), is all set to provide blood free of
population is deprived of ba-
sic sanitation facilities and around 20
percent people lack access to safe
of mothers who are exclusively breastfeed-
ing their children has decreased from 68 cost to pregnant women starting this year. drinking water. A majority of the exist-
percent in 2001 to 53 percent in 2006. The MoHP has been conducting free ma- ing water supply infrastructure is either
However, new NDHS-2011 brings positive ternal services, from routine check-ups dysfunctional or lacks proper repair and
news with 70 percent of infants being ex- during pregnancy to delivery care, in all maintenance.
clusively breastfed. government hospitals, birthing centers and Source: ekantipur.com
Source: ekantipur.com selected private hospitals. “We had been
giving all services related to pregnancies USAID's family health program
Many hospitals in sick bed: Report for free, except blood. With the govern-
ment now providing blood for free, we can over
KATHMANDU, AUG 06 - hope to reduce maternal deaths from KATHMANDU, AUG 17 –
blood loss,” said Dr Sinendra Raj Upreti,

A n inspection conducted by the Ministry
of Health and Population (MoHP) has
revealed that the majority of the private
Director at the FHD. He said that the ser-
vices will be carted to selected district
hospitals outside the Kathmandu Valley
U SAID/Nepal and the Health Ministry
commemorated the closure of five-
year Nepal Family Health Program II
and state-run hospitals in the country are and other big municipalities. The govern- (NFHP II). NFHP II helped strengthen
not up to the standards. The ministry had ment has allocated two million rupees for Nepal government's health systems,
formed 14 teams who were deployed in all this purpose. The FHD estimates that policy and leadership and enhance pub-
14 zones of the country from October 31, there are around 770,000 pregnant lic health service delivery by increasing
2011. Though the monitoring process re- women every year. Although all of them marginalized populations' access to
mained paused following an instruction do not require blood, the 2008-09 Mater- health services, according to a US em-
from Health Minister Rajendra Mahato two nal Mortality Survey showed that 24 per- bassy release. Besides, the program
months ago, the inspection team covered cent of maternal deaths were due to post- helped increase community participation
173 hospitals of around 65 districts. “Most partum hemorrhage, a loss of great in health service management and ad-
of the private hospitals have been found amounts of blood from the body during vance global best practices in family
running without renewing their licenses, delivery. planning, maternal and child health ser-
while many of them are running sans min- Source: ekantipur.com vices. The $30 million program was
istry registrations,” an official at the MoHP funded by the USAID and implemented
involved in the inspection said requesting Sanitation summit ends with in 22 districts.
anonymity. “There are private hospitals Kathmandu Declaration Source: ekantipur.com
with only four beds. We are not sure

August 2012

Global Health
hemodialysis for kidney dis- total number of human influ- 15 August 2012 –
South Africa to Become eases, according to the WHO," enza A (H5N1) cases in Indo-
First President's Emer-
gency Plan for AIDS Re-
Reuters notes. “The recent es-
calation of clashes had resulted
in substantial damages to the
nesia is 191 with 159 fatali-
ties, 8 (all fatal) of which
occurred in 2012. Source:
B ill Gates, co-chair of the
Bill & Melinda Gates Foun-
dation, on Tuesday
lief (PEPFAR) Country to pharmaceutical plants located WHO "announced the winners of the
'Nationalize' AIDS Pro- in rural Aleppo, Homs and Ru-
Ebola in Uganda – up-
Reinvent the Toilet Challenge -
ral Damascus, where 90 per- - an effort to develop 'next-
gram cent of the country's plants date generation' toilets that will
8 August 2012 – were located, a WHO spokes- deliver safe and sustainable

" U.S. Secretary of State person, Tarik Jasarevic, told 14 August 2012 – sanitation to the 2.5 billion
Hillary Clinton said during a
visit to South Africa that Preto-
reporters in Geneva today,” the
U.N. News Centre writes. "Prior
to the violence which has
T he Ministry of Health
(MoH) of Uganda contin-
ues to work with partners
people worldwide who don't
have it," according to a foun-
dation press release. "To pass
ria will begin taking more of the
responsibilities for its HIV/AIDS wracked the Middle Eastern including WHO, CDC, Red the foundation's threshold for
program, part of a broader ef- country, Syria produced 90 Cross, Medecins Sans Fron- the world's next toilet, it must
fort to overhaul the U.S. global percent of its medicines and tieres, World Vision, among operate without running water,
plan for AIDS relief launched drugs locally," the news service others to control the out- electricity or a septic system,
under former President George notes. break of Ebola hemorrhagic not discharge pollutants, pref-
W. Bush," Reuters reports. "On fever in Kibaale district. The erably capture energy or other
Wednesday, Clinton is expected “In addition to the lack of national and district task resources, and operate at a
to sign a deal to rework South medicines, many hospitals and forces continue to meet daily cost of five cents a day," ac-
Africa's programs under PEP- health centers are also closed to coordinate the response to cording to the Associated
FAR, allowing the government as a result of the fighting, while the outbreak. To date, 24 Press. "The new commodes
to better use the funding in its rising fuel costs are preventing probable and confirmed were showcased at a 'Reinvent
fight against the virus," the travel by health workers. Some cases including 16 deaths the Toilet Fair' on August 14-
news service writes. 1.5 million people in rural areas have been reported. Ten 15 in Seattle," CNN writes,
also need food assistance in the cases have been laboratory adding, "The foundation also
"U.S. officials said South Africa next three to six months, confirmed by the Uganda announced a second round of
will be the first PEPFAR country “especially in the areas that Virus Research Institute grants totaling some $3.4 mil-
to begin to 'nationalize' its pro- have seen the greatest conflict (UVRI) in Entebbe. The most lion to organizations that are
gram, but others would be ex- and displacement,” said the recent confirmed case was working to innovative latrines".
pected to follow as their capaci- World Food Programme. admitted in Kagadi isolation
ties increase and the United Source: globalhealth.kff.org facility on 4 August 2012. Gates "handed a $100,000
States seeks to more effectively Suspected cases which tested prize to the California Institute
target its overseas assistance in
Avian influenza – situa- negative during the labora- of Technology on Tuesday for
an atmosphere of budget aus- tion in Indonesia – up- tory investigations have been its work on a self-contained,
discarded as Ebola cases, sun-powered system that recy-
terity at home," according to date treated symptomatically for cles water and breaks down
Reuters. "The United States has
spent $3.2 billion since 2004 on their ailments and discharged human waste into storable
anti-AIDS programs in South 10 August 2012 – following recovery. energy," Reuters reports, not-
Africa, where 5.7 million people
are infected -- or close to 18 T he Ministry of Health of
Indonesia has notified
World Health Organization
A total of 43 people have
been discharged from the
ing, "Gates is focusing on the
need for a new type of toilet as
an important part of his foun-
percent of the adult popula-
tion," the news service notes. (WHO) of a new case of human isolation facility including one dation's push to improve
Source: Source: global- infection with avian influenza A confirmed case. With the health in the developing
health.kff.org (H5N1) virus. The case is a 37 support of the psychosocial world". "'Beyond a question of
year old male from Yogyakarta team, these 43 people have human dignity, this lack of
Syrians in Urgent Need province. He developed fever been counseled prior to dis- access also endangers people's
on 24 July 2012, was hospital- charge and reintegrated into lives, creates an economic and
of Life-Saving Medicines ized on 27 July and died on 30 the community. Even for the a health burden for poor com-
as Fighting Escalates, July. Epidemiological investiga- people who were negative for munities, and hurts the envi-
WHO Warns tion on the case found that the Ebola, psychosocial counsel- ronment,' Gates said," Agency
he had four pet caged birds in ing of the communities to France-Press reports, continu-
8 August 2012 – his home, which is about 50 which they are returning, has ing, "Food or water tainted

" Syrians are in urgent need of meters from a poultry slaugh- been very important. It has with fecal matter causes intes-
life-saving medicines follow- ter house and near a farm. allayed fears and reduced tinal diseases that kill 1.5 mil-
ing an escalation in fighting, Infection with avian influenza A stigma, enabling them to be lion children annually – a fig-
which also threatens further (H5N1) virus was confirmed by accepted back in the commu- ure higher than deaths from
food shortages, U.N. agencies the National Institute of Health nity. Source: WHO AIDS and malaria combined,
warned on Tuesday," Agency Research and Development according to Gates".
(NIHRD), Ministry of Health and Gates Looks To Develop
France-Press reports. "Drugs for
tuberculosis, hepatitis, hyper- reported to WHO by the Na- 'Next-Generation Toilets' Source: globalhealth.kff.org
tension, diabetes and cancer tional Institute of Health Re- For Developing World
are urgently needed, as well as search Focal Point. To date, the

August 2012

Journal Watch
Prevalence of blindness and visual impairment and its causes among
people aged 50 years and above in Karnali Zone, Nepal
How to join PHP? Cataract and refractive error are the common cause of blindness and visual impairment and fe-
males are three times more prone to blindness than male, according to the study published in
2012 Volume 4 Issue 8 of Nepal Journal of Ophthalmology.
e-Mail:
newsletter.php@gmail.com
Twenty four clusters of 50 people aged 50 years and above were selected by stratified cluster
sampling. Visual acuity was recorded with simplified vision testing card with one optotype “E” of
website:
size 60 on one side and size 18 on the other side. Examination by ophthalmologist under mydriasis
www.bmhall.yolasite.com/
was done for those with a pinhole visual acuity of less than 6/18. Out of the 1200 enumerated
publications.php
people aged 50 years or above, only 1174 participated in the study.

Among the examined, 545 (46.6%) were between 50-59 years, 417 (35.6%) were between 60-69
years, 171 (14.6%) were between 70-79 and 38 (3.2%) were above 80 years of age. The number
of male and female was 646 (55.2%) and 525 (44.8%) respectively. According to the study, the
prevalence of blindness in female for available and best correction was 4.8% and 2.3% respec-
Benefits of tively and for male it was 2.3% and 1.1%. Overall, the study found the prevalence of blindness
with available correction as 3.4% and with best correction as 1.6%. As per the study, the preva-
Being a PHP lence of blindness increased with the age, being highest at 70-79 years. The study found cataract
as the main cause of blindness for both sexes followed by uncorrected aphakia. Similarly, un-
Subscriber treated cataract was responsible for severe visual impairment.

The study suggests for accessible and equitable services for blindness prevention.
 Can submit articles to
Full text article is available at: Nepal J Ophthalmol 2012; 4(8):282-287.
PHP newsletter
Authors: Dulal S, Sapkota YD
 Heavy discount rate in
PHP trainings, work-
shops, seminars, con- Resource of the Month (Climate Change Action Website)
ferences
Climate Change Action is a website that provides basic climate change information for health pro-
 Get acquainted with fessionals. The website main aim is to support to mitigate and adapt to the effects of climate
public health news from change. This website is thought to be useful to those interested in climate change as it contains
assessment tools to reduce the carbon footprint of hospitals, clinics, and offices. Other features of
around the nation and
the website include climate change related documents on lessons learned and success stories, and
globe at a time an area for blogging.
 Enhances professional
Some useful resources and tools include– public health related resources, the health impacts of
writing skills
climate change Information,
URL of some useful links, docu-
ments and links on how to
change our everyday activities
to reduce the effects of climate
Send Letters to the change and slow down its proc-
Editor ess. The video section of the
website is a hub of climate
change related videos where
 All readers can post you can watch them online.
comments on articles The website is developed by
and news mentioned in Ms. Rose M. Schneider--RN
PHP or could be sugges- MPH, who is a climate change &
tions and compliments. sustainability advisor and a
 Send letters to: senior health specialist with climate change programming expertise. She has 20 years of public
newsletter.php@gmail.com health and clinical experience with USAID, World Bank, UNFPA, NGOs and the private sector. She
has also experience linking climate change mitigation and adaptation to health and population
 Word limit 150 max. and programming. Ms. Schneider provides senior level advice to missions, ministries, NGOs and pri-
the title of news or arti-
vate organizations on actions to mitigate and adapt to the effects of climate change. Currently she
cles of critique.
is working as a chair of American Public Health Association (APHA) International Health Section
 Email should include Climate Change Working Group.
‘letters to the editor’
in email subject line. If you are interested in knowing more about climate change action and its work, please contact:
Rose Schneider RN MPH, roseschneider05@gmail.com
http://www.climatechangeaction.info

August 2012

The 10 Essential Services of Public Health, With Climate
Change Examples

Service Climate Change Example
1. Monitor health status to identify and solve community
Tracking of diseases and trends related to climate change
health problems.

2. Diagnose and investigate health problems and health Investigation of infectious water-, food-, and vector-borne disease
hazards in the community. outbreaks

3. Inform, educate, and empower people about health Informing the public and policymakers about health impacts of
issues. climate change

4. Mobilize community partnerships and action to iden- Public health partnerships with industry, other professional groups,
tify and solve health problems. faith community, and others, to craft and implement solutions

5. Develop policies and plans that support individual and
Municipal heat-wave preparedness plans
community health efforts.

6. Enforce laws and regulations that protect health and
(Little role for public health)
ensure safety.

7. Link people to needed personal health services and
ensure the provision of health care when otherwise un- Health care service provision following disasters
available.

8. Ensure competent public and personal health care
Training of health care providers on health aspects of climate
workforce.
change

9. Evaluate effectiveness, accessibility, and quality of Program assessment of preparedness efforts such as heat-wave
personal and population-based health services. plans

Research on health effects of climate change, including innovative
10. Research for new insights and innovative solutions
techniques such as modeling, and research on optimal adaptation
to health problems.
strategies

>> Source.

August 2012

Being Healthy
director of the Interpersonal Relationships Have you ever wondered why some of your
Healthy relationships Laboratory at New York’s Stony Brook Uni- relationships are more effective than others?
lead to better lives versity. Researchers have learned a lot in the last 30
years about what makes good relationships
The quality of our personal relationships tick, and it boils down to just a few things.
also has an enormous impact on our physi- Unfortunately, most folks are only minimally
Unless you’re shipwrecked on a cal health, as evidenced by a hefty number aware of those elements, Aron says, and
deserted island, you probably of research studies. “We support each other therefore aren’t doing everything they could be
enjoy a handful of close relation- in getting enough exercise, eating right, doing to improve their relationships.
ships. From spouses to children flossing — all the things that make for bet-
to friends, parents, siblings and ter health can be supported or undermined Mind your mental health
significant oth- by close relation- Without
ers, healthy rela- ships,” Aron question,
tionships build says. the mental
self-esteem, im- health of all
prove mental and In the movie parties is
emotional health “Cast Away,” the most
and help you live Tom Hanks’ char- important
a fuller life. acter — stranded element of
on an uninhab- a good re-
“Relationships ited island — lationship.
are — not sur- creates a face on If you suf-
prisingly — enor- volleyball and fer from
mously important for health, and talks to the ball, which he names “Wilson,” depression,
there are lots of studies on the as if it were a person. Though fictional and anxiety,
biological processes that account funny, the gesture illustrates something insecurity
for the link between relation- very basic about us: Relationships are im- or low self-esteem, seek help from a health
ships and health,” says psychol- portant — so important, in fact, that our professional right away, because it’s not just
ogy professor Arthur Aron, PhD, brains are hardwired to form them. you, but also your relationship, that will suffer.

friends and family members.
You can’t always control the stressors in your life, but for your
relationships to be effective, try to keep stress to a minimum. Learning to recognize unhealthy relationships should start
Also, be understanding when others are going through a tough early. The Centers for Disease Control and Prevention’s Choose
time. Someone who loses her or Respect initiative, online at http://www.cdc.gov/chooserespect,
his job, for example, might be- is available to help teens learn how to make decisions about
have negatively for a little while. relationships with their friends, family and dating partners.
But things should get better
eventually. Build a bridge of support
Support from family and a
Keep the lines open friend is an ingredient that
“We just don’t communicate!” is repeatedly surfaces in
a common refrain in relationships good relationships. You
— too common in fact, because might need someone to
after mental health, effective take the kids for the night,
communication is the second most important ingredient in a or help with carpooling. If
healthy relationship. Communication is important because con- you have a support system
flicts are inevitable in relationships, and “most people are in place, or live near
poorly prepared to deal with them well,” Aron says. friends and family, don’t
be afraid to ask them for a
Watch for unhealthy relationships helping hand, a sympa-
Not all relationships are going to be perfect all thetic ear or advice.
the time, but for the most part, a good relation-
ship makes you feel secure, happy, loved, re- “All relationships require effort and attention,” Aron says.
spected and free to be yourself. If you are in a “Sometimes that effort and attention is automatic, such as with
relationship that makes you feel fearful, humili- an infant. Beyond what is automatic, for most relationships, we
ated or controlled, or are a victim of physical, usually need to put attention and effort into them, and it pays
emotional or sexual abuse, consult with your off.”

>> Source: Healthy You
Public Health Perspective (PHP) Online Newsletter (The Nations’ Health, March
2011)
www.bmhall.yolasite.com/publications.php

August 2012

WHO Publications
Bulletin of WHO Vol. 90, No. 08, 2012
The Bulletin of the World Health Organization is an international journal of public health with a special focus on developing
countries. Since it was first published in 1948, the Bulletin has become one of the world's leading public health journals. As the
flagship periodical of the World Health Organization (WHO), the Bulletin draws on WHO experts as editorial advisers, reviewers,
and authors as well as on external collaborators. Full bulletin is available at:
http://bit.ly/Ph9r9b

Safe Abortion Second edition
In view of the need for evidence-based best practices for providing safe abortion care and in order to protect the health and human
rights of women, the World Health Organization (WHO) has updated its 2003 publication -Safe abortion: technical and policy guid-
ance for health systems. Download is available at:
http://bit.ly/Nnj9ZD

Toxicological Evaluation of Certain Veterinary Drug Residues in Food
This volume contains monographs prepared at the seventy-fifth meeting of the Joint FAO/WHO Expert Committee on Food Addi-
tives (JECFA), which met in Rome, Italy, from 8 to 17 November 2011. The toxicological monographs in this volume summarize
data on the veterinary drug residues that were evaluated toxicologically by the Committee: the antimicrobial agent’s amoxicillin
and apramycin and the anthelminthics derquantel and monepantel. Download is available at:
http://bit.ly/HKIQLc

Global Plan for Insecticide Resistance Management in Malaria Vectors
The next few years will be critical in the fight against malaria and the global health community needs to recognize that mosquito
resistance to insecticides is now also a serious challenge to malaria control efforts. Insecticide resistance has been identified in 64
countries around the world, affecting all WHO Regions with ongoing malaria transmission. Download is available at:
http://bit.ly/THvtBa

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August 2012

Public Health Perspective (PHP) Team
International Honorary Editorial Advisories Rajiv Gandhi University Contributing Writers
Bangalore
Editorial Advisories Dr. Duk Bahadur Dr. P. Ravi Shankar
Ms. Rose Schneider -- Chhetri Madan Kc Professor, Clinical Phar-
RN MPH MD, Pathologist Msc. Medical and Health macology & Medical Edu-
Chair of the Climate Western Regional Hos- Care Devices cation
Change Working Group pital Lab. University of Bolton, UK KIST Medical College
of the APHA Interna- Pokhara Lalitpur, Nepal.
tional Health Section. Dr. Santosh Raj
Senior Health and HIV/ Mr. Balram Banstola Poudel Dr. Anis Rehman
AIDS Specialist Managing Director, Residency (MD) in Inter- Associate Chief Editor at
Health Systems Man- Senior Pharmacist nal medicine Journal of Pakistan Medi-
agement Banstola Medical Hall Interfaith Medical Cen- cal Students (JPMS)
1414 Perry Place NW - Kaski ter, New York HIFA 2015 Country Rep-
Suite 100 resentative for Pakistan
Washington, DC 20010 Board of Advisories Dr. Krishna Chandra
Ms. Sami Pande Rijal Newsletter Team
B. Pharm, MPH Dept. of Otorhinolaryn-
Editor-in Chief
Australian Leadership gology and Head & Neck
Amrit Banstola
Dr. Margaret Steb- Scholar, 2009 Surgery, College of
bing Kathmandu Medical Sciences and
Section Editors
PhD, Master of Public Teaching Hospital
Anoj Gurung
Health, Dip App Sci Arjun Poudel Bharatpur, Chitwan
Dikshya Sherchan
Nursing Msc. Pharm (Social and Dipendra Malla
Population Health Aca- administrative Phar- Mr. Chandra Bhushan
Sandeep Pahari
demic macy) Yadav
Sangita Shrestha
School of Rural Health, Universiti Sains Malay- Information Officer
Subash Timilsina
Monash University sia, Penang , Malaysia (MLIS)
Sulochana Prajapati
Australia Nepal Health Research
Ashik Banstola Council (NHRC)
M. Pharm MOHP, Kathmandu
(Pharmacology), PDCR

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Articles appearing in Public Health Perspective (PHP) Online Newsletter do not necessarily reflect the views of the PHP team but are in-
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