Public Health Perspective (PHP) Newsletter April 2013 Issue

Editorial: Public understanding of climate change as a
human health risks in Nepal-A research need
Vol. 3 Issue 4 April 2013the first public health online newsletter of Nepal
Public Health Perspective
community. Similarly, World
Health Organization has
urged to emphasize research
on climate change and health
in order to improve the over-
all global health and health
equity at an international
level. At the national level,
the Nepal Health Research
Council (NHRC) has priori-
tized climate change as a key
environmental health re-
search priority area for Nepal
in 2006.
Since public are the ones who
have closely observed the
local climatic patterns, their
understanding and predic-
tions of changes in climate,
the consequences it places on
their health and well-being
can be an important source of
information for policy makers
to develop effective mitiga-
tion and adaptation meas-
ures, provide important in-
sights into the phenomenon
for scientists and help com-
munities to better anticipate
and cope with these conse-
quences. Having said that,
there is a need to expand the
knowledge on climate change
and its health impact studies
at the community level where
adaptations ultimately take
place. In addition, under-
standing how people re-
sponded and adapted to se-
vere events in the past, will
inform future policies and
programs that will work to-
wards minimizing the impacts
of extreme weather events on
the health and well-being of
people.
Therefore there is a need for
research on public under-
standing of climate change as
a human health risks in Ne-
pal.
Amrit Banstola
ever, Pun et al., 2011 re-
ported that it is now being
increasingly diagnosed in
patients from non-endemic
areas of Nepal. According to
them, in the five year period
(from April 2004 to March
2009), VL was reported in 15
new non-endemic districts
suggesting that VL might be
expanding into newer areas.
NHRC says, one of the rea-
sons for increasing the dis-
ease and geographical
spread might be because of
climate change.
The seasonal outbreak of
different diseases which is
the major concern of Nepal-
ese Health System clearly
shows the link between cli-
mate change and health. For
example, increasing trend of
respiratory diseases linked
with air pollution like Acute
Respiratory Infection (ARI),
bronchitis, and asthma
among others, temporal and
spatial increment of water
and food borne disease
(diarrhea, typhoid, giardi-
asis, and jaundice). The
other major health impacts
of climate change in Nepal
are increasing morbidity and
mortality due to cold waves
and heat waves in the south-
ern plain area (Terai), disas-
ters, famine and disease
outbreak triggered by pro-
longed droughts and flash
floods. Data from the Minis-
try of Home Affairs, Nepal
shows that every year more
than one million people are
susceptible to climate in-
duced disasters such as
floods, landslides, and
droughts.
The Lancet (reputed journal)
stated that climate change is
the biggest global health
threat of the 21st century
and protecting health from
its impacts is an emerging
priority for the public health
Very little research to date
has been conducted in Nepal
concerning the local percep-
tion of climate change and
they all are from farmers’
perception and experience,
biodiversity and agriculture.
However, there has not been
any research on perception of
climate change as a human
health risk in Nepal.
The purpose of this article is
to provide some arguments
showing the usefulness of
research in understanding the
public perception of climate
change and its impact on hu-
man health in Nepal.
In the context of Nepal (the
fourth most climate vulnerable
country in the world), the
health impact of climate
change is obvious. NHRC re-
ports that the first outbreak of
dengue in Nepal in Morang,
Parsa, Chitwan, Dang, and
Nepalgunj in 2006 and Kath-
mandu in 2009 may be attrib-
uted by climate change. The
report has also linked the out-
break of diarrhea and cholera
in mid-western development
region of Nepal in 2009 with
climate change. Now, the
community people have felt
that the mosquitoes are shift-
ing in higher altitudes where
there was no occurrence of
mosquitoes previously trans-
mitting the mosquitoes borne
diseases to non endemic ar-
eas. For example, malaria,
which was previously concen-
trated in the Terai and inner
Terai regions, is now distrib-
uted over almost 65 districts
of the country. Similar is the
case for Japanese encephalitis
(JE). It has been reported
from hilly districts of Nepal
since 2004 and is now present
in 24 districts. Visceral
leishmaniasis (VL) also known
as Kala-azar was confined to
the southeast area in the
Terai region of Nepal. How-
Public Health Important
Days (April)
April 7: World Health Day
Theme: High Blood Pressure
April 25: World Malaria Day
Theme: Invest in the future. Defeat ma-
laria.
Inside This Issue

National News
Page 2P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
April 2013
MUGU, APR 07 -
A majority of women in the
district do not visit health
institutions for delivery, thus
risking the lives of both child
and mother, health officials
said. The District Public Health
Office (DPHO) said at least
nine women die every year
due to unsafe abortion. Birkha
Bahadur Shahi, an official at
the DPHO, said more than 45
women visited the DPHO for
treatment after undergoing
unsafe abortion at home this
year. The figure stood at 44
last year. They said those
women who undergo un-
safe abortion are between 16
to 40 years of age. Auxiliary
nurse midwife Saroja Ghimire
said many women visit health
institutions only at the last
stage after the abortion, thus
making the matter worse. A
health worker said the figure
also includes unmarried girls
and women whose husbands
are abroad for employment.
Source: ekantipur.com
KATHMANDU, APR 15 –
Bir Hospital has started to
provide free treat-
ment services to senior citi-
zens starting 15th April, 2013.
Senior citizens will get free
treatment services available
at Bir, the country's oldest
hospital. Senior citizens
should submit identity cards
including elderly allowance
certificate and citizenship to
g e t t h e f r e e t r e a t -
ment services in the hospital.
They will be entitled to get all
the health tests including X-
ray and other laboratory fa-
cilities under this service.
Hospital's administrator,
Khumkanta Acharya, said that
the hospital has started to
p r o v i d e f r e e t r e a t -
ment services as per their/
(the senior citizens') request
to provide treatment services
on discount. Acharya said that
the hospital is committed to
making the services more
effective in the coming days.
However, the senior citi-
zens themselves should bear
the expenses for necessary
medicines after the tests.
People above 70 years of age
are known as senior citi-
zens as per national rule.
KATHMANDU, APR 21 -
The National Tuberculosis
Centre (NTC) has traced
the family members of a
Nepali man who is undergoing
medical isolation in south
Texas after being detained in
November last year. Accord-
ing to medical reports, the
man—who was held after
crossing the US-Mexico bor-
der—was found to be infected
with XDR-TB, “one of the
most severe types of drug-
resistant tuberculosis known
today”. The NTC—which over-
sees the tuberculosis pro-
gram—corresponded with the
family members of the de-
tainee, surnamed Sherpa,
after a letter demanding the
man’s identity was dispatched
from the Centre for Disease
Control and Prevention. The
Atlanta-based health agency
communicated with the World
Health Organization, Nepal
and the NTC, briefing on the
c u r r e n t c o n d i t i o n o f
the detained patient and ask-
ing for further details about
his family.
A Wall Street Journal news
dispatch published on March 2
reported that he is the “first
person to cross and be held in
detention while infected with
one of the most severe types
of drug-resistant tuberculosis
known today”. “His three-
month odyssey through 13
countries—from his homeland
of Nepal through South Asia,
Brazil, Mexico and finally into
Texas—shows the way in
which dangerous new strains
of the disease can migrate
across the world unchecked,”
said the report.
A medical team of WHO and
NTC travelled to Dhunge-4 of
Shyama VDC in Jiri searching
for the family members. One
of the team members said the
man’s family consisted of his
father and mother while he
frequently travelled and spent
less time at his village home.
The medical team has also
sampled sputum from his fam-
ily members and neighbors
citing possible fear of the drug
-resistant TB, which would
require at least 8 weeks to
confirm its presence in the
body, the NTC said. Dr Rajen-
dra Pant, director of NTC, said
the man is undergoing treat-
ment in the US and his depor-
tation was not yet confirmed.
“Since it is one of the most
severe forms of TB, he has to
receive an intensive treat-
ment. His recent photos show
his improving health condi-
tion,” he said. According to Dr
Pant, WHO Nepal will write to
the CDC in Atlanta, briefing on
his family details for refer-
ence. According to the NTC,
1,221 drug-resistant TB pa-
tients are receiving treatment
in Nepal while 251 new such
cases were reported last year.
Furthermore, XDR-TB, the
most severe form, has been
detected in 24 patients.
KATHMANDU, APR 25 -
The government has
started an initial assessment
o f t h e m u c h
vaunted health insurance pro-
gram in five districts. The Min-
istry of Health and Population
(MoHP) is assessing services
a v a i l a b l e a t
the health facilities in Ilam, Sar-
lahi, Baglung, Banke and Kailali
along with the proposed insur-
ance scheme that aims to cover
all households in the five dis-
tricts. Kabiraj Khanal, under-
secretary at the MoHP, said the
ministry was sending another
supervision team to those dis-
tricts to monitor the assessment
work this week. The insurance
program is likely to start from
next fiscal year if the Cabinet
endorses a draft of the National
Health Insurance Policy-2012.
The draft has been sent to the
National Planning Commission
and the Ministry of Finance seek-
ing recommendations and neces-
sary changes.
Earlier in 2003, the government
had piloted community health
i n s u r a n c e i n s i x p r i -
mary health care centers, which,
however, did not work out well.
The program was implemented in
Mangalbare (Morang), Katari
(Udaypur), Chandranigahapur
( R a u t a h a t ) , D u m k a u l i
(Nawalparasi), Lamahi (Dang)
and Tikapur (Kailali), where a
majority of the health centers
witnessed a dropout of over 50
percent. Fatta Bahadur KC, chair-
man of the Insurance Board Ne-
pal, said the government has to
include private insurance compa-
nies to sustain the insurance pro-
gram. Source: ekantipur.com
KATHMANDU, APR 26 -
In its efforts to meet the na-
tional target of controlling ma-
laria by 2015, the government is
planning to distribute over 2.5
million Insecticide-treated bed
nets (ITNs). The Epidemiology
and Disease Control Division
(EDCD) under the Department of
Health services plans to distrib-
ute 2,574,932 ITNs in 31 districts
affected by malaria. As the coun-
try marked World Malaria Day on
25th April, Chief of the EDCD, Dr
GD Thakur said they will distrib-
ute 1.4 million nets this fiscal
year, while the remaining will be
disturbed next year. The govern-
ment will provide one net for two
people aged more than five in
Continue on page 4
Unsafe abortion goes
unchecked in Mugu
Senior citizens to get
free treatment at Bir
Hospital
Health insurance in the
offing in five districts
Nepali detained in US
with chronic TB
Govt to distribute over
2.5m mosquito nets

Message from the Regional Director
P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 3
April 2013
The focus of this year’s World Health Day is high blood pressure1 also known as hypertension.
High blood pressure is the single most important risk factor for mortality, accounting for 1 in every 10
deaths in the South-East Asia Region. High blood pressure increases the risk of heart attack, stroke,
loss of vision and kidney disease. Each year, hypertension kills nearly 1.5 million people in our Region.
High blood pressure and related non-communicable diseases have become rampant. Globalization and
unplanned urbanization are driving unhealthy lifestyle patterns in the population, such as increased
consumption of processed foods containing excessive salt, low levels of physical activity, and use of tobacco and alcohol. In
addition, increasing levels of mental stress contribute to the adoption of unhealthy behaviors thus putting people at a higher
risk of acquiring hypertension and related non-communicable diseases.
High blood pressure can affect anyone regardless of age, race, ethnicity, gender or income level. Today, one in three adults in
WHO’s South-East Asia Region has hypertension. As the population of our Region ages, more and more people are likely to be
affected.
The good news is that high blood pressure is both preventable and treatable. A holistic approach based on health promotion and
primary prevention is required to address risk behaviors that cause hypertension and related non-communicable diseases.
There is a need to promote healthy lifestyle behavior among populations. This includes increased physical activity to maintain a
healthy weight; avoiding tobacco use and limiting alcohol intake; and consumption of a healthy diet that is rich in fruits and
vegetables, and low in saturated fats and salt. Promoting healthy behaviors will reduce mortality not only due to hypertension-
related cardiovascular diseases but also due to other non-communicable diseases such as diabetes, cancer and chronic respira-
tory diseases. Therefore, it should be our priority to educate and motivate people of all ages and in all walks of life to be proac-
tive in preventing the onset of hypertension, by making health-promoting behaviors a part of their everyday lives.
Prevention and management of hypertension and related non-communicable diseases is not the responsibility of the health sec-
tor alone but requires integrated, multi-sectoral, multidisciplinary and culturally relevant approaches. As most of the major de-
terminants of the disease burden lie outside the health sector, we need to ensure that the strategy for prevention and control of
hypertension and related non-communicable diseases cuts across all sectors and involves collaboration with many stakeholders.
Education and labor, food and nutrition, transport and communications, urban development, sports and youth affairs sectors, all
need to come together to design interventions to raise awareness and encourage people to make healthy lifestyle choices. Na-
tional governments of Member States in the South-East Asia Region need to institute programs in schools and workplaces to-
wards healthy eating and effective physical fitness. The governments also need to work with the food industry to put regula-
tions in place for decreasing the amount of salt/sodium added to processed foods and increasing the availability of healthier
food options.
High blood pressure is a “silent killer” with no signs or symptoms. Many people, therefore, do not realize that they have hyper-
tension. Thus, alongside promoting healthy behaviors for prevention of hypertension, it is also important to educate the popula-
tion about regular check-ups of blood pressure levels as a means of timely diagnosis of hypertension. Timely diagnosis and
treatment can avoid complications such as stroke, heart attacks, kidney and eye damage. It is possible to diagnose and treat
hypertension at the primary health care level using simple equipment and standard treatment guidelines. Health systems need
to be strengthened to make these services available, affordable and accessible. Improved access and affordability should par-
ticularly focus on groups for whom the reach of health programs is low. In addition to improved access to treatment, counseling
should be offered to promote adherence to prescribed medicines and adoption of healthy lifestyles.
In September 2011, at the historic meeting of the United Nations General Assembly on non-communicable diseases, Member
States made commitments to take concerted and comprehensive actions for prevention and control of non-communicable dis-
eases. These commitments must now be translated into concrete actions through adoption of effective public policies. Adequate
resources should be dedicated to promote healthy lifestyles, empower communities and strengthen primary health systems to
thwart the growing burden of these diseases.
On World Health Day 2013, I urge all Member States and partner agencies to take tangible and sustained actions to combat
high blood pressure through national and local public health agencies and other organizations within and beyond the health
sector. Preventing and controlling hypertension means reducing disease, disability and death by protecting the people of the
South-East Asia Region from the risk of heart disease, stroke and related non-communicable diseases, and thereby, further
increasing their health and well-being.
WORLD HEALTH DAY 2013 | High Blood Pressure
Dr Samlee Plianbangchang, Regional Director,
World Health Organization, South-East Asia Region

World Malaria Day, 25 April 2013
April 2013
National News
Continue from page 2
each household, while preg-
nant women will be given the
nets during their routine preg-
nancy check-up. Earlier, the
government had provided the
nets to only 13 districts bor-
dering India.
However, this time, apart
from 10 districts in the Hima-
laya region, the government
will provide the nets to 13
most vulnerable and 18 vul-
nerable districts. The 13 dis-
tricts that the programme
covered earlier were Jhapa,
Ilam, Morang, Dhanusa, Mo-
hattari, Sindhuli, Kavre,
Nawalparasi, Bardiya, Kailali,
Kanchanpur, Dadeldhura and
Banke. The added districts
include Panchthar, Dhankuta,
Sunsari, Saptari, Siraha,
Udayapur, Sarlahi, Rautahat,
Bara, Parsa, Makawanpur,
Chitwan, Sindhupalchowk,
Rupandehi, Kapilvastu, Dang,
Surkhet and Doti. According
to the EDCD, around 20.5
million people of 65 districts
are affected by malaria. The
government has also been
conducting malaria control
programs with support from
the Global Fund since 2004.
The EDCD says that the num-
ber of confirmed malaria
cases has decreased by 1/3 in
comparison to 2004. Statistics
show there are over 3,200
malaria cases in Nepal at pre-
sent.
Source:ekantipur.com
Quiz: World Health
Day Special
1. Hypertension is
 high blood sugar
 high blood pressure
 high blood cholesterol
2. A blood pressure reading
has two numbers, 120/80
mmHg. The top number is
the _________ pressure
and bottom number is the
__________ pressure.
 diastolic and systolic
 systolic and diastolic
3. A blood pressure reading
of 146/92 mmHg is
 high
 low
 Normal
4. Someone with high blood
pressure may have
early morning headaches
 irregular heartbeats
 no symptoms
 all of the above
5. The total daily intake of
salt from all sources should
be no more than:
 20 grams per day
 5 grams per day
6. Eating more fruits and
vegetables helps to control
blood pressure because of
their
 low potassium content
 low sodium content and
high potassium content
 high sodium content and
low potassium content
 high sodium
7. Treating high blood
pressure helps reduce the
risk of complications such
as strokes, heart attacks
and kidney disease
 true
 False
8. Which of the following
can help to prevent high
blood pressure?
 regular physical activity
 not using tobacco
 limiting alcohol use
 all of the above
9. High blood pressure kills
__________ people each
year in the WHO South-
East Asia Region
 100 000
 150 000
 1 500 000
 1 000 000
10. Blood pressure usually
increases as we grow older
 true
 False
>>Check you answer on page 6
World Malaria Day is commemorated each on April 25 and
provides an opportunity to reflect on the status of global efforts
to "roll back malaria." The global campaign theme for 2013 and
the coming years "Invest in the future. Defeat malaria," is a
reminder of the need to continue to make progress and defeat
malaria.
World Malaria Day was instituted by WHO Member States dur-
ing the 2007 World Health Assembly. It is an occasion to high-
light the need for continued investment and sustained political
commitment for malaria prevention and control. It is also an
opportunity:
 for countries in affected regions to learn from each other's
experiences and support each other's efforts;
 for new donors to join a global partnership against malaria;
 for research and academic institutions to flag scientific ad-
vances to both experts and the general public; and
 for international partners, companies and foundations to
showcase their efforts and reflect on how to further scale
up interventions.
Over the last decade, the world has made major progress in the
fight against malaria. Since 2000, malaria mortality rates have
fallen by more than 25%, and 50 of the 99 countries with ongo-
ing transmission are now on track to meet the 2015 World
Health Assembly target of reducing incidence rates by more
than 75%. A major scale-up of vector control interven-
tions, together with increased access to diagnostic test-
ing and quality-assured treatment, has been key to this
progress.
But we are not there yet.
Malaria still kills an esti-
mated 660 000 people
worldwide, mainly chil-
dren under five years of
age in sub-Saharan Africa. Every
year, more than 200 million cases
occur; most of these cases are
never tested or registered. A re-
cent plateauing of international
funding has slowed down progress,
and emerging drug and insecticide resistance threaten to reverse
recent gains.

Global Health
P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
April 2013
Page 5
they found that having a vita-
min D level above 20 de-
creased the risk for fibroids by
32 percent, and that each in-
crease of 10 nanograms per
milliliter in vitamin D was as-
sociated with a 20 percent
lower risk of having a fibroid
tumor.
Source: New York Times
21 April 2013 -
As of 21 April 2013
(18:00CET), the National
Health and Family Planning
Commission notified WHO of
an additional six laboratory-
confirmed cases of human
infection with avian influenza A
(H7N9) virus and one fatal
case from Shanghai Municipal-
ity. Of the latest laboratory
confirmed cases, five are from
Zhejiang Province and one is
from Shanghai Municipality.
Additionally, 1 patient earlier
reported from Zhejiang Prov-
ince has died. To date, there
are a total of 102 laboratory-
confirmed cases of human
infection with avian influenza A
(H7N9) virus in China; includ-
ing 20 deaths. Contacts of the
confirmed cases are being
closely monitored. Currently,
70 patients are being treated
in hospital and 12 patients
have been discharged. Na-
tional authorities continue to
implement prevention and
control measures.
Source: WHO
The Obama administration
seems to be pushing this line.
"Young smokers are incredibly
price sensitive," observed
Health and Human Services'
Secretary Kathleen Sebelius a
few days ago, according to The
Associated Press. Upping the
tax to $1.95 a pack will pre-
sumably be a further deterrent
-- CNN said cigarette sales fell
by ten percent four years ago
after the government increased
the cigarette tax.
Thus, Obama's proposed fed-
eral cigarette tax "could have a
huge effect on public health"
given that one-in-five Ameri-
cans smoke, said AP.
The US spends $193 billion a
year on smoking-related costs,
if direct medical payments and
productivity losses are taken
into account, according to a
large Centers for Disease Con-
trol study conducted in the
early 1990s, said CNN.
Source: Global Post
18 April 2013 -
The American government’s
goal of vaccinating young
girls against the human papil-
loma virus (HPV) has been dis-
appointing, with less than a
third of teenagers having com-
pleted a full course of HPV vac-
cine. But now the United States
can look to Australia, which six
years into a successful nation-
wide HPV vaccination campaign
has experienced a sharp de-
cline in the number of new
cases of genital warts among
young men and women.
The country, one of the first to
establish a nationally financed
HPV vaccination program for
girls and young women, has
also seen a decrease in the
number of cases of cervical
abnormalities, a precursor to
cervical cancer.
Australia’s program, which
started in 2007, offers free HPV
2 April 2013 -
In France, any woman who
chooses to can have an abor-
tion for free. As of April 1, the
French state covers 100 percent
of the costs for 100 percent of
terminations. Previously only
girls under 18 could claim the
full cost back from social secu-
rity, while older women would
receive between 70 and 80 per-
cent.
The new provision, introduced
as one of Socialist President
François Hollande's campaign
promises in early 2012 and ap-
proved in October, is part of a
drive to bolster women's repro-
ductive rights. The reform is
designed to help remove the
barriers that continue to pre-
vent women exercising their
"fundamental right" to decide
what happens to their bodies,
said Health Minister Marisol
Touraine.
Source: Global Post
10 April 2013 -
US President Barack
Obama's new budget would
nearly double the cigarette tax,
slapping an additional 94 cents
onto the current $1.01-a-pack
tax, reported CNN Money.
The president wants to put the
money toward early childhood
education programs, but critics
say because most smokers are
middle-to-lower class, the non-
sliding-scale tax will hurt those
already hardest-hit, said CNN.
But Obama argues that the
"increase would have substan-
tial public health benefits, par-
ticularly for young Americans,"
CNN said, citing the budget.
"Researchers have found that
raising taxes on cigarettes sig-
nificantly reduces consumption,
with especially large effects on
youth smoking."
France makes abortion
free
vaccination to girls who are
12 and 13 years old, and
catch-up programs for girls
and women under 26. The
vaccine protects against
genital warts as well as can-
cers of the cervix, head and
neck.
The vaccine is typically ad-
ministered in three doses,
beginning around age 12. In
2010, coverage rates for girls
that age in Australia’s school-
based programs reached 83
percent for the first dose, 80
percent for the second dose
and 73 percent for the third.
Source: New York Times
19 April 2013 -
Inadequate levels of vita-
min D may increase the
risk for uterine fibroids, a
new study reports.
Vitamin D has been associ-
ated with reduced risk for
various diseases, but this is
the first to examine the con-
nection to fibroids, benign
tumors of the uterus that can
cause pain and bleeding.
Researchers randomly se-
lected 620 black and 410
white women, ages 35 to 49,
and determined their vitamin
D levels with blood tests and
their health status with ques-
tionnaires. Their analy-
sis appears in the May issue
of Epidemiology. About two-
thirds of the women had fi-
broid tumors. In the entire
group, only 10 percent of the
black women and 50 percent
of white women had vitamin
D levels above 20 nanograms
per millilitre, generally con-
sidered an adequate level.
After adjusting for age,
physical activity, sun expo-
sure and other variables,
Low Vitamin-D Tied to
Fibroids
Obama wants to nearly
double cigarette tax
Human infection with
avian influenza A(H7N9)
virus in China - update
HPV Vaccine Showing Suc-
cesses in Australia

Birth preparedness is one of the critical factors in determining the likelihood of having institutional
delivery and checkups after delivery, according to the study published in the 2013 issue of PLoS
ONE.
Secondary data such as latest round of Nepal Demographic and Health Survey Data (NDHS, 2011)
has been used in the study. Bivariate and multivariate models are applied as the methods of data
analyses.
As per the study, only 32% of women in Nepal have birth preparedness. The women who are well
prepared belong to higher age group (45%), higher education (36%) and with higher women
autonomy (86%). Women, who are well prepared for child birth (OR = 3.137, p<0.01) have a
greater likelihood of going for institutional deliveries that women with no preparation (OR = 1).
However, irrespective of level of birth preparedness, women in Nepal preferred to deliver the baby
in public health facility than private health facility.
The study recommend for ensuring adequate and universal birth preparedness in order to achieve
goal 4 and 5 of MDGs at policy level.
Full text article is available at: PLoS ONE 8(5): e60957. doi:10.1371/journal.pone.0060957
Authors: Dipty Nawal, Srinivas Goli
Journal Watch
April 2013
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Birth preparedness and its effect on place of delivery and post-natal check-
ups in Nepal
Quiz: Answers with explanation
1. high blood pressure is correct! Explanation: Blood pressure is the force exerted on the walls of blood vessels. This force is
necessary to make blood flow and deliver oxygen and nutrients to the body. If blood pressure constantly remains above the healthy
range, it is called hypertension or high blood pressure. High blood pressure is dangerous because it makes the heart work harder
and increases the risk of heart attacks, strokes, kidney disease and blindness.
2. systolic and diastolic is correct! Explanation: Blood pressure is written as two numbers, measured in millimetres of mercury
(mmHg). The two numbers in the blood pressure reading represent the systolic pressure and the diastolic pressure, respectively.
The systolic pressure is the pressure in your blood vessels when your heart beats. The diastolic pressure is the pressure in your
vessels when your heart rests between beats.
3. high is correct! Explanation: An individual with a systolic blood pressure of 140 mmHg or higher and a diastolic blood pressure of
90 mmHg or higher is considered to have hypertension or high blood pressure. If you have persistently high blood pressure, you
should consult a healthcare professional for further evaluation and treatment.
4. all of the above is correct! Explanation: Someone with high blood pressure may not have any symptoms at all or may experi-
ence one or more symptoms such as early morning headaches, irregular heartbeats and nosebleeds. Because it may not present
with any signs or symptoms, high blood pressure is often called “the silent killer”. Therefore it is important to get your blood pres-
sure checked regularly.
5. 5 grams per day is correct! Explanation: WHO recommends no more than 5 grams of salt per day, which is the equivalent of one
level teaspoon. Reduce the amount of salt consumed by avoiding “chutneys” and sauces, chips and biscuits, and processed foods.
Limit the addition of excess salt during cooking.
6. low sodium content and high potassium content is correct! Explanation: Excess sodium is linked to high blood pressure
whereas potassium has a protective effect against hypertension. Fruits and vegetables are a great choice as they both have low
sodium and high potassium contents.
7. true is correct! Explanation: Over time, uncontrolled high blood pressure will cause damage to the blood vessels of the brain and
heart, which can lead to strokes, and heart attacks. It can also cause kidney and eye damage. When lifestyle modification alone is
not adequate, blood-pressure-lowering medicine may be prescribed to control high blood pressure and to avoid associated compli-
cations.
8. all of the above is correct! Explanation: Adults should engage in moderate physical activity for at least 150 minutes throughout
the week. Tobacco and excess alcohol increases the risk of high blood pressure and should be avoided.
9. 1 500 000 is correct! Explanation: High blood pressure/Hypertension is the leading cause of risk for death. It kills 1.5 million
people in the South-East Asia Region each year. Approximately one third of the adult population in the South-East Asia Region has
hypertension.
10. true is correct! Explanation: Blood pressure increases progressively with age. Therefore, it is important to follow a healthy life-
style from an early age. This can be achieved by eating a balanced diet low in salt and rich in fruits, vegetables and whole grains,
as well as exercising regularly, avoiding tobacco and excess alcohol, and positively managing stress.

Climate Change: Back from the Past
April 2013
Page 7
International Conference of Mountain Countries on Climate Change,
5-6 April 2012
KATHMANDU CALL FOR ACTION
We, the Ministers, Heads of Delegations and Representatives of International and National organizations, having attended the
International Conference of Mountain Countries on Climate Change held from 5 to 6 April 2012 in Kathmandu, Nepal;
Aware of the human-induced multiple impacts of climate change on mountain ecosystems, goods and services and implications
on livelihoods, health and welfare of the mountain people and environment;
Recognizing the need for urgent, collaborative and effective actions at all levels for addressing climate-induced vulnerabilities and
impacts on mountains, enhancing the well-being of climate vulnerable communities and also strengthening the climate resilience
of the people of mountainous countries; and
Applauding the Government of Nepal for starting the Mountain Initiative;
Appreciating the international expert consultation on mountains and climate change and taking note of their recommendations;
Also appreciating the South Asian Parliamentarians' Workshop on Climate Change and taking note of their recommendations;
Hereby express our resolve to:
1. Reaffirm the spirit of solidarity and cooperation among the mountain countries and countries with mountainous regions for
addressing the common problems affecting all the mountainous regions, and for consolidating our common efforts to effec-
tively integrate mountain issues into the global climate change and development agenda including the Rio+20 process and
beyond;
2. Promote research as well as use of traditional knowledge for sharing, learning and exchange of information and best prac-
tices to support science-policy interface and help find best solutions to climate change challenges through global cooperation,
including south-south cooperation, recognizing that the mountains provide solutions for sustainable development using eco-
system services, in particular, water, biodiversity, energy, and for enhancing food security;
3. Reinforce that our collective actions will complement the objectives of achieving equitable and sustainable development in-
cluding the Millennium Development Goals with a focus on reducing poverty and enhancing gender equity and social inclusion
among the people in mountain countries and regions;
4. Agree to update the sustainable mountain development agenda in the context of growing challenges and opportunities, re-
sulting from climate change and globalization;
5. Encourage building appropriate incentive mechanisms at various levels to recognize and reward mountain communities for
conservation and maintenance of mountain ecosystem services through climate change adaptation and conservation of criti-
cal ecosystems;
6. Strengthen and consolidate the Mountain Initiative as a global platform for all mountainous countries to discuss common
issues through collaborative and cooperative efforts for mobilizing the necessary support and raising awareness globally
about the adverse impacts and vulnerabilities of mountain ecosystem services and implications on the livelihoods of the poor
and disadvantaged people and make efforts to reduce impacts of climate change collectively;
7. Urge the development partners to support through the establishment of dedicated funding arrangements for the adaptation
and mitigation programs in mountain countries within the framework of UNFCCC and other sustainable development proc-
esses and build the resilience of communities, women and disadvantaged groups in particular, through a comprehensive and
holistic approach at the local, national, regional and international levels in the spirit of enhanced global partnership; and
8. Recognize and build on high potentials of mountain ecosystem services to promote green growth strategies and strengthen
linkages between mountain ecosystem and other ecosystems to reduce poverty and promote sustainable development;
9. Work collectively to mobilize global support to promote investment in mountain countries in an institutionalized manner, and
to enhance the level of concrete cooperation among all the stakeholders, including the private sector, local communities, civil
society and youth, with action plan based on mutual collaboration and commitments among the mountain countries and the
development partners, UN system, including the Mountain Partnership, and multilateral organizations in order to ensure ade-
quate and effective flow of financial resources, including innovative financing, technology and capacity building to the moun-
tain countries;
10. Agree to give continuity to the Mountain Initiative on a sustainable basis, organize the next conference through mutual con-
sultations at an appropriate time, and develop the program of work to carry forward the Kathmandu Call for Action;
Have hereby decided to adopt this Kathmandu Call for Action.
Kathmandu, Nepal
6 April 2012

Being Healthy
Get acquainted with
Malaria
April 2013
 Patient experiences the nausea, vomiting and body ache
 Diarrhea is also seen in some of the symptomatic patients
 Jaundice is common
Diagnosis and treatment
Early diagnosis and treatment of malaria reduces disease and
prevents deaths. It also contributes to reducing malaria trans-
mission. The best available treatment, particularly for P. falci-
parum malaria, is Artemisinin-based Combination Therapy
(ACT). WHO recommends that all cases of suspected malaria be
confirmed using parasite-based diagnostic testing (either mi-
croscopy or rapid diagnostic test) before administering treat-
ment.
Prevention
Vector control is the main way to reduce malaria transmission
at the community level. It is the
only intervention that can reduce
malaria transmission from very
high levels to close to zero.
For individuals,
personal protec-
tion against mos-
quito bites repre-
sents the first line
of defense for
malaria prevention. Two forms of vector control are effective in
a wide range of circum-
stances.
 Insecticide-treated mos-
quito nets (ITNs)
 Indoor spraying with re-
sidual insecticides
In addition, surroundings
around the house should be
kept clean and any malaria-
breeding sites such as ditches,
water ponds and swampy
places should be removed. It
is also recommended to use
full-sleeved clothes, mosquito repellants to avoid mosquito
bite.
Malaria control program, Nepal: At a Glance
Malaria control program was started in Nepal in 1950 which
operated the research on malaria control in Hetauda. In 1954,
Insect-Born Disease Control program was launched with assis-
tance from United Sates Overseas Mission (USOM), the objec-
tive of which was to control malaria mainly in Terai belt of
Eastern Nepal. On 4 December 1958, Malaria Eradication Pro-
gram was processed with the assistance from USOM and WHO
as a vertical program. Its objective was to eradicate malaria
from the country in a time-bound manner which was later
changed into malaria control program in July 1978. This pro-
grams was integrated into primary health care approach and
now is functional under the Disease Control Section.
>>For more information, visit who.int/
www.bmhall.yolasite.com/publications.php
parasite that causes malaria.
There were 216 million episodes of malaria
and 655,000 deaths worldwide in 2010,
according to the World Health Organization
(WHO). Most of the deaths had occurred in
the African region (91%), followed by the
South East-Asian Region (6%) and the East-
ern Mediterranean Region (3%). Similarly,
around 86
per cent
deaths
were of
children
globally.
Nepal is
among
104 ma-
laria en-
demic
countries
in the
world.
Although,
it has al-
ready
achieved
the ma-
laria control target for 2015 under Millen-
Malaria is a vector-borne infec-
tious disease caused by Plasmo-
dium parasites that are trans-
mitted to people through the
bites of
infected
female
Anophe-
les mos-
quitoes,
which
bite
mainly
between
dusk and
dawn.
Plasmo-
dium
falcipa-
rum and
Plasmo-
dium
vivax are
the most common species of
nium Development Goal (MDG), it still has to
go far for malaria eradication. More than 1,
00,000 clinical malarial cases are reported
annually in Nepal among which 2000-3000
cases are from tropical regions.
Who is at risk?
Specific population risk groups include:
 young children
 non-immune pregnant women
 semi-immune pregnant women
 semi-immune HIV-infected pregnant
women
 people with HIV/AIDS;
 international travelers from non-endemic
area
 Immigrants from endemic areas and their
children
Symptoms
Generally, symptoms of malaria appear usually
two weeks after the infected mosquito bite.
 High grade fever along with chilling and
sweating is the foremost sign of malaria
 Fever repeats in every 48-72 hrs
Public Health Perspective (PHP)

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health decision-makers and researchers who require its special blend of research, well-informed opinion and news. Full bulletin
is available at: http://bit.ly/10MAXOM
WHO Publications
Bulletin of WHO Vol. 91, No. 04, 2013
April 2013
Page 9
Research Priorities for the Environment, Agriculture and Infectious Diseases of Poverty
The Thematic Reference Group on Environment, Agriculture and Infectious Diseases of Poverty (TRG 4) addresses the nature of the
intersections and interactions between environment, agriculture and infectious diseases of poverty in order to identify research
priorities for improved disease control. The report is available for download at: http://bit.ly/12yevuR
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Sustaining the Drive to Overcome the Global Impact of Neglected Tropical Diseases
The second WHO report on neglected tropical diseases builds on the growing sense of optimism generated by the 2012 publication
of the WHO Roadmap. The report is available for download at: http://bit.ly/13wYrs3

Public Health Perspective (PHP) Team
April 2013
P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 10
Dr. Santosh Raj
Poudel
Residency (MD) in Inter-
nal medicine
Interfaith Medical Cen-
ter, New York
Dr. Krishna Chandra
Rijal
Dept. of Otorhinolaryn-
gology and Head & Neck
Surgery, College of
Medical Sciences and
Teaching Hospital
Bharatpur, Chitwan
Mr. Chandra Bhushan
Yadav
Information Officer
(MLIS)
Nepal Health Research
Council (NHRC)
MOHP, Kathmandu
Contributing Writers
Dr. P. Ravi Shankar
Professor, Clinical Phar-
macology & Medical Edu-
cation
KIST Medical College
Lalitpur, Nepal.
Editorial Advisories
Dr. Duk Bahadur
Chhetri
MD, Pathologist
Western Regional Hos-
pital Lab.
Pokhara
Mr. Balram Banstola
Managing Director,
Senior Pharmacist
Banstola Medical Hall
Kaski
Board of Advisories
Ms. Sami Pande
B. Pharm, MPH
Australian Leadership
Scholar, 2009
Kathmandu
Dr. Sitaram Khadka
Pharm D, Pakistan
Birendra Hospital
Madan Kc
Msc. Medical and
Health Care Devices
Uni. of Bolton, UK
Dr. Anis Rehman
Associate Chief Editor at
Journal of Pakistan Medi-
cal Students (JPMS)
HIFA 2015 Country Rep-
resentative for Pakistan
Chief Executive Officer
Ashik Banstola
M. Pharm
(Pharmacology), PDCR
Rajiv Gandhi University
Bangalore
Newsletter Team
Editor-in Chief
Amrit Banstola
Section Editors
Anoj Gurung
Sandeep Pahari
Sangita Shrestha
Subash Timilsina
International Honorary
Editorial Advisories
Ms. Rose Schneider --
RN MPH
Chair of the Climate
Change Working Group
of the APHA Interna-
tional Health Section.
Senior Health and HIV/
AIDS Specialist
Health Systems Man-
agement
1414 Perry Place NW -
Suite 100
Washington, DC 20010
Dr. Margaret Steb-
bing
PhD, Master of Public
Health, Dip App Sci
Nursing
Population Health Aca-
demic
School of Rural Health,
Monash University
Australia
Welcome to New Subscribers
International
Kristin Miller
Sadhu Panda
Nepal
Deepak Sapkota
Dr. Kshitiz Shrestha
Mahesh Bista
Articles appearing in Public Health Perspective (PHP) Online Newsletter do not necessarily reflect the views of the PHP team but are in-
tended to inform and stimulate thought, discussion and comment. The PHP newsletter do not discriminate on the basis of race, color, gender,
religion, age, sexual orientation, national or ethnic origin, and disability . Contributions are welcome and should be sent to:
The Editor, Public Health Perspective Online Newsletter,
Banstola Medical Hall, Milanchowk, Hemja-8 VDC, Pokhara, Kaski, Nepal, or email newsletter.php@gmail.com

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