A large meta-analysis study published in the prestigious JAMA on January 2nd explored the association between various grades of obesity and all-cause mortality. 97 total studies were included in the final analysis, covering over 2.88 million patients and over 270,000 deaths. Continue reading
Paul Farmer and the new World Bank President Jim Kim called it the “neglected stepchild” of global health. Atul Gawande admitted his surprise, “I could not understand why the world was not seeing avoidable harm in surgery as a major danger to public health.” The global health agenda is moving forward at an astonishing pace, but surgery seems to only recently have begun substantially entering the picture. The typical medical access trends in the developing world- very few physicians, even fewer in rural areas, and even fewer than that when considering specialists- are all exacerbated when isolating the surgical subspecialties. Currently, estimates suggest that of the 234 million surgeries occurring annually, only 26% take place in the poorest countries accounting for 70% of the global population. Given the large number of nonsurgical interventions that are cheaper, quicker, and easier to administer, one must ask whether surgery is rightfully neglected in developing countries.
The numbers don’t seem to suggest so. In the paper referenced above, Farmer and Kim suggest that a lack of surgical interventions is responsible for up to 15% of global Disability Adjusted Life Years (DALY) and that surgical disease, in some settings, is in the top 15 causes of disability. Other estimates suggest that surgery is responsible for ~11% of the Global Burden of Disease. Moreover, obstructed labor, postpartum hemorrhage, and trauma from birth and road accidents are among the leading causes of death in low and middle income countries, all of which usually require surgical intervention. Continue reading
I recently came across a television show, “Monsters Inside Me,” on Animal Planet which presents dramatized recollections of people’s experiences with parasitic infections. Parasites such as the Soil Transmitted Helminthes are on the World Health Organization’s list of Neglected Tropical Diseases. A multitude of parasitic infections are all too common in tropical climates, particularly in developing countries. The literature on parasitic infections is quite interesting and risk factors have been well documented. What’s more interesting are the various cultural beliefs that have made parasites more common and even accepted as a regular part of life in some communities. A recent study published in Parasitology International showed how people in Southeast Asia had strong cultural inclinations toward eating raw fish which were vectors for transmission of a type of parasite.
Ascaris worms coming out of a boy's nose.
Parasitic infections do not receive too much attention as a global health issue because they are usually non-fatal and are rare in developed countries. Nonetheless, as Animal Planet reminds us, we could have a monster inside us and not even know it. I personally have contracted multiple parasitic infections in my various global health field experiences and make it a point to get checked by my physician whenever I return from abroad. I suggest you do the same!
The first major independent evaluation of the famous Millenium Villages Project (MVP) has recently been released by Kenyan economist Bernadette Wanjala of Tilburg University in the Netherlands and has found an insignificant increase in household income
in a Millennium Village compared to a control village. This is primarily because the increased agricultural production in the studied Millennium Village (Sauri, Kenya) was offset by a resulting over-reliance on agriculture and under-reliance on diversified, non-agricultural economic pursuits. Continue reading
It has been over 30 years since the first cases of “Slim” started appearing in men and women from the villages dispersed near the border of Uganda and Tanzania. Since then, the world has made progress- “Slim” was recognized as the Human Immunodeficiency Virus, the progression of HIV to AIDS was more clearly understood, the science behind HIV transmission dispelled xenophobic notions (for the most part), antiretroviral therapy was discovered and is improving, researchers have demonstrated a functional cure via stem cell transplant, and the results of a recent multinational trial presented at the 2011 Intl. AIDS Society Conference have finally confirmed the highly effective duality of treatment as prevention. The statistics reflect these advances- nearly 50% of ARV eligible people now have access to treatment, in 2010 there were only 1.8 million AIDS-related deaths as compared to 2.2 million in 2005, and there has been a 15% reduction in new infections per year over the last decade, with 22 African countries now reporting incidence rates which are 25% lower than in 2001 (UNAIDS World AIDS Day Report 2011).
