World Health Organisation releases the health challenges of Migrants: Accepting refugees and migrants is not the issue but being able to cater for their health to maintain our commitment on universal health coverage.

 Frequently asked questions on migration and health

What are the common health problems of refugees and migrants arriving in the European Region?

The health problems of refugees and migrants are similar to those of the rest of the population, although some groups may have a higher prevalence. The most frequent health problems of newly arrived migrants include accidental injuries, hypothermia, burns, cardiovascular events, pregnancy and delivery-related complications, diabetes and hypertension. Female migrants frequently face specific challenges, particularly in maternal, newborn and child health, sexual and reproductive health, and violence. The exposure of migrants to the risks associated with population movements – psychosocial disorders, reproductive health problems, higher newborn mortality, drug abuse, nutrition disorders, alcoholism and exposure to violence – increase their vulnerability to noncommunicable diseases (NCDs). The key issue with regard to NCDs is the interruption of care, due either to lack of access or to the decimation of health care systems and providers; displacement results in interruption of the continuous treatment that is crucial for chronic conditions.
Vulnerable children are prone to acute infections such as respiratory infections and diarrhoea because of poor living conditions and deprivation during migration, and they require access to acute care. Lack of hygiene can lead to skin infections. Furthermore, the number of casualties and deaths among refugees and migrants crossing the Mediterranean Sea has increased rapidly, with a reported 1867 people drowned or missing at sea in the first 6 months of 2015, according to the United Nations High Commissioner for Refugees (UNHCR).

Do migrants contribute to the spread of communicable diseases?

In spite of the common perception of an association between migration and the importation of infectious diseases, there is no systematic association. Communicable diseases are associated primarily with poverty. Migrants often come from communities affected by war, conflict or economic crisis and undertake long, exhausting journeys that increase their risks for diseases that include communicable diseases, particularly measles, and food- and waterborne diseases. The European Region has a long experience of communicable diseases such as tuberculosis (TB), HIV/AIDS, hepatitis, measles and rubella and has significantly reduced their burden during economic development, through better housing, good water and sanitation, efficient health systems, vaccines and antibiotics. These diseases have not, however, been eliminated and still exist in the European Region, independently of migration. This is also true of vector-borne diseases in the Mediterranean area, such as leishmaniasis, with outbreaks recently reported in the Syrian Arab Republic. Leishmaniasis is not transmitted from person to person and can be effectively treated. The risk for importation of exotic and rare infectious agents into Europe, such as Ebola, Marburg and Lassa viruses or Middle East respiratory syndrome (MERS), is extremely low. Experience has shown that, when it occurs, it involves regular travellers, tourists or health care workers rather than refugees or migrants.
Tuberculosis
Migrants' risk for being infected or developing TB depends on: the TB incidence in their country of origin; the living and working conditions in the country of immigration, including  access to health services and social protection; whether they have been in contact with an infectious case (including the level of infectiousness and how long they breathed the same air); and the way they travelled to Europe (the risk for infection is higher in poorly ventilated spaces). People with severe forms of infectious TB are often not fit to travel. The incidence of TB in the countries of origin varies from as low as 17 new cases in 100,000 population in the Syrian Arab Republic to 338 in Nigeria. The average TB rate in the European Region is 39 per 100 000 population. TB is not easily transmissible, and active disease occurs in only a proportion of those infected (from 10% lifetime risk to 10% per year in HIV-positive people) and within a few months or a few years after infection.  TB is not often transmitted from migrants to the resident population because of limited contact.
­HIV infection and viral hepatitis
Conflict and emergencies can disrupt HIV services; however, the prevalence of HIV infection is generally low among people from the Middle East and North Africa. Hence, there is a low risk that HIV will be brought to Europe by migrants from these countries. The proportion of migrants among people living with HIV varies widely in European countries, from below 10% in eastern and central Europe to 40% in most northern European countries; in western Europe, the proportion is 20–40%. Despite a declining during the past decade, migrants still constitute 35% of new HIV cases in the European Union and the European Economic Area; however, there is increasing evidence that some migrants acquire HIV after their arrival.
As many developing countries have a high burden of viral hepatitis, the increasing influx of refugees from highly endemic counties is changing the disease burden in Europe.
­Respiratory diseases and MERS-CoV
Refugees do not pose an increased threat of respiratory infections – from, e.g. influenza, respiratory syncytial virus, adenovirus, parainfluenza virus – to the populations of the countries they migrate to because these are common infections that circulate widely in the host countries. However, physical and mental stress and deprivation related to lack of housing, food and clean water, increase refugees' risk for respiratory infections, which can cause severe disease in vulnerable groups (pregnant women, neonates, children below the age of 5 years, people with chronic underlying conditions, the elderly).
Since September 2012, 15 laboratory-confirmed cases of MERS coronavirus (CoV) infection, including seven related deaths, have been reported by eight countries in the WHO European Region. Most of the cases were imported and did not result in further spread of the virus. The risk that another traveller infected with MERS-CoV will enter the European Region remains, but it is low.  Most travellers to Europe do not transit through the countries currently reporting MERS-CoV cases; if they do, they will probably not use local hospitals. The only unknown factor is their likelihood of contact with camels and camel products. While the risk of a larger outbreak in European Union countries is considered small, the outbreak in the Republic of Korea earlier this summer demonstrates that this possibility cannot be excluded.
­Vector-borne diseases
The risk for reintroduction and localized outbreaks of vector-borne diseases such as malaria and leishmaniasis can be increased by a mass influx of refugees, as seen by the recent resurgence of malaria in Greece that was directly linked to an influx of migrants from Pakistan. This experience highlights the continual threat of reintroduction and the need for continued vigilance to ensure that any resurgence can be rapidly contained. At the moment, two countries in the WHO European Region, Tajikistan and Turkey are at high risk for reintroduction of malaria due to importation from Afghanistan and the Syrian Arab Republic, respectively.
­Antimicrobial resistance
Antimicrobial resistance is not a disease in itself but a complication of the treatment of disease. In certain situations, such as crowded settings with poor hygienic conditions in refugee camps, infections can easily occur and spread. Whether an infection is caused by resistant pathogens depends on its origin, which can be the environment, animals, food or humans.
­Food- and waterborne diseases
The risk for food- and waterborne illness can increase in the poor living conditions associated with migration. Some people might have been affected before their departure, but most typically get ill during their journey and especially in overcrowded settlements. Living conditions can disrupt the supply of safe food and water and can lead to unsanitary conditions for obtaining, storing or preparing food and water. When the supply of safe food and water is uncertain, people may use contaminated food ingredients or eat spoilt food. Overcrowding is a critical determinant of outbreaks of food- and waterborne diseases. Diarrhoea is the commonest symptom but can be accompanied by nausea, vomiting or fever. Examples of such diseases are salmonellosis, shigellosis, campylobacteriosis and hepatitis A. Infants and young children, pregnant women and elderly and immunocompromized individuals, including those with HIV/AIDS are particularly susceptible to these diseases.
The Sphere Handbook  sets the water intake requirement for survival at 2.5–3 L of drinking-water per person per day; in camps, this should be 15 L per persons. Those standards are not met during the journeys of most migrants, and drinking-water is often of unknown origin and untreated. Hand-washing with soap and personal hygiene, including laundry, often cannot be observed.
At border points, there is usually no drinking-water, toilets or shower facilities. Waste bins and regular removal of waste in reception centres are insufficient, posing additional health threats for migrants, as flies, mosquitos and rodents find easy breeding places.
­Heat
Very hot weather can cause illness and kill. When the outdoor temperature is higher than the skin temperature, the only heat loss mechanism available is evaporation (sweating). Therefore, any factors that hamper evaporation, such as high ambient humidity or tight-fitting clothes, can result in a rise in body temperature that may culminate in life-threatening heatstroke. It can trigger exhaustion, heart attacks or confusion and can worsen existing conditions such as cardiovascular and respiratory diseases.
An individual's risk for heat stress is increased by a wide range of factors, including chronic medical conditions, social isolation, overcrowding, being confined to bed and certain medical treatments.

What interventions should be used to prevent the spread of communicable diseases?
­ 
Tuberculosis
European countries should ensure universal health coverage of refugees and migrants (both documented and undocumented), including early diagnosis of TB and effective care for the duration of the treatment course. This is essential not only to respect human rights but also to succeed in TB control and elimination in the WHO European Region. The Region is the only one of the sic WHO regions with a consensus document on the minimum package of cross-border TB control and care interventions. This includes ensuring access to medical services. irrespective of a migrant's registration status and a non-deportation policy until intensive TB treatment has been concluded. TB cases are notifiable under the International Health Regulations (2005).
­HIV infection and viral hepatitis
Health systems must enhance viral hepatitis prevention and care programmes. Several countries in the WHO European Region vaccinate only high-risk groups against hepatitis B, contrary to the WHO recommendation to introduce universal vaccination of newborns, which is the most effective way to prevent mother-to-child transmission. Social, economic and political factors in the origin and destination countries of migrants influence their risks for infection with HIV and hepatitis viruses. These include poverty, separation from a spouse, social and cultural norms, language barriers, substandard living conditions and exploitative working conditions, including sexual violence. Isolation and stress may lead migrants to engage in risk behaviour, which increases the risk for infection. This risk is exacerbated by inadequate access to HIV services and fear of being stigmatized. Female migrants may be particularly vulnerable. Some countries in Europe do not provide HIV services for people of uncertain legal status, which can include migrants. WHO supports policies to provide HIV testing, prevention and treatment services irrespective of migrants' legal status. Mandatory HIV testing is applied to migrants in some countries; WHO and the European Centre for Disease Prevention and Control strongly advise against mandatory HIV testing for migrants but support routine offering of HIV rapid testing and linkage to HIV treatment and care. Similarly, voluntary screening of migrants for viral hepatitis has been shown to be cost-effective. Some countries fear that allowing HIV-positive asylum seekers to enter their countries would result in an overwhelming number of requests for treatment or that an influx of asylum seekers or refugees living with HIV would pose a substantial public health threat. Both of these concerns are contrary to the evidence and have no moral, legal or public health basis.
­Respiratory diseases and MERS-CoV
Transit and host countries should have the capacity to recognize and treat severe respiratory disease. These countries or WHO should consider offering seasonal influenza vaccine to at-risk refugees, starting in October–November 2015, i.e. before influenza becomes widespread in the Region. Laboratory capacity to detect MERS-CoV, treatment facilities equipped with isolation wards, arrangements for contact tracing, consistent application of adequate measures to prevent infection and provision of public health advice are all crucial to obviate or mitigate transmission.
­Vector-borne diseases
Experience in Turkey shows that a well-prepared health system can prevent reintroduction of vector-borne diseases. Since 2012, Turkey's health system has demonstrated strong capacity and flexibility in adapting to changing needs, and, so far, reintroduction of malaria and outbreaks of leishmaniasis have been prevented.
­Antimicrobial resistance
Knowledge about the patterns of antimicrobial resistance that are prevalent in a migrant's country or region or origin and in the recipient country is important for treatment. Preferably, patients should be tested, so that doctors can make informed decisions about individual treatment. This requires access to the host country's health system. Depriving migrants from access to the health system may result in lack of access to the appropriate antimicrobials. This will not benefit the patient and can induce resistance in microorganisms that are exposed to them.
­Food- and waterborne diseases
It is important to prevent the to prevent the development of foodborne and waterborne diseases among migrants, especially during their stay in camps, where they can easily attain epidemic proportions, especially in spontaneous migrant settlements. Information about safe food handling practices, such as WHO's five keys to safer foods, should be disseminated. Access to safe drinking-water is critical for the prevention of food- and waterborne diseases, and thorough assessments of water and sanitation should be conducted at borders and reception centres. These should include the establishment of an emergency water supply (packaged or tanker water) and water treatment, disinfection, storage and distribution. Local authorities must monitor water quality and make hand-washing facilities and sufficient soap available near toilets. Although the Sphere Handbook recommends one toilet for no more than 20 people in emergencies, this cannot be respected in most circumstances: 10 toilets are available for the thousands of migrants arriving daily at the reception centre in Gevgelija, in southern Macedonia, and the situation in the Serbian reception centre is no better.
­Heat
The most important actions to take during a heat-wave are: to avoid or reduce exposure, to communicate risks effectively, to take particular care of vulnerable population groups and to manage mild and severe heat illness. WHO/Europe has prepared information sheets with public health advice for different audiences on preventing the health effects of heat.

Why are noncommunicable diseases important for large arrivals of refugees and migrants?

NCDs are common causes of preventable morbidity and mortality:

• The major NCDs are cardiovascular diseases, diabetes, cancer and chronic lung diseases. 
• The prevalence of NCDs such as diabetes and hypertension in adults in certain low- and middle-income countries is as high as 25–35%.

People with NCDs may be more vulnerable the conditions prevalent during migration 
NCDs have common characteristics that can make affected people more vulnerable when they are refugees or migrants. NCDs:

• require the provision of continuous care over an extended time (often lifelong);
• often require regular treatment with a drug, a medical technology or an appliance;
• can have acute complications that require medical care, incur health costs and may limit function, affect daily activities and reduce life expectancy;
• necessitate coordination of care provision and follow-up between different providers and settings; and 
• may be associated with the need for palliative care

Challenges specific to sexual and reproductive health and action taken by WHO to address them
During the past 20 years, diverse issues related to sexual and reproductive health have been seen in the WHO European Region due to increased migration. For example, female genital mutilation has become a topical issue in the Region in countries such as Belgium, Norway, Sweden and the United Kingdom, and countries have asked for guidance from WHO in tackling this issue. Furthermore, a proportion of the migrant and refugee population has undiagnosed NCDs, such as cardiovascular disease and diabetes; these health problems cause problems during pregnancy and can result in severe maternal morbidity and sometimes death.
Unregistered migrants, who do not have access to and are not informed about the availability of reproductive health services, including antenatal care, are of concern, as this can result in late diagnosis and sometimes life-threatening conditions for women, mothers and their babies.
An analysis led by the WHO Health Evidence Network of the status of maternal health of refugees and migrants is under way and will be ready in 2016. This target group will be covered in the WHO European Sexual and Reproductive Health Action Plan, which will be presented to the Regional Committee in 2016.
How does sudden migration affect the health of people with NCDs?
The conditions in which refugees and migrants travel can acutely exacerbate or cause a life-threatening deterioration in the health of people with NCDs. Elderly people and children are particularly vulnerable. Complications can result from:

• physical injuries: direct traumatic injuries (e.g. secondary infection, poor glycaemic control) that compromise management of acute injury;
• forced displacement: loss of access to medication or devices, loss of prescriptions, lack of access to health care services, leading to prolongation of disruption of treatment;
• degradation of living conditions: loss of shelter, shortages of water and regular food supplies and lack of income add to physical and psychological strain;
• interruption of care: due to destruction of health infrastructure, disruption of medical supplies and inability to access health care providers, who may have been killed, injured or are unable to return to work; also, interruption of power supplies or safe water can have life-threatening consequences, especially for people with end-stage renal failure who require dialysis.

Minimum standards for responding to the needs of NCD patients among refugees and migrants 

• Identify individuals with NCDs to ensure continuing access to the treatment they were receiving before their migration. 
• Ensure treatment of people with acute, life-threatening exacerbation and complications of NCDs.
• When treatments for NCDs are not available, establish clear standard operating procedures for referral. 
• Ensure that essential diagnostic equipment, core laboratory tests and medication for routine management of NCDs are available in the primary health care system. Medications that are on the local or WHO essential medicines list are appropriate.

Key indicators: 

• All primary health care facilities have clear standard operating procedures for referral of patients with NCDs to secondary and tertiary care facilities.
• All primary health care facilities have the necessary medication to continue pre-emergency treatment of patients with NCDs, including for pain relief.   

What are the WHO recommendations for triage and screening of migrants upon arrival?

WHO does not recommend obligatory screening of refugee and migrant populations for diseases, because there is no clear evidence of benefits (or cost-effectiveness); furthermore, it can trigger anxiety in individual refugees and the wider community.
WHO strongly recommends, however, offering and providing health checks to ensure access to health care for all refugees and migrants in need of health protection. Health checks should be done for both communicable and NCDs, with respect for migrants' human rights and dignity.
The results of screening must never be used as a reason or justification for ejecting a refugee or a migrant from a country:

• Obligatory screening deters migrants from asking for a medical check-up and jeopardizes identification of high-risk patients.
• In spite of the common perception that there is an association between migration and the importation of infectious diseases, there is no systematic association. Refugees and migrants are exposed mainly to the infectious diseases that are common in Europe, independently of migration. The risk that exotic infectious agents, such as Ebola virus, will be imported into Europe is extremely low, and when it occurs, experience shows that it affects regular travellers, tourists or health care workers rather than refugees or migrants.

Triage is recommended at points of entry to identify health problems in refugees and migrants soon after their arrival. Proper diagnois and treatment must follow, and the necessary health care must be ensured for specific population groups (children, pregnant women, elderly).
Each and every person on the move must have full access to a hospitable environment, to prevention (e.g. vaccination) and, when needed, to high-quality health care, without discrimination on the basis of gender, age, religion, nationality or race. This is the safest way to ensure that the resident population is not unnecessarily exposed to imported infectious agents. WHO supports policies to provide health care services to migrants and refugees irrespective of their legal status as part of universal health coverage.

What does WHO recommend with regard to vaccination for newly arrived migrants?

Transmission of vaccine-preventable diseases to host country populations is just as likely to happen after the return of a resident of that country from a holiday in an endemic country as after the arrival of a migrant from the country. There are still large gaps in the immunity of populations across the Region, either because countries decide not to avail themselves of the benefits of vaccination or because of limited access to vaccination services.
The WHO Regional Office for Europe does not routinely collect information on transmission of vaccine-preventable diseases among migrants or on their immunization coverage. However, well-documented outbreaks of measles have originated by transmission from migrants, mobile populations, international travellers and tourists alike. Equitable access to vaccination is of prime importance and is one of the objectives of the European Vaccine Action Plan 2015–2020. The plan proposes that all countries in the Region pay special attention to ensuring the eligibility and access of migrants, international travellers and marginalized communities to (culturally) appropriate vaccination services and information. We applaud the many countries, such as those receiving large influxes of migrants, that are including migrants into their routine vaccination programmes. Immunization coverage of all countries can be accessed at: http://www.who.int/immunization/monitoring_surveillance/routine/coverage/en/.

What health care access does WHO recommend for refugees and migrants?

Legal status is one of the most important determinants of the access of migrants to health services in a country. Each and every refugee and migrant must have full, uninterrupted access to a hospitable environment and, when needed, to high-quality health care, without discrimination on the basis of gender, age, religion, nationality or race. WHO supports policies to provide health care services irrespective of migrants' legal status. As rapid access to health care can result in cure, it can avoid the spread of diseases; it is therefore in the interest of both migrants and the receiving country, to ensure that the resident population is not unnecessarily exposed to the importation of infectious agents. Likewise, diagnosis and treatment of NCDs such as diabetes and hypertension can prevent these conditions from worsening and becoming life-threatening.

Are countries in the European Region adequately prepared to respond to the public health challenges of large migration?

Health systems in the countries receiving migrants are well equipped and experienced to diagnose and treat common infectious and NCDs; they should also be prepared to provide such health care to migrants. Under the International Health Regulations (2005), all countries should have effective disease surveillance and reporting systems, outbreak investigation ability and case management and response capacity. Should a rare exotic infectious agent be imported, Europe is well prepared to respond, as shown over the past 10 years with imported cases of lassa fever, Ebola virus disease, Marburg virus disease and MERS, due to good laboratory capacity, treatment facilities equipped with isolation wards, a trained health workforce and a system for contact tracing. While we should remain vigilant, this should not be our main focus.
Responding quickly and efficiently to the arrival of large groups of people from abroad requires effective coordination and collaboration between and within countries as well as between sectors. A good response to the challenges faced by migrant groups requires good preparedness: preparedness is the basis for building adequate capacity in the medium and long term, requiring robust epidemiological data and migration intelligence, careful planning, training and, above all, adherence to the principles of human rights. Defining contingency scenarios to adequately address current or potential large influxes of migrants into a country will improve coordination among the numerous stakeholders involved, improve resilience and avoid the distress of the health system.
Access of vulnerable groups such as young children to acute care for common and severe conditions must be assured, as children can deteriorate quickly if they do not have adequate care. Where necessary, health care professionals should learn to detect and treat communicable diseases that they don't often see. In addition, they should strengthen their preparedness to communicate with foreigners who speak different languages and are from different cultural backgrounds (through interpreter services or other means). High-quality care for migrant groups cannot be ensured by health systems alone. The social determinants of health, such as education, employment, social security and housing, all have a considerable impact on the health of migrants.

What is WHO doing to address the public health implications of the large influxes of refugees and migrants into the European Region?

WHO works to: develop migrant-sensitive health policies; strengthen health systems to provide equitable access to services; establish information systems to assess migrant health; share information on best practices; increase the cultural and gender sensitivity and specific training of health service providers and professionals; and promote multilateral cooperation among countries in accordance with resolution WHA61.17 on the health of migrants endorsed by the Sixty-first World Health Assembly in 2008.
Health issues related to people's movements have been on the agenda of the WHO European Region for many years. The WHO European health policy framework Health 2020 has drawn particular attention to migration and health, with population vulnerability and human rights. Following the political, economic and humanitarian crises in the north of Africa and the Middle East, the WHO Regional Office for Europe, in collaboration with the Italian Ministry of Health, established the Public Health Aspects of Migration in Europe project in April 2012. The aims are to strengthen health system capacity to meet the health needs of mixed inflows of migrants and host populations; promote immediate tialessen health interventions; ensure migrant-sensitive health policies; improve the quality of the health services delivered; and optimize use of health structures and resources in countries receiving migrant populations. Up to August 2015, the Regional Office had conducted joint assessment missions with ministries of health in Bulgaria, Cyprus, Greece, Italy, Malta, Portugal, Serbia and Spain, with the new "Toolkit for assessing health system capacity to manage large influxes of migrants in the acute phase", to respond to and address the complex, resource-intensive, multisectoral, politically sensitive issues in health and migration.

Source: WHO.

World Health Organisation new guidance on "proterm birth" gives Malawi children new hope of survival.

Malawi: Giving the smallest babies the best chance at life.

Malawi has one of the highest rates of preterm birth in the world. Nearly 1 in 5 babies are born before 37 weeks of gestation. Globally, complications of prematurity, such as difficulty in feeding, breathing and regulating body temperature, are the single largest cause of neonatal death. In order to survive, these babies need specialized care and equipment—resources most developing countries do not have.

Malawi is no exception.

When Dr Elizabeth Molyneux started treating preterm babies at Queen Elizabeth Central Hospital in Blantyre, Malawi more than 40 years ago, she did not have incubators to keep babies warm. Nor did she have phototherapy lights to prevent jaundice or specialized equipment to ensure their tiny airways stayed open.
“It’s been clear over the years that the smallest babies in Malawi were the most neglected,” explains Dr Molyneux.
Determined to help, Dr Molyneux helped to set up the hospital’s neonatal care unit, which today admits more than 3 000 babies a year. At first, she introduced warm cots and kangaroo mother care, a method which encourages skin-to-skin contact, but found she also needed a way to help babies whose lungs were not fully developed to breathe.

A low-cost solution

Engineering students at Rice University in Texas, USA, were able to design the solution—a low-cost bubble continuous positive airway pressure (CPAP) device called Pumani, which means “breathe” in the Malawian language of Chichewa. And it’s working. Since 2006, more than 1000 babies’ lives have been saved.
“Before CPAP we found that, if we couldn’t give any breathing support, mortality was high. By giving CPAP to babies who needed the support, survival rates improved in premature babies with breathing difficulties from 24% to 67%,” says Norman Lufesi, Head of the Acute Respiratory Infection Unit, Malawi Ministry of Health.
This is good news in a country where 1 out of 43 newborns die within the first 4 weeks of life.
“While CPAP has made a big difference for babies with respiratory distress syndrome, we still have a long way to go to reduce neonatal mortality,” says Dr Molyneux. “We still need a package of care that can be sustained in all of our hospitals.”

Preterm birth guidelines

Worldwide, complications of prematurity are the leading cause of deaths among children under the age of 5. In order to reduce neonatal and child mortality, WHO recommends evidence-based interventions be given to women at imminent risk for preterm birth or to preterm babies after birth.
CPAP, kangaroo mother care, surfactant and oxygen therapy are all newborn interventions outlined in, "WHO recommendations on interventions to improve preterm birth outcomes," a new guideline published this month. Recommended maternal interventions to improve preterm babies’ chances of survival include antenatal corticosteroids, when gestation is confirmed to be between 24 and 34 weeks, antibiotics when the fetal membranes are ruptured, and magnesium sulfate for protecting the infant against serious neurological complications.
While Malawi has implemented CPAP, kangaroo mother care and oxygen therapy at Queen Elizabeth Central Hospital, which is the country’s largest health facility, the designated neonatal rooms in most of the district hospitals are without specialized equipment or trained staff. Over the past 2 years CPAP has been introduced into 28 district hospitals and will soon be in 8 non-profit hospitals.

Focused on every newborn

Through early adoption of global policies and programmes to increase access to life-saving newborn and child health interventions, Malawi is one of a few countries in sub-Saharan Africa to achieve Millennium Development Goal 4, which aims to reduce under-5 mortality by two-thirds by the end of this year. In 1990, 1 in 4 Malawian children died before the age of five. Today, the rate is 1 in 14.
“We have done a good job at reducing under-5 child mortality in Malawi, but 44% of the deaths continue to be babies within their first month of life,” says Fannie Kachale, Director of Reproductive Health, Malawi Ministry of Health. “We realize we could have done even better if we had focused more on newborn health.”
To improve the situation, the country recently launched an adaptation of WHO and UNICEF’s Every Newborn Action Plan, with the goal of reducing neonatal mortality to 17 per 1 000 births by 2030. As part of the plan, Malawi is increasing the number of skilled birth attendants, giving antenatal corticosteroids and antibiotics to women with preterm labour using stringent criteria as defined by WHO, and strengthening newborn care during the first 4 weeks of life.
The country is also renovating 10 neonatal care units in the district hospitals and expanding Queen Elizabeth Central Hospital’s kangaroo mother care unit to 40 beds. “Through CPAP, babies who wouldn’t otherwise have survived are now surviving,” says Lufesi. “Hopefully by adding good neonatal care units in our hospitals we’ll be able to save even more babies and reduce our neonatal mortality rates.”

Source: WHO

Britain & HIV/AIDS: Six English Premier Leaugue stars undergoes HIV test as the same girl they all slept with contracted the disease.

Six soccer stars were last night facing an agonising wait for the results of HIV tests.
The shocked Premier League players have all slept with the same female soccer groupie.
They had tests for HIV - the virus that causes AIDS - after the girl told them she had found out she was infected. She has no idea whether she contracted the disease before or after she slept with them all.
The stars, who play for three different clubs, cannot be named for legal reasons.
But a source said: "All of them are beside themselves with worry. They are all only too aware of the scandal it will cause.
"None of them have let their families know yet because they don't want to worry them.
"It's like a ticking timebomb for them all and would almost certainly end their careers if they have contracted it."
The AIDS scare is the biggest sex scandal to hit the Premier League since the "roasting" rape allegations six years ago.
The infected girl met the stars through her ex-boyfriend who moves in footballing circles.
When she and the boyfriend split up she slept with the players over several months, many of them more than once. It is believed she got back together with her boyfriend and then discovered he was HIV positive.
The girl had a test and was devastated last month to discover SHE was also HIV positive. The girl then immediately told all her sexual partners including the six players. Our source added: "The woman had no idea she was infected while she was sleeping with these guys.
"She now has to deal with the reality she may have infected other people. She is absolutely distraught, virtually suicidal."
Hiv attacks the body's immune system but can be kept under control with drugs.

Source:  Daily Mirrow.

Find out the drug that UK healthcare recommended for cancer treatment in Britain.

Britain's healthcare cost-effectiveness watchdog NICE on Monday recommended use of Merck's immunotherapy drug Keytruda, after the U.S. drugmaker promised to supply it to the state health service at a discounted price.

The move comes amid controversy over access to costly cancer medicines in the country. On Friday, a fund that helps patients receive cancer drugs not routinely paid for by the National Health Service said it would no longer pay for a number of medicines.

In the case of Merck's drug, the National Institute for Health and Care Excellence (NICE) said in final draft guidance that it should made available for certain patients with advanced melanoma.
The drug costs about $150,000 for a year of treatment in the United States but will sell for less in Britain. The scale of the discount being offered to Britain's health service is commercially confidential, NICE said.

Keytruda is a so-called anti PD-1 inhibitor, which works by making cancer cells ‘visible’ to the immune system and so open to attack. The drug received a speedy assessment in Britain under a recently introduced early access scheme for promising new treatments.

(Reporting by Ben Hirschler; Editing by Mark Potter)
Reuters.

Find out why the eye drops - Chlorhexidine Digluconate solution was withdrawn from Nigerian market to save the sight of children.

Early in September 2015, in Yobe State in Nigeria, a three-week old baby was brought to a doctor with corneal ulceration leading to immediate blindness. The doctor took a detailed history, and the only possible cause that he could find was the use of what the mother described as “eye drops”, given to her as part of a pack to support the delivery. The doctor asked the mother to go home and bring in the “eye drops”. She went home and returned with a bottle similar to the one below.

The contents of this bottle is chlorhexidine digluconate 7.1% solution packaged in a white plastic bottle apparently manufactured by Galentic Pharma (India) Pvt Ltd, as can be seen on the picture. The problem with this is that chlorhexidine digluconate 7.1% is licensed for use in Nigeria for use as an antiseptic gel to be applied to the newborn’s cord stump to prevent infection. Most people reading this will associate the container as the usual means of dispensing eye drops in Nigeria. It should never have been applied to the eyes, and therefore should never have been delivered in containers generally used for eye drops, especially when you are targeting an intervention at the poor living in mostly rural communities. It has been distributed in Yobe since March 2015.
What are the consequences so far? There are five known cases of irreversible blindness associated with the use of these drops already, three reported in Yobe State and two in Adamawa State. The three children in Yobe are 3 weeks, 4 weeks and two years. Old. All their parents were uneducated, their fathers, farmers. This will represent the socio economic circumstances of many people in the area. An unknown number of these containers were distributed to patients in Yobe, Adamawa through government primary healthcare centres. The source of these bottles is not yet clear. They do not have a NAFDAC number inscribed on them. It is not clear if they were distributed in other states in Nigeria. We have some very graphic pictures of the consequences of these drops on children, which we have decided not to show here.
What has been the response? Many astute and hardworking physicians and other health care workers have personally led advocacy campaigns and search efforts to retrieve as many of these bottles still in circulation. Our understanding is that the Federal Ministry of Health and its agencies; National Agency for Food and Drug Administration (NAFDAC), whose vision is to “safeguard the health of the nation” and the National Primary Health Care Development Agency (NPHCDA) have responded to this, as well as the Yobe State Government, trying to find and retrieve as many of the remaining bottles in circulation. The Yobe State Ministry of Health has reached out to all the Primary Health Care and Maternal and Child Health coordinators in the Local Government Areas with relevant information and apparently all the remaining stock of the drugs have been collected and as much as possible, those that were already dispensed traced and retrieved. It is clear that health workers did not actually prescribe the drugs for use in eyes but the packaging was misleading and parents mistakenly used these as eye drops. Local awareness campaigns have been carried out and the three children affected in Yobe are getting care and support. At the time of publishing this piece, none of the responsible agencies, the Federal Ministry of Health (FMoH), or the Yobe State Ministry of Health has made any public announcement, and there is nothing on any of their websites.
What YOU need to do: If you are a clinician reading this, especially if you are practicing in northern Nigeria where the few cases have been reported, look out for the bottles in the image above and retrieve these. Immediately contact relevant authorities with the information. Please inform any clinician that you know who deals with children on the situation and ask them to look out for these bottles. Distribution chains are generally weak and porous in Nigeria, but we know how well we can work together when there are concerted efforts. Details of the product being withdrawn is as below:
Composition: Chlorhexidine Digluconate Solution BP 7.1%
Manufacturing Licence No.: KD-214
Batch No: Variable
Manufacturing Date: Variable
Expiring Date: Variable
NAFDAC No: None
Manufactured By: Galentic Pharma(India) Pvt Ltd, R- 673 MIDC, T.T.C., Rabale, Thane Belapur Road, Navi, Mumbai, India.

What you do need to know about Chlorhexidine Gel: Used appropriately, the evidence is that this gel, leads to a reduction in the risk of death by 23% in children when applied on the umbilical stump. We wrote this piece on Nigeria Health Watch highlighting the impact of its introduction in Bauchi and Sokoto States. Read here an excellent recently published article on the impact of the gel in Sokoto and lessons learnt from its introduction. The only licensed formulation of chlorhexidine in Nigeria is as a GEL in a TUBE; which is what is recommended and manufactured in Nigeria. Chlorhexidine is life saving when applied appropriately on the cord, but should not be applied on any other part of the body. Its appropriate use is described in the image below.

The correct application of Chlorhexidine Gel

What are the unanswered questions?

1. How can a drug, not registered by NAFDAC, not appropriately packaged, end up being distributed to mothers in government health care facilities? Who procured, imported, authorized, distributed this product? Where did the product governance processes fail?
2. What assurance can be given to the Nigerian public that ALL of the bottles that were procured and distributed have been retrieved? The information on numbers procured, distributed and retrieved must be shared publicly to restore and assure public confidence.
3. In 2014, the Nigerian Ministry of Health granted regulatory approval for the production Chlorhexidine Digluconate 7.1%, by a local company, Drugfield Pharmaceuticals Ltd. Why should this commodity be imported at all?
4. What are the medico legal consequences for healthcare providers through the entire chain from clinicians to government to the regulators through to the manufacturers, considering the implications of a life without vision for the babies involved?
5. How do we safeguard the legitimate use of lifesaving chlorhexidine gel in Nigeria.

Again – the governance of several aspects of our health system has left a lot to be desired. As authorities investigate this issue, emphasis should be less on what happened, but on how it could possibly have happened.

Source: Nigerian Health Watch.

Japan female workers and abortion: See what the Prime Minister of Japan told the World Assembly for women summit in Tokyo about Japan bosses forcing female employees to have abortion.

                      Pregnant women are furious about how they are treated at the office.
Women and work in Japan.

We are busy, get an abortion.

“ABENOMICS is womenomics,” Japan’s prime minister declared, marrying two atrocious words in a single phrase, at a glamorous shindig called WAW!, or the “World Assembly for Women in Tokyo”, on August 28th-29th. Before an international audience of high-powered female leaders and businesswomen, Shinzo Abe promised to help women “shine” at work as a way to boost Japan’s talent pool and economy. As the conference opened, the Diet (parliament) passed a long-awaited law calling on companies to find ways to promote more women.
Yet such grand visions are beside the point for most working women. Sayaka Osakabe, founder of a new non-profit outfit called Matahara Net, which campaigns for the rights of pregnant women at work, says that before “shining” women just need to be allowed to work without being harassed. Matahara, (a contraction of “maternity” and “harassment”), is illegal but rife.
The worst examples involve bosses urging pregnant women to have abortions. One woman who now works for Matahara Net landed a prized “career-track” job at a big bank alongside her boyfriend, who worked in another department. After she became pregnant, a manager told her he would “crush” both her own career and that of her boyfriend if she went ahead and had the baby. In 2011 she took the hint and had an abortion.
Ms Osakabe herself suffered two miscarriages. She says that stress caused by ill-treatment at work was partly to blame. Other women have had to apologise in front of co-workers for becoming pregnant. Those on precarious part-time contracts are particularly vulnerable to being fired while on maternity leave. A fifth of young mothers experience some kind of office harassment, according to Rengo, Japan’s biggest trade union confederation.
Part of the problem is the country’s culture of pointless workaholism—office workers are expected to stay late even if they have no work to do. Anyone exempted from this ordeal—mothers with young children, for instance—is envied. Also, since companies seldom hire cover for women on maternity leave, colleagues have to pick up the burden. Twice as many female as male colleagues dish out verbal criticism of pregnant women. It is one reason why seven out of ten women give up their jobs on having their first child.
Not all women think this is a problem. Ayako Sono, a conservative who was once on a government panel on education, calls matahara a “dirty” expression that signifies women’s overreaction to minor social discomforts. Yet it is hard for the government to ignore the harassment, since it contributes to the relentless decline in the Japanese population, policymakers’ biggest headache. Women who find it hard to combine work and motherhood often forgo the latter.
Last year the Supreme Court ruled for the first time on matahara. It found in favour of a mother who had sued a medical practice in Hiroshima for demoting her. This judgment, and Mr Abe’s championing of working-women’s rights, have emboldened more women to speak out. Those expecting are starting to expect better treatment.

From the economist via the print edition: Asia

Why viral hepatitis is 'nicknamed' the silent killer and even more dangerous than HIV or Tuberculosis.

Putting an end to global health's 'silent killer'.

By Gottfried Hirnschall.

There’s a reason viral hepatitis has been dubbed the “silent killer.”

People generally know very little about viral hepatitis, a disease of the liver caused by five different viruses. In fact, most of the 400 million people with chronic hepatitis B and C, the most serious forms of viral hepatitis, don’t know that they are infected. This enables the infection to go unnoticed, and undiagnosed, until the virus has caused serious liver damage. This, in turn, has resulted in viral hepatitis becoming the seventh leading cause of death worldwide. Together hepatitis B and C cause approximately 80 percent of all liver cancer deaths and kill close to 1.4 million people every year — more than either HIV or tuberculosis.

This silent, hidden evolution has meant that for decades hepatitis has been one of the poor relations of global public health — its impact underestimated, services underresourced and minimal political attention paid. Despite this neglect, a wide range of effective tools exist to both prevent and treat hepatitis.

Hepatitis B and C are transmitted through blood and bodily fluids. Infections can be prevented by using only sterile equipment for injections and other medical procedures, and testing all donated blood and blood components for hepatitis B and C. Similarly, people who inject drugs can be protected by providing them with sterile injection equipment. Children in most of the world’s countries now routinely receive hepatitis B vaccine — and are thus protected from infection for life. Safer sex practices, including minimizing the number of partners and using condoms and other barrier measures, also protect against transmission.

The most notable advances in the field of hepatitis are in the area of treatment. Recently developed medicines can cure most people with hepatitis C and can control hepatitis B infection. People who receive these medicines are much less likely to die from liver cancer and cirrhosis and much less likely to transmit the virus to others.

In part as a result of these advances, public health leaders are increasingly calling for more to be done to reduce the health burden from these infections. More and more are raising the possibility that viral hepatitis could be eliminated. Last year, at the World Health Assembly, 194 countries approved a resolution calling for measures to improve prevention, diagnosis and treatment of viral hepatitis and called on the World Health Organization to assess the feasibility of eliminating hepatitis. They also agreed to consider a range of measures to improve access to effective and affordable hepatitis medicines and diagnostics.

A number of countries have already taken concrete steps to do so — Egypt has substantially increased the number of people receiving treatment for hepatitis C in recent years, Georgia has set a goal for the national elimination of hepatitis C, and China has dramatically reduced the rate of hepatitis B infection in children by promoting universal vaccination.

At the same time, countries asked the WHO Secretariat to continue to help them develop robust strategies and goals on hepatitis and to report regularly on the progress of such programs. WHO has responded by providing guidance to countries on developing a national hepatitis response that is tailored to a country’s particular circumstances. WHO is also drafting the first global strategy for the control of hepatitis. This strategy is based on the principles of universal access and includes ambitious targets to reduce infections and deaths from hepatitis, with the goal of eliminating hepatitis B and C by 2030.

But to make a real difference, it will be critical to establish the sort of global political commitment that has built up around other communicable diseases — notably HIV, tuberculosis, malaria and polio.

Younger women at risk to contact heart disease. Find out why?

Younger Women With Diabetes and Heart Attack Risk

By Robert Preidt

HealthDay Reporter

Young women with diabetes are much more likely to have a heart attack than those without the blood sugar disease, new research says.

The study from Poland also found that young women who actually had a heart attack were more likely to be smokers than older women who had suffered heart attacks.

To reach these conclusions, the researchers looked at nearly 7,400 Polish women. Among those aged 45 and younger, women with diabetes were six times more likely to have a heart attack than those without diabetes.

High blood pressure increased the risk by four times, high cholesterol levels tripled the risk and smoking nearly doubled the risk. There was no significant link between obesity and heart attack risk, but this may be due to the fact that diabetes was so common among obese young women, according to study co-author Hanna Szwed, a professor at the Institute of Cardiology in Warsaw.

The study was presented Monday at the European Society of Cardiology annual meeting in London. Research presented at meetings is considered preliminary until published in a peer-reviewed medical journal.

"We found that the risk factor profile in young women with [heart attack] was similar to the older population, apart from the greater occurrence of tobacco smoking in young women," Szwed said in a society news release.

"This finding correlates with other research which shows that smoking is a growing problem in young women. This is clearly an area where prevention efforts are needed," she added.

"At present there are not enough global scientific reports focused on the problem of coronary heart disease in young populations, particularly in women," Szwed said.

 

Natural Bodybuilding – The Secrets of Natural Bodybuilding without steroids.

Most of the people today are familiar with the word bodybuilding. It is a process in which the person loses mass accumulated in the body due to excessive fat and develops bulky and huge muscles all over the body. The process of bodybuilding also helps these muscles to be healthy and maintain a proper shape. Usually every bodybuilder consumes some or the other type of supplement which contain steroids or other chemicals which are harmful for our body in the long run. Natural bodybuilding is just a simple bodybuilding process in which no such steroids or chemical compounds are involved. The drugs which are responsible for artificial enhancement of a person’s body growth are not used in a natural bodybuilding process. Instead of using these drugs, a combination of intense weight training and a complete nutritional balanced diet are used to make a person body more muscular and fit.
In this process, a person does not have to use artificial supplements to fulfill the requirements of the basic nutrients of the body to perform and tolerate the intense workout. The intense workout in a bodybuilding process is required to lose fat accumulated in the body and keep the muscles in a proper shape. In a natural bodybuilding process, all the nutrients are supplied to the body in their natural form through the balanced nutritional diet. This makes the body free from any side effects and the person does not gets affected to any of the diseases that are caused by the side effects of chemical supplements used in a normal bodybuilding process in case of their over dosage.

 

It does not only includes the process of bodybuilding but guides a person to live a better way of life by having a complete balanced diet and exercising regularly to complete his body fit and muscles in proper shape. Natural bodybuilding is free from any side effects and due to this fact only; it is getting more and more famous among the bodybuilders and bodybuilding enthusiasts. Artificial bodybuilding is nowadays discarded by most of the bodybuilders and natural process of bodybuilding is being adopted by them. They find it a cleaner way to obtain bulky muscles that too without any side effects of the process. So natural bodybuilding is surely better than any other bodybuilding process!

Article Source: http://EzineArticles.com/?expert=Subodh_Jain