Exposure of lead amongst primary school children in fishing communities in South Africa

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, South Africa in partial fulfilment of the requirements for the Master of Medicine in the branch of Community Health Johannesburg, 2014BACKGROUND: Lead is one of the most widely used and studied heavy metals. Lead has a number of serious detrimental effects including those related to the nervous system (seizures, ataxia) heamotological system (anaemia) and renal system. The severity and prognosis of diseases related to lead exposure is more pronounced in children, even with very low blood levels. Anecdotal reports of lead melting to make fishing sinkers in South African subsistence fishing communities prompted the conduct of an epidemiological study in four South African fishing villages to investigate the extent of lead melting and the associated risks in children. METHODS: A cross sectional analytical study was conducted. The study was conducted in two schools located along the western (Atlantic Ocean) coast of South Africa (HP Williams Primere in Stompneusbaai and NGK Primary School in Elands Bay) and in two schools located along the southern (Indian Ocean) coast of South Africa Bertie Barnard School in Stilbaai, Struisbaai Primere School in Struisbaai. Blood samples were collected for lead content analysis, and anthropometric measurements were taken. Questionnaires were administered to obtain information about socio-economic status and risk factors for lead exposure. A total of 196 children from grade 0, 1 and 2 were included in the study. RESULTS: Blood lead levels in the sample ranged from 1.9 to 22.4 μg/dl. Central tendency of the blood lead level demonstrated an arithmetic mean of 6.87 μg/dl (95% CI: 6.36 to 7.37 μg/dl) and a median of 6.1 μg/dl. More than half of the children in the study had blood lead levels between 5.0 - 9.9 μg/dl, whilst 13% that had levels higher than 10 μg/dl. Age, sex and ethnicity was not significantly associated with high blood lead levels whilst, lead melting practices and interaction of children with pets were strongly associated with high blood lead levels in children. Multivariate analysis showed that the presence of a fisherman in the household and children watching smelting were significantly associated with higher blood lead levels. Village remained a confounding variable in the model. CONCLUSIONS: This study is the first report on blood lead levels in fishing villages on the African continent and provides evidence that lead is still used widely as the primary substance used to make fishing sinkers. The prevalence of plumbism was high at 75%. Policy and awareness is needed to address this neglected public health concern

Role of Tourism in shaping positive image of Pakistan

This study will analyze the role of tourism in shaping the positive image of Pakistan. Tourism has not only proved vital for the economy and a key source of income and employment but also built a positive image of their society and national identity in developing countries. It promotes cross-cultural connections, appreciation, and understanding. Promoting cross-cultural awareness for both locals and tourists builds bridges of understanding between cultures. During the worst wave of terrorism after the year 2000 Pakistan has almost lost its true identity in the world and tourism can be the best tool to raise its profile of Pakistan in the world. Tourism also promotes international connections which can be helpful in increasing business opportunities and cultural exchange. There is tremendous potential for tourism across Pakistan. The tourism industry is expanding but not at the expected pace, further rise is expected in the coming years in the tourism industry. Pakistan is becoming an attractive tourist destination for international tourists. The government of Pakistan is taking initiatives to grow tourism as a priority. Data and information, I lifted in this study have been collected through secondary sources including Books, Magazines, Articles, Journals, E-Journals, the Internet, Reports of the World Tourism Organization, the Ministry of Tourism, and World Travel, etc. Government, tourism industry, and society need to join hands to shape the positive image of Pakistan.

Recommendations to improve the National Development Plan for Health

In November 2011, a draft National Development Plan (NDP) was released that addresses two of South Africa’s major challenges: poverty and inequity. Health and economic development are interdependent, presenting an important opportunity through the NDP to integrate health within goals of broader socio-economic development. Reviewing the NDP identified gaps based on evidence and the epidemiological risk profile of South Africa. Recommendations to improve the NDP and to deal with poverty and inequity should focus on prevention and addressing the social determinants of health, including: (i) a multisectoral approach to establish a comprehensive early childhood development programme; (ii) fiscal and legislative policies to bolster efforts to reduce the burden of non-communicable diseases; (iii) promoting and maintaining a healthy workforce; (iv) and promoting a culture of evidence-based priority setting. Achieving the goal of ‘a long and healthy life for all South Africans’ will require healthy public policies, well functioning institutional and physical infrastructure, social solidarity, and an active and conscientious civil society

A STUDY ON RATIONAL DRUG PRESCRIBING PATTERN IN GERIATRIC PATIENTS IN HYDERABAD METROPOLITAN

ABSTRACT Objective: To describe rational drug prescribing in general practice for elderly patients, using patients age, sex, encounters and the occurrence of some predefined inappropriate drug prescribing, according to Beer’s criteria, drug-drug interaction of common OTC drugs and WHO essential drug list. Design: A retrospective study on rational drug prescribing patterns in geriatric patient was carried out using prescriptions issued to the geriatric patients, 65 years and above, attending the outpatient and inpatient department of various hospitals and clinics of Hyderabad. Results: Of the 150 prescriptions consecutively selected, Anti diabetics (142, 15.58%) were the most commonly prescribed medicines with metformin being the most prescribed anti diabetic. The medications prescribed by generic names were 92 (10.08%). 40% of medicines were prescribed from the WHO essential drug list. 17 (11.3%) prescriptions had one or more potentially inappropriate medicines from Beer’s criteria and in 16 (10.6%) prescriptions drug – drug interactions were ascertained according to drug - drug interactions of common OTC drugs. Conclusions: The drug prescribing pattern among the elderly is still suboptimal. Appropriate interventions are needed for both health care providers and patients alike. Key words: Geriatric patient, Drug-drug interactions, Essential drug list, Rational drug use

Addressing failures in achieving hypertension control in low- and middle- income settings through simplified treatment algorithms

Hypertension is the most important risk factor for cardiovascular diseases (CVDs), which are the leading global cause of death. Hypertension is under-diagnosed and under-treated in most low- and middle-income countries (LMICs). Current algorithms for hypertension treatment are complex for the healthcare worker, limit decentralization, complicate procurement and often translate to a large pill burden for the person with hypertension. We summarize evidence supporting implementation of simple, algorithmic, accessible, non-toxic and effective (SAANE) algorithms to provide a feasible way to access and maintain quality care for hypertension. Implementation of these algorithms will enable task shifting to less specialised health care workers and lay cadres, provision of fixed dose combinations, consolidation of the market while retaining generic competition, simplification of laboratory requirements, and lowering costs for health systems and people who incur out of pocket expenses.https://globalheartjournal.comSchool of Health Systems and Public Health (SHSPH

The 2020 “WHO technical specifications for automated non-invasive blood pressure measuring devices with cuff”

High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2; 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment.The 2020 “WHO Technical Specifications for Automated Non-Invasive Blood Pressure Measuring Devices With Cuff” was supported financially by the World Health Organization and Resolve to Save Lives. O. John is a recipient of Australia University International Postgraduate Awards scholarship from University of New South Wales, Sydney. T.M. Brady received support from Resolve to Save Lives, which is funded by Bloomberg Philanthropies, the Bill and Melinda Gates Foundation, and Gates Philanthropy.http://hyper.ahajournals.orgam2022School of Health Systems and Public Health (SHSPH

Hypertension pharmacological treatment in adults : a world health organization guideline executive summary

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.The US Centers for Disease Control and Prevention and the World Health Organization.https://www.ahajournals.org/journal/hyphj2023School of Health Systems and Public Health (SHSPH

The HEARTS partner forum—supporting implementation of HEARTS to treat and control hypertension

Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs)

Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens