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PubMed2003

A framework linking community empowerment and health equity: it is a matter of CHOICE.

This paper presents a framework to explore the relationship between health equity and community empowerment. It traces the progression of the concept of participation to the present term of empowerment and the links among empowerment, equity, and health outcomes. It argues that the relationship can best be described by using the acronym CHOICE (Capacity-building, Human rights, Organizational sustainability, Institutional accountability, Contribution, and Enabling environment). Based on the concept of development as freedom put forward by Nobel Laureate Amartya Sen, the paper describes how each factor illustrates the relationship between equity and empowerment in positive health outcomes, giving appropriate examples. In conclusion, it is suggested that these factors might form the basis of a tool to assess the relationship between equity and empowerment and its impact on health outcomes.

Community Health Planning↗

PubMed2003

Global partnerships: a key challenge and opportunity for implementation of international health law.

Forging global partnerships between governments, international organizations, NGOs, civil society and business constitutes a key component of the UN and WHO action agenda. Several of these innovative alliances have galvanized important health campaigns and scaled up the response to global health problems. Guiding principles for partnerships design and implementation have been elaborated in particular to ensure quality, accountability and transparency. Partnerships are not intended to substitute commitments made by governments but to complement them, increasing the quality of implementation of international agreements, mobilizing the capacity for action on the ground and forging capacity building efforts to support weaker partners. Partnerships have the potential for weaving together economic law and human rights law, democracy and pluralism. Building into partnerships democratic commitments and safeguards for public interests is essential in creating a true sense of shared global responsibility.

Global Health↗

PubMedDate not supplied

Karachi Cancer Registry Data--implications for the National Cancer Control Program of Pakistan.

Cancer registries play a major role in providing the data to justify establishment, implementation and monitoring of cancer control programs, therefore stability in cancer registration is of pivotal importance. An erroneous assessment of the cancer burden can have long-term negative implications for the limited health resources of a country. Thus, registries starting simultaneously with cancer control programs clearly cannot be adequate for the purpose. The Karachi Cancer Registry (KCR) is the first population-based registry of Pakistan, with 9 years proven data stability (1995-2003) for Karachi South (KS), a location with a population distribution similar to that for the country in general as regards age, gender, and religion. It also has the distinction of being the only district in the country with representation of all ethnic and socio-economic groups of the country. The primary recommended strategy for the 'National Cancer Control Program' (NCCP), Pakistan based on the assessment of eight common cancers in Karachi and the WHO estimates would be identical. A curb on the epidemic levels of tobacco and areca nut use would reduce malignancies in males by 43.7% and in females by 17.8%. WHO estimates put these figures at 45% and 18.5% for males and females respectively. Primary prevention in the form of diet control, checks on preservatives, dyes, and pesticides; protection from occupational hazards, control of biological agents and solar UV protection would help control of another half of the malignancies. Resource restrictions put high technology methods beyond the scope of Pakistan today. Early detection of cancers of accessible sites, though not an urgent requirement, would be warranted for oral, cervical and breast cancer, after sufficient capacity building, initially in the high-risk groups. In females, this could help target 47.6% (approximately half) of the malignancies and in men 13% of the total. Establishment of equitable pain control and a palliative care network throughout the country is an urgent and essential measure as more than 70% of cancer patients report with very advanced stages of malignancy. The estimated annual incident cancer cases for Pakistan, year 2000 on the basis of KCR data were 138,343 for males and 135,054 for females; approximately twice the number cited by WHO for the same year. The argument that higher KCR estimates reflect an urban catchment population may be justified, the urban: rural ratio being 2:1 in Pakistan. Evidence-based strategies, however,support the counter argument, that the rising incidence of cancer in Pakistan is primarily attributable to risk factors equally prevalent in the rural and urban areas viz. increasing tobacco use, low socio-economic conditions, dietary deficiencies and prevalence of oncogenic viruses. Pakistan has a significant cancer burden and rising trends of risk factors - it is a country in dire need of a Cancer Control Program. KCR data along with WHO estimates can form the initial framework of a NCCP in Pakistan; the lack of a national cancer registration should not deter initiatives. Benefits of an immediate, prompt and targeted implementation established today will be realized after 20-30 years. Otherwise the country should be prepared to face epidemic proportions of the disease in the next decade or two. Prerequisite 'qualification criteria' or 'sincerity of intent test' for NCCP funding by international donors should be legislation against tobacco and areca nuts in Pakistan and stringent evaluative criteria.

Adolescent↗

PubMed2003

Egyptian Smoking Prevention Research Institue (ESPRI).

The overall goal of the ESPRI is to reduce tobacco use in Egypt by carrying out interlocking observational, intervention and policy research, and through capacity building for research, prevention, communications and policy on smoking prevention. Having the ability to rely on ESPRI for the best scientific knowledge will add momentum to the current efforts underway to curb smoking in Egypt.

Cooperative Behavior↗

PubMed2004

Medical examiners, coroners, and biologic terrorism: a guidebook for surveillance and case management.

Medical examiners and coroners (ME/Cs) are essential public health partners for terrorism preparedness and response. These medicolegal investigators support both public health and public safety functions and investigate deaths that are sudden, suspicious, violent, unattended, and unexplained. Medicolegal autopsies are essential for making organism-specific diagnoses in deaths caused by biologic terrorism. This report has been created to 1) help public health officials understand the role of ME/Cs in biologic terrorism surveillance and response efforts and 2) provide ME/Cs with the detailed information required to build capacity for biologic terrorism preparedness in a public health context. This report provides background information regarding biologic terrorism, possible biologic agents, and the consequent clinicopathologic diseases, autopsy procedures, and diagnostic tests as well as a description of biosafety risks and standards for autopsy precautions. ME/Cs' vital role in terrorism surveillance requires consistent standards for collecting, analyzing, and disseminating data. Familiarity with the operational, jurisdictional, and evidentiary concerns involving biologic terrorism-related death investigation is critical to both ME/Cs and public health authorities. Managing terrorism-associated fatalities can be expensive and can overwhelm the existing capacity of ME/Cs. This report describes federal resources for funding and reimbursement for ME/C preparedness and response activities and the limited support capacity of the federal Disaster Mortuary Operational Response Team. Standards for communication are critical in responding to any emergency situation. This report, which is a joint collaboration between CDC and the National Association of Medical Examiners (NAME), describes the relationship between ME/Cs and public health departments, emergency management agencies, emergency operations centers, and the Incident Command System.

Bioterrorism↗

PubMed2004

Working towards compliance with international standards.

Developing countries are increasingly coming under pressure to improve their delivery of veterinary services as a prerequisite for entering the competitive arena of international trade in animals and animal products. The demands placed on developing countries by predominantly developed countries to comply with international disease prevention standards have also resulted in increasing demands on the financial, human and technological resources of these developing countries. The minimum requirements of the Agreement on the Application of Sanitary and Phytosanitary Measures and the standards, guidelines and recommendations of international standard-setting organisations, such as the OIE (World organisation for animal health), are evaluated in terms of the opportunities embedded within these guidelines for developing countries. Such an evaluation indicates that the rights and obligations contained in these standards, guidelines and recommendations do not necessarily protect only the interests of developed countries but also encourage developing countries to work towards the levels of compliance and disease prevention required by their potential trade partners. The costs of this compliance can be reduced by exploiting more cost-effective alternatives for delivering services, when dictated by budgetary constraints. International organisations have illustrated on many occasions, and through a variety of development programmes, that they do indeed realise their responsibility towards developing countries in the areas of increased capacity building and technical assistance. If international organisations can refocus their interventions on the actual and specific needs of developing countries, then they can help to expedite the process of compliance with international standards.

Animals↗

PubMed2004

[To promote the change of health education orientation and to incorporate the Spanish universities to the task].

The problem health education faces in Spanish schools is the inconsistency between objectives and means. Therefore, it is common to find health education initiatives limited by not only lack of institutional support and training of professionals, but also by its adherence to a theory-based learning. This article analyses the need for a practical alternative, which would involve researchers/teachers and students in thinking and building the best health practices for them and their community. Parent-like behaviour, based on information and/or persuasion, looks to protect adolescent health and well-being until they are able to take on responsibility of their own, despite the fact that adolescents' search for knowledge influences their own perceptions of what is best for individual and community health. In order to tackle this challenge faced by health educators, in contrast to the theory-based teaching model, it is necessary to implicate the people into the learning process. An in depth study on the definition of health education paradigms (informative, persuasive and political-ecological) (García et al., 2001) has been developed, and which Jensen (1997) divides into two types: moral (informative) and democratic (ecological). As part of this process to transform health education into a participatory practice, and given its social impact, there is also a need to implement health education at higher educational levels and not only in primary and secondary school as occurs in Spain. Turning universities into 'health promoting agencies' (Dooris, 2001) would imply coordinating education with personal, professional and community action, and would be supported and driven by organisational change at university level and would require the participation of all involved when defining the course of action. As a consequence, the people involved in health education learning processes at university level would improve not only their quality of life, but they would also build capacity to influence the different sectors of society they are in contact with (Toyne and Ali-Khan, 1998.).

Health Education↗

PubMed2003

Evaluation of pilot control trial of intestinal schistosomiasis in the Finchaa Sugar Estate, Ethiopia.

Intestinal schistosomiasis is undergoing a rapid increase in magnitude in Finchaa Sugar Estate in Ethiopia. A pilot control trial of intestinal schistosomiasis was instituted in 1995 to reduce the magnitude of the disease and introduce sustainable schistosomiasis control approaches in the Sugar Estate. Following initial parasitological survey of all the camps in the Sugar Project area in 1995 using Kato method, mass chemotherapy of the heavily infected residents of Camp 7 and selective treatment of lightly infected residents of other camps were made using praziquantel. Endod (type 44) was applied to transmission sites along Fekerie stream in Camp 7 on quarterly basis whenever Biomphalaria pfeifferi was detected. Other inputs to the project as parts of capacity building included transplantation of Endod cuttings (type 44), training and health education. Cross sectional parasitological surveys were made in 1998 to assess the impact of the pilot control trial. The results of stool examination showed that the prevalence of schistosomiasis was reduced from 30% in 1995 to 26% in 1998 among residents of Camp 7 and the intensity of infection from 198 eggs per gram of feces (EPG) in 1995 to 85 EPG in 1998. Similarly, the prevalence of infection among children in Finchaa Valley Elementary School was reduced from 78% in 1994 to 56% in 1998 and the reduction in respective intensity of infection was from 283 EPG to 114 EPG. Although significant reduction in the magnitude of the disease was not achieved, the control activities were taken over by the Sugar Project Polyclinic to ensure sustainability. In addition to chemotherapy and snail control using Endod, other disease non-specific methods such as health education should be used to get maximum benefit from such facilities as latrines, and ensure participation of the community in order to sustain the control activities.

Adolescent↗

PubMedDate not supplied

Retinoblastoma in Karachi, Pakistan.

The objective was to assess epidemiologic aspects of retinoblastoma development in Karachi, Pakistan. Incident cases, diagnosed clinically or microscopically and registered at Karachi Cancer Registry (KCR) during 1(st)January 1998 to 31(st) December 2002 were reabstracted, rechecked and reanalyzed for this purpose. One hundred and one cases of retinoblastoma were reported to KCR over the 5 years (1998-2002). Fifty-seven were residents of Karachi, 34 (59.6%) males and 23 (40.4%) females. The gender ratio (M:F) was 1.5. The mean age at diagnosis was 3.96 years (95% CI 2.92; 4.99) and 3.85 years (95% CI 2.72; 4.98) in males and females respectively. The annual crude incidence of retinoblastomas in Karachi was 4.0/100,000 and 2.4/100,000 in children under the age of 5 and 10 years respectively, the corresponding age standardized rates being 5.3/100,000 and 4.8/100,000. The age groups at risk of developing retinoblastoma, associated morbidity and possibility of almost 100% 5-year survival with available treatments, calls for ophthalmologic screening of all infants below 1 year, and high-risk children until the age of 7 years. In order to detect retinoblastoma, as early as possible, health education for parents and health providers, and improved training of ophthalmologists is essential. Genetic testing for siblings and children of retinoblastoma cases and identification of high-risk children would be helpful, but lacks financial feasibility in developing countries at present. Future health care planning should focus on capacity building for neonatal ophthalmologic screening, handling of parents'and children'emotional reactions and opportunities for education, occupational training and cosmetic rehabilitation for surviving retinoblastoma patients.

Adolescent↗

PubMed2003

Highland fringe malaria and challenges in its control: the lesson from Akaki town.

Malaria is a major public health problem and of considerable socio-economic burden in most parts of Ethiopia. The country has witnessed recurrent epidemics of the disease, resulting in grave consequences including in areas designated as highland fringe. A study was undertaken to grossly assess the magnitude of the problems, the effectiveness of the control options and to explore the challenges encountered and the experiences gained during the 1998 malaria epidemic in Akaki Town and its environs. Health facility clinical records of individual patients and weekly surveillance and epidemic control reports were utilized as principal sources of data. The information revealed that the epidemic was very alarming affecting a sizable part of Akaki and the surrounding areas, with the total number of cases amounting to 622. The epidemic was controlled by case detection and treatment as well as by intensive vector control activities. The control endeavor, however, posed great difficulties due to the absence of systematic malaria control program, owing to underestimation of the threat from highland malaria. The contribution from the adjacent Oromia Malaria Control Program and The Federal Ministry of Health to control the epidemic (mainly vector control) was reckoned to be substantial. Thus, capacity building targeted to early detection, prevention and control of malaria epidemics, and preparedness is deemed to be of paramount importance. A viable Integrated Disease Surveillance and Response at health facilities could ensure early containment of the otherwise devastating epidemics.

Disease Outbreaks↗

PubMed2003

A case study of domestic defluoridation of ground water in Jaipur, India.

This study was undertaken to assess the success of the intervention programmes of Centre for Community Economics and Developmental Consultants Society (CECOEDECON) initiated in the rural areas of Jaipur district of Rajasthan, India. The programme focussed on capacity building among villagers to create awareness about fluorosis and used Nalgonda technique for removal of excess florides from ground water in selected areas. The data and information were collected from respondents in six village related to aworeness and incidence of fluorosis, awareness regarding the CECOEDECON project and the use and effectiveness of domestic defluoridation technology. Analysis of collected data revealed that level of awareness was highest (68%) among the respondents of Barkheda and Yarlipura villages where the project was withdrawn in 1998. It was observed that the level of awareness decreased over time and it was found lowest in the villages where project was withdrawn in 1996. About 87% of the respondents reported that most of the women are members of the Mahila Mandal started under CECOEDECON project. Some of the respondents (38%) mentioned that they were experiencing problems after the withdrawal of project teams. Thus, it is evident that follow up programmes play an important role in sustenance of the use of defluoridation techniques in villages along with the infrastructure to take care of minor repairs and supply of chemicals.

Adult↗

PubMed2004

Rationalizing historical successes of malaria control in Africa in terms of mosquito resource availability management.

Environmental management of mosquito resources is a promising approach with which to control malaria, but it has seen little application in Africa for more than half a century. Here we present a kinetic model of mosquito foraging for aquatic habitats and vertebrate hosts that allows estimation of malaria transmission intensity by defining the availability of these resources as the rate at which individual mosquitoes encounter and use them. The model captures historically observed responses of malaria transmission to environmental change, highlights important gaps in current understanding of vector ecology, and suggests convenient solutions. Resource availability is an intuitive concept that provides an adaptable framework for models of mosquito population dynamics, gene flow, and pathogen transmission that can be conveniently parameterized with direct field measurements. Furthermore, the model presented predicts that drastic reductions of malaria transmission are possible with environmental management and elucidates an ecologic basis for previous successes of integrated malaria control in Africa before the advent of DDT or chloroquine. Environmental management for malaria control requires specialist skills that are currently lacking in sub-Saharan Africa where they are needed most. Infrastructure and human capacity building in clinical, public health, and environmental disciplines should therefore be prioritized so that growing financial support for tackling malaria can be translated into truly integrated control programs.

Animals↗

PubMed2004

Orbital embryonal rhabdomyosarcoma in Karachi (1998-2002).

OBJECTIVE: To study the epidemiology of ocular Rhabdomyosarcoma (ORMS) in Karachi. METHODS: Incident ORMS cases resident of Karachi, registered at Karachi Cancer Registry (KCR) during 1st January 1998 to 31st December 2002 were included in the study. The data were classified using ICD-O2; computerized with Canreg-3, and analyzed using SPSS 10.0. RESULTS: Ten cases of ORMS were reported to KCR during 1998-2002. RMS originated in the orbit in eight cases, conjunctiva in one and eyelid in one. Nine cases presented with proptosis, associated with conjunctivitis in four cases. One case presented with eyelid swelling. The crude annual incidence rate was 0.13/100,000, the age standardized rate was 0.3/100,000. The mean age of childhood cases was 10.4 years (95% CI 4.0; 16.7); and adult cases was 24.8 years (95% CI 12.8; 36.7). At presentation, eight patients were older than 10 years and three were older than 20 years. Five cases were categorized as childhood malignancies. Tumors were a TNM stage III disease at presentation in eight cases; survival at the end of one year was 70%, and at the end of two years 20%. There were no survivors at the end of three years. CONCLUSION: ORMS in Karachi is a disease with a dismal survival. It may reflect a late presentation, or shorter adult ORMS survival or a manifestation of a different genetic pattern, associated with rapid evolution and poor prognosis. Health education for the population, especially parents and health providers is essential for early ORMS diagnosis. Pediatricians, ophthalmologists and health professionals, can play a vital role. Healthcare planning should focus on capacity building for ophthalmologic screening. Cytogenetic studies are advised to determine the genetic pattern.

Adult↗

PubMed2004

Intermediate outcomes of a tribal community public health infrastructure assessment.

The purpose of this collaborative participatory project was to assess the strengths and needs of a tribal community as part of a larger public health capacity building program. Key project partners included: the Ramah Band of Navajo Indians, the Albuquerque Area Indian Health Board, the University of New Mexico Masters in Public Health Program, and the University of Nevada, Las Vegas, American Indian Research and Education Center. Principal intervention steps entailed: 1) relationship-building activities among tribal programs and between the Tribe and the scientific community; 2) an orientation to public health; 3) a comprehensive public health infrastructure assessment, utilizing a standardized CDC instrument; and 4) a prioritization of identified needs. The direct outcome was the development and beginning implementation of a community specific public health strategic action plan. Broader results included: 1) increased comprehension of public health within the Tribe; 2) the creation of a community public health task force; 3) the design of a tribally applicable assessment instrument; and 4) improved collaboration between the Tribe and the scientific community. This project demonstrated that public health assessment in tribal communities is feasible and valuable. Further, the development of a tribally applicable instrument highlights a significant tribal contribution to research and assessment.

Adolescent↗

PubMed2004

Eliminating disparities in HIV disease: community mobilization to prevent HIV transmission among Black and Hispanic young adults in Broward County, Florida.

A coalition led by public health professionals adopted the PRECEDE-PROCEED model for community planning and health promotion to eliminate local disparities in HIV disease. Discussion groups and other formative evaluation activities conducted during the first year of the project maximized input from community members and community-based organizations. Twelve of 53 ZIP-code areas, which accounted for 73% of reported AIDS cases among Black and Hispanic young adults (18 to 39 years) from 1994 through 1999, were selected as the primary sites for intervention. Horizontal outreach to residents, vertical outreach to stakeholders and gatekeepers, strategic communications, and capacity building and infrastructure development, were chosen as the most promising activities to promote behavioral and social change. Results from baseline computer-assisted telephone-interview (CATI) surveys completed with 2,011 community residents in 2001, and first-year follow-up interviews with 2,381 in 2002, indicated that: awareness of program efforts had increased from 5.4% in 2001 to 6.7% in 2002; recognition of the extent of the HIV/AIDS problem had increased from 27.5% in 2001 to 35.3% in 2002; and participation in HIV-prevention efforts had increased significantly. Interventions are reaching the target audience, informing young adults of the risks of HIV infection, and encouraging them to take ownership and action.

Adolescent↗

PubMed2004

Diabetes prevention and control: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

More than 10% of the adult population in Pakistan suffers from diabetes. The National Action Plan for Non-communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) incorporates prevention and control of diabetes as part of a comprehensive and integrated national non-communicable disease (NCD) prevention effort. Building on existing data, the diabetes surveillance process has been integrated with a comprehensive population-based NCD surveillance system using waist circumference as a proxy indicator for the risk of diabetes in the short term; however, the surveillance strategy makes a case for future efforts to upgrade surveillance to allow a more comprehensive assessment incorporating biochemical assessments. The programme focuses on diabetes prevention by maximizing risk factor control as a common theme across the range of NCDs and lays emphasis on integrating prevention of'diabetes and intensified case finding in high-risk groups into health services as part of a comprehensive and sustainable, scientifically valid, culturally appropriate and resource-sensitive Continued Medical Education (CME) programme for all categories of healthcare providers. The programme also focuses on ensuring availability of anti-diabetics (insulin, sulphonylureas, metformin) at all levels of healthcare. Building capacity in the health system and coalitions in support of diabetes prevention has also been regarded as being critical.

Communicable Disease Control↗

PubMed2004

Tobacco control: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

Reliance on revenue generated from tobacco is one of the fundamental barriers to effective tobacco control in Pakistan. The tobacco control component of the National Action Plan for Non-Communicable Diseases Prevention, Control and Health Promotion in Pakistan (NAP-NCD) deems it critical to address this issue. A range of policy and environmental strategies are part of this comprehensive effort; these involve regulating access and limiting demand through restrictions on advertising, marketing, promotion and through price and taxation. The NAP-NCD also encompasses community and school interventions, enforcement of tobacco control policies, cessation programmes, mass media counter-marketing campaigns for both prevention and cessation, and surveillance and evaluation of efforts. As part of NAP-NCD, surveillance of tobacco use has been integrated with a population-based NCD surveillance system. Featuring tobacco prominently as part of an NCD behavioural change strategy and providing wide-ranging information relevant to all aspects of tobacco prevention and control and smoking cessation have been identified as priority area in NAP-NCD. Other priority areas include the gradual phasing out of all types of advertising and eventually a complete ban on advertising; allocation of resources for policy and operational research around tobacco and building capacity in the health system in support of tobacco control. NAP-NCD also stresses on the need to develop and enforce legislation on smuggling contrabands and counterfeiting and legislation to subject tobacco to stringent regulations governing pharmaceutical products. The adoption of measures to discourage tobacco cultivation and assist with crop diversification; integration of guidance on tobacco use cessation into health services and insuring the availability and access to nicotine replacement therapy are also part of NAP-NCD.

Air Pollution↗

PubMed2004

Prevention and control of cancers: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

The National Action Plan for Non-communicable Diseases Prevention, Control and Health Promotion in Pakistan (NAP-NCD) integrates prevention and control of cancers with a comprehensive NCD prevention framework with a specific emphasis on tobacco, diet and physical activity as cross-cutting risks. The programme prioritizes on sustainable institutional support for mature cancer registries in order to facilitate cancer surveillance; prevention of cancers and early detection as part of an integrated NCD behavioural change communication strategy and building capacity in the health system for cancer prevention and control. The programme's research agenda also includes appropriate studies to bridge critical gaps in evidence relating to appropriate and cost-effective strategies for preventing common cancers in Pakistan. To contain exposure to carcinogenic agents in the environment and in worksites, NAP-NCD stresses on the transparent enforcement of National Environmental Quality Standards; the institution to take proactive measures to contain potential risks to cancers in industrial settings; stricter enforcement of labour laws, stringent regulations governing chemical handling and the active incorporation of preventive health in the mandate of organizations providing health coverage for the labour workforce. It has also been deemed essential to study cancer trends in defined industrial settings at high-risk and to identify causal associations in order to delineate precise targets for preventive interventions in the native setting. NAP-NCD stresses on the development of institutional mechanisms with a regulatory function for cancer control; these include a National Cancer Control Council, with the mandate to uphold ethics and principles and guidelines on technical matters and a National Occupational Safety and Health Association. The Plan also prioritizes on pain relief and palliative care alongside prevention and control efforts and stresses on the need to integrate prevention efforts into health services as a sustainable and evidence-based activity.

Breast Neoplasms↗