The World Health Day this year focuses on diabetes, a disease that affects the WHO South-East Asia Region. More than one in four of the 3.7 million diabetes-related deaths globally occurs in the Region. Diabetes prevalence exacerbates difficulties in the control of major infectious diseases such as tuberculosis. Almost half of the 96 million people suffering the disease don’t know they have it.
If present trends continue diabetes will become the world’s 7th largest killer by 2030. The epidemic’s greatest impact will be in low- and middle-income countries, including those in the SEA Region. This edition of the newsletter focuses on diabetes to emphasize the urgent need for all to take measures to prevent, treat and beat the disease.
This edition also comes as we prepare to mark one year following the devastating earthquake in Nepal. On 25 April last year over 8000 people lost their lives in the magnitude 7.8 quake, which was followed by another quake on 12 May measuring 7.3. WHO continues to support the health needs of quake-affected communities.
Also included are stories on India’s momentous achievement of eliminating maternal and neonatal tetanus and Myanmar’s response to an outbreak of vaccine-derived poliovirus.
I hope you enjoy this edition of the Health in South-East Asia e-newsletter.
Dr Poonam Khetrapal Singh
World Health Day 2016:
Prevent. Treat. Beat diabetes
Over 90 million adults have diabetes in the South-East Asia region. Half of those with diabetes remain undiagnosed. The diabetes epidemic is rapidly increasing across the world, with the documented increase most dramatic in low- and middle-income countries.
A large proportion of diabetes cases are preventable. Maintaining normal body weight, engaging in regular physical activity, and eating a healthy diet can reduce the risk of diabetes. Diabetes is also treatable. Diabetes can be controlled and managed to prevent complications.
The greatest threats to public health are far from shocking or contagious. They are familiar and common. Globally, non-communicable diseases such as cancer, hypertension and asthma account for 38 million deaths per year. Of these diseases, diabetes – a condition often the result of excess bodyweight and physical inactivity – is expected to increase rapidly to become the world’s seventh largest killer by 2030. Though this seldom makes headlines, and is as confronting to our vanity as it is our health, the implications are alarming. By preventing and managing diabetes, we can, however, defy expectations and chart a different reality. This is a life and death battle that we must all sign up to.
In the WHO South-East Asia Region the stakes are particularly high. In SEA countries, diabetes, which can cause serious damage to every major organ system in the body, resulting in heart attacks, strokes, kidney disease and nerve damage, is a major public health issue. More than one out of every four diabetes-related deaths globally occurs in the Region, while its prevalence exacerbates difficulties in the control of major infectious diseases such as tuberculosis. Though Type 1 diabetes is thought to be caused by genetic or environmental factors, Type 2, or ‘adult-onset’ diabetes, is primarily the consequence of lifestyle factors. Type 2 diabetes accounts for 90% of all cases.
Squaring up to Diabetes:
How Bhutan is confronting an emerging epidemic
In the year 2000 there were approximately 35 000 people with diabetes in Bhutan.
By 2030 that number is expected to surge more than threefold, to 109 000.
For the past 23 years, Inda Tshering has been at the frontline of Bhutan’s public health mission.
The solidly-built health assistant is stationed at Dawakha Basic Health Unit II, a primary health facility located in the country’s spectacular Paro Valley. Though the health issues affecting Tshering’s community have varied over the years, according to him there has been a tangible increase in the number of type 2 diabetes cases.
“The numbers of diabetes cases have been increasing. In my catchment area alone I have around 4-5 cases under medication,” he says, adding with concern, “I am sure there are many undiagnosed cases.”
One Step at a Time:
Reversing Sri Lanka’s diabetes epidemic
In 2015, over 16 000 Sri Lankans died as a result of diabetes-related complications.
The country’s ongoing epidemic has signaled the need for a more active approach.
At just 14 years of age Kusum became the primary caregiver in her family. Her mother Binari died leaving behind Kusum, her three younger siblings and their diabetic father, Siridasa. For the family, who live in a small town in Sri Lanka’s North-West, the future was ominous.
Kusum soon discovered the difficulty of caring for her diabetic father, who is one of 1.16 million people suffering the disease in Sri Lanka. Diabetes, which is largely the result of poor diet and physical inactivity, affects every major organ system in the body and can increase the risk of heart attacks, strokes and nerve damage. While prevention is the best course of action, and can be achieved through healthy eating and regular exercise, the disease can also be managed.
MoHP, WHO Provide Mental Health Gap Training in Quake-Affected Districts
To improve the basic skills of health care workers in diagnosing, treating and referring patients with mental health issues, Nepal’s Ministry of Health and Population and WHO are carrying out mental health training workshops for health care professionals in districts most affected by last year's earthquake.
Since Nepal’s 25 April and 12 May earthquakes, Dr Neelam Kumari has treated more patients with mental health issues than at any other time in her career.
The softly-spoken medical officer at Dolakha’s Jiri Hospital says that the increase in patients suffering mental health problems is understandable given the trauma suffered in the district. Dolakha District was one of the 14 most affected by the quakes, with 87 percent of houses fully or partially destroyed.
Myanmar Rolls Out Mass Polio Immunization Campaign
After Myanmar reported two cases of vaccine-derived poliovirus type 2, the Ministry of Health, with support of WHO, UNICEF and partners, rolled out an intensive immunization response.
When in November 2015 Myanmar reported an outbreak of circulating vaccine-derived polio, Ko Aung became anxious for his five-month-old son.
Ko Aung and his wife Daw Khin (names changed) make an itinerant living selling fish across Myanmar’s hardscrabble interior. They have no fixed address, meaning their baby boy has no regular health care provider. After learning of the country’s nation-wide polio vaccination drive at a festival in Magway, they seized the opportunity for their son to get protection against the debilitating disease. Ko Aung came to know that the vaccine was an absolute must to protect children against polio as well as the circulating vaccine-derived polio virus. Both can cripple a child for life.
India Achieves the Goal of Maternal and Neonatal Tetanus Elimination (MNTE)
The number of neonatal tetanus deaths dropped to about 31 500 in 2005, subsequently declining to below 500 in 2013 and 2014. This has paved the way for validation of India for maternal and neonatal tetanus elimination by mid-April 2015.
The scorching dry heat was palpable as the sun sizzled at 44 degrees. The temperature inside the barely 10X10 feet room was, however, several notches lower. It was bustling with a bevy of new mothers with their babies and their elderly female family members. The room houses the anganwadi [child and mother care center] of Basantpur Sainthali village, located off National Highway 58.
On pre-designated immunization days, the anganwadi turns into a makeshift health facility to provide vaccination services to expectant mothers, newborns and children below 5 years of age. “The heat does not make a difference as long as the temperature inside this box is maintained,” remarks Prasanna Kumari, an experienced health worker, pointing to the grey colored plastic box, which keeps life-saving vaccines at the right temperature.
One Year Post-quake, Nepal’s Health Workforce Remains Focused, Committed
One year after Nepal’s devastating earthquake, the health workforce remains focused on and committed to providing the best care possible.
When on 25 April 2015 an earthquake measuring 7.8 tore across Nepal’s central and western districts, the country’s health workforce was placed under immense pressure. From triaging waves of incoming patients at remote health posts to carrying out round-the-clock surgeries at Kathmandu’s major hospitals, the workforce faced formidable challenges. It proved itself more than capable. Almost one year on, Nepal’s health workforce continues to overcome adversity in support of the health and wellbeing of communities.