International Infection Prevention Week: Snapshot from the Field

 

 

During the last two weeks of September, I had the opportunity to participate in a week-long surveillance training and a week-long Ebola/Cholera Preparedness Training, respectively. Here at the CDC Zambia office I work with the Field Epidemiology Training Program. Our goal is to provide technical assistance and expertise in order to build local epidemiology capacity in Zambia. The surveillance training we conducted was geared towards surveillance officers that work in various districts throughout Zambia. These officers are accepted into a Frontline program as residents and trained on the public health surveillance cycle over the course of 3 months. The training is both classroom learning and hands-on application as residents are given projects that take them through the surveillance cycle and provide them with an opportunity to explore the data in their jurisdictions. My role during this first training was to lead excel trainings and assist with daily pre and post tests. I enjoyed the surveillance workshop so much that I feel a similar curriculum should be provided to all entry-level epidemiologists working in governmental public health in the states.

The Ebola/Cholera Preparedness Training was very intense. It was a collaboration between CDC Zambia, WHO, Zambia National Public Health Institute, local universities, and the Ministry of Health. Lectures and hands-on training were incorporated into this workshop as well. The participants consisted of surveillance officers, environmental health technicians, laboratory specialists, and health directors from various districts. These individuals make up a newly developed rapid response team that is being built in Zambia. During the Ebola preparedness portion of the training, participants were trained on triage, wearing proper PPE, lab specimen packing/shipping, setting up a treatment center, and transporting ill patients. The cholera preparedness portion consisted of a discussion about what went well and what didn’t go so well during last year’s cholera outbreak that lasted ~8 months. Participants walked through the process of investigating an outbreak and creating products such as epi curves and line lists. I could see the light bulbs going off for many people as they realized how efficient this was for ensuring data quality and tracking cases. Lightbulbs also went off during discussions about how to appropriately use the Incident Command System. My duties consisted of helping in the triage station, acting out scenarios, and helping with pre and post tests. Participants are now tasked with going back to their jurisdictions to train others.

Some interesting things to note is that we have built in “tea times” where you can take a coffee or tea break and grab a snack, someone is also asked to pray at the beginning and end of the day, and there are usually lengthy delays when it comes to gathering large groups together for training/workshops (but things come together at the end).

 

 

 

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Global News Round Up

Politics & Policies

Republicans and Democrats on Capitol Hill hope to combat the opioid epidemic in part by expanding access to addiction treatment, a key part of a major legislative package.

Melania Trump began her week-long sojourn to Africa in Accra, Ghana.  The First Lady was greeted on the tarmac by Ghanaian first lady Rebecca Akufo-Addo and a bouquet of flowers wrapped in kente cloth followed by a performance of dancing and drumming.

Dr. Anthony Fauci says he’s “cautiously optimistic” about the future of global health, which he says has the potential to be enhanced by the development of universal vaccines and improved preventative measures.

In the lead-up to the first U.N. high-level meeting on tuberculosis, global health experts said the momentum was different, that a turning point was near in the fight against the disease, the world’s top infectious killer.

The House and Senate have reached agreement on a big package of measures to address the opioid epidemic.  The legislation, backed by leaders of both parties, is a rare bipartisan achievement that lawmakers are eager to have in hand when they go home to campaign for the midterm elections.

Programs, Grants & Awards

Global Health Corps (GHC), a leadership development organization working to build the next generation of global health leaders, was named for the prestigious of 2018 Skoll Award for Social Entrepreneurship.

October 1 marks World Vegetarian Day 2018, which takes place to raise awareness of the benefits of a vegetarian diet.  With many lpeople now considering at least reducing their meat intake, here we round up what research from the past year says about how a vegetarian diet may be able to boost health.

National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases, is investing in a young generation of HIV prevention researchers by providing African-American and Latino medical students with opportunities to conduct independent research while receiving mentoring, project and salary funding, training, and professional development opportunities.

Research

Fuel cells have long been viewed as a promising power source. But most fuel cells are too expensive, inefficient, or both.  In a new approach, inspired by biology, a team has designed a fuel cell using cheaper materials and an organic compound that shuttles electrons and protons.

Preterm birth remains a global epidemic linked to a lifetime of potential health complications. It also is difficult to study in living creatures–especially the uniquely precise biology of preterm birth in humans.

Although substantial progress has been made in reducing diarrhoeal deaths among children in low-income and middle-income countries, from approximately 1.6 million in 1990 to 450, 000 in 2016, sustaining these improvements will require additional strategies and approaches.

The University of Birmingham has been awarded £1.9 million through the National Institute for Health Research (NIHR) Global Health Research (GHR) Programme to fund world class research into a common heart condition in disadvantaged populations in China, Brazil and Sri Lanka.

Diseases & Disasters

More than 80,000 Americans died of flu in the winter of 2017-2018, the highest number in over a decade, federal health officials said last week.

Global health officials are preparing for African swine fever, which has been spreading in pigs across borders since 2014, reaching Western Europe last week.

Everyone feels isolated sometimes, but with one in five Americans chronically lonely, has loneliness reached epidemic proportions?  In 1988, the journal Science published a landmark study suggesting isolation was as strong a risk factor for morbidity and mortality as sedentary lifestyle, high blood pressure and smoking or obesity

Governments should raise the price of alcohol and restrict its availability in a bid to reduce harmful drinking, the World Health Organization has said.

Researchers have found a link between sudden cardiac death (when the heart suddenly stops beating) and a common heart condition known as mitral valve prolapse that affects around 12 in every 1000 people worldwide.

The risk of Ebola escaping from the Democratic Republic of Congo is now “very high,” and the outbreak already is nearing Uganda, the World Health Organization said on Thursday.

Technology

Mobile is a key enabler of sustainable economic growth and a major contributor to the delivery of the UN’s 17 Sustainable Development Goals (SDGs), a set of audacious targets to end poverty, halt climate change, and fight injustice and inequality – all to be achieved by 2030.

Environmental Health

Health officials say smoking not only kills about 7 million people every year, but has a devastating impact on the environment contributing to deforestation, water and soil depletion and acidification.

Following the extreme, earthquake-triggered tsunamis unleashed in the Indian Ocean in 2004 and Japan in 2011, a spate of disaster films like The Impossible have depicted doomsday tidal wave scenarios.

A landmark treaty signed in Greenland will help to protect vulnerable fisheries in the Arctic.

October 1 marks the 41st annual World Vegetarian Day and the start of Vegetarian Awareness month. The annual occasion was founded in 1977 by the North American Vegetarian Society and was endorsed by the International Vegetarian Union in 1978 to entice omnivores “to give meatless fare a try (even for a day)” and to commend those with “healthy, compassionate food choices.”

Equity & Disparities

Sweat poured down Fenol’s body as he writhed in pain on a stretcher in a southern Haiti emergency room. Two days earlier, a motorcycle crash caused massive trauma to his abdomen.  His internal injuries had precipitated multi-organ failure and shock, and he had lost precious time searching desperately for a hospital with surgical capacity. His pain, fear, and mortal predicament was borne from a violation of what we believe is a fundamental human right: he had no access to essential, life-saving surgery.

Women, Maternal, Neonatal & Children’s Health

There’s very little research on whether medications are safe and effective in pregnant and lactating women, but an expert panel has ideas for how to close that information gap — and it’s calling on the federal government to take action in a new report that could stir change.

 

Three Observations from UN High Level Health Meetings

During the United Nations (UN) General Assembly, two historical High-Level meetings in the realm of health were held addressing ailments that afflict individuals from every corner of this fragile planet. The first UN High-Level meeting on Tuberculosis (TB), focusing on preventing and treating this elusive disease, was held on Wednesday, September 26th which finally put TB in a global spotlight. Additionally, the third UN High-Level Meeting on Non-Communicable Diseases (NCDs), under the theme “Scaling up multi‑stakeholder and multisectoral responses for the prevention and control of non‑communicable diseases in the context of the 2030 Agenda for Sustainable Development,” took place on Thursday, September 27th. World leaders and their ministers, non-government organizations (NGOs), and other stakeholders partook in these crucial meetings to curtail the suffering these various diseases cause. For each of these meetings, governments approved drafts of political declarations that commit countries to follow through with health policy, funding, and a multisector approach to these disorders. The following summarizes key points and commitments from each of the high-level meetings:

UN High-Level Meeting on Tuberculosis

  • A commitment to mobilize $13 billion for universal access to quality prevention, diagnosis and treatment
  • $2 billion for research and development of new drugs, diagnostics, vaccines, and other tools.
  • Commit to provide diagnosis and treatment with the aim of successfully treating 40 million people with tuberculosis from 2018 to 2022 (including 3.5 million children, and 1.5 million people with drug-resistant tuberculosis including 115,000 children with drug-resistant tuberculosis)
  • Pledge of 30 million people (including 4 million children under five years of age, 20 million other household contacts of people affected by tuberculosis, and 6 million people living with HIV and AIDS) to receive preventive TB treatment by 2022
  • Promise to overcome the global public health crisis of multidrug-resistant tuberculosis through actions for prevention, diagnosis, treatment and care, including compliance with stewardship programs to address the development of drug resistance
  • Oblige to consider how digital technologies could be integrated into existing health systems infrastructures and regulation for effective tuberculosis prevention, treatment and care
  • Commit to provide special attention to the poor, those who are vulnerable, including infants, young children and adolescents, as well as the elderly and communities especially at risk of and affected by tuberculosis.

UN High-Level Meeting on NCDs

  • Commitments to reduce NCD mortality by one third by 2030, and to scale-up funding and multi-stakeholder responses to treat and prevent NCDs
  • Health systems should be strengthened — and reoriented — towards the achievement of universal health coverage and improvement of health outcomes
  • Greater access to affordable, safe, effective and quality medicines and diagnostics
  • A commitment to ambitious multisectoral national responses, integrating action on prevention and control with promotion of mental health and well‑being
  • Increasing energies to reduce tobacco use, harmful alcohol use, unhealthy diets and physical inactivity through cost‑effective, evidence‑based interventions to halt obesity
  • To develop a national investment plan in order to raise awareness about the national public health burden caused by non‑communicable diseases and health inequities

While these are not all-inclusive of the commitments between nation states at these two meetings, they highlight the prominent concerns leaders in both the political and health dominion share. However, special attention should be brought to the dialogue held before and after the duration of the meetings. These discussions reveal the true apprehensions that world leaders fear affects their citizen’s health and well-being. The following are three observations from these two UN high-level meetings that may provide some significance in the future battle with TB and NCDs.

1. Is health trending towards being a right rather than a commodity among world leaders?

Before the UN high-level meeting on TB came to fruition, there was a highly controversial commitment in the declaration that concerned high-income countries like the United States. The commitment was centered around access to affordable medications, in particular, generic medications. The concerned countries had expressed reservations about language supporting UN member states’ rights to interpret and implement intellectual property rights in a way that defends public health and encourages access to medicines. Global health advocates believed this point as being essential to equitable access to medications across the world – treating health as a right rather than a product. In the end, health as a right was included into the declaration, through the leadership of South Africa and Médecins Sans Frontières (MSF), despite upsetting these powerful nation states. In addition, at the high-level meeting on NCDs, language was included that stated a similar commitment – to affirm the rights of UN member states to use intellectual property flexibilities to safeguard public health. Although the fight against these two devastating classes of diseases is certainly at the forefront of leaders’ minds, the seemingly endless interchange of health as a right and health as a commodity seems to be finally leaning towards the betterment for humanity – health as a right.

2. Technology and Policy – Finally Uniting to fight TB & NCDs

Throughout the UN General Assembly last week, several reports, policies and studies were released or highlighted that may prove to shape the future treatment of TB & NCDs. The following list are just a few of the major contributions that various sources released:

Health care professionals throughout the world realize that diseases need to be undertaken in a biosocial manner – utilizing both technology and policy. The outcomes that resulted from last week’s reports reaffirm that political leaders realize that the true way to overcome these burdens is to address them through this manner.

3. Multi-Sectoral Approaches – How should they be conducted?

One of the biggest initiatives in global health is the necessity to bring together all stakeholders in disease management in order to properly address the situation. With a vast array of input and ideas, different perspectives, and an atmosphere of collaboration, global health is trending rapidly in this manner – with a significant portion of the world partaking in multi-sectoral approaches already. However, the manner in which these are conducted can vary within countries and between NGOs and governments. Although these remarks may not apply to every country, the following statements made by world leaders may provide some insight into how a country could carry out these approaches:

  • A representative from the Netherlands state that including all stakeholders into the approach may cause conflict of interests – “The days are gone when the tobacco industry has a seat at the table” while also stating “multi-sectoral approaches are good, but governments should be in the lead” in reference to NCDs.
  • An NCD Alliance representative mentioned “it is for governments to determine their own priorities” and “civil society is ready to support, but governments must lead the way.” while simultaneously reaffirming her support for multi-sectoral approaches.
  • Finally, Gerda Verburg, coordinator of Scaling-Up Nutrition Movement explained that “Bigger companies are part of the problem, but we won’t succeed unless we make them part of the solution,” while also adding that she realizes that this is often difficult for civil society, and that “too often, they stand with their backs to the table where we need a critical dialogue with the private sector.” In addition, she supports the priority to “strengthen national systems.”

In a global society where the healthcare landscape is in constant motion, the ability to gather world leaders to commit to significant leaps of change is promising to all those who inhabit this planet. However, these commitments need to be followed up with action, funding, and the political will to properly solve the world’s number one killer and the deadliest infectious disease. The global health community should inspire and encourage their governments while correspondingly holding them accountable to adorn these commitments and continue to battle these overwhelming diseases.

 

Read the latest issue of the IH newsletter, Section Connection!

The latest issue of Section Connection, the IH Section quarterly e-newsletter, is now available! You can find the latest issue of the newsletter here: http://bit.ly/SectionConnection9 

If you cannot access the newsletter for any reason please email Theresa Majeski, Global Health Connections Chair, at theresa.majeski@gmail.com 

World Heart Day 2018

Today, September 29, marks World Heart Day (WHD) around the world. World Heart Day brings awareness to the prevention and control of cardiovascular diseases (CVDs) which plays a significant role in our daily lives contributing to our overall health and wellness.

What are Cardiovascular diseases?

Cardiovascular diseases are a group of disorders of the heart and blood vessels and they include:

  • Coronary heart disease – disease of the blood vessels supplying the heart muscle;
  • Cerebrovascular disease – disease of the blood vessels supplying the brain;
  • Peripheral arterial disease – disease of blood vessels supplying the arms and legs;
  • Rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;
  • Congenital heart disease – malformations of heart structure existing at birth;
  • Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

According to the World Health Organization (WHO), cardiovascular diseases take the lives of 17.7 million people every year, and accounts for 31% of all global deaths. Of these deaths, 85% are due to heart attack and stroke.

Projects around the world

The global fight against CVDs is happening throughout the world. Some examples include:

– Through the HEARTS project based in Manila, Philippines, WHO and partners like the United States Centers for Disease Control and Prevention (CDC), are supporting ways to fight cardiovascular disease through training, planning and implemention.

– A two-year Standardized Hypertension Treatment project launched in 2015 by the Pan American Health Organization (PAHO) and CDC on the Caribbean island of Barbados, enacted a mission to improve hypertension treatment and control among Barbadians with raised blood pressure through standardizing care for hypertensive patients, prescribing and making available the most effective medicines for treating each person’s condition. The principal investigator of the project highlighted, “It was also encouraging to see the cultural and behavioural change in the clinics among health workers who had to deliver a more focused form of care.” It is important to also note how cultural and social factors play a vital role to behavioral change when it came to seeing patients achieving satisfactory blood pressure control.

Specific intervention activities included: (1) Developing salt reduction and tobacco control plans, (2) Implementing simplified and standardized management protocols, (3) Improving access to medicines and technologies, and (4) Building capacities of health and other providers.

http://www.who.int/news-room/feature-stories/detail/treating-cardiovascular-disease-in-barbados

http://www.who.int/news-room/feature-stories/detail/philippines-embraces-efforts-to-step-up-cardiovascular-disease-care

Key messages to protect heart health

There are small, yet very impactful ways to make “heart health at the heart of all health”. Here are some facts/tips!

  • Tobacco use, an unhealthy diet, and physical inativity increase the risk of heart attacks and strokes.
  • Engaging in physical activity for at least 30 minutes every day of the week will help to prevent heart attacks and strokes.
  • Eating at least five servings of fruit and vegetables a day, and limiting your salt intake to less than one teaspoon a day, also helps to prevent heart attacks and strokes.

When it comes to reducing cardiovascular diseases and improving heart health, it is pivotal to identify those individuals with or at highest risk of CVDs due to risk factors such as hypertension, diabetes, hyperlipidaemia or an already established disease to ensure they receive appropriate treatment in order to prevent premature deaths. During 2015, 17 million premature deaths occurred from noncommunicable diseases (under the age of 70) with 82% of deaths reported in low- and middle-income countries, and 37% caused by CVDs (WHO, 2017). Although there has been great strides toward the prevention of cardiovascular diseases, inequalities including access to noncommunicable disease medicines, and basic health technologies in all primary health care facilities is essential to those in need of receiving treatment and education.

The epidemic of cardiovascular diseases has also impacted my life with my grandmother,mother, and all 4 of my aunts and uncles suffering from hypertension. In March 2018, my cousin at the age of 35 suffered from a massive stroke and is successfully recovering. I spent bringing awareness to this day by cooking popular caribbean dishes with a healthy spin and educating family and friends across the United States and Caribbean on the importance of having and maintaining a healthy heart. In addition, I took a 2 mile walk through my neighborhood taking in the beautiful Florida scenery and cool breeze.

How did you celebrate World Heart Day?