From Diabetes to Diarrhea

Join me on my journey as a Global Health student discovering the complexities of the diseases that burden healthcare systems around the globe.

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Thank you for joining me on my global burden of disease journey. I hope some of my posts resonated with you and made you think about how you, as the present, can make changes for global healthcare. Of course, there are many problems to fix within this field but there are so many bright individuals out there who can tackle even just one or two problems and can together change the world for the better. 

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Something to keep in mind :) 

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No Health Without Mental Health: Global Burden of Psychiatric Illness

Hello Readers, It’s been a long but extremely knowledge-filled journey this semester and our last lecturer, Dr. Sheila Harms was the perfect end to an amazing course. Dr. Harms is a child psychiatrist at McMaster’s Children Hospital. She has such a great passion for this topic was was demonstrated by her interactive teaching style that all had thoroughly engaged in a topic that is already so interesting to many of us. Of the world’s population, 450 million suffer from neuropsychiatric disorders (NPDs), which are also the leading cause of disability. In fact, mental disorders contribute to about 13% of the global burden of disease. It has been said that 25% of families have at least one member with a mental health disorder. NPDs are an umbrella term for a vast amount of illnesses ranging from mood disorders to psychosis to eating disorders. In line with mood disorders, Dr. Harms mentioned a very interested statistic - 1 suicide occurs every 40 seconds, 3000 suicides occur per day and 1 million occur every year. This numbers are definitely alarming yet mental health disorders are strongly associated with stigma and discrimination. According to WHO, the single most important barrier to overcome for individual with mental health issues is the stigma and discrimination that plagues their lives.  Thus it is essential to create a climate that respects and protects basic civil, political, socio-economic and cultural rights. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health. In 2013, the World Health Assembly approved a “Comprehensive Mental Health Action Plan for 2013 to 2020”. The Plan is a commitment by all WHO’s Member States to take specific actions to improve mental health and to contribute to the attainment of a set of global targets. Its overall goals are to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders. It focuses on 4 key objectives: 1) Strengthen effective leadership and governance for mental health 2) Provide comprehensive, integrated and responsive mental health and social care services in community-based settings 3) Implement strategies for promotion and prevention in mental health 4) Strengthen information systems, evidence and research for mental health. It is believed that once this Action plan is implemented it will allow individuals with mental illness find it easier to access mental health and social care services, be offered treatment by appropriately skilled health workers in general health care settings, gain greater access to government disability benefits, housing and livelihood programmes, and better participate in work and community life and civic affairs. What stands out most to me about this Action plan is the fact that WHO is trying to INTEGRATE individuals with mental illness into society, just like we do with any other illness. We no longer live in a time where an individual with mental illness is shipped off to an asylum, away from their loved ones and the world. Just like any other illness, mental health needs treatments, whether it be drugs or psychotherapy, and above all, it needs support from fellow loved ones and respect from healthcare workers for a better prognosis. Undoubtedly, within Canada I have seen mental illness be approached in a much better way today, however, just the fact that so many homeless individuals exist in Canada that are mentally ill as well indicate that our mental health services still need to be a bit more inclusive to ensure that everyone can live under a roof. But still, there’s definitely been a lot of progress. On the flip side my occasional visits to my native country of Pakistan shows a very pessimistic side for mental health patients. Mental illness afflicts 10 to 16% of the population in Pakistan. However, only 400 psychiatrists and 5 psychiatric hospitals exist within the entire country for a population exceeding 180 million. This roughly translates to an alarming psychiatrist-to-person ratio of 1 to half a million people!! Sadly, mentally ill patients have very bleak prospects with many patients never seeking treatment, quitting prematurely, or are shunned by family members.Thus, it is absolutely essential that we figure out how we can help translate our knowledge from this side of the world to help those in developing countries in order to overcome their seemingly impenetrable cultural barriers.Mental health campaigns such as  Bell’s Let’s Talk, The Elephant in the Room, Opening Minds etc. have really helped raise awareness of mental issues in Canada. I have yet to ever experience these sort of campaigns happening in Pakistan. How do you think we could tailor these campaigns to make them effective in developing countries as well? Iqra Effendi McMaster University M.Sc. Global health

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One Lucky Iron Fish can provide an entire family with up to 75% of their daily iron intake for up to 5 years. All you have to do is cook with it.

It’s a simple, affordable, and effective solution anyone can use.

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Global Burden of Hemoglobinopathies: Catching Hemoglobin levels before they fall too far.

Hello Readers,  In this post, I will talk about hemoglobinopathies. Our guest lecturer for this course was Dr. Madeline Verhovsek, Consultant Laboratory Hematologist at St. Joseph’s healthcare.  Hemoglobinopathies are blood disorders in which a genetic defect results in abnormal structure of one of the globin chains of the hemoglobin molecule. There are many types of hemoglobinopathies e.g. sickle-cell disease and anemia. For the purpose of this post, I will focus mainly on anemia since I have a personal interest in it, having gone through anemia myself when I was younger.  Anemia is a condition in which a decreased quantity of red blood cells, often accompanied by diminished hemoglobin levels or altered red blood cell morphology. Anemia is often pathologically diverse and multifactorial with potential causes ranging from iron deficiency to lead poisoning. A systematic analysis of global anemia burden from 1990 to 2010 found that 32.9% of the global population in 2010 had anemia, causing 68.36 million years lived with disability. This was extremely surprising to me as I never knew that anemia had such a big effect on so many individuals in the world. On the bright side, it was found that prevalence dropped for both sexes from 1990 to 2010 although more so for males. South Asia and Central, West and East sub-Saharan Africa had the highest burden but the greatest reduction was found in East, Southeast and South Asia. As for the most common cause - Iron Deficiency Anemia (IDA). Iron deficiency is actually the most common and widespread nutritional disorder in the world. IDA has been found to be correlated with decreased cognitive performance in many studies. This is due to impaired tissue oxygen delivery that may lead to weakness, fatigue, difficulty concentrating, or poor work productivity.  A decrease in work productivity is not only bad for the individual but also brings serious economic consequences for national development due to a weaker labour force - poorer countries can definitely not afford to have this due to the economic situations they are already in.Children may have issues with mental and motor development. Severe IDA is correlated with increased risk of preterm labor, low birth weight, and child and maternal mortality and may predispose to infection and heart failure. 

Overall, the most vulnerable are the poorest and the least educated who are disproportionately affected by iron deficiency, thus, it is important to target reduction strategies towards them. WHO has developed a comprehensive package of public health measures addressing all aspects of iron deficiency and anaemia. The 3 main measures that the package address are:

1) Increase iron intake: Dietary diversification including iron-rich foods and enhancement of iron absorption, food fortification and iron supplementation. 2)Control infection: Immunization and control programmes for malaria, hookworm and schistosomiasis.Improve nutritional status. 3) Prevention and control of other nutritional deficiencies, such as vitamin B12, folate and vitamin A. Improving iron deficiency in developing nations is extremely vital not only due to health reasons but due to the fact that timely treatment can restore personal health and raise national productivity levels by as much as 20%. By having a more productive workforce, it can help a developing country to pull itself out of its poverty conditions which will have widespread positive impacts on the various diseases (outline throughout my blog) that have been perpetuated by poverty conditions.  Lastly, I will be sharing a link of a video about the “Lucky Iron Fish” - a simple strategy that has helped with improving iron levels in developing countries. It’s one of my favourite global health projects today due to the beauty in its simplicity. iqra Effendi M.Sc. Global Health McMaster University 

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These statistics were found on http://www.care.org/work/health/maternal-health.  CARE believes that access to quality sexual, reproductive and maternal health is both a fundamental human right and a critical development issue. Improving sexual, reproductive and maternal health is therefore central to our commitment to gender equality and to reducing global poverty.

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The Global Burden of Maternal Health: Let’s face it..women are NOT supposed to lose their life while they are bringing a new life onto the Earth.

Hello Readers, In this post, I will be discussing maternal health. Our lecturer for this topic was Dr. Ahimbisibwe, an OB/GYN from Uganda who is now continuing his medical training here in Canada. I feel so blessed to have been able to meet him because honestly, even saying that he was inspiring is an understatement. The experiences that he’s had and the passion with which he spoke had the entire class hanging onto his every word. His passion for maternal health started from a young age when he witnessed the death of a woman at a hospital in Uganda - as a curious 8 year old, he simply questioned “why do women die when they are giving birth?”..it made no sense to him and i completely agree with him, it really doesn’t. From that day, he decided he wanted to become an ob/gyn so that he could prevent these un-necessary deaths. However, the reality is that worldwide, hundreds of thousands of women die from complications during pregnancy or childbirth each year – that's one woman dying every 90 seconds – and millions more are left with life-altering disabilities. In some countries, one in seven women dies in pregnancy or childbirth. Dr. Ahimbisibwe told us that in Uganda 20 women are dying daily while giving birth and for every woman that dies, 20 survive with some sort of complication. He proceeded to show us pictures of the state of hospitals in Uganda, with pregnant women lined up in corridors waiting for treatments. The beds on which women had to give birth seemed to be made out steel or a material just as uncomfortable. And would you believe that there is a 7 to 12 hour wait for women to access EMERGENCY c-sections in Uganda?? Furthermore, there are transport barriers with women not even being able to access an ambulance, yet alone a car, when they go into labour. In fact, many women are transported by their husbands on bicycles up and down hilly slopes in search for the nearest hospital. It really made me extremely sad to think of the conditions that women have to deal with just to be able to give birth whereas here when a woman is pregnant, most of the time she has amazing facilities, both medically and socially, to help her get through it.   One of the millennium development goals is to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Progress has definitely been made - in 2013, an estimated 289 000 women died during pregnancy and childbirth globally, a decline of 45% from levels in 1990. There has also been progress in sub-Saharan Africa. But still the risk of maternal death is very high at 1 in 38, whereas in the developed world the risk is 1 in 3700. The good news is that more women are now seeking care during childbirth in health facilities but as Dr. Ahimbisibwe’s story showed us, the care in hospitals isn’t always optimal. So what we need to ensure that women receive the best care in hospitals as well. WHO has recognized this and has focused on several key areas. These are: - Strengthening health systems and promoting interventions focusing on policies and strategies that work, are pro-poor and cost-effective. -Monitoring and evaluating the burden of maternal and newborn ill-health and its impact on societies and their socio-economic development. -Building effective partnerships in order to make best use of scarce resources and minimize duplication in efforts to improve maternal and newborn health. -Advocating for investment in maternal and newborn health by highlighting the social and economic benefits and by emphasizing maternal mortality as human rights and equity issue. -Coordinating research, with wide-scale application, that focuses on improving maternal health in pregnancy and during and after childbirth. With continued efforts such as these of developed and developing nations to improve maternal health, it may be possible to make childbirth a natural part of life that is celebrated by all.  I have seen just how much monitoring a mother’s health during her pregnancy can make a difference to her own health outcomes and her child. My own mother, who is also an OB/GYN, has been able to deliver a lot of babies successfully in this world. However, when it was time for her to have her own child, she lost her first newborn a day after she was born, another newborn after a year a day after he was born, and also suffered from two miscarriages. These pregnancies occurred back in Pakistan. Once my parents left Pakistan and moved to Bahrain, in the Middle East, my mom was once again pregnant (with me!) and her fellow colleagues made sure that she was monitored on a daily basis and was pretty much put on bed-rest for 9 months. As you can tell from the fact I am alive and well writing this post to you, this last pregnancy of hers was successful. This personal example of mine should highlight the utmost importance of proper maternal care for not only the mother, but also for her child. So it is absolutely essential that we continue our best efforts on maternal care, and thankfully, for all of us Canadians out there - we can be proud of the fact Canada is one of the global  leaders when it comes to maternal, newborn and child health. We definitely have the resources to help mothers all around the world and it is important that we keep doing the best of our abilities. Iqra Effendi M.Sc. Global Health McMaster University

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The Global Burden of Paediatric Disease: Every Beat Matters

Hello Readers, In this post, I will be discussing newborn and child health. For this class, our guest lecturer was Dr. Andrea Hunter, a kind-hearted Consultant Pediatrician at McMaster Children’s Hospital and St. Joseph’s. She is also one of the professors who leads our Burden course and is behind many of the interactive and insightful discussions we had after many of our classes.  As usual, I’ll start off with a statistic - Imagine one of those big yellow school buses that most of you reading this post have been fortunate enough to travel in since you’ve had the opportunity to go to school...now imagine TEN of these school buses crashing EVERY HOUR. This analogy reflects annual child mortality. In 2013, WHO reported that 6.3 million children under the age of 5 died in 2013 with nearly 17000 deaths on a daily basis. 74% of the deaths of children under the age of five occur within the first year of life. In addition, the first days of life are the risked with about 25-45% of neonates dying on their first day and 75% of neonates dying in the first week. So why do so many kids die? It turns out that four PREVENTABLE diseases cause most child deaths - neonatal deaths (37%), Respiratory Illnesses e.g. pneumonia (17%), Diarrhea (16%) and Malaria (7%). The fact that these are all preventable indicates that we can definitely combat them with the proper resources, however, many developing countries lack these. Furthermore, malnutrition contributes to more than half of the child mortality at 55%! Malnutrition can lead to the 4 preventable diseases in children leading to a spiral of undernutrition. Children who face undernutrition usually do so because of inadequate access to food, inadequate breast feeding and inadequate food preparation. When these factors lead to disease, the inadequate sanitation, water, vaccines and other treatments available for these sick children leads to further under-nutirion causing a spiral effect. It is important to note that under-nutrition also leads to stunting (lower height-for-age than reference population) in children which the most sensitive indicator for a child’s quality of life. Unfortunately, stunting is 2.5 times higher in poor countries than developed nations.   So what can we do to save children all over the world? Canada, as well as many other developed nations, are lucky to have such low child and newborn mortality rates. Organizations such as SickKids reach out to developing countries all over the world in hopes of developing interventions that can help save young lives. This summer, I will actually doing my internship at SickKids and nutritional interventions that can save children are a passion of mine. It has been found that good nutrition during the “first 1000 days of life” is essential for ensuring a healthy start in life and avoiding early morbidity and mortality. An amazing series on nutrition and maternal, child and newborn health has been published in the Lancet and features the research of leading researchers at SickKids here in Canada. I could talk about how amazing all their research has been for hours but since I am limited when it comes to space, I urge you to read them if this topic is of interest to you at this link: http://www.thelancet.com/series/maternal-and-child-nutrition What fascinates me the most is the fact that such simple nutritional interventions that we take for granted here can have a huge impact on lives. For example, here in Canada our salt has been iodized which has virtually help to eliminate iodine-related deficiencies. Iodine deficiency is the leading cause of preventable mental retardation which occurs primarily when babies or small children are iodine-deficient. Of course, many developing countries face this problem but by helping them to implement iodine in their salt, it can improve the quality of lives of so many children.  Lastly, I want to mention the “Every Newborn action plan” that sets out a vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. You can read about this plan more here http://www.everynewborn.org/every-newborn-action-plan/. I absolutely love what this plan stands for and truly thing it can make a difference for babies and children all over the globe. What interventions with regards to paediatric care have you all heard of? What do you think is the best way to go about reducing child mortality rates successfully with the experience that we hold in developed nations?  Looking forward to your replies! Iqra Effendi M.Sc. Global Health McMaster University

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It’s time for global health to realize the advantages of effective surgical care. 

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Is Surgery the Neglected Step-Child of Global Health?

Hello Readers, In this post, I will discuss the surgical burden of disease. Our guest lecturer for this topic was Dr. Brian Cameron, a highly-respected paediatric surgeon at McMaster Children’s Hospital. I’m not going to lie when I tell you that I never though about surgery in the realm of Global Health. Yes, I’ve always thought about how so many medical interventions are hard to get to developing countries - vaccines, ARVs etc. But never explicitly did I think about its burden in the grander scheme of things. However, this lecture truly changed my perspective on the issue. Surgery is an essential component of health systems but has generally been neglected within global public health. Dr. Cameron talked about a study by Dr. Farmer and Dr. Kim on surgery and global health (found here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267857/) that refers to surgery as the neglected step child of global health in Africa because there are fewer physicians per population on this continent than any other, with surgeons being extremely rare. This is also true in the poorer regions of Asia and Latin America. This is unfortunate because disease preventable by surgery is a high killer of the world’s poor but public health funders do not prioritize it. WHO has estimated that 11% of global burden of diseases can be treated with surgery. Moreover, 500 000 annual deaths of women during childbirth have been found to be largely attributed to a lack of surgical services. Evidently, surgery needs to be emphasized on more but several reasons have contributed to its neglect. First of all, there has been an ever-lasting emphasis on communicable diseases and surgery is not “communicable”, it usually does not garner much public support. Furthermore, it has only been recently that surgeons are involving themselves in matters of global health. Lastly, surgery is a very complex intervention that requires not only a surgeon, but also anaesthesia, a room,a autoclaves, drapes and many more supplies. In addition, postoperative care and blood banking are also required. Thus, to be able to do surgery properly, a significant investment in infrastructure and training and a steady supply of consumables are required.  Within the aforementioned study, it has been mentioned that a long-term vision of the role of surgery in global health is required. Since surgery is very limited in developing countries and is usually only concentrated in urban centres and for people who can afford to pay for them, the vision should be to make surgery available within the public sector, free of charge. One way to accomplish this vision is by carrying out long-term medical missions within developing countries. This requires the implementation of programmes and infrastructures that would either train local physicians to be the best surgeons or to open up more twining programs, residencies and fellowship opportunities for those trained in first-world hospitals to come and apply their skill in developing countries. If physicians from first-world hospitals are brought in, it is absolutely essential that they devote a part of their time to training local physicians in order to keep this vision sustainable. WHO has provided future directions for surgical illnesses as well. WHO is optimistic when it comes to the support that surgery now receives and believes this will help to move forward. WHO established a Global Initiative on Emergency and Essential Surgical Care (GIESSC), and the WHO Integrated Management of Emergency and Essential Surgical Care toolkit includes training and research for surgical services at the district hospital. Lastly, I would like to end my discussion on surgical care by a quote from the WHO that really resonated with me: “The common perception that surgical care is merely a luxury in poor countries must be reconsidered and its essential role in global public health must be acknowledged. Anything less will ensure that the morbidity and mortality endured by millions of people in poor countries unable to access surgical care will continue to remain invisible to the rest of the world.” More information of WHO’s take on this issue can be found here http://www.who.int/bulletin/volumes/86/8/07-050435/en/  Now I would like you to think about something: During this class, we engaged in a class discussion in which we were divided into 3 teams who had to advocate for why their assigned field should receive funding. The 3 fields were infectious diseases, non-communicable diseases, and surgical illness. This was one of the most enjoyable discussion I participated in due to the fact that it really provided a glimpse into how funders must feel when trying to figure out where the money should go too. So the question I would like to pose to you is if that you had to argue for surgery to be given the funding over the other two fields, how would you build your case? Iqra Effendi M.Sc. Global Health  McMaster University   

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During my research about NTDs (I talked about them in my previous post), I actually found out that one of my favourite Bollywood actors, Abhishek Bachan, advocates for NTDs. Since he’s a super famous actor in India has made a name internationally, especially within South Asians all over the globe. What a neat way to raise awareness!

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1 in 6 people suffer from diseases you may have never heard of: Neglected Tropical Diseases

Hello Readers, In this post, I will be discussing Neglected Tropical Diseases (NTDs). Our guest lecturer for this topic was Dr. Martha Fulford, an associate professor at McMaster University. She also provides infectious disease consultations for both the paediatric and adult patient population at the McMaster University Medical Centre, as well as for the Ontario Agency for Health Protection and Promotion. So you may be wondering what are NTDs? Firstly, it is important to understand what tropical diseases are in general - there is no clear definition but simply, they are infectious diseases that occur in the tropics (although many can also be found in temperate climates). This includes diseases such as malaria, yellow fever, cholera, HIV/AIDs. These diseases are now most commonly associated with developing countries but they were in developed countries at one point as well e.g. yellow fevers killed thousands in the U.S from the 1600 to 1905. They have been successfully eradicated in the developed world due to good sanitation, hygiene, vector control methods and of course, a higher standard of living. Over 100 tropical diseases exist in the world today but there are definitely a couple that we give a lot more importance to than others such as malaria and HIV/AIDs. This is even reflected in the way the UN Millenium Goal is phrased for tropical diseases where malaria and HIV are stated but the rest are just called “the others”. This is when the term “neglected’ tropical diseases were born to describe these other infectious diseases. WHO has listed 17 NTDs, ranging from helminth infections to dengue fever, that are endemic in 149 countries and affect more than 1.4 billion people. The full list can be found here http://www.who.int/neglected_diseases/diseases/en/. Moreover, NTDs cause about 534 000 deaths per year and result in 56.6 million DALYs lost annually. NTDs are chronic, disabling, disfiguring and often stigmatizing, and occur in extremely poor conditions. While each of the NTDs have their own specific primary symptoms, they all can also result in impaired child growth, adverse pregnancy outcomes, impairment of intellectual development and decreased work productivity. Cumulatively, these all promote poverty conditions further. Despite the significant burden of NTDs, they are usually the lowest prioirity for funding and pharmaceutical companies when it comes to infectious disease. Between 1975 and 1997, 1233 new drugs were commercialized but only 4 were developed for NTDs. This seemed very surprising me to first but then Dr. Fulford mentioned something significantly important when we are trying to figure out how funding is allocated: This infections generally do NOT pose a threat to foreign travellers and the upper and middle class of countries, unlike the big 3 (HIV/AIDs, malaria and TB) which can easily affect either of these groups. What health conditions get funding are determined by well-profiled members in healthcare systems. Individuals suffering from NTDs would barely have any resources to advocate for themselves and since not many other people get it unless they are poor, it becomes a situation of if it’s not affecting me then does it really matter? Of course, I do not support this mentality but it definitely makes a lot of sense when it comes to certain things with funding.  However, not everything is so gloomy when it comes to NTDs. It turns out that with the term NTDs have started to be use, it’s really helped to increase the focus on these diseases (our psyche is great, isn’t it?), and right now NTDs are receiving the highest level of funding that has ever been provided for them. Partnerships have been created to provide more effective interventions for these diseases and there are also efforts to raise awareness observed by the creation of the Global Network for NTDs (found here http://www.globalnetwork.org/). So while we are still lagging behind when it comes to NTDs, we’ve definitely taken a step in the right direction. Healthcare funding is always an issue but that’s what I loved about this course so far. By understanding the burden of all these different type of diseases, it really shows you how important it is to not favour one over another and instead, provide proportional budgeting. Of course, this is better said than done but as an optimist, I would like to think that we have slowly made progress towards being as equitable as possible when it healthcare. 

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If only laughter could cure everything...

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Diarrhea, TB & HIV/AIDs: Global Health’s Never-Ending Battle with Infectious Disease

Hello Readers! In this post I will be discussing infectious diseases, in particular, diarrhea, tuberculosis and HIV/AIDs. Our guest lecturer for this topic was Dr. Jeffrey Pernica, whose major interest focuses on Paediatric Infectious disease. Dr Pernica’s passion is also reflected in his work. In fact, he is a recipient of the prestigious Grand Challenges Canada grant for a research project involving improved detection of diarrhea in Sub-Saharan Africa. You can read more about this project here http://www.cbc.ca/news/canada/hamilton/news/mcmaster-projects-win-big-global-health-grants-1.1352056 Let’s start off with a statistic that reflects the reality of infectious diseases in our world today - of the 6.3 million children who died in 2013, 51.8% of them died due to infectious causes. Diarrhea is the second leading cause of death, following closely behind pneumonia, in children under 5. It kills approximately 2195 children every day! The tricky thing about Diarrhea is that it doesn’t just directly kill children, it’s the malnutrition that it causes that can kill by almost anything due to their depressed immune system. Thus, this is a way for children to even end up getting pneumonia which makes diarrhea have a sort-of double burden of disease effect. Furthermore, as Dr. Pernica stated, “Diarrhea doesn’t just kill kids, it can screw them up” - as the number of diarrhea episdoes go up, so does stunting.  The definition of stunting according to WHO is for the "height for age" value to be less than two standard deviations of the WHO Child Growth Standards median. A study in the LANCET stated that stunting at age 2 is the best predictor of poorer quality of health throughout your life. Thus, diarrhea can lead to a lasting disability beginning during child development and leading into adult development. Diarrhea is caused by a large range of pathogens. The most well known ones are rotavirus and ST-ETEC (this one causes traveler’s diarrhea). For those of you reading this post that have experienced diarrhea, you were healthy enough for the effects to not be severe. The way the disease manifests in you vs. a child in Africa are polar opposites. This needs to be kept in mind when figuring out which drugs or vaccines are the best in different parts of the world. While the rotavirus vaccine has been very effective in the devleoped world at 80% efficacy, the effectiveness is relatively lower in developing countries at 50%. This number is still significantly substantial the availability of these in developing countries is also a major barrier that has not yet been overcome. Next, we have tuberculosis (TB) which is estimated to affect about one third of the world’s population and is common in all age groups. In 2013, there were 9 million new infections and 1.5 million deaths. It is most common in the developing world, majorly due to suppressed immune systems in individuals that can be a result of HIV infections. Again, this link of HIV and TB show the extra burden that needs to be dealt with in infectious diseases.  TB can be either active or latent, and the active form often leads to death if it is left untreated. Diagnosing TB is a difficult process as the signs and symptoms alone are not enough, so, further clinical samples are required that can take up to 2-6 weeks for cultures to grow.  Treatment for TB relies on antibiotics, but, effective treatment is difficult due to the unusual structure and chemical composition of the TB bacterium which hinders the entry of drugs and makes many antibiotics ineffective. As TB requires multiple antibiotics a patient may develop  resistance during therapy because of inadequate treatment, lack of adherence, or using low-quality medication. Patients with drug-resistant TB require longer treatment that also requires more expensive drugs, which becomes extremely impractical for those lacking financial resources. Thus, the greatest strategy for TB is prevention and control via the BCG vaccination as well as WHO’s STOP TB Strategy promoting prevention, control and better treatment. More details about the plan can be found here  http://www.who.int/tb/strategy/en/ Lastly, HIV/AIDs is a topic that probably deserves a post all on its own, but since I’m limited to one post per lecture topic for now, I’ll be giving a brief overview. As of 2012, HIV/AIDs affected 35.3 million people worldwide, with the most cases in Sub-Sahara Africa. HIV is transmitted by three main routes: sexual contact, exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding. HIV is diagnosed via laboratory testing and then staged based on the presence of certain signs and symptoms, particularly CD4 cells count levels. Dr. Pernica mentioned that HIV testing is actually a lot easier than TB testing but the issue is that many in the developing world don’t have the testing available to them. Antiretrovirals (ARV) used in combination in what is termed as cART/HAART therapy have been extremely effective in the treatment of HIV. Using combination pills containing several different ARVs allows these drugs to block the action of the HIV virus through multiple routes. When ARVs were first introduced in the late 90s, they managed to achieve an 84% drop in AIDS-related deaths in developed countries. However, they were not as readily available in developing due to the high costs - US$15 000 per person per year! Fortunately, an Indian pharmaceutical company started to produce generic ARVs at much lower costs of about $115 instead which has resulted in 8 million individuals in developing countries receiving ARV today. Of course, more efforts are still needed but we have definitely taken a step in the right direction. A brief summary of these 3 big killers indicate the disparity of global distribution of diseases in the developed vs the developing world. It also shows the disparity in treatment availabilities as well. It always boggles my mind to figure out how I can help those individuals who do not have these treatments in a cost-effective and sustainable way. Giving donations is simply not enough but is definitely a start. I have been scratching my head to think of something more innovative than that but haven’t been able to come up with anything so far. So here’s some food for thought: where do we go from here?  Iqra Effendi M.Sc. Global Health McMaster University

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WASH: Save Water, Shower Less?!

Hello Readers, In this post, I will discuss the global burden of water, sanitation and health, or as UNICEF conveniently and effectively has made an acronym for - WASH. Our lecturer was Dr. Christian Kraeker, an internal medicine specialist and one of the professors that is in charge of our Global Burden of Disease course.  Dr. Kraeker started off by talking about climate change. As many of you may already know, we are currently living in a world of mass technology and industries fuelled by the combustion of fossil fuels (coal, petroleum and natural gas) that create greenhouse gases - carbon dioxide, methane and nitrous oxide. Today, we are combusting more fossil fuels and producing more greenhouse gases than any other point in history. These gases are infamous for causing global warming via the greenhouse effect that prevents heat from escaping our atmosphere. As a result, it has been predicted that overall there will be a rise of between 1.8 to 5 degrees C in the global temperature by the end of the century. While this may not seem that biv, our world has been created on a system of balance on which not only humans rely but also many other animals and plants. Even a 1 degree C imbalance can have profound impacts on an organism's basic survival and reproduction. Additionally, there are also consequences on the water cycle which is resulting in some areas having more rainfall leading to flooding, some having less rainfall leading to droughts and some having severe weather effects from heatwaves to ice storms - a perfect example is Canada's bipolar weather! It was -30 yesterday and it's -6 today! The famous Kyoto Protocol was adopted by many countries to help reduce greenhouse gas emissions but with little success. In fact, Canada was the first country to pull out of the Kyoto Protocol, tarnishing its reputation of its environmental policies. At least Canada was honest in saying that they would not be able to meet the targets  because even those countries that didn't pull out of it, such as U.S.A, were still unsuccessful in reducing their emissions. It makes me question whether in a world of an ever-increasing population and development, will we ever be able to reduce our emissions or have we crossed the limit of irreversible damage? The optimist in me hopes otherwise. For the purpose of our course, Dr. Kraeker focused on the health effects of climate change particularly on vector-borne pathogens, water borne illness and heat-related illnesses. Malaria, a vector borne disease caused by anopheles mosquitoes that tend to be more active at higher temperatures, is infecting more regions that are getting warmer and wetter. Overall, the population at risk will increase by 3-5% which in actual numbers amounts to millions. Keep in mind that these are people being exposed for the first time in regions where malaria is not usually present, thus, the population is non-immune and is more likely to experience severe effects. When thinking about water-borne diseases, the effects of both drought and flooding need to be taken into account. Climate change is leading to some areas to become drier resulting in droughts. During droughts, a lack of water supply can lead to poor hygiene and sanitation as people share scarce resources in a small space. As a result of this, it is estimated that by 2030, there will be 10% more illnesses secondary to diarrhea. Diarrhea is a major killer developing world and I will discuss this more in my next reflection. On the flip side, areas that will experience too much rainfall can have outbreaks of deadly diseases such as cholera due to flooding. Pakistan experienced cholera outbreaks due to flooding resulting in 1000s of deaths despite the disease being absent in the country previously. Lastly, heat waves have put several populations at risk particularly those with chronic cardiac and respiratory illnesses whose conditions flare up, and the elderly who are prone to dehydration. In 2003, over 15000 deaths occurred in France as a result of temperatures of over 40 degrees C for 2 weeks mainly in those individuals who were old, lacked access to a cool environment, had pre-existing cardiac or respiratory illness and lacked mobility to be able to access water and shelter. It is evident just how much climate change is affecting the health of the entire global population, highlighting the dire need for environmental and health policies that can combat and adapt climate change. While many strategies exist, I would like to highlight the UNICEF WASH strategies. Their objective is to "contribute to the realization of children’s rights to survival and development through promotion of the sector and support to national programmes that increase equitable and sustainable access to, and use of, safe water and basic sanitation services, and promote improved hygiene." Their two measurable targets to see if they have achieved their goals are: 1) Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation (MDG Target 10) 2) Ensure that all schools have adequate child-friendly water and sanitation facilities, and hygiene education programme. They have created 3 packages to be able to achieve these goals and a detailed outline of their packages can be found here: http://www.unicef.org/wash/index_43084.html  While many of you reading this have never even had to think about where your water is coming from or whether you will have enough, just like me, I hope my post provided you with some empathetic insight into the hardships associated with something that we tend to take for granted. Making a change starts at home - what ways can you save water? Showering less may be one but remember...hygiene is important too, so maybe instead of long showers in which we contemplate our entire life, we can just stick to shorter ones where we just contemplate our day! Iqra Effendi M.Sc. Global Health  McMaster University 

[infectious-inspirations]

A great concept "heart" reflecting the important concepts in cardiovascular disease. 

[infectious-inspirations]

The Heart Of All Our Problems: Non-Communicable Diseases

Hello Readers, In this post I would like to discuss with you what I have learnt about non-communicable diseases (NCDs). WHO defines NCDs as those diseases that are NOT transmitted from person to person, are of long duration, and progress slowly. The 4 main types of NCDs are cardiovascular disease (e.g. heart attacks & stroke), cancers, chronic respiratory disease (e.g. asthma) and diabetes. NCDs kill 38 MILLION PEOPLE ANNUALLY and almost 3/4 of NCD deaths (28 million) occur in low and middle income countries. In fact, NCD related deaths in these countries are even surpassing those of infectious diseases (e.g. malaria and HIV). Even just these introductory statistics alone highlight the severity and global burden of NCDs and the dire need for us to be able to control and prevent NCDs on a global scale. Our guest lecturer on this topic was Dr. Joshua Manolakos, the 2013 McMaster Resident Research Prize Recipient and an aspiring cardiologist, who specifically focused on the global burden of cardiovascular disease (CVD). Why the specific focus on CVD? Well, CVD is actually the NCD that causes the most deaths annually - 17.5 million deaths/year! In addition, CVD is a multifactorial process meaning that it is caused by a wide range of factors that can be either individual biological factors, lifestyle factors or environmental factors. Traditional factors, as published in the JAMA report of 2003, include hypertension, cigarette smoking, obesity, diabetes, dyslipedimia, physicial inactivity, microalbuminuria, family history of CVD, and age of >55 for men and >65 for women. The factors published in this report were as a result of the analysis of those who develop the disease in the "Western World" since it was historically most prevalent in high-income countries. However, with time it has become more and more prevalent within middle and low income countries causing them to now surpass high-income countries. As a result, it is an absolute necessity to research the underlying causes and risk factors for CVD in different ethnic populations to ensure that effective treatments and strategies are being implemented for them.  Dr. Salim Yusuf, one of the most influential health care professionals within this field, decided to investigate the differences in risk factors based on ethnicity in his famous INTERHEART study. His colloborative efforts with the work of 600 other investigators around the globe enabled this study to obtain data from 52 countries. It was found that 9 modifiable risk factors account for over 90% of the risk of an initial heart attack across all ethnic groups, with smoking and high level of lipids being the most important. Another important finding were protective factors that can reduce the risk of heart attacks which included fruit and vegetable intake, not smoking, exercise and moderate alcohol intake. For more details of INTERHEART you can access it at this link: http://www.sciencedirect.com/science/article/pii/S0140673604170189 These findings are GOOD news! It implies that we can actually change some habits in our life to lower our risk. However, despite the fact that all these factors are well known, there is a big discrepancy in the policies that exist to ensure that the public actually makes the necessary lifestyle changes. I will reflect on my own experiences with regards to nutritional policies but I would love if you could share your experiences too with any policies/strategies, positive or negative, for any of the risk factors in INTERHEART. So, for the past year I've tried to adopt a healthy lifestyle by doing regular exercise and trying to incorporate a more well balanced diet. I thought my biggest hurdle would be keeping my motivated myself to go to the gym. However, it turned out that the most difficult task for me was finding healthy, affordable nutritional options on campus. Why is is that a tiny salad that I wouldn't even pass as an appetizer is for $9 while a calorie-loaded beef burger is only $3? Realistically, which option would most of the general public choose? Similarly, when I visited my native country, Pakistan, I also noticed a similar trend in prices. Remember that CVD is increasing in low and middle income countries where many struggle to afford even just bread. So if someone like me who doesn't have as much financial restrictions but still thinks twice before buying an extremely over-priced salad, how do we expect poorer populations to eat better? I've heard of policies where people have proposed to increase the prices of fast food by putting tax on them but what about making healthy options cheaper? I've always been intrigued by the lack of solid nutritional policies to combat not only CVD but also obesity and diabetes. I am hoping to explore this further this upcoming summer in order to understand what the difficulties are in coming up with an effective strategy to combat these risk factors and how to tailor these strategies according to the local population.  I hope this post was able to shed some light about the severity of the global burden of NCDs. Stay tuned for my next post on water, sanitation and health.  Iqra Effendi M.Sc. Global Health  McMaster University