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Press releases Saturday 21 October 2006

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(1) OVER 700,000 CHILDREN DIE NEEDLESSLY EVERY YEAR IN THE EASTERN MEDITERRANEAN

(2) LACK OF EQUIPMENT AND SKILLED DOCTORS COSTING CIVILIAN LIVES IN IRAQ

(3) MALARIA IN THE MIDDLE EAST – NEW STUDY REVEALS WORRYING TREND

(4) POPULATION TRENDS, PRACTICES AND BELIEFS COULD HAVE ADVERSE EFFECT ON HIV RATES

(5) PHYSIOTHERAPISTS AND PHARMACISTS CAN HELP REDUCE KNEE PAIN AND RELIANCE ON PAINKILLERS

(1) OVER 700,000 CHILDREN DIE NEEDLESSLY EVERY YEAR IN THE EASTERN MEDITERRANEAN

(Child health and survival in high burden countries of Eastern Mediterranean)
http://bmj.com/cgi/content/full/333/7573/839

Over 700,000 babies and children could be saved every year in the Eastern Mediterranean region if countries adopted some simple low cost health measures, say researchers in this week’s BMJ.

The Eastern Mediterranean region accounts for 1.4 million deaths among children under 5 every year. Most of these occur in just seven countries (Pakistan, Afghanistan, Egypt, Sudan, Somalia, Iraq, and Yemen) where mortality exceeds 50 for every 1,000 live births.

Yet more than half of these deaths could be prevented if these countries implemented a range of proven, low cost health measures, write Professor Zulfiqar Bhutta and colleagues.

For example, they calculate that promoting breast feeding would prevent 151,000 deaths, while more skilled mother and baby care would avert another 53,000 deaths. Giving oral rehydration therapy (a simple mixture of sugar, salt and water) would prevent a further 65,000 needless deaths.

Many of these interventions could be delivered to whole populations through community based approaches and outreach programmes, say the authors. However, efforts are slow in most countries, and where programmes do exist, evaluation and research are limited.

These data point to an unacceptable persistent burden of child mortality from common disorders in some countries in the region, they write. These deaths are largely preventable and much can be done with existing knowledge and even limited resources.

These existing interventions, as well as the promising new targeted strategies, must be delivered to all those who need them most. This will require concerted efforts by public health policy makers, development agencies, and civic societies to garner resources for child health. Not only must these interventions be based on robust evidence but their implementation in health systems must also be part of a learning process, they conclude.

Contact:

Professor Zulfiqar Bhutta, Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Email: zulfiqar.bhutta@aku.edu

(2) LACK OF EQUIPMENT AND SKILLED DOCTORS COSTING CIVILIAN LIVES IN IRAQ

(Iraq lacks facilities and expertise in emergency medicine)
http://bmj.com/cgi/content/full/333/7573/847

Doctors working in Iraq admit that more than half of the civilians killed could have been saved if better medical equipment and more experienced staff and were available.

Writing in this week’s BMJ, Bassim Al Sheibani and colleagues say that as the violence escalates, the reality is that they cannot treat many of the victims.

Official figures from Iraqi authorities and UN agencies suggest that more than 14,338 Iraqi civilians were killed between January and June 2006. And reports indicate that the killing of civilians is rising, with more than 5,800 deaths and over 57,000 people injured during May and June 2006.

But emergency medicine in Iraq has never developed to meet such unprecedented demand, they say. As a result, emergency departments are staffed by doctors who do not have the proper experience or skills to manage emergency cases, and this lack of expertise is aggravated by the lack of medical equipment, supplies, and drugs.

Doctors also face challenges beyond poor resources and lack of emergency staff, they add. Perceived as members of an elite, they have become the target of daily insurgent activities. Many have been killed, others have fled the country, and those who decided to stay have closed their clinics, fearing for their lives.

In Diwaniyah College of Medicine, the authors are trying to establish a specialist unit in emergency medicine to train the medical students and doctors. But they desperately need international support.

Iraqi doctors are doing their best in difficult circumstances, they say. But despite the daily violence that is crushing Iraq, the international medical community is doing little more than looking on.

Contact:

Dr Bassim Al Sheibani, Lecturer Physician, Diwaniyah College of Medicine, Iraq
Email: jumabassim@yahoo.co.uk or bassimim2003@yahoo.co.uk

(3) MALARIA IN THE MIDDLE EAST – NEW STUDY REVEALS WORRYING TREND

(Severe malaria in children in Yemen: two site observational study)
http://bmj.com/cgi/content/full/333/7573/827

Malaria is not usually thought of as a major disease in the Middle East, but a study from Yemen in this week’s BMJ reveals worryingly high levels of severe malaria in children.

In fact, the figures show that as many as 4 out of 10 children attending hospital with severe illness could be affected during the peak season. This is comparable to many areas of Africa.

Researchers identified over 2,000 children aged 6 months to 10 years who were admitted to two public hospitals with suspected severe malaria. Malaria was confirmed in 1,332 children, 808 of whom had severe malaria.

The proportion of admissions varied according to the season, from 1% between July and September to 40% in February and March. Twenty six children died in hospital. Most deaths were in children with a neurological presentation, and more girls died than boys.

Severe malaria puts a high burden on health services in Yemen, say the authors. Malaria control should be a priority and lesson should be learnt from other areas of highly seasonal malaria.

Contact:

Christopher Whitty, Professor of International Health, London School of Hygiene and Tropical Medicine, UK
Email: christopher.whitty@lshtm.ac.uk

(4) POPULATION TRENDS, PRACTICES AND BELIEFS COULD HAVE ADVERSE EFFECT ON HIV RATES

(HIV in the Middle East and North Africa: a review of the evidence)
http://bmj.com/cgi/content/full/333/7573/851

A review of research on the prevalence of HIV in the Middle East and North Africa has found that whilst cultural and religious practices may be behind a low prevalence of HIV in the region, they could potentially contribute to increasing the spread of HIV.

Research from the World Health Organisation, published in this week’s BMJ, argues it is possible that some practices which are common among Muslim populations may contribute to decreasing the risk of HIV transmission. One is low alcohol consumption, which reduces ‘risky’ behaviours and another is potentially male circumcision which was shown in a recent clinical trial to have a protective effect but application of these results to other epidemiological, cultural and social settings still needs to be confirmed.

At the same time other population trends, beliefs and practices in the region may have an adverse effect. Most countries in the region have young populations with a rapidly increasing age at marriage, but young people may be ill-equipped to protect themselves against sexually transmitted infections. Traditional Muslim approaches have tended to be very conservative, and it is difficult to break the silence around issues of sexual behaviour – especially those which deviate from religious norms.

A detailed analysis of religious publications and doctrinal pronouncements revealed that strong moralising views were common – HIV was seen as divine retribution and religion was presented as a protection. This can mean that those with HIV/AIDS are stigmatised.

The construction of gender also plays a part - strong prohibitions against extramarital sex, which are applied more strictly to women, are associated with lower HIV prevalence. While there are fewer women than men with HIV in the region, this sex ratio appears to be shifting, suggesting the disease is spreading and highlighting women's special vulnerability as they are married to older men who are more likely to have been exposed to HIV infection. The cultural view that women are innocent reinforces the lack of information about sexual risk and makes it difficult for women to protect themselves.

The author notes that ‘a theology of compassion and approaches advocating harm reduction seem to be emerging in several Muslim countries, and greater acceptance of HIV positive people is justified with reference to religion. Things are also improving on a practical level - in recent years better information systems to track HIV have been put in place in the region and around half of the countries have formulated national plans to tackle HIV.'

The author concludes that whilst knowledge is still inadequate and stigma and greater discrimination prevail in many settings, over the past couple of years 'there has been greater visibility and more public discussion of HIV/AIDS in the region. Throughout the region governments and non-governmental organisations have initiated promising projects to break the silence around HIV, spread information, promote prevention and provide care and treatment. The challenge now is how to capitalise on the strengths represented by cultural tradition while fostering effective responses to the epidemic.'

Contact:

For further information, or to arrange an interview with Dr Carla Makhlouf Obermeyer, please contact: Iqbal Nandra, HIV/AIDS Department, WHO, Geneva, Switzerland
Email: nandrai@who.int

(5) PHYSIOTHERAPISTS AND PHARMACISTS CAN HELP REDUCE KNEE PAIN AND RELIANCE ON PAINKILLERS

Online First
(Pragmatic randomised clinical trial of the effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in older people presenting to primary care)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38977.590752.0B

Older people with knee pain who receive their main care from physiotherapists and pharmacists are more likely to experience improvements in pain levels and knee function, and are less likely to need NSAIDs (non-steroidal anti-inflammatory drugs, eg asprin and ibuprofen), according to a BMJ study.

Researchers from Keele University undertook a study involving over 300 people with knee pain. The participants (aged over 55), were split into three groups.

The first group took part in an ‘enhanced pharmacy review’ with up to 6 appointments with an experienced community pharmacist to monitor the appropriateness and effectiveness of medication. A second group received up to 6 sessions with a physiotherapist, which included general aerobic exercise and specific muscle strengthening and stretching exercises. A final ’control’ group received an information and advice leaflet – which was also issued to the other two groups – plus a telephone call to reinforce the information in the leaflet and address any specific concerns about putting the advice into practice.

When compared with the control group, those in the physiotherapy group reported a significant improvement in pain levels and in knee function after three months of treatment. Participants in the pharmacy group also reported improvements in pain levels.

However, in the longer term (at six months and 12 months), there were no significant differences in pain or function between the physiotherapy, pharmacy and control group. The researchers suggest that this change may in part be due to a lack of adherence to the programme – as time goes by people may not be as strict about keeping up with their exercise programme or taking their medication.

However, there were differences between each groups’ usage of NSAIDs (non-steroidal anti-inflammatory drugs, e.g. asprin and ibuprofen). The study found that participants in the pharmacy and physiotherapy groups were less reliant on NSAIDs than the control group. At six months NSAID usage was 16% lower in the pharmacy group and 15% lower in the physiotherapy group than those in the control group, with no increase in pain reporting and high levels of patient satisfaction. The researchers say that this finding has ‘important safety implications’ as NSAIDs can cause adverse reactions and illness, and are not recommended for long-term use, particularly for older people.

The study also found that physiotherapy appeared to encourage a long-term shift in behaviour away from GP led care – with participants in the physiotherapy group less likely to consult their GP about knee pain than patients in the control group.

The authors conclude that further investigation is needed to how the early clinical benefits of physiotherapy and pharmacy can be sustained in the long-term.’

Contact:

Elaine Hay, Professor in Community Rheumatology, Primary Care Musculoskeletal Research Centre, Keele University, Keele, UK
Email: e.m.hay@cphc.keele.ac.uk

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