Campylobacter diarrhea in children in South Asia: A systematic review

Background: Campylobacter spp. are one of the commonest causes of diarrhea in children under five and in resource poor settings also lead to malabsorption and stunting. The purpose of this systematic review was to understand the burden of Campylobacter spp. associated diarrhea among children in the South Asian countries. Methods: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Databases were searched with defined keywords for publications from the years 1998–2018. Data on proportion of positive samples was extracted to compare the rates of Campylobacter infection among children (under the age of 19) from different study populations. Results: Of the 359 publications screened, 27 eligible articles were included in this systematic review and categorized based on study design. In 8 case-control studies, Campylobacter spp. was detected more frequently among diarrheal cases (range, 3.2–17.4%) than non-diarrheal cases (0–13%). Although there were variations in the study population, overall, children under the age of two years experienced Campylobacter diarrhea more often than older children. Most studies reported stool culture as the method used to detect Campylobacter spp. however retesting using PCR-based methods significantly increased detection rates. Limited data were available on Campylobacter species. In 4 studies that provided species data, C. jejuni (3.2–11.2%) was shown to be the most common species, followed by C. coli. Conclusion: In South Asia, Campylobacter spp. are one of the most common bacterial diarrheal pathogens affecting children but there is a paucity of data on species, risk factors and attributable sources. Although a few studies were available, the epidemiology of campylobacteriosis remains uncertain. To understand the true burden and sources of infection, more detailed studies are needed collecting data from human, animal and environmental sources and using both culture and genomic tools.

Association of family history of cardiometabolic diseases (CMDs) and individual health behaviours: Analysis of CARRS study from South Asia

Objectives: Family history is considered as an important predictor of cardiovascular diseases (CVDs) and diabetes. Available research findings suggest that family history of chronic diseases is associated with perceived risk of disease and adoption of healthy behaviours. We examined the association between family history of cardio-metabolic diseases (CMDs) and healthy behaviours among adults without selfreported CMDs. Methods: Cross-sectional data of 12,484 adults, without self-reported CMDs, from the baseline survey of Centre for cArdiometabolic Risk Reduction in South-Asia (CARRS) cohort study were analysed. Results: Family history was positively associated with non-smoking and high fruits & vegetables consumption in the age group of 45e64 years and moderate to high physical activity in the age group _x0001_65 years after adjusting for sex, education, wealth index, city and body mass index. Conclusions: Understanding perceived risks and cultural or psychological factors related to family history through ethnographic studies may deepen understanding of these associations.

Ecological impacts of climate change on the snow leopard (Panthera unica) in South Asia / Impactos ecológicos da mudança climática no leopardo-da-neve (Panthera uncia) no sul da Ásia

Snow leopard (Panthera unica) is a felid which lives in the highly rugged areas of alpine regions in different mountain ranges of South and Central Asia. This solitary animal needs large spaces for its ranges but due to climate change and relatively faster rate of global warming in South Asian mountain ranges, its habitat is going to shrink and fragment by tree-line shifts and change in hydrology of the area. Vegetative modification of montane flora and competition with domestic goats will create its prey's population to decline along with a chance of a direct conflict and competition with the common leopard. Common leopard being more adaptable, grouped, and larger in size can be a significant stressor for a smaller and solitary snow leopard. Habitat would shrink, and snow leopard can possibly move upslope or northward to central Asian ranges and their predicted migratory patterns are unknown.

O leopardo-das-neves (Panthera uncia) é um felídeo que vive nas áreas altamente acidentadas das regiões alpinas, em diferentes cadeias de montanhas do sul e do centro da Ásia. A revisão atual tem o objetivo de abordar a questão da possível perda de hábitat do leopardo da neve em razão da interferência humana nas montanhas do sul e do centro da Ásia. Esse animal solitário precisa de grandes espaços para suas faixas, mas, devido às mudanças climáticas e à taxa relativamente mais rápida de aquecimento global nas cadeias montanhosas do sul da Ásia, seu hábitat vai encolher e fragmentar-se por mudanças nas linhas de árvores e na hidrologia da área. Este artigo teve o objetivo de rever vários estudos sobre os impactos das mudanças climáticas em um futuro próximo e distante sobre os hábitats do leopardo-da-neve. O estudo revelou que a modificação vegetativa da flora da montanha e a competição com cabras domésticas poderiam ocasionar na diminuição da população de suas presas, com a chance de um conflito direto e competição com leopardo comum. Leopardo comum sendo mais adaptável, agrupado e maior em tamanho pode ser um estressor significativo para um leopardo-da-neve menor e solitário. Conclusão: devido ao encolhimento do hábitat, o leopardo-da-neve pode, possivelmente, mover-se para cima ou para o norte, para faixas da Ásia Central com padrões migratórios não previstos.

Ecological impacts of climate change on the snow leopard (Panthera unica) in South Asia

Abstract Snow leopard (Panthera unica) is a felid which lives in the highly rugged areas of alpine regions in different mountain ranges of South and Central Asia. This solitary animal needs large spaces for its ranges but due to climate change and relatively faster rate of global warming in South Asian mountain ranges, its habitat is going to shrink and fragment by tree-line shifts and change in hydrology of the area. Vegetative modification of montane flora and competition with domestic goats will create its preys population to decline along with a chance of a direct conflict and competition with the common leopard. Common leopard being more adaptable, grouped, and larger in size can be a significant stressor for a smaller and solitary snow leopard. Habitat would shrink, and snow leopard can possibly move upslope or northward to central Asian ranges and their predicted migratory patterns are unknown.

Resumo O leopardo-das-neves (Panthera uncia) é um felídeo que vive nas áreas altamente acidentadas das regiões alpinas, em diferentes cadeias de montanhas do sul e do centro da Ásia. A revisão atual tem o objetivo de abordar a questão da possível perda de hábitat do leopardo da neve em razão da interferência humana nas montanhas do sul e do centro da Ásia. Esse animal solitário precisa de grandes espaços para suas faixas, mas, devido às mudanças climáticas e à taxa relativamente mais rápida de aquecimento global nas cadeias montanhosas do sul da Ásia, seu hábitat vai encolher e fragmentar-se por mudanças nas linhas de árvores e na hidrologia da área. Este artigo teve o objetivo de rever vários estudos sobre os impactos das mudanças climáticas em um futuro próximo e distante sobre os hábitats do leopardo-da-neve. O estudo revelou que a modificação vegetativa da flora da montanha e a competição com cabras domésticas poderiam ocasionar na diminuição da população de suas presas, com a chance de um conflito direto e competição com leopardo comum. Leopardo comum sendo mais adaptável, agrupado e maior em tamanho pode ser um estressor significativo para um leopardo-da-neve menor e solitário. Conclusão: devido ao encolhimento do hábitat, o leopardo-da-neve pode, possivelmente, mover-se para cima ou para o norte, para faixas da Ásia Central com padrões migratórios não previstos.

Ecological impacts of climate change on the snow leopard (Panthera unica) in South Asia / Impactos ecológicos da mudança climática no leopardo-da-neve (Panthera uncia) no sul da Ásia

Snow leopard (Panthera unica) is a felid which lives in the highly rugged areas of alpine regions in different mountain ranges of South and Central Asia. This solitary animal needs large spaces for its ranges but due to climate change and relatively faster rate of global warming in South Asian mountain ranges, its habitat is going to shrink and fragment by tree-line shifts and change in hydrology of the area. Vegetative modification of montane flora and competition with domestic goats will create its prey's population to decline along with a chance of a direct conflict and competition with the common leopard. Common leopard being more adaptable, grouped, and larger in size can be a significant stressor for a smaller and solitary snow leopard. Habitat would shrink, and snow leopard can possibly move upslope or northward to central Asian ranges and their predicted migratory patterns are unknown.

O leopardo-das-neves (Panthera uncia) é um felídeo que vive nas áreas altamente acidentadas das regiões alpinas, em diferentes cadeias de montanhas do sul e do centro da Ásia. A revisão atual tem o objetivo de abordar a questão da possível perda de hábitat do leopardo da neve em razão da interferência humana nas montanhas do sul e do centro da Ásia. Esse animal solitário precisa de grandes espaços para suas faixas, mas, devido às mudanças climáticas e à taxa relativamente mais rápida de aquecimento global nas cadeias montanhosas do sul da Ásia, seu hábitat vai encolher e fragmentar-se por mudanças nas linhas de árvores e na hidrologia da área. Este artigo teve o objetivo de rever vários estudos sobre os impactos das mudanças climáticas em um futuro próximo e distante sobre os hábitats do leopardo-da-neve. O estudo revelou que a modificação vegetativa da flora da montanha e a competição com cabras domésticas poderiam ocasionar na diminuição da população de suas presas, com a chance de um conflito direto e competição com leopardo comum. Leopardo comum sendo mais adaptável, agrupado e maior em tamanho pode ser um estressor significativo para um leopardo-da-neve menor e solitário. Conclusão: devido ao encolhimento do hábitat, o leopardo-da-neve pode, possivelmente, mover-se para cima ou para o norte, para faixas da Ásia Central com padrões migratórios não previstos.

Epidemiologic studies targeting primary cardiovascular disease prevention in South Asia

South Asia has experienced a 73% increase in healthy life years lost due to ischemic heart disease between 1990 and 2010. There is a lack of quality data relating to cardiovascular risk factors and disease from this region. Several observational and prospective cohorts in South Asia have been established in recent times to evaluate the burden of cardiovascular disease and their risk factors. The Prospective Rural Urban Epidemiology (PURE) study is the largest of these studies that has provided data on social, environmental, behavioral and biologic risk factors that influence heart disease and diabetes. Some studies have also borrowed data from large datasets to provide meaningful insights. These studies have allowed a better understanding of cardiovascular disease risk factors indigenous to the South Asian population along with conventional risk factors. Culturally sensitive interventions geared towards treating risk factors identified in these studies are needed to fully realize the true potential of these epidemiologic studies.

A Framework for Addressing Implementation Gap in Global Drowning Prevention Interventions: Experiences from Bangladesh.

Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where there are implementation gaps in the drowning prevention interventions. This article reviews common interventions for drowning prevention, introduces a framework for effective implementation of such interventions, and describes the Saving of Lives from Drowning (SoLiD) Project in Bangladesh, which is based on this framework. A review of the systematic reviews on drowning interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The implementation framework builds upon two existing frameworks and categorizes the implementing process for drowning prevention interventions into four phases: planning, engaging, executing, and evaluating. Eleven key characteristics are mapped in these phases. The framework was applied to drowning prevention projects that have been undertaken in some LMICs to illustrate major challenges to implementation. The implementation process for the SoLiD Project in Bangladesh is used as an example to illustrate the practical utilization of the framework. Drowning interventions, such as pool fencing and covering of water hazards, are effective in high-income countries; however, most of these interventions have not been tested in LMICs. The critical components of the four phases of implementing drowning prevention interventions may include: (i) planning—global funding, political will, scale, sustainability, and capacity building; (ii) engaging—coordination, involvement of appropriate individuals; (iii) executing—focused action, multisectoral actions, quality of execution; and (iv) evaluating—rigorous monitoring and evaluation. Some of the challenges to implementing drowning prevention interventions in LMICs include insufficient funds, lack of technical capacity, and limited coordination among stakeholders and implementers. The SoLiD Project in Bangladesh incorporates some of these lessons and key features of the proposed framework. The framework presented in this paper was a useful tool for implementing drowning prevention interventions in Bangladesh and may be useful for adaptation in drowning and injury prevention programmes of other LMIC settings.

Ebola virus disease: Getting to know a new emerging foe.

Viral hemorrhagic fevers have been at the top of the severity scale in terms of morbidity and mortality among human beings. Many of the viruses have their reservoirs in animal kingdom and from time to time they get introduced to humans and cause sporadic outbreaks and epidemics. Thousands of people from the Western African region have already succumbed to the complications due to Ebola virus infection.</p> <p>The South East Asian region including India has been affected by several outbreaks of communicable diseases like SARS, bird flu, swine flu etc. The current outbreak has been a global concern due to its spread beyond the African continent. WHO has declared EVD as an international health emergency and worldwide efforts have been enhanced to escalate research to find a vaccine or cure for the disease.

Determinants of Infant And Child Mortality in Bangladesh: Time Trends and Comparisons across South Asia.

In spite of various effective intervention programs, the under-5 child mortality rate (U5MR) is still high in Bangladesh. The present paper focused on the levels, trends and determinants of U5MR in Bangladesh utilizing data from Bangladesh Demographic and Health Survey (BDHS), 2007. Differential pattern in U5MR in Bangladesh was examined using life table technique as a bi-variate analysis and Cox proportional hazard model was used to analyze the determinants of U5MR mortality. Data from BDHS (2007) showed that U5MR during the five years preceding the survey was 65 per 1,000 live births, i.e. one in fifteen children born in Bangladesh died before reaching the fifth birthday. The risk of dying in the first month of life (37 per 1,000) was nearly two and a half times greater than in the subsequent 11 months (15 per 1,000). Deaths in the neonatal period accounted for 57 percent of all under-five deaths. In the Cox proportional hazard model analysis, factors such as the place of residence, parent’s education, father’s working status, sources of drinking water, type of toilet facility, wealth status, watching of television, mother’s age, months of breastfeeding, birth interval had significant influence on infant and child mortality. The most significant predictors of neonatal, post-neonatal, infant and child mortality were residence, parent’s education, type of toilet facility, wealth status, watching TV, months of breastfeeding, and birth interval. Despite the improvement of medical technology, child mortality remained alarmingly high, indicating that demographic, socioeconomic, household and environmental conditions must be improved to substantially reduce child mortality in this population.

Prevalence and risk factors for psychological distress and functional disability in urban Pakistan.

Background: There is a close association between poor mental health status and both poor physical health and decreased productivity. An evidence base on the risk factors for psychological distress in low-income countries is lacking and is much needed to help develop appropriate interventions. We aimed to estimate the prevalence of psychological distress in urban Pakistan and identify associated risk factors and functional disability. Methods: This was a population-based study of 18–75-year-olds in urban Pakistan. The Self-Reporting Questionnaire (SRQ) was offered to 1000 adults to measure psychological distress. The Life Events Checklist, Oslo-3 for Social Support and Brief Disability Questionnaires were used to establish social stressors, support and functional disability. Results: Questionnaires were completed by 880 (94%) eligible participants, of whom 41% of women and 19% of men scored 9 or more on the SRQ (possible range 0–20). Low educational status was associated with high rates of psychological distress. Women had significantly higher levels of distress than men and were less likely to receive practical support. Conclusions: The prevalence of psychological distress was lower in urban Karachi than that reported previously for rural Punjab province, Pakistan. However, in urban Karachi, as in rural Punjab, socioeconomic status seemed to have more of an impact on the mental health of women than that of men.

Medical Humanities.

Medical humanities (MH) have been described as using subjects traditionally known as the humanities for specific purposes in medical education. Learning MH provides a number of advantages to medical students. I have been involved in facilitating MH sessions for over seven years. MH modules are still not com-mon in South Asia. There are various challenges in initiating a MH module in a medical school in south Asia. MH modules should be driven by the energy and creativity of facilitators in each medical school, should use small group learning strategies and be fun.

Elderly and Dementia in Nepal / 国際保健医療

<b>Background</b><BR>  Dementia is defined as a decline in cognition or behavior in one or more of the following areas: memory, social-interpersonal behaviors etc. It is regarded differently depending on the society of each country. To compare the effect that it has on Japanese society, we started research in Nepal.<BR><b>Methods</b><BR>  We asked Medical doctors and nurses in remote areas and the capital city in Nepal about their awareness of dementia. We also examined the elderly in communities and hospitals, using the Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale Revised (HDS-R), and asked family members about the elderly’s daily life and checked Clinical Dementia Rating (CDR).<BR><b>Results</b><BR>  Three out of six medical staff members in remote areas did not know the word “dementia.” However, most medical staff had seen cases of suspected dementia. The averages and deviations of MMSE and HDS-R in 6 elderly in community were 16±4.2 and 17±5.0, respectively. The average of CDR was 0.9.<BR><b>Conclusions</b><BR>  There was a lack of awareness about dementia in remote areas. Nepali society was found to be tolerant of aging and dementia.

Prevalence of Vitamin A Deficiency in South Asia: Causes, Outcomes, and Possible Remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot’s spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stern efforts are needed to address this issue of publichealth significance at local and international level in lower- and middle-income countries of South Asia.

Zinc Status in South Asian Populations—An Update.

This article attempts to highlight the prevalence of zinc deficiency and its health and economic consequences in South Asian developing countries and to shed light on possible approaches to combating zinc deficiency. A computer-based search was performed on PubMed, Google, and ScienceDirect.com to retrieve relevant scientific literature published between 2000 and 2012. The search yielded 194 articles, of which 71 were culled. Studies were further screened on the basis of population groups, age and sex, pregnancy, and lactation. The most relevant articles were included in the review. Cutoffs for serum zinc concentration defined for zinc deficiency were 65 μg/dL for males and females aged <10 years, 66 μg/dL for non-pregnant females, and 70 μg/dL for males aged ≥10 years. Population segments from rural and urban areas of South Asian developing countries were included in the analysis. They comprised pregnant and lactating women, preschool and school children. The analysis reveals that zinc deficiency is high among children, pregnant and lactating women in India, Pakistan, Bangladesh, Sri Lanka, and Nepal. Diarrhoea has been established as a leading cause to intensify zinc deficiency in Bangladesh. Little has been done in Sri Lanka and Nepal to estimate the prevalence of zinc deficiency precisely. A substantial population segment of the South Asian developing countries is predisposed to zinc deficiency which is further provoked by increased requirements for zinc under certain physiological conditions. Supplementation, fortification, and dietary diversification are the most viable strategies to enhancing zinc status among various population groups.

Barriers to and Facilitators of Antiretroviral Therapy Adherence in Nepal: A Qualitative Study.

Patient’s adherence is crucial to get the best out of antiretroviral therapy (ART). This study explores in-depth the barriers to and facilitators of ART adherence among Nepalese patients and service providers prescribing ART. Face-to-face semi-structured interviews were conducted with 34 participants. Interviews were audiotaped, transcribed, and translated into English before being analyzed thematically. ART-prescribed patients described a range of barriers for failing to adhere to ART. Financial difficulties, access to healthcare services, frequent transport blockades, religious/ritual obstacles, stigma and discrimination, and sideeffects were the most-frequently discussed barriers whereas trustworthy health workers, perceived health benefits, and family support were the most-reported facilitators. Understanding barriers and facilitators can help in the design of an appropriate and targeted intervention. Healthcare providers should address some of the practical and cultural issues around ART whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.

Incidence of Bladder Cancer in Sri Lanka: Analysis of the Cancer Registry Data and Review of the Incidence of Bladder Cancer in the South Asian Population

PURPOSE: To investigate the incidence of bladder cancer (BC) in Sri Lanka and to compare risk factors and outcomes with those of other South Asian nations and South Asian migrants to the United Kingdom (UK) and the United States (US). MATERIALS AND METHODS: The incidence of BC in Sri Lanka was examined by using two separate cancer registry databases over a 5-year period. Smoking rates were compiled by using a population-based survey from 2001 to 2009 and the relative risk was calculated by using published data. RESULTS: A total of 637 new cases of BC were diagnosed over the 5-year period. Sri Lankan BC incidence increased from 1985 but remained low (1.36 and 0.3 per 100,000 in males and females) and was similar to the incidence in other South Asian countries. The incidence was lower, however, than in migrant populations in the US and the UK. In densely populated districts of Sri Lanka, these rates almost doubled. Urothelial carcinoma accounted for 72%. The prevalence of male smokers in Sri Lanka was 39%, whereas Pakistan had higher smoking rates with a 6-fold increase in BC. CONCLUSIONS: Sri Lankan BC incidence was low, similar to other South Asian countries (apart from Pakistan), but the actual incidence is likely higher than the cancer registry rates. Smoking is likely to be the main risk factor for BC. Possible under-reporting in rural areas could account for the low rates of BC in Sri Lanka. Any genetic or environmental protective effects of BC in South Asians seem to be lost on migration to the UK or the US and with higher levels of smoking, as seen in Pakistan.

Small group facilitation skills in problem-based learning.

Medical schools are increasingly changing over to a problem-based system of learning. Students work in a small group to analyze a well-structured, clinically relevant patient case. Problem Based Learning (PBL) provides a logical approach in training students for practicing medicine in a complex environment by exposing them to simulated problems which may reflect real life situations. PBL requires a change in mindset on the part of both the learner and the teacher/facilitator. For tutors, metacognitive skills, i.e. the ability of active, positive, conscious monitoring and direction of activities carried out by the students who were confronted with a problem, clear communication, and awareness of the learning needs of the students are rated as important. The ‘knowledgeable’ teacher no longer dominates learning, and students and teachers became equal partners in the learning process. Teachers/facilitators are requested not to give answers but to provide students with more room for active self-learning. An effective PBL tutor has the ability to communicate informally with students and has an empathic attitude which creates an atmosphere in which open exchange of ideas is facilitated. Programmes to improve PBL facilitation skills have been carried out in various institutions in the South Asian region. The positive impact of these training programmes highlights the need for workshops to develop such facilitative skills among South Asian medical educators. Problem-based learning should gradually become the more important and more widely used method of learning compared to didactic lectures.