CNS: September 2014

Early diagnosis of female genital TB can reduce morbidity

Dr AG Radhika, CNS Columnist

Photo credit: CNS: citizen-news.org

Tuberculosis (TB) is an important health problem in the low and middle income countries. Pulmonary TB is estimated to have affected about 14 million people in India, most of who are in the reproductive age group. About 12% of women with pulmonary TB also suffer from female genital TB (FGTB). FGTB constitutes almost 9% of extra-pulmonary cases of TB and 13% of gynaecological admissions in India. Infertility is the most frequent clinical presentation of FGTB (43%-74%).

Dr Meenu Singh, co-chair
22nd Cochrane Colloquium

Shobha Shukla, CNS Columnist
Very often the plea for simple and effective healthcare for children gets drowned in the din of voices of vested interests (including those of pharmaceutical companies) that clamour to draw attention to long lasting adult diseases like cardiac, neurological, and diabetes problems, just to name a few. Producing/selling drugs for them is far more profitable than for childhood diseases like diarrohea and pneumonia, which have a short span, and so are nobody’s baby. It is high time we stood up for the cause of evidence based healthcare for children.

Rhythm of the heart

Dr Bobby John, CNS Columnist

A little fluttering in the chest or pounding of the heart is all too familiar and a common phenomenon that we often ignore; rightly so, when it is before a public speech or while we run to catch a bus or train that is leaving the platform. These are normal responses to stressful events. However, when it occurs without any rhyme or reason, then we ought to give it some thought.

Wikipedia and Cochrane collaboration: Big push for evidence-informed public health

Shobha Shukla and Bobby Ramakant, CNS

Dr David Tovey

The Cochrane Collaboration has undoubtedly succeeded in deepening the roots of evidence-based medicine, policy and practice, despite challenges and limitations. How to ensure that healthcare professionals, policy makers, and citizens can have access to this reliable and trustworthy evidence while making decisions is indeed a key challenge. At 22nd Cochrane Colloquium, Wikipedia and Cochrane collaboration attracted huge attention: because it can indeed be a potential game-changer in terms of widening the audience manifold, astronomically!

Knowledge translation into policy is not automatic, it is political: Dr Binayak Sen

Shobha Shukla and Bobby Ramakant, CNS

"Translation of knowledge into policy is not automatic. It is a political process" said Dr Binayak Sen, a recipient of prestigious Jonathan Mann Award for Global Health and Human Rights in 2008. He spoke to Citizen News Service (CNS) at 22nd Cochrane Colloquium in Hyderabad, India, and remarked that "technical advancements in informatics and processing of information and the impulse towards democratization of knowledge structures have come together at this Colloquium. Coming together of these two processes will create an impulse for genuine democratization of medical knowledge. We are looking forward to the day when everybody will be able to access all the medical knowledge in the world. At least there should be no barrier for people who want to access knowledge from medical system."

Medical malpractices: Is there light at the end of the tunnel?

Shobha Shukla and Bobby Ramakant, CNS

Dr Peter Gotzsche

The noblest professional of all-to heal fellow human beings- is certainly witnessing its worst decay. Dr Peter Gotzsche, Director, Nordic Cochrane Centre and Professor in University of Copenhagen, said to Citizen News Service (CNS): "There is a lot that needs to change in healthcare. It is one of the most corrupted sectors in society. In Denmark, for example, we have thousands of doctors who are on industry payrolls - they are consultants, they sit on advisory boards - but in reality it is a soft form of bribery because if you do not behave as expected you will no longer be on the payroll." Dr Gotzsche is one of the sanest voices in medical fraternity striving hard to bring evidence-based medicine, ethics and integrity back in fashion.

Dr Jeremy Grimshaw

Shobha Shukla and Bobby Ramakant, CNS
Till recently, medical schooling curriculum did not include training for searching medical literature, doing systematic reviews or finding credible evidence from time-tested repositories such as The Cochrane Library. But in the last decade or so, medical training has incorporated some of the evidence-based medicine principles in countries such as Canada. Dr Jeremy Grimshaw, Director of Canadian Cochrane Centre and current co-chair of The Cochrane Collaboration globally spoke with Citizen News Service (CNS) on the sidelines of 22nd Cochrane Colloquium in Hyderabad, India.

Prof Lisa Bero
Photo credit: UCSF

Shobha Shukla and Bobby Ramakant, CNS
The World Health Organization (WHO) has accepted the Cochrane Collaboration, the largest repository of systematic reviews that provides reliable and thorough evidence on healthcare, as a non-governmental agency in "official relations with WHO". This collaboration between the two can potentially accelerate the uptake of evidence-based medicine, health policy and practice. Citizen News Service (CNS) interviewed Professor Lisa A Bero, the key leader in the Cochrane Collaboration who helped make this synergistic two-ways linkage happen in 2011.

Hyderabad to Cape Town: Evidence driving medical research and health systems strengthening

Shobha Shukla and Bobby Ramakant, CNS

Prof Jimmy Volmink

"We develop medicines and other therapies which are based on very good research, but then we offer those therapies often in ways that are untested and have never been evaluated. So there is a natural progression from making sure that our treatments are evidence-based, to the next phase of ensuring that the way we offer those treatments to people is also evidence-based” said Professor Jimmy Volmink, Director of South African Cochrane Centre and Dean, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Chhatra Karki, CNS Correspondent
Situated at an altitude of 2,400 metres, Toplang, a village in the South West district of Dhading, Nepal, has been successfully maintaining its identity as an 'organic village' of the country. The village is merely an hour's drive along the Chandragiri hill from Kathmandu's Thankot pass.

Dr Pradeep K Srivastava

Kulsum Mustafa, CNS Correspondent
Every minute a child dies from malaria. According to the World Health Organization (WHO), half of world's population is at risk of malaria. "Mosquito borne diseases are a major health problem in India. Globally every year 3.4 billion people are at risk. Early diagnosis and prompt treatment of malaria prevent deaths," said Dr Pradeep K Srivastava, a well known 'scientoonist'. He advised that adequate preventive dose of malaria are a must when one is visiting a mosquito-prone place. Urging medical alertness and timely blood tests if fever persists beyond a day, Dr Srivastava said that timely detection of malaria and proper medication can help prevent death.

Overcoming roadblocks in translating evidence-based healthcare into public health gains

Shobha Shukla and Bobby Ramakant, CNS

Dr Prathap Tharyan, Director, SACNC
Photo credit: SACNC

Commendable progress has been made in the South Asian region to advance evidence-based healthcare and let evidence inform policy and programmes at different levels. But there have been roadblocks too that are slowing down the progress. Citizen News Service (CNS) spoke with Dr Prathap Tharyan, Director, South Asian Cochrane Network and Centre, who has led from the front on the cause of evidence-based healthcare in this region, and globally. Dr Tharyan is also the co-chair of the 22nd Cochrane Colloquium, which is taking place for the first-time ever in the South Asian region in Hyderabad, India.

Dr Matthew Varghese

Shobha Shukla and Bobby Ramakant, CNS
Corporate capture of healthcare in India has got much less attention than it should. Systematic weakening and dis-crediting of public health system, deepening roots of a bias towards private healthcare system, corporations chipping in with 'profit before people' principles, corruption and malpractices, shifting scales of public versus private medical education, strong influx of public healthcare experts in private sectors, sky-rocketing prices of medical care, drugs and diagnostics, and most importantly, less takers of evidence-based healthcare among doctors, policy makers and people at large, are just some of the reasons which are responsible for the state of healthcare in the country.

Evidence-based medicine is the basis of sound healthcare

Shobha Shukla and Bobby Ramakant, CNS

Dr Gordon Guyatt

Evidence based medicine (EBM) emphasizes the use of evidence from robust research in healthcare decision-making. It is the conscientious and judicious use of current available best evidence in making decisions about the care of individual patients. It integrates individual clinical expertise with the best available external clinical evidence obtained from systematic research and with the patient's values and expectations. It informs the doctor which drugs and procedures are best for treating diseases.

Shobha Shukla and Bobby Ramakant, CNS
For management of disasters and humanitarian crises, doing something is not enough—but doing the right thing at the right time is. Decision-makers need to know which interventions, actions and strategies would work, which would not work, and which, no matter how well-meaning, might be harmful. They need to make well informed choices and decisions and for this they need access to reliable evidence.

When natural disasters happen: do more good than harm!

Shobha Shukla and Bobby Ramakant, CNS

Whenever natural disasters and humanitarian crises occur, enormous amount of resources are spent on relief and aid services, albeit without knowing whether they will do more good than harm. At a pre-conference symposium organized by Evidence Aid, before 22nd Cochrane Colloquium opens in Hyderabad, India, the message was clear from those with experience in disaster management activities: despite best intentions, lot of interventions are happening without strong evidence that they actually do more good than harm.

Shobha Shukla, CNS Columnist
Well, any right-minded person would say NO. But the global, as well as the local media, has castigated India for not ratifying the Protocol of Amendment for the Trade Facilitation Agreement (TFA) at the recent World Trade Organization (WTO) negotiations in Geneva in July 2014, and for linking it to discussions for a permanent solution to the G-33’s Food Security Proposal. India’s refusal to tow the line of developed countries has caused worldwide uproar.

Nenet Ortega, CNS Correspondent, Philippines
A government hospital is usually the preferred facility to seek medical and clinical consultation by people in a rural community and they do come when they are already sick. Everyday hundreds of clients seek consultation. A review of the out patients census and data for the first two quarters of 2014 in a hospital in Philippines showed that the top three leading causes for which patients sought medical and clinical consultation were--TB, upper respiratory tract infection/asthma and pneumonia.

Dr Aparna Srikantam, LEPRA

Genital tuberculosis (TB) is one of the major causes of tubal infertility. Some studies show that only two per cent of women with genital TB have live births. Genital TB is usually asymptomatic so needs higher degree of clinical suspicion so that accurate and confirmed diagnosis of TB can be made and standard anti-TB treatment provided as early as possible. But the challenge is that current range of standard diagnostic tests are less likely to pick up every case of genital TB.

Shobha Shukla, CNS Columnist
Abused by her own family in childhood, Bela (name changed) was sold by a relative and trafficked to India. She eventually came out of her harrowing ordeal, turned her life around and became a peer counsellor and educator with Family Planning Association of Nepal (FPAN). She was supported for 5 years by the anti trafficking project of FPAN. But once the project got over she was once again left to fend for herself.

Eranga Isaac, CNS Correspondent, Nigeria
It has been established by health experts in Nigeria that indoor and outdoor environments are usually polluted by multifarious mixtures of gases and particles that are produced by combustion of various types of fuels. Sources of indoor pollution include cooking stoves, cigarettes smoking, burning of various fuels for indoor heating, burning of mosquito coils and burning of incense for religious purposes and defecating in the living room.

Babs Verblackt, CNS Correspondent, Belgium
Progress made in tuberculosis control is at risk of being undermined by the rapid rise of diabetes in regions where both diseases are prevalent, experts warn. Patients living with diabetes are especially vulnerable to catching the lung disease. Improved care and increased efforts to diagnose and treat both diseases are urgently needed.

Shobha Shukla
It has been one year since you left us. And yet not a day has gone by when your invisible, but all pervading, presence was not felt by us. You had touched the lives of not only your near ones but even those who had never met you personally and had heard about you through common friends.

Strangely, during this one year I never ever felt the urge to mourn your loss, rather your remembrance fills my mind with peace and an indescribable calm.

Chhatra Karki, CNS Correspondent, Nepal
The degradation of indoor air quality is a critical issue throughout the world today, which is convicted for causing severe impacts on human health. World Health Organization (WHO) reports that around 38 million of the global population is forced to face untimely death every year due to household air pollution. To aggravate the matter, indoor air pollution is catapulting the number of the people contracting maladies like pneumonia, stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD), lung cancer, and others.

Know your epidemic: First-ever national anti-TB drug resistance survey launched

Shobha Shukla and Bobby Ramakant, Citizen News Service – CNS

India took a historic step for control and management of multidrug-resistant tuberculosis (MDR-TB) when the Union Health and Family Welfare Minister of Government of India, Dr Harsh Vardhan formally launched the first-ever nationwide anti-TB drug resistance survey (2014-2015) on 6th September 2014 in New Delhi.

Diana Wangari, CNS Correspondent, Kenya
(First publish in The Star News, Kenya): Early in the morning, the scene in large areas of rural Kenya is that of women walking towards their kitchen, often situated in a separate structure next to their living quarters. Homestead after homestead, the woman gathers firewood beneath her three stone make shift cooker or begins the process of getting the coal on the jiko to light.

Owen Nyaka, CNS Correspondent, Malawi
People all over the world are living in homes with poor indoor air quality. This can have profound health impacts. According to the World Health Organisation, 4.3 million people die prematurely every year from illnesses attributed to household air pollution. These illnesses include pneumonia, stroke, ischaemic heart disease, chronic obstructive pulmonary disease (COPD), and lung cancer. There is also evidence of links between household air pollution and low birth weight, tuberculosis, cataract, nasopharyngeal and laryngeal cancers.

Shobha Shukla, CNS Columnist
Findings of the World Health Organization (WHO) confirm that, ‘Air pollution is now the world’s largest single environmental risk’. Globally, 7 million people die each year because of exposure to air pollution, which means that 1 in 8 deaths occurring worldwide are due to breathing dirty air. While outdoor air pollution is responsible for 3.7 million of these deaths, surprisingly more deaths — 4.3 million — are linked to indoor air pollution chiefly caused by use of solid fuels for cooking and heating. Add to this smoking tobacco and e-cigarettes, and you have a veritable inferno of deadly air circulating within closed doors.