CABI Blogs: hand picked... and carefully sorted

Mystery disease in Ethiopia solved: linked to weed toxin

Imagine this…

A mysterious disease terrorising your community, not infectious but spreading nonetheless, and killing your relatives and neighbours. All you want to do is pack your bags and flee. Worse, when your plight comes to the attention of the health authorities, they are stumped and its not going to be easy or quick to solve.

A recent example of this kind of illness is “nodding disease” (South Sudan, Uganda, and Tanzania), which affects children 5-15 years old: they suffer epileptic seizures which causes their heads to nod, and they end up severely disabled and finally die. The USA’s Centre for Disease Control (CDC) is working to identify the cause: so far, the best guess is that it’s linked to the parasite that causes river blindness combined with an autoimmune reaction, and exposure to chemicals could predispose.

Other examples of non-communicable disease outbreaks

On Global Health, I found there are outbreaks going back to 1911 (epidemic dropsy) but more recent ones were in India,  Bangladesh, Nigeria, Brazil, China, Afghanistan and even the USA.

 What are the likely causes for these outbreaks? The body of research, as found on databases like Global Health, tells us that they could be contamination of food and water supply, exposure to chemicals or heavy metals in the environment, or even use of traditional medicine.

 Mystery liver disease in Ethiopia with a ‘happy’ ending

Can public health authorities in low-income countries solve & stop such outbreaks?   Yes. In 2005, in Ethiopia, a 4 year long outbreak of liver disease in Tseda Emba, a small village of the Tahtay Koraro district of Tigray, finally reached the attention of the Tigray Health Bureau (THB). Now, in 2012, the multidisciplinary and one-health approach they initiated has “solved” the mysterious illness, significantly reducing new cases. 

 The research work was the subject of an entire session at the recent World Congress Public Health (WCPH-2012) in Ethiopia, and is now published as 5 papers in the supplement to April 2012’s edition of Ethiopian Medical Journal (EMJ). [Abstracts to these papers will be available on Global Health]. It demonstrates the relevance of the one-health approach to public health in low-income countries and is a fascinating detective story….

Jumping the red light – Do consumers pay attention to nutritional labels?

There have been many labelling schemes to make clearer to consumers the healthiness of foods, such as traffic light codes with green for healthy and red for less healthy. But do consumers actually make use of the labels and choose healthier foods?
In a paper in CAB Reviews, Sophie Hieke and Jo Wills of the European Food Information Council examine the recent evidence. A consistent finding is the “attitude-behaviour gap, meaning that consumers will say one thing and do another.” Some experiments suggest that people will try to avoid “red traffic-light” foods. However, a German study showed people could distinguish the healthiest drink using such a “traffic-light” coding system, but did not choose the healthy option when picking out their meal for the next day.

Is there a role for law(yers) in public health?

ITS not often that speakers forgo the chance to present in favour of opening up debate, but this is exactly what happened here at the World Congress Public Health 2012 (Addis Ababa, Ethiopia,Tuesday April 24), in the session “Law: a public health tool”. Moderator, Michele Forzley, chose not to talk on access to medicines in favor of a longer group discussion, following presentations from 3 African speakers on law related to women’s rights, public health emergencies, and setting up NGOs.

Split into small groups,  we, the audience, were asked to identify public health issues which persisted despite knowing the cause and cure, and despite the existence of laws providing protection. The speaker panel then commented on the identified issues, relating them to existing law in their various countries and suggesting why the law had failed to protect.. Michelle Forzley supplied the international perspective. 

Issues identified by the groups related to LMICs (low and middle income countries) and included khat use by young people in Ethiopia; environmental pollution from mining; migrant rights; counterfeit drugs, poor quality breast milk substitutes; training needs of public health workers to enable them to defend and advocate effectively for public health law enforcement; and food labelling/quality, particularly of imported foods.

How tai chi is good for the heart

As an Editor with varied responsibilities at CABI, information I come across at work often overlaps with what I do away from my desk. Thus, as a long-time practitioner of tai chi who isn't getting any younger, I was interested when looking for subjects to write about for the Leisure Tourism Database, to come across the latest piece of research on the health benefits of tai chi for 'older adults'.

The study from Hong Kong, recently published online in the European Journal of Preventive Cardiology, found that older subjects regularly practicing tai chi were less likely to suffer high blood pressure, and were physically stronger in particular areas such as the knees.

Is three minutes exercise a week enough?

 On Tuesday evening this week, television viewers in the UK got to see a BBC programme investigating claims that just three minutes intensive exercise a week could give significant health and fitness benefits. Presented by medically-trained Michael Mosley, the research presented seems to be counter to current recommendations for "at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more" or "75 minutes of vigorous intensity activity spread across the week", which are the guidelines in the UK.

For a lot of people, lack of time after work and family commitments are met is either a genuine reason for not getting enough exercise, or alternatively a convenient excuse for not exercising regularly. An alternative is offered by High Intensity Training (HIT), which some researchers claim can improve aerobic fitness, burn fat and improve insulin sensitivity in just a few 20-30 second bursts of maximum effort a week.

Tuberculosis treatment- end of an era?

The 1940s saw the beginning of the era of effective drug therapy for TB with the discovery of streptomycin. At the beginning of the 21^st century we are seeing its end. Last month doctors in India reported an outbreak of a strain of TB that was termed totally drug resistant. It could be a false alarm because as it turns out the strains were not tested against all known drugs for TB but they were resistant to all 12 of the most common first and second line drugs.

Unfortunately India wasn’t the first place to report totally drug resistance such strains were reported in Italy in 2007 and Iran in 2009. Its presence in India is a concern, say experts because of the large poor population living in crowded conditions and government funded treatment of only simple TB cases.

TB develops drug resistance readily, probably aided by the long treatment times needed. Drug resistant strains followed very soon after the development of the first anti TB drugs and multiple drug resistant (MDR) forms heralded the resurgence of TB globally in the 1980s.

In response the World Health Organization developed the DOTS strategy, where adherence to the drug regime is ensured by observing the patient each time they take a drug dose. But despite this half a million cases of MDR TB occur each year because of poor adherence, poor quality drugs or erratic supply of drugs.

In 2006 the next step on the slippery slope to an incurable TB was the appearance of extremely drug resistant TB in an outbreak in South Africa. This was resistant to first and some secondline drugs.

This increasing drug resistance puts recent progress in decreasing the number of worldwide TB cases in jeopardy.

What can be done? Early diagnosis and testing and a better vaccine would go a long way to getting cases early and giving the right drugs. Treating early and accurately will stop the spread of TB.

TB diagnosis is antiquated - requiring use of microscopy in low resource settings. Matters are complicated by unreliable blood tests on the market which are attractive, quick to do and cheap. WHO issued a warning about those last year.

Progress is being made towards a rapid test. The Xpert MTB/RIF assay is a real-time PCR assay that is fully automated, and that has demonstrated high performance and could be deployed in a range of low- and middle-income settings. The World Health Organization (WHO) has publicly backed it.

World TB day is on 24^th March 2012. Join the campaign against this disease of poverty here.

CABI is publishing a book about tuberculosis this year: Tuberculosis diagnosis and treatment.

See Global Health Knowledge Base for access to Global Health abstracts on tuberculosis

Photo credit: Janice Haney Carr

No strings attached: public health messages from puppets!

Image:Loren Javier           Father Christmas & wife puppets         Happy Christmas!
                                                                                       

One intriguing way of getting health messages across to communities who are illiterate and whose spoken language may not even have words to describe the medical concept, is to entertain them. Travelling theatre groups  in Africa sing or act out AIDs prevention stories, board games educate children on climate or help mothers cope with domestic violence, and, not to be left out, there is now an online game that can support the fight against hunger (see UN food aid agency helps create online game to fight hunger)

Another way is storytelling with puppets and I am going to tell you about the work of one particular company No Strings.

Superfood Beetroot: just in time, for me…

Beetroot: amortize/flickr

THANK you dear Libby Purvis for having Italian chef Antonio Carlucci on to talk about beetroot recipes in your BBC Radio4 show, Midweek, (Wednesday 9 November)!

The recipes feature in his BBC TV Great British Food Revival Series 2, programme-7: Beetroot & Currants.  On Midweek, he mentioned an Exeter University study (UK) where cyclists are being fed the stuff (beetroot juice, packed with betalains and nitrates) to improve performance.

Well here in this blog, for your delectation, is the link to the actual research!  We have it on our public health database Global Health, and you can read the detailed summary with the URL I have provided. There you will see that just (!) O.5 litre beetroot juice, was taken 2.5 hours before cycling. The result? The juice increased power output, a measure of performance, in both 4km (up by 2.7%) and 16.1 km (up by 2.8%) cycling time trials.I know you will be glad to see that for completeness, I’ve also included an earlier blog about beetroot’s ability to reduce blood pressure (“Beetroot with everything”)!

August babies lack self-esteem

Image:'popofatticus

This week we heard that being born in August in England leads to lack of self-esteem and a lifelong tendency to underachieve (Does when you are born matter?, from Institute of Fiscal Studies (IFS)). This appears to be a follow-up study to one focussed on primary school children in 2007, and it certainly got covered well: BBC, Guardian and Telegraph to name just a few.

Speaking as an August baby, the only reason why I grew up lacking confidence and my brother, also an August baby, lacked self-esteem (note the difference between us) was that we had a father who was, frankly, a bully. For us, school was an escape; weekends could be very hard.

So you can imagine what I first thought when I heard about the study on BBC Radio4 Tuesday morning (1/11/2011). My second more rational thought was about this link to underachievement, with 20% less of us going to Russell Group universities. Is it linked to our school year starting in September, is it therefore confined to the UK? Is it linked to day length? Is there a difference between decades reflecting changes in society?

The answer to my questions would lie in studies of August-born children in northern France, or southern parts of Scandinavia, or closer to home, Eire.  Or looking at other countries which have cut-off dates for school entry. Very close to home, it’s February cut-off in Scotland.

I went looking on CABI's public health database, Global Health, for studies on health or educational attainment or adult socioeconomic status, which others may have also linked to birth month (see Further Reading for some examples).

NICE people lend a helping hand

“Nice” is not a word often used in scientific research and when it appears in the UK media, it’s now associated with NICE, National Institute for Health & Clinical Excellence.

More often than not this government organisation makes headlines with bad news: the press reports quickly when a drug is not approved for general use by the NHS. Occasionally the news concerns a drug approval, after a long campaign by an individual and their family.

So attending the Global Health 2011 at the BMA, London, made a very NICE change.  It was an eye-opener to see that an offshoot of NICE, “NICE International”, is making a real positive difference to health systems in many countries.

Funded solely by their client countries and international donors (World Bank, DFID and IADB, to name a few), NICE International has sent its adviser teams into Latin America, China, Georgia and India to improve clinical practice  and help them develop relevant guidelines. These countries may even set up their very own NICE organisation.