South-East Asia Regional Office Research Articles

A National Assessment of Public Health Instructions in Medical Schools of Thailand

Epidemiological transition, population ageing, and pandemics posed new challenges to the health system. Current global situation demands many new competencies within the scope of teaching public health in medical schools. The aims of this study were to identify the needs of public health competencies for medical doctors in Thailand and to assess the level of integration for technical collaboration in teaching public health. The national survey of all Thai medical schools applied the list of public health competencies framework recommended by the World Health Organization, Southeast Asia Regional Office (WHO-SEARO). Qualitatively, community representatives from 11 sample villages were interviewed in the focus groups and representatives from stakeholder organizations, particularly employers in the in-depth interviews. Data integration applied recursive mixed-method approach. While the survey identified that health economics, disaster management, leadership, and teamwork are not well addressed in curriculum, employers, and national health authority uttered the need to strengthen the health system sciences and leadership in new generation medical doctors. Almost two third of medical schools could not apply interdisciplinary integration to teach such public health subjects. Furthermore, experiential learning and role play are recommended, in addition to the usual teaching method and multiple-choice questions. Thai communities expect doctors to serve the community, lead the primary healthcare team and train the health professionals and community health volunteers. Therefore, future medical doctors require interdisciplinary competencies. The findings of this study may provide evidence to step forward to a national framework of public health core competencies and interdisciplinary collaborations.

Bacterial coinfection among coronavirus disease 2019 patient groups: an updated systematic review and meta-analysis

The pandemic of severe acute respiratory syndrome coronavirus 2 raised the attention towards bacterial coinfection and its role in coronavirus disease 2019 (COVID-19) disease. This study aims to systematically review and identify the pooled prevalence of bacterial coinfection in the related articles. A comprehensive search was conducted in international databases, including MEDLINE, Scopus, Web of Science, and Embase, to identify the articles on the prevalence of bacterial coinfections in COIVD-19 patients from 1 December 2019 until 30 December 2020. All observational epidemiological studies that evaluated the prevalence of bacterial coinfections in patients with COVID-19 were included without any restriction. Forty-two studies including a total sample size of 54,695 were included in the analysis. The pooled estimate for the prevalence of bacterial coinfections was 20.97% (95% CI: 15.95–26.46), and the pooled prevalence of bacterial coinfections was 5.20% (95% CI: 2.39–8.91) for respiratory subtype and 4.79% (95% CI: 0.11–14.61) for the gastrointestinal subtype. The pooled prevalence for Eastern Mediterranean Regional Office and South-East Asia Regional Office was 100% (95% CI: 82.35–100.00) and 2.61% (95% CI: 1.74–3.62). This rate of coinfection poses a great danger towards patients, especially those in critical condition. Although there are multiple complications and adverse effects related to extensive use of antibiotics to treat patients with COVID-19, it seems there is no other option except applying them, and it needs to be done carefully.

Implications of Birth-Dose Vaccination against Hepatitis B Virus in Southeast Asia.

The World Health Organization (WHO) South-East Asia Regional Office (SEARO) covers 11 countries with a combined population of about 2 billion people, making it the most populous of the six WHO regions. In 1992, the WHO advocated including the hepatitis B vaccine in the Expanded Program of Immunization (EPI) and vaccinating all infants and children three times within 1 year of birth (HepB3). Recently, the WHO advocate birth-dose hepatitis B vaccination (HepB-BD) as soon as possible after birth, preferably within 24 hours. In 2016, the SEARO endorsed a regional hepatitis B control goal with a target of hepatitis B surface antigen (HBsAg) seroprevalence of ≤1% among children aged ≥5 years by 2020. Of the 11 SEARO countries, four achieved this target on schedule. Out of these four countries, two countries (Bangladesh and Nepal) have not adopted HepB-BD in EPI program. On the other hand, the coverage of HepB3 is not satisfactory in some SEARO countries, including India which adopted HepB-BD but could not achieve the overall target of SEARO. Thus, it is a point of debate whether emphasis should be placed on proper implementation of HepB3 or whether a new agenda of HepB-BD should be incorporated in developing countries of SEARO. The article discusses strengthening and expanding the Hepatitis B vaccination program in SEARO countries with an emphasis on HepB and HepB-BD programs.

Entomological Index and Home Environment Contribution­ ­to Dengue Hemorrhagic Fever in Mataram City, Indonesia

Indonesia is a member of Southeast Asia Regional Office (SEARO) ranked the first in dengue hemorrhagic fever (DHF) problem based on incidence rate (IR)and case fatality rate (CFR). Several provinces in Indonesia experience an outbreak, one of which is the Mataram City in West Nusa Tenggara Province.Mataram City is an endemic area of DHF because the DHF cases are always found in three consecutive years with the number of cases that fluctuate andtend to increase. This study aimed to obtain factors that could be used to improve early warning systems in controlling DHF. This study used a case controldesign with a ratio of 1:1 to 180 house holds. The results showed that home environmental factors, such as no ceiling, indoor and outdoor temperature thathad the potential for breeding places for mosquitoes, no wire net in ventilation, low lighting and high humidity, related to DHF transmission. Vector distibutionwith entomology index showed that the existence of larvae, eggs and mosquitoes played a role in dengue transmission. The dominant factors affecting the transmission of dengue in Mataram City are the condition of the ceiling and the existence of mosquito eggs in the house.

Cora Du Bois' Brief Stint With the World Health Organization (1950-1951): Right Time, Wrong Place.

Brock Chisholm, director-general of the World Health Organization (WHO) in the early 1950s, was heard to say that "one cultural anthropologist [Cora Du Bois] was worth one hundred malaria teams." Paul Russell, the leading malariologist at the time, responded (privately in his diary) that Chisholm's remark was the sort that "one might expect from a psychiatrist planning a world health program." George Foster reported that Du Bois "was completely disgusted with" her stay at WHO. "They never asked her to do anything. She never followed up." Chisholm was not the only one who appreciated her contribution to the work of WHO; other WHO programs and offices would have welcomed her contribution. However, by operating out of WHO's South-East Asia Regional Office (SEARO), she found herself isolated with little chance of her work being reviewed favorably, i.e., the "wrong place."

Policy Brief: Economic Evaluation of the Implementation of the WHO Package of Essential Non-Communicable Disease (PEN) Interventions in Indonesia

A collaborative study was conducted by the representatives from the Ministry of Health’s Directorate of Non-Communicable Disease (NCD) Control and the National Institute of Health Research and Development, the WHO Indonesia office, the WHO Southeast Asia Regional Office, and the Health Intervention and Technology Assessment Program (HITAP) to assess value for money and budget impact of the current PEN interventions compared to “no screening” and other policy options. This economic evaluation assessed the integration of screening and treatment for diabetes and hypertension, which are part of NCD interventions in the Package of NCDs (PEN) program, into primary health care in Indonesia and found that it yields cost saving to the government and society. The findings are expected to be a tool to assist the government in making resource allocations in this area.

Migration and health: a review of policies and initiatives in low and middle income countries

BackgroundThe migration of people within national borders is nearly four times higher than international migration. Internal labour migration is an important livelihood strategy for many poor groups worldwide, but this population faces exclusion from existing mainstream health programmes. We aimed to conduct a literature review to understand factors in low and middle income countries affecting the health of migrants, and policies and initiatives to address health issues. MethodsPubmed, The Lancet, Google Scholar, Advanced Google, Popline by K4 Health, reports of international agencies, country official websites, government publications and conference proceedings (restricted to the English language) were searched. Keywords were “low- and middle-income countries”, “urbanization”, “internal labour migration”, “rural-urban”, “migration”, “migrant workers”, “internal migrants”, “health problems/issues” “health”, “migrant women/children”, “social determinant”, “health services”, “social inclusion”, “health policies”. Empirical, non-empirical papers, reports from agencies, regional forums, and international conferences from 1970 to 2015 were retrieved. A narrative synthesis of literature was undertaken. Findings209 articles were retrieved; after screening for duplication and relevance, 136 were included in the review. Factors affecting migrants' health included political and social marginalisation, lack of socioeconomic and societal resources, inadequate nutrition, poor housing, hazardous occupational conditions, lack of access to health-care services, discrimination, and financial burden. Access to health and social benefits were usually linked to identity, and migrant families often did not have location-specific identity documents. Migrant women had less antenatal care than non-migrant women. Migrant women were more likely to experience violence, and their children were six times more at a risk of physical abuse. Policies related to migration included security, labour, trade, enforcement, and international aid laws; they rarely included health policy for migrants which was traditionally viewed in terms of a threat to public health resulting in screening, monitoring, quarantine, and communicable disease control. InterpretationLessons drawn from our review suggest three key strategies to improve the health of internal migrants—namely, formation of a nodal agency for the welfare of internal migrants, formation of a database on internal migrants and development of a tracking system to accommodate their mobility, and universal coverage of health and social security. FundingWellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities, WHO South-East Asia Regional Office.

Implementation Progress on IHR (2005) among WHO Member States

It has been eight years since the International Health Regulations (2005) (hereinafter ＂IHR (2005)＂) enacted on June 15, 2007. During this period, the occurrence of several public health emergencies of international concern, including the 2009 H1N1 influenza pandemic, the 2011 Fukushima nuclear disaster in Japan, the 2012 Middle East Respiratory Syndrome(MERS) outbreak in Middle East countries, the 2013 H7N9 avian influenza outbreak, the 2014 Ebola outbreak in West Africa, and the 2015 MERS outbreak in South Korea, has constantly challenged the implementation of IHR (2005). This report summarized publications concerning the implementation of IHR (2005) made by the WHO Director-General and WHO Secretariat as well as speeches concerning the same issue made by the WHO Member States during the meetings of Committee A of the 61^(st)-67^(th) World Health Assembly. Five Member States addressed to the Assembly on the topic of IHR (2005) every time. On average, Member States within South-East Asia Regional Office(SEARO) engage on this topic the most, followed by Members States within Regional Office for the Americas(AMRO). Member States' reports on the topic were broadly categorized into six subject matters that were most commonly spoken about: applauding, affirming continuous cooperation, reporting progress, making suggestions, seeking assistance, and requesting extensions. Two-third of the WHO Member States have yet to meet the IHR core capacity requirements mainly because they need additional time and require external assistance and funding. Hence, the U.S. initiated the Global Health Security Agenda aimed to call for the global united action to assist low-and middle-income countries to improve their core capacity requirements.

Regional health governance: A suggested agenda for Southern African health diplomacy.

Regional organisations can effectively promote regional health diplomacy and governance through engagement with regional social policy. Regional bodies make decisions about health challenges in the region, for example, the Union of South American Nations (UNASUR) and the World Health Organisation South East Asia Regional Office (WHO-SEARO). The Southern African Development Community (SADC) has a limited health presence as a regional organisation and diplomatic partner in health governance. This article identifies how SADC facilitates and coordinates health policy, arguing that SADC has the potential to promote regional health diplomacy and governance through engagement with regional social policy. The article identifies the role of global health diplomacy and niche diplomacy in health governance. The role of SADC as a regional organisation and the way it functions is then explained, focusing on how SADC engages with health issues in the region. Recommendations are made as to how SADC can play a more decisive role as a regional organisation to implement South–South management of the regional social policy, health governance and health diplomacy agenda.

Reviewing the literature for epidemiological trends of dengue disease: introduction to a series of seven national systematic literature reviews.

Reviewing the literature for epidemiological trends of dengue disease: introduction to a series of seven national systematic literature reviews.

Revised National Tuberculosis Control Program: Evolution, Achievements, and Challenges

India initiated National Tuberculosis Control Program (NTCP) in 1962. After reviewing NTCP and realizing its shortcomings, the Government of India evolved and adopted a revised strategy - the directly observed treatment short course (DOTS) - under Revised National Tuberculosis Control Program (RNTCP) with the goal of reducing TB burden and the twin objective of 70% case detection and 85% cure rates. RNTCP was launched in 1993, in a phased manner to be evolved through pilot phase (1993-1996), DOTS intensification phase (1997-2006), Stop TB strategy (2007-2011), and currently the Universal Access or National Strategic Plan (2012-2017). RNTCP has been progressing successfully toward its goal and achieving its objectives since 2007. This addresses the Millennium Development Goal (MDG) and target to be achieved by 2015 and the Stop TB Partnership targets to be achieved by 2015 and by 2050. By 2011, the RNTCP has treated more than 14.2 million TB patients and saved 2.6 million additional lives using the DOTS strategy. The spread of human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), emergence of multidrug resistant TB (MDR-TB) and the unregulated and underutilized vast private sector using anti-TB regimes different from those under RNTCP pose additional challenges in the control of tuberculosis.<br>For this review, information has been collected from official websites of World Health Organisation (WHO) Geneva, WHO South East Asia Regional Office (SEARO) New Delhi, Ministry of Health and Family Welfare; Government of India and published literature, through search engines like Google, Google Scholar and Pub Med using MeSH Terms DOTS and Tuberculosis Control.

Time to act to prevent and control tuberculosis among inmates [Official Statement of The International Union Against Tuberculosis and Lung Disease

* World Health Organization, Regional Office for Europe, Copenhagen, Denmark; † International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India; ‡ Department of Global Health, University of Amsterdam, Amsterdam, § PharmAccess Foundation, Amsterdam, The Netherlands; ¶ Ministry of Justice, Baku, Republic of Azerbaijan; # University of Malaya, Kuala Lumpur, Malaysia; ** AIDS Foundation East-West, Amsterdam, The Netherlands

Burden of Malaria in India: Retrospective and Prospective View

In India, nine Anopheline vectors are involved in transmitting malaria in diverse geo-ecological paradigms. About 2 million confirmed malaria cases and 1,000 deaths are reported annually, although 15 million cases and 20,000 deaths are estimated by WHO South East Asia Regional Office. India contributes 77% of the total malaria in Southeast Asia. Multi-organ involvement/dysfunction is reported in both Plasmodium falciparum and P. vivax cases. Most of the malaria burden is borne by economically productive ages. The states inhabited by ethnic tribes are entrenched with stable malaria, particularly P. falciparum with growing drug resistance. The profound impact of complicated malaria in pregnancy includes anemia, abortions, low birth weight in neonates, still births, and maternal mortality. Retrospective analysis of burden of malaria showed that disability adjusted life years lost due to malaria were 1.86 million years. Cost-benefit analysis suggests that each Rupee invested by the National Malaria Control Program pays a rich dividend of 19.7 Rupees.

Sanjoy Bhattacharya, Expunging variola: the control and eradication of smallpox in India, 1947–1977, New Perspectives in South Asian History, New Delhi, Orient Longman, 2006, pp. xv, 326, Rs 750.00 (hardback 81-250-3018-2).

Sanjoy Bhattacharya, Expunging variola: the control and eradication of smallpox in India, 1947–1977, New Perspectives in South Asian History, New Delhi, Orient Longman, 2006, pp. xv, 326, Rs 750.00 (hardback 81-250-3018-2).

The economic impact of visceral leishmaniasis on households in Bangladesh

To explore current patterns of diagnosis and treatment, quantify household economic impact and identify household strategies to cover the costs of visceral leishmaniasis (VL) care in rural Bangladesh. Structured interviews with 113 VL patients from 87 households documenting all provider visits and expenditures for health care for VL, and the ways in which the expenditures were covered. Patients paid a median of 7 visits to six different providers before beginning VL treatment. All visited the subdistrict government hospital at least once. While health care, including antileishmanial drug therapy, is officially available free of charge at government facilities, 79% of patients reported making informal payments for provider access, diagnostics and drug administration; only 14% of patients received their full drug course from this source. For the 58% of patients who purchased the full treatment course, drug cost constituted 34% of direct expenditure. Median direct expenditure for one VL patient was US$87 and median income lost was $40; median total expenditure was 1.2 times annual per capita income of our study population. Households employed multiple coping strategies to cover expenditures, most commonly sale or rental of assets (62%) and taking out loans (64%). Visceral leishmaniasis treatment causes a major economic burden in affected families. Control strategies for VL should facilitate timely, affordable diagnosis and treatment of patients to decrease the infection reservoir and to alleviate the economic burden of VL on households.

Why do case studies on national health research systems matter? Identifying common challenges in low- and middle-income countries

Since health research has become increasingly acknowledged as an important tool for development, many approaches have been undertaken to understand national health research from a systems perspective. This paper reviews 28 case studies that describe or analyse health research systems in 26 low- and middle-income countries. These case studies were sponsored either by the Council on Health Research for Development or the South-East Asia Regional Office of the World Health Organization. In reviewing these case studies, we identify several common challenges facing national health research systems. These challenges include the lack of coordination in research activities; the inadequate participation of stakeholders in research, policy and implementation processes; the lack of demand for research and the low accessibility of research findings. These obstacles are compounded by some fundamental systems constraints, such as the lack of financial resources, human capacities, infrastructure and data. By identifying from these case studies the common challenges of health research systems as well as approaches to overcome these, this paper highlights the potential for case studies to inform policies and strategies for strengthening health research systems, and presents recommendations for future case studies to increase this potential.

A Role for Public Health History

A Role for Public Health History

Global Infectious Disease Policy

At the International Conference on Emerging Infectious Diseases 2002, held in Atlanta, the Centers for Disease Control and Prevention (CDC) released a document entitled, “Protecting the Nation’s Health in an Era of Globalization: CDC’s Global Infectious Disease Strategy,” which describes plans for controlling infectious diseases worldwide. The document outlines global partnerships and measures for improving capacity for disease surveillance and outbreak response and for applying proven public health tools to the control of emerging infectious diseases over the next decade. In addition, the document calls for strengthening global initiatives for disease control, conducting applied research on diseases of international importance, and building public health training and capacity worldwide. International Emerging Infections Programs in various parts of the world will support the activities outlined in the global strategy document. The International Emerging Infections Program (IEIP), Thailand, is the first site in the network of IEIPs proposed in the plan. Through the IEIP network, modeled after the U.S. Emerging Infections Program, specialists will work with local ministries of health to support laboratory-enhanced, population-based surveillance for infectious diseases. Data from this surveillance will allow ministries of health to prioritize diseases, evaluate targeted interventions, and support global efforts to prevent and control disease. IEIPs will train local scientists and CDC personnel, provide diagnostic and epidemiologic resources when outbreaks occur, and serve as platforms for regional infectious disease control activities. In December 2001, IEIP Thailand and the Southeast Asia Regional Office of the World Health Organization hosted a training course on anthrax, attended by 64 participants from 16 countries. In 2002, IEIP initiated an investigation of an increase in reported leptospirosis cases in Thailand through a study of hospitalized patients with febrile illness. IEIP Thailand is planning studies of respiratory illness and encephalitis later this year; a second IEIP site will be launched soon.

Organisation of veterinary public health in the South Asia region

In the South Asia region vast human populations are exposed daily and with considerable intensity to close contact with vast animal populations and their excreta. There is no veterinary public health unit in the World Health Organisation (WHO) South-East Asia Regional Office (SEARO) in New Delhi (India), the Western Pacific Regional Office (WPRO) in Manila (Philippines) or the Eastern Mediterranean Regional Office (EMRO) in Alexandria (Egypt). However, these offices do support a number of activities on zoonoses and food-borne diseases in WHO member countries of the region. Maintenance of the health of farmers and of their families (often termed "rural health") has assumed increasing importance in most member countries of the region. In most of the countries, there is no actual veterinary public health unit functioning as a national body common to the ministries of health and agriculture. Among the commonest zoonotic diseases prevalent in member countries are rabies, brucellosis, Japanese encephalitis, echinococcosis, tuberculosis, visceral leishmaniasis, taeniasis, salmonellosis, campylobacteriosis and leptospirosis. A national plan is necessary for each country to give priority to controlling these diseases, based on health systems research or primary health care, with intersectoral and regional cooperation through the South Asian Association for Regional Cooperation (SAARC) under Technical Cooperation among Developing Countries (TCDC). There should be a strong unit for veterinary public health in all WHO regional offices to coordinate zoonotic disease surveillance, training and control programmes in countries of the region.

Book Reviews

Journal Article Book Reviews Get access The Eradication of Smallpox from India. R N Basu , Z Jesek , N A Ward . WHO South East Asia Regional Office, 1979, Regional Publications South East Asia Series No 5, WHO Series History of International Public Health No 2, pp 346, Sw fr 30. GEORGE DICK GEORGE DICK Search for other works by this author on: Oxford Academic PubMed Google Scholar International Journal of Epidemiology, Volume 9, Issue 4, December 1980, Pages 381–382, https://doi.org/10.1093/ije/9.4.381 Published: 01 December 1980