New insights from mapping the global burden of disease

The Lancet calls the new report “the most comprehensive worldwide observational epidemiological study to date.”

This report, "Mortality by cause for 8 regions of the world: Global Burden Disease Study," is an update - 20 years later – of a revolutionary idea at the time. The two men, Chris Murray, a young Rhodes scholar at the time and Alan Lopez, a WHO epidemiologist, who engineered it started with just over 100 diseases and injuries which has grown to more than 300. In the early years, they considered 10 risk factors for ill health, such as tobacco and alcohol. Today there are 80 risk factors.

Over the years, new infections such as Ebola and Zika have come into play. And the new study shows a rise in non-infectious diseases. Diabetes was the 24th leading contributor to the global burden of disease in 1990. Here are a few more highlights from the study:

  • 1.1 billion people were living with mental health and substance abuse disorders in 2016;
  • tobacco is linked with 7.1 million deaths;
  • poor diet is associated with 1 in 5 deaths;
  • deaths from firearms and terrorism have increased globally;
  • 72 percent of deaths worldwide are caused by non-communicable diseases.

Later this month in Seattle, Bill Gates is scheduled to give the keynote address, as the Bill & Melinda Gates Foundation has been the major funder of the Global Burden of Disease Project. The new study will provide the backdrop against which the world needs to respond to disease and disease risk.

Sept 20, 2017

Old fashioned AIDS is still with us – shocking in 2017

With advances in HIV care, persons with HIV/AIDS (PWHA) can lead healthy lives, but avoidable, HIV-related deaths continue to occur in New York City. Authors, Braunstein, Robbins and others, are reporting in PubMed.

Braunstein et al. used existing laboratory and other data to construct a retrospective analysis of what happened in the intervenable period during which different treatment approaches might have prevented more than 11,000 people from dying with HIV between 2007 and 2013.  They found that a substantial proportion of people were not properly treated, as shown by the finding that 60% of people did not have a suppressed viral load in the period analysed.  This was despite the majority of patients having some engagement with the health system as shown by laboratory records. The challenge seemed to be to provide high quality care with continuity of care and decisions made promptly according to the findings.

Sept 12, 2017

Young women in South Africa and transactions around sex

A study shows young women know they have better bargaining power in sexual relationships if they have some of their own money. Findings suggest there is a nuanced relationship between sex, love and gifts: money has symbolic meaning, and money transfers, when framed as gifts, indicate commitment from the man. Young women express agency in their choice of partner, but their agency weakens once they are in a relationship characterized by exchange. This may undermine their ability to reduce HIV and STI risk.

Using five focus group discussions and 19 in-depth interviews with young women enrolled in the HPTN 068 conditional cash transfer trial (2011–2015), this qualitative study explores young women’s perceptions of transactional sex within the structural and cultural context of rural South Africa.

Evidence shows that HIV prevalence among young women in sub-Saharan Africa increases almost five-fold between ages 15 and 24, with almost a quarter of young women infected by their early-to mid-20s. Transactional sex or material exchange for sex is a relationship dynamic that has been shown to have an association with HIV infection.

sept 6, 2017

In Zambia, HIV testing is now compulsory

Internews and AVAC partners in the Coalition to Accelerate and Support Prevention Research (CASPR) project in Zambia report that a new HIV testing policy in Zambia has dominated news headlines – with articles outlining the pros and cons of the announcement made somewhat out of the blue by the country’s president. Concern is rising among advocates about what it means for the country’s HIV programs and for human rights. A civil society coalition has noted that compulsory testing is illegal and unconstitutional and will prevent more people from accessing healthcare.

Zambia Daily Mail reported in an article headlined “Comply or Else” that “Government has threatened to shut down all private health facilities that will not comply with the policy decision of compulsory testing for HIV of individuals who visit health facilities for any ailment. Another Daily Mail article says, “The launch of the mandatory HIV Testing, Counselling and Treatment (HTCT), has been received with mixed reactions across Zambia”, and Africa News reports “President Edgar Lungu has dared stakeholders planning to take him to court over his recent pronouncement on mandatory HIV testing to go ahead.

In a statement UNAIDS and WHO commended Zambia for adopting WHO “guidelines on offering all people living with HIV antiretroviral therapy regardless of their CD4 count.”  But the statement noted that “The World Health Organization and UNAIDS do not support mandatory or compulsory testing of individuals on public health grounds.”

Chief Government Spokesperson Kampamba Mulenga has defended the Zambian government’s plans. “It is your life and the government has the duty to save the lives of its nationals. Those that are saying ‘it’s my privacy and you are infringing on my rights’, what human rights [do you mean] when people are saving your life to prolong your life? [The] government is saying if you cannot be responsible for your own life, let government take responsibility.”

In an opinion piece, Joe Mwansa Lombe Kaluba, a PhD candidate in Political, Gender and Transnational Studies at the International Postgraduate Centre (IPC), Faculty of Social Sciences at Goethe University Frankfurt, writes:When the news about making HIV testing compulsory broke, instead of seeing a real debate about the pros and cons, all I could see were childish jokes. To me stigmatization has already started... Making or forcing people means we have failed on the part of education. In some of these countries a referendum would be called to determine something like the issue at hand. And those of you using jokes and social media as a way of getting at people with different challenges or HIV status. Shame on you.”

More than 11% of Zambia adults aged 15 to 49 years are HIV positive, according to the National HIV/AIDS/STI/TB Council.

august 21, 2017

Black experts in the health sector: Where are they?

"It's not right that only black voices in health stories are those patients," writes Pontsho Pilane in South Africa’s Mail & Guardian.  

Pilane writes that in a year of being a health reporter, she has been alarmed at the lack of diversity among experts in the health sector. "Most of them are white–in a country where, according to Statistics South Africa (Stats SA), 81% of the population is black."

“It’s not surprising. Apartheid made it much easier for white people than their black peers to access good education...It’s been 23 years since South Africa had its first democratic elections. Where are the black experts? The few we have in the health sector are rarely quoted in the media.

“Each year, the Mail & Guardian publishes a list of 200 of the country’s brightest young minds. The 2017 Young South Africans included 22 health experts, 12 of whom were black. Cardiologist Nqoba Tsabedze is researching what makes sudden heart failure prevalent among black South Africans and Salome Maswime completed her PhD on how Caesarean sections contribute to maternal deaths in South Africa.

But I rarely see their names in the media,” writes Pilane.

Read the whole article here:

august 14, 2017

It starts from the womb – how gender differences impact health

A “think piece” in The Conversation outlines how men and women respond differently to diseases and treatments for biological, social and psychological reasons. Deb Colville of Monash University outlines how, until the turn of this century, clinical trials mainly involved males and the results became the evidence base for the diagnosis and treatment of both genders. Medication dosages were typically adjusted for patient size and women were simply “small men”. The discipline of “gender medicine” (also called sex-specific medicine) was born in the early 2000’s, with more emphasis on how, when and why a person accesses medical care.

Some examples: In the area of heart health, women are less likely to seek help for a heart attack as their symptoms make it harder to identify. In mental health, depression is more common in women, but suicide rates are higher in men.

Generalisations about gender can be both useful and problematic, so careful analysis is needed.

We talk about inequalities in terms of males and females, but gender diversity isn’t mentioned at all. “I shudder to think of the barriers and obstacles you might face in training if you were transgender or non-gender conforming”, writes Colville, “I haven’t heard anyone raise that”.

See: Medicine's gender revolution – part of a new series on a gender lens needed for medicine.

august 7, 2017

Public trust in science spiked after media coverage of Zika vaccine trial - study finds

ScienceDaily reports on a study published in the journal Science Communication, which examined what happened in August 2016 after the launch of the first human trial of a Zika vaccine. Following widespread media coverage of the trial, people paid more attention to news about the Zika virus and showed greater trust in science. The spike in public confidence in science lasted just two weeks, though the heightened attention to the Zika virus persisted for six weeks.

In the weeks following the vaccine trial, there was "a significant, albeit short term, increase in an otherwise stable indicator of confidence in science," the researchers said. "This finding opens the possibility that confidence in science could be bolstered in a more sustained fashion by regularized communication about advances made by science," the researchers said. "These communications may be particularly effective when they provide potential solutions to problems placed by media on the national agenda."

August 3, 2017

Positive news from high level HIV science conference

Headline news from the ninth International Aids Society (IAS) Conference on HIV Science in Paris is that a child born with HIV has been found free of the virus for a long time, after a high dose of treatment early in life.

Worldwide, news outlets are reporting that the discovery has raised hopes: the fact that the 9-year-old South African girl has been in remission for more than eight years holds clues for ongoing cure research. This is the third time in recent years that scientists have reported on individuals being able to hold the virus at bay. Journalists have been urged not to report this as an “Aids cure” – the patient is in remission and her case further enhances scientists’ understanding of how a cure might be developed.    

Other news from the IAS conference is further confirmation that when HIV positive people take their treatment regularly, they almost zero the probability of spreading HIV infection to others.

AND: "Broadly neutralizing antibodies" or BNA’s are another buzzword at the conference. In a Thai trial, infusions of antibodies of those rare individuals who produce very effective HIV neutralizers were given to participants to evaluate how these would function as immune boosters. This experimental therapy has held back one man's HIV infection for 10 months, participants at the IAS conference heard.

Good news all round, but larger studies need to be done to increase scientists’ understanding of this approach.

July 26, 2017




Germany Takes Leadership on Global Health

By Andrew Jack in FT Health

Just as President Donald Trump is scaling back US leadership in global health, other political leaders are coming forwards — none more so than Angela Merkel, host of the G20 summit in Hamburg, which began on Friday.  Germany has stepped up its funding and provided focus, notably around strengthening the response to the rising threat of antibiotic drug resistance. This year’s holder of the G20 presidency has also worked to boost the international system that identifies and responds to new infectious disease threats, from flu to Zika. Some experts argue that other areas deserve more attention. These include a wider commitment to tackling non-communicable diseases such as diabetes, improved family planning, broader coverage and better-quality healthcare.  

The G20 group of leading economies has a strong self-interest in encouraging better health systems in other countries to help foster economic growth and political stability.  Lack of success in this area is likely to mean greater global displacement and disruption, as people fleeing conflict or seeking better lives try to move from poorer to richer countries. Whatever the rich nations’ motives, the reality is that both interest in — and funding for — such support is limited. The new World Health Organization chief, Tedros Adhanom, has said that poorer countries outside the G20 will need to take greater responsibility for funding and building better health systems. 

July 11, 2017



Ebola threat in DRC is over

The World Health Organization (WHO) has declared the end of the most recent outbreak of Ebola virus disease (EVD) in the Democratic Republic of Congo (DRC).

The announcement comes 42 days (two 21-day incubation cycles of the virus) after the last confirmed Ebola patient in the affected Bas-Uélé province tested negative for the disease for the second time. Enhanced surveillance in the country will continue, as well as strengthening of preparedness and readiness for Ebola outbreaks. "With the end of this epidemic, DRC has once again proved to the world that we can control the very deadly Ebola virus if we respond early in a coordinated and efficient way,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Internews was part of the rapid response, working with partner radio stations to relay critical information in a variety of local languages and French and Kiswahili on how to prevent infection and what to do when someone showed symptoms of Ebola. A high-level roundtable discussion was convened with journalists and in-house mentoring provided to ensure that those in affected areas received ongoing accurate information about the disease. For the first time, critical information was also provided about the Ebola vaccine, which had been approved for limited use in the most recent outbreak of the virus.

Related to the outbreak, 4 people died, and 4 people survived the disease. Five of these cases were laboratory confirmed.  A total of 583 contacts were registered and closely monitored, but no known contacts developed signs or symptoms of EVD.

July 3, 2017