Urban-rural inequities in knowledge of tuberculosis in Pakistan

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Knowledge of tuberculosis (TB) is poor especially in rural areas of Pakistan, according to a study conducted in Pakistan’s Punjab province. The study also found that people living in urban areas were more likely to seek treatment at a health facility, compared to rural folk. TB is re-emerging as a global public health problem and a better understanding of the urban and rural communities’ perception of the disease is needed to implement better prevention and control.

Knowledge regarding symptoms, transmission, prevention, duration of standard treatment and DOTS treatment was significantly higher in urban areas. Although more than 80 percent of both urban and rural people in the study were aware of the correct treatment for TB, less than half knew of the availability of the diagnostic facility and treatment free of cost.

People in the urban areas were more likely to feel ashamed and embarrassed being a TB patient; however, they seem to be supportive in case their family member suffered from TB. Nearly half of the study respondents, irrespective of the area of residence, believed that the community rejects TB patients.

Television (urban 80 percent, rural 68 percent) and health workers (urban 31 percent, rural 41 percent) were the main sources for people to acquire TB-related information.

“Television can be recommended as a suitable medium for future campaigns provided that information should be tailored according to the needs of all people, and health workers can be involved in this regard especially in the rural areas,” the study suggested.

1. Mushtaq MU, Shahid U, Abdullah HM, et al. Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan’s Punjab province. International Journal for Equity in Health 2011; 10: 8. (open access)

Reversing China’s HIV/AIDS epidemic by 2015

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In the past decade, tremendous efforts have been made and impressive achievements have been obtained in accelerating universal access for HIV prevention, treatment and care and support worldwide and in China. China is one of only a few low- and middle-income countries in which domestic funds account for the major proportion of their HIV/AIDS program funding.

The International Journal of Epidemiology December 2010 supplement issue entitled “China’s AIDS Policy Implementation,” has assembled and editorial and 11 papers describing the various aspects of China’s response to the HIV/AIDS epidemic. All articles in the issue are open access.

Editorial: China AIDS policy implementation: reversing the HIV/AIDS epidemic by 2015

1. Evolution of information-driven HIV/AIDS policies in China
China’s current national policies are increasingly information driven and responsive to changes in the epidemic. However, gaps remain in policy implementation, and new policies are needed to meet emerging challenges.

2. Contributions of international cooperation projects to the HIV/AIDS response in China
International cooperation projects have been an invaluable component of China’s response to HIV/AIDS, and China has now been able to take this information and share its experiences with other countries with the help of these same international programs.

3. Estimating the number of people living with HIV/AIDS in China: 2003–09
Repeated estimates have improved understanding of the HIV/AIDS epidemic in China. HIV estimates are a valuable tool for guiding national AIDS policies evaluating HIV prevention and control programs.

4. Scaling up the national methadone maintenance treatment program in China: achievements and challenges
This article documents the steps China made in overcoming the many barriers to success of its methadone program. These lessons might be useful for other countries in the region that are scaling-up their methadone programs.

5. Scaling up prevention programmes to reduce the sexual transmission of HIV in China
Prevention programs for reducing sexual transmission of HIV have reasonable coverage, but can still improve. The quality of intervention needs to be improved in order to have a meaningful impact on changing behaviour to reducing HIV sexual transmission. Systematic evaluation of the policies, guidelines and intervention programmes needs to be conducted to understand their impact and to maintain adherence.

6. Design and implementation of a China comprehensive AIDS response programme (China CARES), 2003–08
China CARES has facilitated AIDS prevention, treatment and care in resource-poor, rural and ethnic minority areas of China.

7. Changing baseline characteristics among patients in the China National Free Antiretroviral Treatment Program, 2002–09
Limited treatment resources can be focused on areas with more patients. Greater emphasis needs to be placed on earlier HIV diagnosis and treatment. New strategies must be identified to bring HIV-infected injection drug users into treatment. Routine HIV testing would identify those at risk earlier.

8. From spectators to implementers: civil society organizations involved in AIDS programmes in China
Civil society organizations (CSOs) have significantly increased their participation and contribution to HIV/AIDS programs in China. Policies for registration and financial support to CSOs need to be developed to enable them to play an even greater role in HIV/AIDS programs.

9. Quality assurance in the HIV/AIDS laboratory network of China
China has made significant progress in establishing a well-coordinated HIV laboratory network and quality assurance systems. However, the coverage and intensity of HIV testing and quality assurance programs need to be strengthened so as to ensure that more infected persons are diagnosed and that they receive timely prevention and treatment services.

10. Development of a unified web-based national HIV/AIDS information system in China
China’s new unified, web-based HIV/AIDS information system has improved the efficiency of data collection, reporting, analysis and use, as well as data quality and security. It is a powerful tool to support policy making, program evaluation and implementation of the national HIV/AIDS program and, thus, may serve a model for other countries.

11. Quantitatively monitoring AIDS policy implementation in China
Setting targets for core indicators and monitoring performance has facilitated implementation of the national AIDS program in China.

New estimates of malaria deaths in India

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A study has found that approximately 205,000 deaths due to malaria occur in India every year. The majority of malaria deaths occur in people age 15-69 years (120,000), followed by children under age five (55,000) and age 5-14 years (30,000).

India is the most populous country in which malaria is common. The cases and deaths reported by the Indian government are concentrated mainly in a few states in east and northeast India (the so-called high-malaria states; mainly Orissa but also Chhattisgarh, Jharkhand, and the states in the far northeast of India).

These new results greatly exceed the World Health Organization’s estimate of only 15,000 malaria deaths per year in India. “This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide,” the study said.

The methods of the new study, which used “verbal autopsies” to assign the cause of death, have been criticized by WHO.

1. Dhingra N, Jha P, Sharma VP, et al. Adult and child malaria mortality in India: a nationally representative mortality survey. Lancet, published online 21 Oct 2010. (open access: free registration required)

Quitting smoking in China—the need for improved tobacco control

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China is facing a public health crisis with over 350 million smokers, representing nearly one-third of all smokers in the world. The World Health Organization estimates that one million smokers in China die from tobacco-related illnesses each year, and this number is expected to rise to 2.2 million deaths by 2020.

Despite these grim facts, more than three-fourths of Chinese smokers have no plans to quit smoking. Furthermore, less than one-third of smokers are aware of the harmful effects smoking has on their health, according to new research based on the International Tobacco Control (ICT) China Survey.

There is a need for smoking cessation support, anti-tobacco laws, higher cigarette taxes and awareness of the health risks of smoking.

Read more at Suite101.

1.Feng G, Jiang Y, Li Q, et al. Individual-level factors associated with intentions to quit smoking among adult smokers in six cities of China: findings from the ITC China Survey. Tobacco Control 2010; 19: i6-i11. (0pen access)
2.Jiang Y, Elton-Marshall T, Fong GT, Li Q. Quitting smoking in China: findings from the ITC China Survey. Tobacco Control 2010; 19: i12-i17. (open access)
3.Yang J, Hammond D, Driezen P, et al. Health knowledge and perception of risks among Chinese smokers and non-smokers: findings from the Wave 1 ITC China Survey. Tobacco Control 2010; 19: i18-i23. (open access)

HIV epidemic likely to emerge in the Philippines

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HIV prevalence in the Philippines has been described as “low and slow,” but an HIV epidemic is likely to emerge as the components for such an epidemic are already present in the Philippines, according to a study in the Journal of the International AIDS Society.

While the number of people living with HIV throughout Asia is around 5-10 million—with prevalence estimates well over one percent among adults in numerous countries—the Philippines has maintained an HIV prevalence of less than 0.1 percent.

Experts are predicting a dramatic increase in HIV cases in the Philippines due to several factors: low rates of condom use, increasing casual sexual activity, needle sharing among injection drug users (IDUs) and lack of education about HIV/AIDS, among other factors.

Read more at Suite101.

1. Farr AC, Wilson DP. An HIV epidemic is ready to emerge in the Philippines. Journal of the International AIDS Society 2010; 13: 16. (open access)

Diabetes is a major public health problem in China

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Diabetes has become a major public health problem in China. Rapid economic growth, an increase in life expectancy and adoption of unhealthy lifestyles has contributed to the increase in diabetes among Chinese adults.

More than 92 million Chinese men and women have diabetes and 148 million have pre-diabetes, according to a study in the  New England Journal of Medicine.

The China National Diabetes and Metabolic Disorders Study is based on a nationally representative survey in which nearly 50,000 adults aged 20 years and older from 14 provinces and municipalities throughout China participated over a one-year period beginning in 2007.

Read more at Suite101.

1. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090-1101. (open access)

Support for smoking bans widespread in China

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Comprehensive anti-smoking policies in public places—particularly schools, public transportation and hospitals—are widely supported by both non-smokers and smokers in China, according to a six-city Chinese study.

Knowledge about the adverse health effects of secondhand smoke and the presence of existing anti-smoking laws likely increase support for a total smoking ban in workplaces, restaurants and bars, Additionally, the results of this study suggested that, like smokers in other countries, Chinese smokers are likely to adapt to and even eventually support 100 percent smoking bans.

Read more at Suite101.com.

1. Li Q, Hyland A, O’Conner R, et al. Support for smoke-free policies among smokers and non-smokers in six cities in China: ITC China Survey. Tobacco Control 2010;19:i40-i46. (0pen access)

Cigarette packs should carry health warnings with pictures

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Including graphic pictures on health warnings on cigarette packages is more effective than text-only warnings at getting people to consider the health risks of smoking and motivating them to quit smoking, a study from China has found.

More than 80 percent of smokers, non-smokers and youth from four Chinese cities that participated in the study said that warning labels on cigarette packs should include pictures. It is also notable that participants in Kunming, located in the heart of the tobacco industry in China, were the highest among the four cities in their desire for the government to implement stronger health warnings.

Read more at Suite101.com.

1. Fong GT, Hammond D, Jiang Y, et al. Perceptions of tobacco health warnings in China compared with picture and text-only health warnings from other countries: an experimental study. Tobacco Control 2010; 19: i69-i77. (open access)

Swine flu patients benefited from taking Tamiflu


Healthy people who caught the H1N1 flu during the 2009 pandemic may have been protected against developing (x-ray) confirmed pneumonia by taking the antiviral drug oseltamivir (Tamiflu), according to a study from China. The researchers call for continued investigation into the effectiveness of antiviral treatment to allow for improvement both in clinical treatment and public health guidance. The study was conducted among 1300 Chinese patients with confirmed 2009 H1N1 infection.

1. Yu H, Liao Q, Yuan Y, et al. Effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1: opportunistic retrospective study of medical charts in China. BMJ 2010; 341: c4779. (open access)