BLOG: By Janet Janbek: Vaccine Preventable Infectious Diseases in the Syrian Context

The Zaatari refugee camp near the Jordanian-Syrian border. Available: http://www.dailymail.co.uk/news/article-342983

The combination of having lived in Jordan for over 20 years and being a passionate public health student, it seemed obvious to me which topic I would cover with research when talking about health care in disaster situations. When the Syrian war first broke out, we could see and feel the consequences first hand in Jordan with a huge influx of Syrian refugees into the country- most directly sensed economically due to a simple equation of having huge numbers of people in a small country with limited recourses. When zooming in on the different dimensions of this crisis, one particular issue catches the eye- the infectious diseases situation, and more specifically the vaccine preventable ones. These include polio, Tuberculosis (TB), cutaneous leishmeiniasis (CL) and measles. The table below shows numbers for the cases of these diseases in Syria and the neighboring countries.
Infectious disease Country and Statistics
Measles Syria: UNICEF reported 594 cases by end of 2014, other sources claim 7000 to 10000 cases Lebanon: 13% increase.* Jordan: From 24 cases to over 200 in one year.*
TB Syria: 6% new cases and 31% re-treatment cases Lebanon: 27% increase in cases * Jordan: 22% increase in cases due to Syrian refugees (of the total 40% increase).
CL Syria: More than 41,000 cases in 2013 ** Turkey: 1843 cases in refugee camps in 2014 * Lebanon: 97% of all cases involve Syrian refugees in 2013
Polio Syria: 7,600 cases. No new cases from 2015 until April 2016
*Increase in cases is documented to be attributed to the Syrian refugees. ** Syria has been endemic with CL for decades. Table by Janet Janbek, adapted from (1) and (5). It is important to note that these statistics are not inclusive of all cases due to a large number of refugees living outside of the camps in poor conditions and have no access to medical care, inability of hosting countries to screen refugees when huge numbers come in within a short period of time and difficulty in detecting cases inside Syria due to the hardships and risks connected with reaching the dangerous areas. Many factors have contributed to this crisis, these include destruction of health care systems in Syria, interruption infection control and immunization programs, shortage of drugs, sanctions imposed on Syria, huge numbers of Syrians seeking refuge in neighboring countries and Europe who live in camps or outside in unsanitary and crowded conditions, lack of access to water, starvation and unsafe food. Response has been in the form of huge immunization programs in the whole region by international institutions as well as individual neighboring countries. Despite that, the fact that diseases have not yet been eradicated makes this an important topic for response analysis to identify the gap between the responses and needs. Firstly, the mentioned contributing factors remain present with the ongoing war and constant relocation of Syrian refugees challenges surveillance systems and vaccination programs. Secondly, there is no uniformity in screening procedures among hosting countries where health policies differ and are majorly challenged by having to treat individuals with no medical records. Thirdly, international aid has been modest and underfunding is a big challenge especially for hosting countries with limited recourses. In Jordan for example, the cuts on the governmental health provisions have led to big numbers of refugees being denied access to health care services. Lastly, funding sent to Syria continues to be rejected by the government.   Efforts need to be made and recourses allocated by donor countries to support the national agencies and health care systems in hosting countries. It is crucial to point out the importance of keeping documentations of different offered interventions to avoid repetitions and unnecessary usage of resources. This needs to be achieved by the constant collaboration of involved international health organization in plotting interventions and emergency plans for response as well as unifying guidelines for treatments and interventions offered to the hosting countries. Donor countries and international aid agencies need to continue efforts to negotiate with and put pressure on the Syrian government and their allies and ask for access to distant locations that are difficult to reach. Furthermore, European countries and others need to help host more refugees and lift the burden off the current hosting countries which can allow to better carry out surveillance, screening and vaccinations programs. Financial support from international organizations is highly needed to carry out set out programs. Sources:
  1. Ozaras R, Leblebicioglu H, Sunbul M, Tabak F, Balkan I, Yemisen M et al. The Syrian conflict and infectious diseases. Expert Review of Anti-infective Therapy [Internet]. 2016 [cited 13 December 2016];14(6):547-555. Available from: http://dx.doi.org/10.1080/14787210.2016.11774572.
  2. Sharara SKanj S. War and Infectious Diseases: Challenges of the Syrian Civil War. PLoS Pathogens [Internet]. 2014 [cited 1 December 2016];10(11):e1004438. Available from: http://dx.doi.org/10.1371/journal.ppat.1004438
  3. Syria crisis: humanitarian situation, needs and response [Internet]. International Committee of the Red Cross. 2016 [cited 13 December 2016]. Available from: https://www.icrc.org/en/document/syria-crisis-humanitarian-situation-needs-andresponse
  4. Murthy SChristian M. Infectious Diseases Following Disasters. Disaster Medicine and Public Health Preparedness [Internet]. 2010 [cited 2 December 2016];4(03):232-238.Available from: http://dx.doi.org/10.1001/dmp.2010.hcn10005
  5. Ismail S, Abbara A, Collin S, Orcutt M, Coutts A, Maziak W et al. Communicable disease surveillance and control in the context of conflict and mass displacement in Syria. International Journal of Infectious Diseases [Internet]. 2016 [cited 6 December 2016];47:15-22. Available from: http://dx.doi.org/10.1016/j.ijid.2016.05.011
 

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BLOG: By Annariina Koivu: From Darfur to Liberia - Heidi Isohanni's lecture on humanitarian emergencies was a success

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Ambulance service in a refugee camp in Darfur. Photo: Heidi Isohanni

Global Health & Development was proud to have Heidi Isohanni (London School of Hygiene and Tropical Medicine) as a guest speaker. Having worked in various roles from outreach nurse supervisor to Ebola response coordinator in countries like Sudan, Democratic Republic of Congo, Zambia, Liberia and Tanzania, her guest lecture was a treat for all of us who are interested in humanitarian work and emergency preparedness. Besides sharing her real-life field experiences, her lecture provided insight what it means to work for an international organization, such as MSF (Doctors without Borders) or Red Cross) The lecture, which is a part of the course Health and Health Care in Disaster Situations, was received with admiration by the students and staff. Global Health & Development welcomes Heidi back soon. 🙂

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BLOG: Panel discussion: Integrating development cooperation and business

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Gentle Birds and photo: Petra Heikkilä

Fresh ideas were elicited on the future of Finland’s development cooperation in a panel by Tampere University’s Student Union TAMY as a part of its annual Development Days. Panelists Suvi Virkkunen (Senior Adviser for Development Policy, Ministry of Foreign Affairs of Finland), Helena Arlander (Director, Portfolio and Risk Management, Finnfund) and Auli Starck (Policy Advisor for Civil Society and Lobbying, Kepa ry, The Platform for Finland’s Development NGOs) provided multifaceted views on the topic. Although Finland’s recent budget cuts in development aid, that were as high as 40 %, including cuts from the NGOs of development cooperation, the panelists shared also several positive views.  There is an increased emphasis on the private sector and stronger involvement of its actors within Finland’s development policy. Kepa’s Auli Starck, although still shocked by the budget cuts that came on a short notice, seems open to find ways to serve Kepa’s over 300 member NGOs in collaboration of private sector organisations. Multi-stakeholder approach is one of today’s catchword in the development policy, also highlighted by Finland. Suvi Virkkunen reminded, however, that Finland’s development aid is still mainly allocated through a large number of separate instruments, which may not best promote collaboration across actors. The concept of the BEAM (Business with impact) programme demonstrates the new way of thinking in encouraging joint proposals by, eg. companies, civil society and research institutes. However, the BEAM serves best highly professional consortiums. Finnfund’s Helena Arlander sees that competitive and sustainable businesses bring jobs and increased incomes which then reflects in wellbeing; education and improved health outcomes. The new Agenda 2030 requires holistic thinking and emphasizes of the role of all policies in promotion of sustainable development. Trade rules, taxation, human rights, migration should all be analyzed and implemented with various development, climate change and environmental policy objectives. Not an easy task! Currently, official development assistance (ODA) forms no more than 2-10 % of the budget of the some of the low income countries which Finland is bilaterally supporting. So, one day there may be a situation where instead of the development cooperation there is just cooperation. On the other hand, ODA remains crucially important in situations of conflict and fragility, possibly for a long time. The moderator of the discussion was Dr. Mikko Perkiö from the Global Health and Development, Tampere University. He wrote this report. TAMY also describes the event. http://www.tamy.fi/kehy/kehitysyhteistyon-tulevaisuus-paneelikeskustelun-antia-the-future-of-development-cooperation-elements-from-the-panel-discussion/

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BLOG: Gains from Intersectoral Brainstorm

gainstorm A new kind of cross-sectoral forum, GainStorm, was held in Tampere Hall on Thursday 15th September. 7-minute talks, conversation and networking took place between members of the business community, the City of Tampere and Tampere’s universities. Nearly 100 took part in the event. Informal networking forums are important for scientists, business people, engineers and public sector experts and enable them to brainstorm. Having TV-person Simo Frangén as the “moderator” ensured that the event was also fun. These kinds of encounters have longer term effects, according to the "godfather" of the idea, University teacher Mikko Perkiö, from the Programme for Global Health and Development, at the University of Tampere. The Mayor of Tampere, Anna-Kaisa Ikonen envisions the city as a “Smart City” in which civil servants are more facilitators than producers of services. Tampere as a campus city would be known as a facilitator and testing ground for new innovations such as IT applications and digitalization linked to new urban culture and new forms of community, including the sharing economy. The business leaders; Aarne Actan, the CEO of Pihlajalinna and independent innovator Jari Pasanen; welcomed the collaboration of academics and researchers and mentioned their concern at how from the business viewpoint, it often takes too long for collaborative results to be utilized. Following on from this, senior expert Oras Tynkkynen from SITRA voiced a need for sectoral boundaries to be more fluid, which would mean freer movement of human resources between academia, business and administration. On the other hand, students and researchers can provide businesses with critical observations on product development as is the case in the "Demola" project. Professor Jyrki Nummenmaa and Janne Eskola Demola introduced Demola as a platform for developing projects or practices, i.e. creating demos, between students and business or public sectors. The famous Demola, a “made in Tampere” innovation, now operates through 17 offices world-wide. Demola network includes over 600 company partners and over 40 universities. The most challenging problems, such as global warming require transcending sectoral boundaries. To face future challenges, Oras Tynkkynen introduced new branches of "green business", many of which relate to practical solutions to everyday needs such a turnkey-version of solar panels. A global perspective offers Tampere-3 University a way to internationalize its research and staff, which is likely to improve its outcome, as outlined by Rector, Liisa Laakso. The speakers identified concrete global problems and how global partnerships could function optimally. Teacher training, water and sanitation issues along with various social innovations were seen as potentially being the most beneficial collaborations from a low income partner’s angle. Fortunately, the innovative Tampere-3 University will have strong capabilities in these areas. Furthermore, a GainStorm participant Dr. Antti Kasvio published an informative blog on global wellbeing (in Finnish) http://anttijuhanikasvio.puheenvuoro.uusisuomi.fi/222915-globaalia-hyvinvointia The University of Tampere is developing a new profile in Global governance and responsibility, which consolidates and updates its historical mandate as a "grand” school of management, social science and health to global level. It is important that the city of Tampere steadfastly stands by the university and assumes the role of facilitator when needed.

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BLOG: Housing policy would save lives in Mongolia by Mikko Perkiö

The world’s coldest capital Ulaanbaatar (1,4 Million people) in Mongolia, suffers wide wellbeing losses due to air pollution. The city’s outskirts are growing with internal migrants, often herders, who have lost a large share of their animals and life-stock because of tough winters. Ger and cowApartment building   Contrasting realities of housing in Ulaanbaatar. Pictures: Mikko Perkiö   The downtown of Ulaanbaatar is surrounded by ger districts, where a newcomer may occupy a small portion of land where to settle family’s home. Large part of the city’s 200.000 outskirt dwellings are gers, which are mobile and light constructions. These can not be connected to the heating grid of the world’s coldest capital. The air pollution causes health problems. The heating of a ger is based the stove in the middle of the ger. During cold months and cool nights, the latter met throughout the year, the stove burns coal or wood (even tyres and trash), which produces smoke and small particles in the air. Air pollution in the Ulaanbaatar ger-districts crosses several time the alarm rate of Peking. One of the most alarming health danger includes fetal abnormalities and miscarriages. Amount of those have increased substantially due to air pollution. Fortunately, there is a simple and affordable solution available: housing policy. The state of Mongolia and the city of Ulaanbaatar just have to replace ger dwellings and wooden houses by apartment buildings. Connection to heating grid and piped water would mean giant health improvements for the city’s people. A flying start would find new tenants to the city’s 20.000 empty apartments. If needed and requested cold latitude countries like Finland and wellbeing research oriented universities such as Tampere-3 would be ideal partners in transforming life of Mongolia‘s people. -------- The insights on Ulaanbaatar were gained through the participation in an evaluation project on Mongolian Red Cross Society's Community Based Health and First Aid Programme. The consultancy was carried out as a training project by the University of Tampere, Global Health and Development, and it was funded by Finland's Red Cross. Link: UNICEF video; Ulaanbaatar (UB) Mongolia: Air Pollution & Human Health Impacts: https://www.youtube.com/watch?v=ge70BlPN6_s

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BLOG: The Global Trends of Child Overweight and Obesity by Ciara McBride

Overweight and obesity are the fifth leading cause of death globally. Poverty and socioeconomic status (SES) determine child weight. The global burden of underweight associated with absolute poverty is reducing and the issue of overweight dramatically growing. Prevalence of overweight and obesity in developed countries is higher than in developing countries, although, in absolute values there are more overweight and obese children in developing countries. Predominantly, higher SES in developing countries and lower SES in developed countries lead to increased risk of overweight and obesity. These trends are complex and not always unidirectional and linear, there are many intertwining influencing factors. Neighbourhood SES and individual demographics determine weight status. Parental income and education determine weight status as well as stress, negative life events and ethnicity. Place of residence effects weight status also; urban poor in developing countries and rural poor in developed countries have higher risk of overweight than their counterparts, the rural poor in developing countries and urban poor in developed countries. Generally, how SES effects weight depends on the equity and socioeconomic development of the country. In developing countries, the rich lavish their children with the novel westernised diet and may be naïve of the dangers of the newly adapted sedentary lifestyle. The developing country poor are catching up with the lifestyle behaviours of the rich as they urbanise and lose the capacity to farm their own healthy and natural food and remain the physically active lifestyle of traditional rural life. The developed country poor struggle to afford healthy diets and expensive sport hobbies and are uneducated in the requirements of a healthy lifestyle. It is only those of high SES in developed countries who have the awareness and means to keep their children physically active with a nutritional and balanced diet and so reduce their risk of overweight. Unsurprisingly, as developing countries progress, their trends in weight status see a transition towards the trends of developed countries. Action in the form of promoting healthy eating and physical activity are required to reduce such inequalities in health, education and lifestyle to decrease the global burden of overweight and obesity.

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BLOG: Needs and Wants – Do the UN Sustainable Development Goals know the difference? By Aada Vihanta

We all have needs and wants, but when it comes to sustainable development, making difference between these two terms is crucial. Abraham Maslow (1954, 80-92) says people have deficiency needs and growth-needs. Deficiency needs are things inevitable for living (food, water, protection etc.). After fulfilling those needs we can move to growth-needs which respond to human’s need for self-actualization. (Maslow 1954). The UN’s Sustainable Development Goals define new millennium development goals. The basic targets are eradicating poverty, achieving equality and making sure everyone has access to basic needs in accordance to sustainable, sustain and inclusive development. The contradiction in SDGs is that they don’t properly define what are basic needs. Without defining them, SDGs allow that everyone can define their own basic needs. The problem is that what people define as needs varies a lot depending on the area and the standard of living there. It leads to situation where rich can be rich and poor will stay poor. The western consumer culture has obscured our understanding of needs and wants. That means we easily include more things to our basic needs than people in the poorer areas. What we think as needs, are somewhere else wants. The SDGs take into account the boundaries set by the environment. They admit the environmental problems are caused mostly because of over-consumption and we have to change our lifestyle. Environment should be taken seriously into account because it can be classified as basic need. That’s because it’s something we can’t live without and it’s inevitable to our lives. However, SDGs target to development which allows the continue of growth. On the contrary, it seems we have to keep on consuming because SDGs aim at increasing economic productivity. But how is it possible to keep on consuming and at the same time protect the environment? If we go on like this, we can’t meet the environmental limits. And if we fail to protect the environment, we can’t eradicate poverty or achieve any other targets described. The consequences of environmental destruction impinge most badly to the poor. (Woodward 2015). The SDGs are trying to find a compromise between our consumer culture and protecting of the environment. It’s hard to change our lifestyle because our whole society is based on growth and consumerism. The SDGs suggest we have to create green jobs and green economy which remain in the boundaries of environment. The new goals are optimistic and maybe even impossible to achieve. We have to be prepared for the possibility that trying to achieve sustainable, sustain and inclusive growth and society isn’t going to be enough to protect our planet (Gough 2013, 199-200).   References Gough, Ian (2013). Climate change, social policy, and global governance. Journal of International and Comparative Social Policy, 29, 185-203. Maslow, Abraham H. (1954). Motivation and personality. New York, NY: Harpers&Brothers. Woodward, David (2015). “Incrementum and Absurdum: Global Growth, Inequality and Poverty Eradication in a Carbon-constrained World.” World Economic Review. Sustainable Development Goals. Retrieved from http://www.un.org/sustainabledevelopment/sustainable-development-goals/

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BLOG: IS PAOLO FREIRE STILL RELEVANT? by Noémie Cely

At the present time, we cannot think anymore about poverty as an isolated problem. Poverty is not related to the absolute scarcity of goods but to an unequal distribution. At the global and at the national level. Indeed, a system is maintaining, in a plutocratic way, a power relationship between a small number of owners and the “marginalized majorities“. Marginalized because devoid of any incentives over their own lives. Devoid of any ability to do or to be, meaning of any ‘capability’, an idea on which Sen and Freire merge. Worse! These majorities are in a way owned by the wealthy people : they are dehumanized. This statement sounds “old fashioned“, ones would argue, “déjà vu“ others would shout, “Still relevant“ I will defend.

In his Pedagogy of the Oppressed (1968), Paolo Freire presented a guide for oppressed people and oppressors ready to join them in their fight to free the whole world. In his view that I share, not only the oppressed people but also the oppressors need to be freed in order to restore the humanity of both of them. The freirian pedagogy requires a concientization of the oppressed people helped by some humanist educators in a very subtle way. It should be oriented to the praxis (dealing with the reality) and avoiding the trap of reproducing the same system. “Nobody frees anybody else; nobody is freed alone; people free themselves together”.

Utopian? His ideas have been implemented by the Worker’s Party in Brazil. The city of Porto Alegre gives a very successful example of it. Through the practice of participatory budgeting, meaning that the population has a voice over the management of the municipal budget. Porto Alegre with 1.3 Million inhabitants and a budget of $7 Billion has seen its service of water reach 98%, its children enrollment in school doubled and even the revenues growing because of the transparency of the model playing a motivational role to pay taxes. This happened in less than 10 years (from 1989 to 1996).

Still irrelevant today? It is up to you!

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Globalizing social and health care conference April 25-26, 2016 at the University of Tampere

The registration for Globalizing social and health care conference 25.–26.4.2016 at the University of Tampere is open. Please, sign in here http://www.uta.fi/edu/en/transit/kvsote/registration.html. Welcome!

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High variation in overweight and obesity across sub-Saharan African countries by Subas Neupane, PhD, Post-doc researcher, UTA

A recently published article of the further analysis of Demographic and Health Survey (DHS) data collected in 32 sub-Saharan African countries among 250651 women (aged 15-49 years) shows a high variation in overweight and obesity among countries in sub-Saharan Africa. Body mass index (BMI) was calculated by dividing body weight by height squared to define overweight (25.0 - 29.9 kg/m2) and obesity (≥30.0 kg/m2). The pooled prevalence of overweight for the region was 15.9 % with the lowest in Madagascar 5.6% and the highest in Swaziland 27.7%.  Similarly, the prevalence of obesity was also lowest in Madagascar 1.1% and highest in Swaziland 23.0%. Twenty-seven of the studied countries had overweight prevalence higher than 10% and 7 countries had more than 10% prevalence of obesity. Urban residents, women with high education and rich women as measured by wealth index quintile had higher odds of overweight and obesity in general. Authors argued that these findings put these countries at the risk of high burden of obesity related morbidity and mortality in the future. The authors also explained the rural-urban disparities in overweight obesity by the differences in lifestyle and dietary pattern between urban and rural dwellers in Africa. In rural areas, residents mainly eat fresh food from the farm, and mostly green and fresh fruits and vegetables are available from backyards. Therefore, the dietary pattern of rural folks although unintentional tends to be healthy compared to that of urban folks. Apart from diet, the lifestyle of urban residents is tilted towards westernization and the blind adoption of the so-called western lifestyle. There are growing numbers of western food outlet and urban residents perceive eating at such joints as a sign of affluence. Transnational fast-food companies in the region are aggressively exploiting this perception. The nature of occupation prevailing in rural and urban setting in Africa also contributes to the differences in obesity and overweight between the two settings. In most rural setting, the main form of occupation is still non-mechanized agriculture and physical activity based vocation such as fishing, small-scale mining and lumbering. The authors concluded that owing to the well-known risk of overweight and obesity, the emerging epidemic in Africa needs to be addressed early enough to prevent its related morbidity and mortality. A number of interventions can be implemented. The fast growing cities should include in their development plans the creation of safe pedestrian walkways and bicycle lanes to enable pedestrians and cyclist feel safe. Reference: Neupane S, KC P, Doku DT. Overweight and Obesity among Women: Analysis of Demographic and Health Survey Data from 32 sub-Saharan African Countries. BMC Public Health, 2016; 16:30. DOI: 10.1186/s12889-016-2698-5. Link to full text: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-2698-5

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