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Asthma is the commonest chronic childhood disease and encompasses a spectrum of airway diseases with similar symptoms. Inaccurate diagnosis remains common, especially in younger children, with failure to characterize the different “asthmas.” Chi
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ldren worldwide repeatedly suffer symptoms which severely affect their everyday lives. Children die from asthma, especially in low and middle-income countries (LMICs). In many countries, asthma prevalence is rising. Access to effective care and changing environments are hugely variable and may explain the higher morbidity in inner-city children, in LMICs, and in deprived populations in high-income countries. Despite the disease being eminently controllable, morbidity and mortality persist.
more
Chronic respiratory diseases, such as asthma and
chronic obstructive pulmonary disease, kill more than
four million people every year and affect hundreds
of millions more. These diseases erode th
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e health
and well-being of the patients and have a negative
impact on families and societies. Women and
children are particularly vulnerable, especially those
in low and middle income countries, where they are
exposed on a daily basis to indoor air pollution from
solid fuels for cooking and heating. In high income
countries, tobacco is the most important risk factor
for chronic respiratory diseases, and in some of
these countries, tobacco use among women and
young people is still increasing.
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The National Asthma Education Programme (or NAEP for short) was started in 2008. We are a registered Non-Profit Organisation that aims to disseminate impartial information about asthma diagnosis and treatment to health professionals and the South African public.
With Asthma Day coming up, Edrine Osteen Mukalazi sat down with Dr. Rebecca Nantanda to discuss "Closing the gap on #Asthma care for children on the Health Pot show."
Leave on a comment and let us know whether this video has been educational for you.
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✽ Our guest Rebecca Nantanda ✽
⊳ Dr. Rebecca Nantanda is a member of the Institute Technical Board (ITB) of Makerere University Lung Institute.
⊳ She has been involved in research on respiratory diseases in children for the past 12 years with specific focus on pneumonia and asthma.
⊳ She has a number of publications in peer-reviewed journals and has made several presentations at International and Local Scientific conferences on the above subjects.
⊳ She is currently involved in research, clinical care and pre-service and in-service training of health care professionals.
⊳ Her qualifications contain MBChB (MUST), M.Med Paediatrics and Child Health (MUK), PhD, Postdoctoral Research Fellow, Sida- Makerere Research Program.
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Childhood Respiratory Diseases & the Environment learning objectives
•To understand how the respiratory tract is affected by the environment
•To describe respiratory diseases linked to the
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environment
•To list one population-level intervention and one personal-level intervention for decreasing risk of respiratory diseases
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The prevalance of asthma an allergy, defined as immunologically mediated hypersensitivity, is increasing. It is estimated that over 20% of the world population suffers from IgE-mediated allergic disease, such as allergic asthma, allergic rhinitis and allergic conjunctivitis, atopic eczema/atopic der
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matitis, and anaphylaxis. Asthma, which in more than 50% of adults and in at least 80% of affected children is allergic, occurs in around 5-15% in the paediatric population. Asthma it estimated by the World Health Organization (WHO) to affect about 150 million people worldwide, placing an enormous strain on health resources in many countries, and is a major cause of hospitalizations for chronic diseases in children in the western wolrd.
Information may be derived from areas where a rapid increase in disease has occured, to from the basis for prevention strategies in areas where the prevalence of these diseases is still low. Where current expert opinion is still divided, where future research is required, or studies have provided negative results, the available information may prevent the implementation of unnecessary, restrictive, and costly avoidance strategies.
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles
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terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
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Monitoring is the on-going collection, management and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
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Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the
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patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
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Chronic noncommunicable diseases (NCDs) are the number one cause of death and disability in the world.
The term NCDs refers to a group of conditions that are not mainly caused by an acute infection, result in long-term health consequences and oft
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en create a need for long-term treatment and care. These conditions include cancers, cardiovascular disease, diabetes and chronic lung illnesses.
Many NCDs can be prevented by reducing common risk factors such as tobacco use, harmful alcohol use, physical inactivity and eating unhealthy diets. Many other important conditions are also considered NCDs, including injuries and mental health disorders.
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Development of cardiovascular disease (CVD) is influenced by risk factors such as:
tobacco use, an unhealthy diet, physical inactivity, obesity (which can result from
a combination of unhealthy diet, physical inactivity, and other factors), elevated
blood pressure (hypertension), abnormal blood l
...
ipids (dyslipidaemia) and elevated blood glucose (diabetes mellitus). Continuing exposure to these risk factors leads
to further progression of atherosclerosis, resulting in clinical manifestations of these diseases, including angina pectoris, myocardial infarction, heart failure and stroke. Total CVD risk depends on the individual’s overall risk-factor profile.
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Air pollution is a major environmental risk factor and contributor to chronic, noncommunicable diseases (NCDs). However, most public health approaches to NCD prevention focus on behavioural and biomedical risk factors, rather than environmental risk
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factors such as air pollution. This article discusses the implications of such a focus. It then outlines the opportunities for those in public health and environmental science to work together across three key areas to address air pollution, NCDs and climate change: (a) acknowledging the shared drivers, including corporate determinants; (b) taking a ‘co-benefits’ approach to NCD prevention; and (c) expanding prevention research and evaluation methods through investing in systems thinking and intersectoral, cross-disciplinary collaborations.
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Polluted air is a public health hazard that cannot be evaded. It is widely known that long-term exposure to air pollution enhances the risks of cardiovascular and respiratory diseases. Scientists from the Max Planck Institute for Chemistry and the U
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niversity Medical Center Mainz now calculated in a new study that the global, public loss of life expectancy caused by air pollution is higher than many other risk factors such as smoking, infectious diseases or violence
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The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes. Over this period, the GBD has become progressively more granular. The latest iteration provides assessments of thousands of outcomes for
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diseases, injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries. With each GBD iteration, the data, data processing and methods used for data synthesis have evolved, with the goal of enhancing transparency and comparability of measurements and communicating various sources of uncertainty. The GBD has many limitations, but it remains a dynamic, iterative and rigorous attempt to provide meaningful health measurement to a wide range of stakeholders.
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Long-term exposure of humans to air pollution enhances the risk of cardiovascular and respiratory diseases. A novel Global Exposure Mortality Model (GEMM) has been derived from many cohort studies, providing much-improved coverage of the exposure to
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fine particulate matter (PM2.5). We applied the GEMM to assess excess mortality attributable to ambient air pollution on a global scale and compare to other risk factors.
Methods and results
We used a data-informed atmospheric model to calculate worldwide exposure to PM2.5 and ozone pollution, which was combined with the GEMM to estimate disease-specific excess mortality and loss of life expectancy (LLE) in 2015. Using this model, we investigated the effects of different pollution sources, distinguishing between natural (wildfires, aeolian dust) and anthropogenic emissions, including fossil fuel use. Global excess mortality from all ambient air pollution is estimated at 8.8 (7.11–10.41) million/year, with an LLE of 2.9 (2.3–3.5) years, being a factor of two higher than earlier estimates, and exceeding that of tobacco smoking. The global mean mortality rate of about 120 per 100 000 people/year is much exceeded in East Asia (196 per 100 000/year) and Europe (133 per 100 000/year). Without fossil fuel emissions, the global mean life expectancy would increase by 1.1 (0.9–1.2) years and 1.7 (1.4–2.0) years by removing all potentially controllable anthropogenic emissions. Because aeolian dust and wildfire emission control is impracticable, significant LLE is unavoidable.
Conclusion
Ambient air pollution is one of the main global health risks, causing significant excess mortality and LLE, especially through cardiovascular diseases. It causes an LLE that rivals that of tobacco smoking. The global mean LLE from air pollution strongly exceeds that by violence (all forms together), i.e. by an order of magnitude (LLE being 2.9 and 0.3 years, respectively).
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The video titled "Physical Activity and Chronic Disease Prevention" emphasizes the importance of regular physical activity in reducing the risk of chronic diseases. It discusses how engaging in consistent exercise can help prevent conditions such as
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heart disease, diabetes, and certain cancers. The video also provides practical tips for incorporating physical activity into daily routines to enhance overall health and well-being.
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Tobacco kills up to half of its users who don’t quit (1-3).
Tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to second-hand smoke Around 80% of the world's 1.3 billion tobacco users live in low- and middle-income countries.In 2020,
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22.3% of the world’s population used tobacco: 36.7% of men and 7.8% of women.
To address the tobacco epidemic, WHO Member States adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. Currently 182 countries are Parties to this treaty.
The WHO MPOWER measures are in line with the WHO FCTC and have been shown to save lives and reduce costs from averted healthcare expenditure.
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Over one third of all deaths in Kenya in 2019 were attributed to NCDs (Vos et al., 2020). The four major NCDs – CVDs, cancer,
diabetes and chronic respiratory diseases – accounted for 57% of these deaths. Furthermore, the direct and indirect ec
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onomic
impact of NCDs is significant- Kenya is said to have lost Ksh 230 billion or 3.4% of its gross domestic product in 2016 from rising
NCD-related medical costs and indirect productivity losses. At the household level, an estimated decrease of 28.6% in income
due to NCDs was reported in 2007 (Mwai & Muriithi, 2016; Mensah et al., 2020). Therefore, preventing and managing NCDs are
significant public health and economic priorities.
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Cardiovascular disease (CVD) is often thought to be a problem of wealthy, industrialized nations. The term “cardiovascular disease” is used throughout the report to refer to cardiac disease, vascular diseases of the brain and kidney, and periphe
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ral vascular disease. The report’s main focus is on the major contributors to global CVD mortality, coronary heart disease and stroke, and on the major modifiable risk factors for cardiovascular diseases. In fact, as the leading cause of death worldwide, CVD now has a major impact not only on developed nations but also on low and middle income countries, where it accounts for nearly 30 percent of all deaths. The terms “developed” and “high income countries” are used interchangeably throughout the report to refer to countries classified by the World Bank as high income economies. The terms “developing” and “low and middle income countries” are used interchangeably throughout the report to refer to countries classified by the World Bank as low, lower middle, and upper middle income economies. The increased prevalence of risk factors for CVD and related chronic diseases in developing countries, including tobacco use, unhealthy dietary changes, reduced physical activity, increasing blood lipids, and hypertension, reflects significant global changes in behavior and lifestyle. The term “chronic diseases” is used throughout the report to refer to CVD and the following related chronic diseases that share many common risk factors: diabetes, cancer, and chronic respiratory disease. These changes now threaten once-low-risk regions, a shift that is accelerated by industrialization, urbanization, and globalization. The potentially devastating effects of these trends are magnified by a deleterious economic impact on nations and households, where poverty can be both a contributing cause and a consequence of chronic diseases. The accelerating rates of unrecognized and inadequately addressed CVD and related chronic diseases in both men and women in low and middle income countries are cause for immediate action.
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High variability in the definition and interpretation of organized cancer screening needs to be addressed systematically. Moreover, the relevance of the current practice of categorizing screening programmes dichotomously into organized or non-organized needs to be revisited in the context of conside
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rable heterogeneity that exists in the delivery of cancer screening in the real world. We aimed to identify the essential and desirable criteria for organized cancer screening that serve as a charter of best practices in cancer screening.
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