Health Wikipedia

Mental health is deeply influenced by external social and environmental factors. Along with physical illness, it is now well evident that extreme climatic events can cause significant psychological stress with long-lasting effects on anxiety levels and depression.

There would be more devastating permanent mental health impact on the survivors like a child, who has to face the burden of pain and stress of losing his or her family members.

Ironically, the issue is overlooked very often and the effects of climate change on mental health are relatively missing in most discussions on climate change. But experts feared that rapid change in the climate is likely to fuel up the current rising trends of mental illness.

UNFCCC 4th report on global warming stated that there is a direct association between the presence of major mental illness like acute psychosis and schizophrenia in tropical countries.

Extreme climate change events like heat stoke which manifest as delirium and other neuro-psychiatric syndromes characterised by altered consciousness to agitation, restlessness, unconsciousness and even death. Heat stroke has already caused deaths among heavy workers and rickshaw pullers in Bangladesh.

A study conducted by Jain S (2001) demonstrated the association between presence of acute psychosis, schizophrenia, mood disorders and obsessive compulsive disorders with post viral infections which is set to increase with the climate change. Post viral infection is one of the important risk factors for damaging fetal brain in the intrauterine period which causes many developmental and mental disorders among children in future.

Major population displacement after an extreme climatic event would cause social disruption, unemployment, social conflicts, mental unrest and economic burden and uncertainty as we see in Haiti following a massive earthquake.

All these factors are associated with increased prevalence of mental disorders like anxiety, depression and stress disorders. Besides, increase salinity of water in the coastal area would hamper food production which results in malnutrition and child developmental disorders.

The extreme events cause immense psychosocial stress especially among vulnerable groups like children, women and elderly. A survey among Asian Tsunami affected population by WHO revealed that 30-50% of population suffered from moderate to severe form of mental disorders.

Natural disasters have shown to result in increased domestic violence due to frustration and anger. Flood is a common natural calamity in Bangladesh. A study in the state of Orissa in India concluded that mental disorder like depression and Post Traumatic Stress Disorders (PTSD) were increased among post flood affected population after one year.

Drought is another serious consequence of climate change which causes food scarcity, hunger and malnutrition. Drought contributes to mental agony and depression among farmers due to financial hardship which increases suicide rate among them. Suicide rate was highest among farmers in drought found in an Australian study.

A recent report of Climate Change Cell of Department of Environment of Bangladesh mentioned that the annual incidence of mental disorder was 22431 per year which was higher than that of Dengue (3305 per year). It indicates the need for prioritisation of mental health in the health component of National Adaptation Programme of Action for climate change of Bangladesh.

Very often, women in Bangladesh present to a doctor’s room when their diseases have already progressed to a grave condition and need aggressive treatment. Sometimes, physicians have very little to do with a woman when she comes at the end stage of a fatal disease like cancer. With simple and inexpensive screening tests, women can prevent a range of deadly diseases like cancer, glaucoma, complications of diabetes etc. and help remain heal and hearty.

1. Breast cancer
Diagnosis in the early stages is crucial for breast cancer like other cancers. Mammograms are used as an ideal screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge. A woman should have a mammogram done within 40s. Onwards, they should get an annual screening for early detection, experts recommended. Any discomfort or pain in the breast should be investigated throughly and must not be neglected. Any unusual discharge should be checked out right away. Sometimes doctors recommend ultrasonography and low-dose x-ray can also detect disease at early stage and used as screening tools.

2. Cervical cancer
Cervical cancer is top ranked killer cancer in Bangladesh. It occurs in the cervix, a part of the uterus that extends into the vaginal cavity. Routine screening can find it early, when it is highly curable. It can also find abnormal precancerous cells on the surface of the cervix so they can be removed before they turn into cancer. Doctors recommend VIA (Visual Inspection of Cervix using Acetic Acid) which is given free of cost in the government settings and Pap test to screen for cancer of the cervix. The screening test should start as early as women enter in reproductive age. For better protection FDA approved vaccine cervical cancer vaccine is available in our country; it confers immunity against HPV virus that causes cancer.

3. Osteoporosis and fractured bones
Osteoporosis is a condition in which bones become weak and fragile. It is caused by bone loss, which accelerates in women after menopause. A test called Dual Energy X-ray Absorptiometry (DXA) can measure bone mineral density and detect osteoporosis before fractures occur. It can also help predict the risk of future bone fractures. Bone density testing is recommended for all women 65 years of age and older. It is also recommended for middle-aged women younger than 65 who have risk factors for osteoporosis.

4. Cholesterol levels
A high level of LDL cholesterol (bad cholesterol) is a major factor that increases the risk of developing heart diseases. Doctors screen for problems with cholesterol by using a fasting blood lipid profile. Management decisions are based on the results.

5. Type 2 Diabetes
Measuring the fasting blood glucose and two hours after breakfast are used to screen for diabetes. Experts also recommend another tests called HbA1C. If a woman is healthy and have a normal risk of diabetes, she should have the test done every two years starting at age 45; with higher risk, one should start testing earlier and more frequently.

6. Colorectal cancer
The majority of colon cancers develop from colon polyps that are growths on the inner surface of the colon. A colonoscopy is a common screening test for colorectal cancer. A doctor views the entire colon using a flexible tube and a camera. Polyps can be removed at the time of the test. A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon. If a woman is at average risk, screening usually starts at age 50.

7. Glaucoma
Glaucoma is a condition that can result in blindness due to damage to the optic nerve. People older than age 50, family history of glaucoma, personal history of eye injury and steroid use are risk factors for glaucoma. For healthy individuals without increased risk, routine screening every two years is recommended for people under age 40. For those between 40 to 54 years, testing should be done every one to three years. From age 55 to 64, testing should be done every one year, and for those over 65, every six to 12 months.

Despite significant improvement in medical science in recent decades, mothers and their babies in the third world countries like Bangladesh are still at risk during the perinatal period, which covers pregnancy, delivery and the postpartum.

Babies born too early are more likely to die than that of born at term. They are also more likely to have neurological and developmental disorders that carry long-term consequences for their quality of life, their families and for health and social services.

Perinatal health includes care for both mother and their new born babies. But we often forget about the care of the mothers during and after delivery. However, maternal deaths are less than babies. This is a tragic event as a significant proportion of these deaths are associated with substandard care.

When we talk about paediatrics (child care), it only deals with children. And the obstetricians deal with mothers only. But we need to set up a sturdy bridge in between these two separate entities. It is impossible to think about healthy child without healthy mother. In fact, perinatal science deals with a unique two in one health delivery system.

Bangladesh has made a significant progress in reducing maternal and infant death in recent years. This has been possible because of strong leadership of the Ministry of Health and Family Welfare (MOHFW) in creating a supportive policy environment, technical and financial commitment of donors and UN agencies, active engagement of professional bodies and academic institutions. National Neonatal Health Strategy has already been prepared by the MOHFW. Now we need to operationalise the recommendations outlined in the strategy and begin to roll out the crucial interventions needed to prevent unnecessary deaths.

Immediate and early postnatal care for mothers and newborns is one such crucial intervention. Most of maternal and newborn deaths occur within the first three days of childbirth. Therefore we need to deliver the services to them in those crucial days.

Neonatal sepsis (infection of the newborn) is the single largest contributor to neonatal mortality. We need to ensure that the health service providers at community level can prevent, detect and manage sepsis when it occurs. Now operation research is underway to see the feasibility of different approaches in order to determine the best way to deliver this service to the majority of the newborns who are born at home.

We need to strengthen the policies, guidelines and service providers’ capacity to ensure that the neonates and the mothers are not left without care. Unless we can scale up these services to reach the primary level of health system, we will not be able to attain the Millennium Development Goals by 2015. We need to create additional posts of neonatologists and obstetricians at the district hospital level as a starting point.

Prof M Shahidullah.

The incidence of mental disorder is rising by and by. Wave of migration, industrialisation, individualism, changing socio-cultural norms, changing family pattern, over careerist drive and drug addiction are the important factors considered behind this rising trend. In Bangladesh, a community based research on mental illness conducted in 2005 reported that 16.1 per cent adult populations suffer from various mental disorders.

It is the scenario of only from adult population and no research has been conducted among the children. The situation is more scary when we look at the statistics that say there is only one psychiatrist for 1500000 persons. There are only 120 psychiatrists in our country that depicts the pitiable condition.

After calculation, it has been found that there are only 813 psychiatric beds in Bangladesh to serve the whole nation. That means 172000 people share one bed. In 2005 only 0.44 percent was allotted for mental health in total health budget which was obviously insufficient.

In this situation, we will observe World Mental Health Day today. This year, the World Federation for Mental Health has decided the theme “Mental health in primary care: enhancing treatment and promoting mental health”. The theme is intended to emphasise the benefits of enhancing overall health and promoting mental health by integrating healthcare services.

National survey on mental health in Bangladesh reveals, about 14 lacs people have been suffering from major mental disorders (schizophrenia, mood disorders etc.), 65 lacs people have been suffering from depressive disorder and 1 crore 18 lacs people have been suffering from minor mental disorders (anxiety, phobia , conversion disorder etc).

Besides, about 46 lacs to 70 lacs people are drug addicted. Most of these patients are found in general practice, outpatient service at hospital and primary health care centers.

Mental disorder creates a substantial personal burden for affected individuals and their families. They produce significant economic and social hardship that affects the society. Many people suffer from both physical and mental health problems. Integrated primary care services help ensure that people are treated in a holistic manner, meeting the mental health needs of people with physical disorders as well as the physical health needs of people with mental disorders.

If the mental health care is included in the primary healthcare, our mental health service will reach the outreach. Patients and families can avoid indirect costs associated with seeking specialist care in distant locations. Treatment of common mental disorders is cost effective. Investments by governments can bring important benefits.

To include the mental health component in primary health care service, it should be first included in the health policy. There is dire need of intensive attention to mental health.

There is also a need of fundamental training in mental health with ensuring the supply of common psychotropic drugs in field level. To build a healthy nation we should promote mental health by enhancing treatment facilities in primary health care system. To survive on the runway to globalisation we should not observe this World Mental Health Day only as one-day event, rather give cordial effort to realise the theme for healthy nation.

Irrespective of gender and age, everyone has the equal right to see the beauty of this world. But access to eye care services for women and girls is not equal to that of men and boys. Only 35 percent of eye care services are received by women and girls who are blind and remaining 65 percent services are received by their male counterparts.

Experts identified gender discrimination, customary social attitude, lack of women empowerment, lack of education and awareness, fissure in national policy for eye health are the barriers to equal access to eye care services.

Nearly two-thirds of blind people worldwide are women and girls. Less access to eye care services than men is one important fact behind the huge number of blind women and girls. Moreover, certain eye conditions like trachoma and cataract affect women more than men contributing the rising number.

The theme of World Sight Day 2009 that was being observed on October 8 was “Gender and eye health — equal access to care”. It was dedicated to ensure gender equality in the access of eye care services, which is unfortunately not the case in Bangladesh.

There is urgent need to step up focus on women and girls who unnecessarily have already become blind or becoming blind where simple interventions can prevent blindness and help them get back their precious sight.

Women and girls face the discrimination in receiving proper eye care services due to certain factors that should be eliminated.

“We have common social attitude that women should always get less priority not only in getting eye care but also in all social services. Male people of the family hold the decision making power and they are reluctant to bring women and girls under eye care services as they are not earning members of the families”, said renowned ophthalmologist Dr M A Muhit, Clinical Research Fellow of International Centre of Eye Health, London.

“Women are also not aware of the fact that they have equal right to access eye care as male. Moreover, many women have accepted the condition as their fate; rather they prefer treatment of their husbands or children. But very few of them know that 80 per cent of the blindness can be prevented with early intervention and sight restoring surgery”, Dr Muhit added.

Although female gender are more in number and deprived more, there is no gender analysis or gender sensitive issue in the national plan for eye health in Bangladesh. Health authorities in the national level need to recognise the existing gender differences in access to eye care services. This could be an important step to reducing the disparity in eye care treatment for women.

Dr Muhit opined that the existing programmes to eradicate avoidable blindness and improve eye health in Bangladesh must give emphasis on counselling, education, awareness and empowering women. Along with women, men as they are considered decision makers, must be motivated and make aware about the significance of sight restoring operations or treatment for women to help them get back their sight.

Blind women cannot contribute to the well-being of the family with ease. Motivating men and women together can have the tremendous impact on community mobilisation. With access to timely treatment of women with impaired vision or avoidable blindness can bounce back and lead more fulfilling lives, Dr Muhit suggested.

Women need better access to eye care services. Without ensuring equal access to eye care for them, we cannot meet the target to eradicate avoidable blindness within 2020. Let’s make a cumulative move to reach the goal.

The recent outbreak of H1N1 influenza epidemic which is better familiar as swine flu is a respiratory disease of pigs caused by type A influenza virus that causes regular outbreaks in pigs.

The human outbreak has created panic in the people due to some fatality. People are in a fix due to some reasons which include the disease is relatively new, healthcare setup is not completely equipped with adequate resources, medical professionals are not quite skilled handling the disease and so on.

When there was first outbreak of dengue haemorrhagic in Bangladesh, people were so worried similarly. But it is no longer a disease of panic.

To deal with the H1N1 influenza, we need keeping in mind several things. The best way to keep from spreading the virus through coughing or sneezing is to limit contact with other people as much as possible. Sick people should avoid work place and children should not go to schools. Concerned authority should be reluctant in this regard.

When coughing or sneezing, mouth and nose should be covered with tissue which should be discard immediately. If tissue is not available, hands are enough which must be washed afterwards. There is serious bad habit spitting and not covering mouth or nose while coughing or sneezing. Use of civic sense and simple courtesy can contribute a great deal here.

Most of the cases are self limiting and personal hygiene is of great value.

People with H1N1 influenza are potentially contagious as long as they are symptomatic with a ceiling of up to seven days following illness onset. Kids, especially younger children, might potentially be contagious for longer periods.

There is a dilemma about using the masks. Usually three types of masks are used — facemask, surgical mask and N95 mask. The N95 mask is effective in protection of H1N1 virus whereas surgical and facemask have almost no contribution for protection. But wearing facemask or surgical mask is of no harm. At least it protects others from spreading the disease. Sometimes, experts opt for double layered mask for resource poor settings.

Since the virus easily spread in crowded places, children are recommended to abstain from their schools where large outbreak occurs. Otherwise, only sick children are recommended to stay home to avoid spreading illness. Children also should not be brought to crowded places unnecessarily like shopping complexes, cinema halls etc.

Treatment is available in Bangladesh now and soon medical professionals will be used to hand H1N1 cases. Suspected cases should stay home and take home management. In case of developing warning signs or complications, individuals should seek emergency medical care in hospitals.

Antiviral drugs (Oseltamivir), which are available in the market can be stored at home for safety purpose, but it should not be readily taken without any clinical judgement or without prescription of physician, as it may develop resistance.

Fatality occurs due to misdiagnosis of the disease and accompanying other serious/chronic medical conditions — not as the disease is virulent too much. Early intervention with medication can cure the disease as usually.