Health Ministry conducts “routine” TB screening at Maafushi prison after inmate diagnosed

The Ministry of Health today confirmed it has conducted a routine tuberculosis (TB) screening of staff and inmates at Maafushi prison after a single case of the disease was diagnosed at the facility.

Health Minister Dr Ahmed Jamsheed Mohamed today told Minivan News that a screening for TB had been undertaken at the prison, but added that just a single inmate had tested positive and been diagnosed with the disease.

The screening comes a month after the country’s Health Protection Agency (HPA) warned that a drug resistant strain of TB had been found in the Maldives, posing a “quite a serious” health threat for authorities to deal with.

However, Dr Jamsheed said today that there was no information at present to suggest the single case of TB detected at Maafushi Prison was a drug resistant form of the disease.

According to the World Health Organisation (WHO), TB is an infectious bacterial disease that can be transmitted via droplets in the throat and lungs of an infected person.

Despite praising authorities for their efforts to eradicate the disease across the Maldives in recent years, the WHO has expressed concern that drug-resistant strains of TB have become a major public health problem resulting from patients not fully completing the recommended six-month course of treatment.

New challenges

The Ministry of Health released a report earlier this year concluding that authorities in the Maldives were facing new challenges controlling the disease.

HPA Public Health Program Officer Shina Ahmed told Minivan News shortly after the report’s publication in March 2013 that although the new strain of TB was “quite serious”, thus far cases of the disease in the Maldives were not resistant to every drug available to patients.

“We have had a few cases come in now with the new strain. The most important thing we have to do is to continue and complete the course of treatment,” Shina said at the time.

“Most of these drug-resistant strains are caused by patients stopping the treatment. We have enough drug supplies to give to them, but because the course goes on for six months, patients tend to go off taking the treatment towards the end.”

In April 2012, staff at the Maldives Criminal Court were screened by health authorities for TB after an employee was found to have tested positive for the disease.

Control programs

International health authorities have previously observed that the Maldives had achieved notable success in TB control since the establishment of a national control program by the Department of Public Health in 1976.

Maldives has an estimated incidence of 47 per 100,000 population of all forms of TB and has sustained meeting the global targets for TB control since 1996, according to the WHO’s communicable disease department for South East Asia.

Tuberculosis, which had a prevalence in the Maldives of 35 cases per thousand people in 1974, declined to about 0.66 per 1000 by 1996, according to the findings.

However, last year the Health Ministry raised concerns over the growing number of multidrug-resistant tuberculosis (MDR-TB) cases in the Maldives.

The rate of TB prevalence among the country’s expatriate population is also reportedly on the rise as well.  “A large migrant workforce from high TB-burden countries,” continues to identified by the WHO as major challenge for local health bodies.


New drug-resistant strain of TB found in Maldives “quite serious”: HPA

The Health Protection Agency (HPA) has warned that a new drug-resistant strain of tuberculosis (TB) that has appeared in the Maldives poses “quite a serious threat” to people’s health.

The agency’s comments follow a report released by the Ministry of Health on Sunday (March 24), revealing that it faces new challenges in order to control the disease in the Maldives.

According to the World Health Organisation (WHO), TB is an infectious bacterial disease that can be transmitted via droplets in the throat and lungs of the infected.

WHO states that drug-resistant strains of TB have become a major public health problem that has resulted from patients not fully completing the recommended six-month course of treatment.

HPA Public Health Program Officer Shina Ahmed told Minivan News today (March 25) that although the new strain of TB is “quite serious”, the particular strain found in the Maldives is not resistant to every drug available to patients.

“We have had a few cases come in now with the new strain. The most important thing we have to do is to continue and complete the course of treatment.

“Most of these drug-resistant strains are caused by patients stopping the treatment. We have enough drug supplies to give to them, but because the course goes on for six months, patients tend to go off taking the treatment towards the end,” Shina said.

Local media reported that the Health Ministry had revealed that 10,563 people had been registered to receive treatment for TB since 1963, out of which 5,256 people were said to have infected lungs.

Shina claimed that the majority of cases within the Maldives have been reported on the islands as opposed to Male’, and that in order to prevent the spread of the disease the HPA will be undertaking awareness programs.

An official from Indira Gandhi Memorial Hospital (IGMH) in Male’ stated that there was no need for the public to be concerned in regard to the spread of the disease, adding that there may have been only “one or two” cases found to have contracted the new strain.

“When we find a patient who is not responding to the prescribed course of treatment, there is always a second course they can take instead,” the official told Minivan News.

According to WHO, healthy individuals infected with TB are not often affected by any symptoms as the person’s immune system acts to “wall off” the bacteria.

The organisation states that symptoms of active TB are coughing, sometimes with blood, chest pains, weakness, weight loss, fever and night sweats.

The WHO Representative to the Maldives, Dr Akjemal Magtymova, Health Minister Dr Ahmed Jamsheed Mohamed and the Health Ministry were not responding to calls at time of press.


Funding and “public hesitancy” key challenges for continuing successful immunisation program

Some 95 percent of the target population of the Maldives’ national inoculation program have received their recommended vaccinations, despite declining state funding for such initiatives and growing public reticence, health authorities have said.

While ongoing commitments by Maldives authorities to protect the public against preventable diseases were praised this month by international experts, sources within the Ministry of Health have said maintaining high immunisation coverage across the country remains challenging.

Aishath Thimna Latheef, Public Health Program Manager for the Expanded Program on Immunisation (EPI) at the Ministry of Health told Minivan News that a lack of funding for additional training and supervision were among crucial challenges facing national inoculation efforts.

Other issues included a growing number of parents opting against having their children inoculated, and need for improved coordination with private schools.

The World Health Organisation (WHO) reviewed the Maldives EPI and vaccine preventable disease (VPD) surveillance programs between January 27 and February 3 this year, and praised the country’s efforts.

Representatives from the Ministry of Health, UNICEF, the Centre for Communicable Diseases, Atlanta (CDC) and experts from Indonesia, India, Nepal, Myanmar, Thailand and Sri Lanka conducted the review, according to the WHO.

“The government is ensuring immunisation against 10 vaccine preventable diseases. Furthermore, steps are being undertaken for the introduction of pentavalent vaccines into routine immunisation schedules,” said the WHO.

“The team verified that more than 95 percent of the target population have received all the recommended vaccines and immunisation service delivery functions, including vaccine distribution and cold chain management. Effective partnership with the government, WHO, UNICEF and other stakeholders have contributed to these achievements.”

The review was the first study of its kind to be conducted in the country since 2006, following previous research carried out in 1994 and 1988.

“Basic right”

Immunisation Program Manager Thimna maintained that immunisation was a “basic right” of Maldives children under successive governments.

“The government regards children as one of the most important assets of the nation and therefore every effort should be made without discrimination of person’s gender and socio-economic status to promote welfare and full development of their potential for a useful and quality of life,” she said.

“This policy has not changed. Immunisation in the Maldives is 100-percent government funded. But over the years the funds for immunisation have gradually declined, limited now to only the purchase of vaccines and vaccine consumables. Training, supportive supervision and IEC developments are not funded any more. From a programmatic perspective, this is a serious concern for us.”

According to Thimna, the reduced funding was a direct result of economic difficulties experienced in recent years that had resulted in continued calls to cut state expenditure both from within parliament and by international organisations like the International Monetary Fund (IMF).

Beyond financial challenges, authorities indicated that education was another area needing review in order to ensure that all children and young people were being included in national inoculation plans.

According to Thimna, in 1994 the government introduced a policy whereby each schoolchild studying at a public institution was included in a state immunisation program.

However, she contended that with a growing number of public schools in the country, some of these institutions were not following state policies such as the inoculation program.

Without greater collaboration between the state and private education providers, Thimna claimed that a growing number of young people faced being excluded from the national immunisation program if fewer schools signed up.

Anther potential concern identified by authorities was a small but growing number of parents who were opting not to have their children immunised, for unspecified reasons.

Thimna said while only a small number of children were not receiving inoculations recommended by the state as a result of “vaccine hesitancy” among parents, the issue was growing and could potentially become a “huge concern” for authorities in the future if not addressed.

However, she stressed that recent amendments to national legislation did grant health authorities power under the law to give vaccinations to children – even if parents refused – on the grounds of public health.

“The most recent change is the passing of Public Health Act in December 17, 2012. This has given some power to the program to address issues of vaccine hesitancy. But this will only be in action after the rules and regulations and  developed and  incorporated and a new immunisation policy is developed,” Thimna added.

Polio prevention

Addressing the potential risk of a re-emergence  of the polio virus, Thimna said the country was always at risk of importation of such threats.  According to official statistics, the last reported indigenous case of the virus in the Maldives was 1982, however the last imported case of the polio virus was in 1994.

“As a tourist destination, the Maldives is always at risk of importation like any other country in the world. We need to have stringent active and passive Acute Flaccid Paralysis (AFP) surveillance to detect and investigate any case of suspected polio. This is something which we already do but needs to be strengthened,” Thimna said.

“The only thing that would perhaps work in our favour if  an importation occurs is the high level of  hygiene and sanitation in the Maldives.”

In an open editorial piece last month, Regional Director for the WHO in the South-East Asia region, Dr Samlee Plianbangchang, stressed a need for vigilance to eradicate the virus from the region.

With India having recorded a second consecutive year without a reported case of polio virus, Dr Plianbangchang called for sustained efforts to combat potential spreads of the disease, particularly across international borders.

“Although not all countries face the same risk, most countries in the region remain at a risk of polio resurgence through a distant or cross border importation of the wild polio virus from countries where it continues to circulate,” he wrote.

“As India completes two years without any cases of wild polio virus, WHO’s South-East Asia Region is firmly on-track for polio-free certification in early 2014. The South-East Asia Region will be the fourth WHO Region to be certified as polio free, the first Region in more than 12 years after the European Region was certified in 2002.”


SE Asia should focus on keeping kids HIV-free: WHO

HIV/AIDS is shifting profile from a “life-threatening emergency to a manageable chronic disease,” finds an annual report on the Global Response to HIV/AIDS.

The report was released in honor of World Aids Day on December 1, 2011 by World Health Organisation (WHO), United Nations Children’s Fund (UNICEF) and Joint United Nations Programme on HIV/AIDS (UNAIDS) in collaboration with international partners.

The report analyses the health sector’s prevention, treatment and care to those infected in low- and middle- income countries using data through 2010. Among the recommendations for South East Asia was to eliminate childhood infection by 2015.

“We must learn from our experiences, and work to ensure that no child born gets infected with HIV,” Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia, said in a press statement.

As of 2010, 16 million people out of South East Asia’s population of 593 million had been diagnosed with HIV/AIDS. But statistics suggest a synchronized solution. Over the preceding decade infection rates in South-East Asia declined by a sharp 34 percent while the number of people receiving treatment increased ten-fold.

“We are coming out of a transformative decade for the HIV/AIDS epidemic. With innovative treatment regimens, improved health services as well as political commitment, HIV-positive people who are on treatment are living longer and better lives,” Plianbangchang said.

As WHO pushes South-East Asia to eliminate the disease it makes children a priority. Towards that end, an initiative to eliminate new paediatric HIV infections and congential syphilis by that date was launched this year.

Meanwhile, less than one in five pregnant women in the region do not have access to testing facilities, and two out of three infected pregnant women do not receive anti-viral prophylaxis.

Historically the Maldives has been minimally affected by HIV/AIDS, however social trends are putting the population at risk.

Between 1991 and 2006 only 13 HIV cases were reported among Maldivians, compared to 168 among expatriate workers. Of the Maldivian cases 10 were sailors, two were spouses, and one was a resort worker who had traveled abroad; 11 cases were male, and all patients cited heterosexual transmission as the cause.

Yet the country’s geographical constraints have made it highly dependent on foreign imports. This has been shown to include human trafficking for purposes including sexual entertainment. In 2010, an HIV-positive prostitute was arrested locally.

Late last month, human trafficking was reported a growing industry. In 2008, a World Bank report listed mobility, sexual practice, commercial sex work and drug use as leading risk factors. Although HIV is not prevalent within the Maldives, the report claims travel, work and education abroad open opportunities for transmission.

The Maldives also has the world’s highest divorce rate, indicating a high rate of shared partners within the country. Without any formal sexual education in schools and a general stigma around purchasing a condom, the basic defenses against HIV transmission are low.

The report also cites drug use as a risk factor for two reasons. “Drug users may resort to selling sex to earn money, and injecting drug users (IDUs) may share needles/syringes.”

In Awareness, the Maldives scored in the middle-range. While 99 percent of Maldivians polled had heard of HIV/AIDS and 91 percent knew at least one mode of HIV transmission, only 50 percent said condoms can protect against HIV and 34 percent did not know that a healthy looking person can carry the virus.

Currently, the government and independent organisations provide support and awareness within the Maldives. The National AIDS Council, established in 1987, oversees the National AIDS Program (NAP) which coordinates and monitors a multi-sectoral response to the issue.

United Nations’ Development Program (UNDP) is also running a project, active in the Maldives until 2012, with several local NGOs. It aims to support preventative efforts and improve treatment.

Among the conclusions drawn in WHO’s 2011 report on Asia are:

  • Cambodia was the only country to achieve universal ART access
  • 39 percent infected children had access to paediatric HIV treatment
  • 49 percent of people living with HIV are in India
  • Infections among children declined by 23 percent in Asia, but increased by 31 percent in East Asia
  • Asia’s death toll from AIDS-related causes in 2010 was the largest outside sub-Saharan Africa; approximately 310,000 people died
  • Half of the 4.5 million people in Asia who inject drugs live in China
  • Homosexual transmission is highest among men in Indonesia, India and Myanmar

Officials at the Ministry of Health and Family and WHO Maldives were unavailable for comment at time of press.


Maldives holds regional record as malaria-free zone

The Maldives holds South-East Asia’s record for being malaria-free. Meanwhile, the region is falling behind as one-third of affected countries show signs of eliminating the vector-borne disease over the next ten years.

Dr Robert Newman, director of the Global Malaria Program of World Health Organisation (WHO) said malaria control has improved significantly. “The world has made remarkable progress with malaria control. Better diagnostic testing and surveillance has shown that there are countries eliminating malaria in all endemic regions of the world.”

Malaria affects 40 percent of the world population. While the Maldives had a volatile track record in the 1970s, peaking at 1100 cases in 1976, virtually no cases of local origins have been reported since 1984.

Director General of Health Services Dr. Ibrahim Yasir said the only malaria cases have involved foreigners or Maldivians who have traveled to regions where the disease is endemic.

“A few times a year a foreigner might come who has been infected elsewhere, or in a recent case a Maldivian boat capsized near Africa and those on board contracted malaria and were treated here,” he said.

Yasir noted that the interiors of transport vehicles coming from malaria-infected locations are sprayed with a disinfectant to prevent accidental importing of the bug.

Certain countries that share regular traffic with the Maldives are showing worrisome resistance to malaria elimination.

According to an article published by Times of India today, Roll Back Malaria Partnership (RBM)’s latest report says that high rates in India, Indonesia and Myanmar have kept South East Asia’s malaria report rate stable while other regions see a declining report rate.

RBM’s report compares 5,200,000 probable and confirmed cases of malaria in 2000 in India against 5,000,000 in 2010. A WHO fact sheet, however, notes that 2 million fewer cases of death due to malaria were reported for the same time period.

Sri Lanka and Korea are in the pre-elimination phase.

Malaria elimination – the deliberate prevention of mosquito-borne malaria transmission resulting in zero incidence of infection in a defined geographical area – was first attempted at large scale during the Global Malaria Eradication Program from 1955 to 1972.

WHO certified 20 countries as malaria-free during this time, however in the 30 years that followed efforts to control the disease deteriorated and only four countries were certified.

During the 1970s, the Maldives successfully eliminated the malaria-carrying mosquito. It continues to combat the dengue-carrying mosquito, however, and several outbreaks have claimed 11 lives this year, making 2011 the worst year on record for dengue fatalities.

Among the factors that prevent the elimination of malaria, dengue and other viral diseases is the over-use of antibiotics. At the 64th meeting of the Regional Committee for South-East Asia in September, members suggested that overuse of antibiotics was making diseases harder to treat.

In 2010, WHO introduced a program combatting the reflexive practice of prescribing anti-malarials to any child with a fever. “Anti-malarial treatment without diagnostic confirmation means poor care for patients. It masks other deadly childhood illnesses, wastes precious medicines, hastens the inevitable emergence of drug-resistant parasites and makes it impossible to know the actual burden of malaria.”

In a previous interview with Minivan News, ADK Chief Operating Officer Ahmed Jamsheed called antibiotics “the most misused drug in the Maldives,” and warned that the trend could put Maldivians more at risk for dengue fever and chikungunya, as well as viral diseases.


Climate experts and celebrities converge on Maldives for Slow Life Symposium

Luxury Maldivian resort Soneva Fushi is currently hosting a three day ‘Slow Life’ symposium bringing together big names in business, climate science, film and renewable energy to come up with ways to address climate change.

Attendees at the Symposium include famous UK entrepreneur Richard Branson, founder of the Virgin Empire; actress Daryl Hannah, star of films including ‘Blade Runner’, ‘Kill Bill’ and ‘Splash’; Ed Norton, star of films including ‘Fight Club’ and ‘American History X’; Tim Smit, founder of the Eden Project; Maldives President Mohamed Nasheed; and an array of climate experts and scientists including Mark Lynas and Mike Mason.

Richard Branson

Branson described how six years ago former US Vice President and environmental advocate Al Gore arrived at his house “and made me realise I had to make changes to the way I was doing business in the own world.”

Among other initiatives, Branson described his creation of a “Carbon War Room” funding scientific work into both climate education and the development of a renewable alternative to jet fuel.

“Ethanol was not a good idea because it freezes at 15,000 feet,” Branson noted. “So we’re investigating alternatives such as algae, isobutanol and fuel created from eucalyptus trees,” he said, adding that Virgin would be making a significant announcement on the subject next week.

Big business had the ability and prerogative to break down market barriers to the development of low carbon technologies, he said. Inefficient shipping, for instance, wasted US$70 billion a year, and led him to create a website allocating ratings to the most efficient vessels and ports, that had attracted interest from large grocery chains.

Branson also outlined his US$25 million prize for the development of a commercial technology capable of removing carbon from the atmosphere, an idea he said was inspired by the 1714 prize offered for developing a means of measuring longitude on a ship, and had attracted thousands of innovative ideas.

President Mohamed Nasheed

Speaking at the symposium on Saturday, Nasheed said it was “very clear, that regardless of whether you are rich or poor, too much carbon will kill us.”

“For us, this is not just an environmental issue. We need to become carbon neutral even if there was no such thing as climate change, simply because it is more economically viable. We spend more than 14 percent of our GDP on fossil fuel energy, which is more than our education and health budget combined.”

The most important adaptation measure, Nasheed said, “is democracy. You have to have a responsive government to discuss this issue. When I do something people do not believe in, they shout at me. But they are not doing this on this issue.”

The government had reformed its economic system and introduced new taxes “so we can fend for ourselves. We cannot endlessly rely on the international community.”

Since last year’s symposium the government had launched its renewable energy investment plan, and contracted an international firm to process waste at Thilafushi, Nasheed said, as well as introduced a feed in tariff which would make generating solar “more profitable than a corner shop.”

“If you are buying electricity at 40 cents a kilowatt hour you can sell electricity to the state at 35 cents. Soneva Fushi is going to be able to produce electricity with solar at 15 cents. We will be able to finance households as a loan to pay back from savings they are making. If you do the sums in the Maldives it is really quite possible, and I’m confident that households will see the commercial viability.”

Ed Norton

Meanwhile Ed Norton, star of films including ‘Fight Club’ and ‘American History X’, linked sanitation and waste management to human development, noting that more people had cell phones than toilets. As a result, Norton said, 1.7 million people died yearly of preventable diarrheal diseases – 90 percent of them under the age of five.

“The World Health Organisation estimates that for every dollar spent on sanitation, $3-34 is returned to the economy,” he observed.

Ocean dumping of sewage was standard, he noted, while septic tanks could leak and contaminate groundwater. He proposed a greater focus on using waste water for fertiliser and water recycling, rather than thinking of it simply as a matter of waste disposal.

Jonathan Porritt

UK environmentalist Jonathan Porritt, founder of Forum for the Future, observed that just by attending the Symposium he had contributed four tons of carbon dioxide to the atmosphere.

He referred to a colleague who was “so overwhelmingly conscious” of his carbon footprint that he weighed his attendance at such events by “the gravity of the audience, the quality of his speech and the effectiveness in lobbying and networking.”

However, he noted that travel and tourism was, overall, a “force for good in an increasingly troubled world.”

“We live in a world where governments invest US$1.4 trillion a year in war. We live in a world where US$4 trillion is invested in the war against terror, a world were fundamentalism is rampant and aggressive nationalism is all over the place. Many countries taking a lead on the issue suffer from a deep sense of exhaustion. Against that backdrop, hands-on [tourism] is a way to bridge the divide,” Porritt said.

At the same time tourism was driven by the balance sheet, and that while there was a great deal of ecotourism initiatives much of it was “marketing, with no credibility.”

“There is a focus on green rather than sustainable tourism, and no real understanding of what it means,” he said. “There is a reluctance to engage on socio-economic issues.”

“Gaps in equity are widening – and the gap between the have and the have nots is widening. Even as tourism contributes economically, because of the gaps resentment about the impact of the industry is rising – especially in a country where access to land, water, beachfront, reef and biomass is being privileged to support growth of tourism industry rather than the interests of local people.”

Tourism, Porritt said, was a microcosm of the local economy, with high end tourism such as that in the Maldives attracting the wealthiest and most influential people.

“For the one percent of the population that control more than 30 percent of the net wealth in a country such as the United States, it is very easy to insulate one’s self from real world by traveling from high security offices to gated communities to privileged, luxury resorts. It is a bubble through which the real world rarely penetrates.”

A state of low carbon with high inequality was “not a judgement anyone should be comfortable with. We should be thinking not just about the need to mitigate carbon impact, but offsetting inequality. I think what we are doing should be from the perspective of social justice as much as low carbon.”

However, he noted, it was easier to educate a few billionaires than the entire population of a country such as the US, distracted from the issue by Xboxes and cable TV.

“Billionaires have a vested interest in keeping the [planet sustainable], because they have enough money enjoy the planet,” he suggested.

Tim Smit

Founder of the Eden Project in Cornwall, Tim Smit, spoke about the need to mobilise people by capturing their imagination – and the responsibility the Maldives has as a symbol of a united effort combating climate change.

“Author CS Lewis said that while science leads to truth, only imagination leads to meaning,” Smit said.

“We are used to talking to halls of middle aged men who want to be inspired. We read the books about affecting change and they have the same language, and it is really dull: paradigm shifts, centres of excellence, leading edge thinking, cutting edge thinking, and when they are very excited, bleeding edge thinking. We don’t write books about the impact of this thinking.”

Incredible things, Smit said, were “being done by the unreasonable.”

“The Maldives has captured the imagination, and the elected political elite are showing charisma and leadership on the issue [of climate change]. The danger is that we listen to too many middle aged white people, and miss the point. I see an incredible moment when the story of Maldives becomes the story of us all – but it needs to be delivered with a pirate grin that says f*** it, we’re going to do this thing. I hate idealists. I like unreasonable people who do things.”

There was, Smit said, a danger that the Maldives would lose sight of its goal, and “lose the moment when the Maldives could become the most important place in world. The goal is open but the moment will be gone, and suddenly the bright future is no longer there, just a job – and not a job in the spotlight.”

The Maldivian people needed to be given the independence to make their own decisions, such as installing solar, and given control so that they knew the impact of flipping the light switch.

“Trust in the people of the Maldives to get excited of a picture of the Maldives reborn,” Smit suggested.

The Slow Life Symposium continues on Sunday.


Antibiotics “most misused drug in the Maldives”: ADK COO

Over-prescription and sale of over-the-counter antibiotics is leading to a rise of resistant super-bugs, the World Health Organisation (WHO) has warned, with the Maldives no exception.

“Antibiotics are the most misused drugs in the country,” ADK Chief Operating Officer Ahmed Jamsheed told Minivan News today. “People are becoming resistant, and in certain cases they might not even need the antiobiotics.”

The WHO is discussing the overuse of antibiotics and growth of superbugs at the 64th meeting of the Regional Committee for South-East Asia, in Jaipur this week.

Director General Dr Margaret Chan said, “we have taken antibiotics and other antimicrobials for granted. And we have failed to handle these precious, yet fragile medicines with appropriate care. The message is clear. The world is on the brink of losing its miracle cures.”

Jamsheed said he has seen patients with headaches prescribed with powerful antibiotics, such as ciprofloxacin. He says a lack of systematic supervision allows pharmacists, who are not educated in medicine, to give antibiotics to anyone who asks regardless of a prescription.

“We have a very rudimentary diagnostic capacity in the Maldives,” said Jamsheed. “Hospitals and physicians are not properly monitored, and patients have a lot of independence to choose the drug they want. There are few national guidelines.”

According to Jamsheed, hospital diagnoses are compromised by inadequate facilities. He said that as organisms  mutate, doctors are not able to keep up. Bacteria samples are usually outsourced, and communication can take weeks. “In some cases, we may not be able to recognise and diagnose a disease until we’ve already lost a few patients,” he said.

Superbugs, or super bacterium, are bacteria that carry several resistant genes and are difficult to treat. When a disease is inappropriately or excessively treated with antibiotics, the body develops an immunity which encourages the bacteria to grow stronger.

Dr Chan said many non-communicable diseases, such as heart disease and cancers, are triggered by “population ageing, rapid unplanned urbanization, and the globalisation of unhealthy lifestyles.”

Chan also noted that “irrational and inappropriate use of antimicrobials is by far the biggest driver of drug resistance.” As communities become more drug resistant, treatments could become more complicated and costly.

ADK Managing Director Ahmed Affal said education was important. “There is an increasing number of antibiotics being prescribed in the Maldives, and we need to talk more. Research shows that there will be problems, as organisms become more resistant.”

Affal said that the majority of cases at ADK are fevers and infections, although heart disease, hypertension, and renal infections are on the rise. “Antibiotics are commonly used for lung infections, and sometimes are given as a preventative measure,” he said.

Speakers at the WHO conference suggested that climate change could accelerate the growth of superbugs. Jamsheed told Minivan News that Maldivians could be more at risk for dengue fever and chikungunya, as well as viral diseases. He predicted that if these diseases were to become more common, the misuse of antibiotics would increase as well and people would become more drug resistant.

“The Maldives is not isolated,” Jamsheed said. “We import almost everything, and any bacteria that is growing elsewhere in the region and the world will certainly be transmitted here.”


Doctor WHO: Celebrating World Health Day in Malé this weekend

The World Health Organisation (WHO) is celebrating World Health Day today with activities around the world, and the theme “urbanisation and health” which aims to improve urban equity gaps, the leading cause for many health problem’s in the world’s poor according to the WHO.

Past themes have been “working together for health” in 2006 which focused on the health workforce crisis; “international health society” in 2007, aiming to improve the first line of defence against public health emergencies; “protecting health from climate change” in 2008, which looked at the effects of climate change on vulnerable populations; and “save lives, make hospitals safer in emergencies” in 2009.

This year’s campaign 1000 cities, 1000 lives is bringing attention to the issues of urban health. The WHO believes “urbanization is one of the major threats to health in the twenty-first century.”

Urban health

Although the WHO recognises urban environments can provide “great opportunities for individuals and families to prosper,” they can also harm our health in many ways, if the infrastructure and lifestyle in these urban sectors aren’t improved.

Some of the challenges the WHO cites as being problematic in urban areas are “overcrowding; air pollution; rising levels of risk factors like tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol; road traffic injuries; inadequate infrastructure, transport facilities, solid waste management systems; and insufficient access to health facilities in slum areas.”

According to the WHO, more than half of the world’s population now lives in urban areas, something that has never before happened in our history. They note that about 34% of the total population of the WHO’s South-East Asia Region is urban.

This year’s World Health Day aims to promote finding solutions to the roots of urban health issues and to “build partnerships with multiple sectors of society to make cities healthier.”

But improving urban sectors does not just benefit health, but is an economically sound proposal. The WHO estimates that “every $1 spent on sanitation gives a return of US$ 9.10 in terms of prevention and treatment of illnesses. Improved transportation, infrastructure and greener technologies enhance urban quality of life, including fewer respiratory ailments and accidents and better health for all.”

WHO Representative to the Maldives Dr Jorge Mario Luna says the solution to many of the health issues exacerbated by overcrowding, pollution, inactivity and unhealthy diets, violence and injury is proper urban planning.

“Proper urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents.”

He added that “such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.”

Malé Health Fair

With this in mind, this year’s campaign is promoting ‘greener’ and healthier lifestyle options, which will be  showcased in Malé’s Health Fair, to be held on Saturday 10 April from 4:00-6:30 pm, and then from 8:00-10:30 pm in different locations around the city.

There will be activities held in Ameenee Park, Children’s Park, the Social Center, and other locations around Malé, Hulhumalé and Vilingili.

Some of the activities include free sporting events like dodge-ball and gymnastics; public awareness demonstrations on first aid and sanitation; food preparation counselling for kids; quizzes and puzzles; medical check-ups at ADK hospital; and distribution of information on living a healthier life.

On Friday 9 April there will be a ‘bicycle round’ where senior government officials and other volunteers will join in bicycle round of Malé.

The ‘round’ will start at the Artificial Beach at 4:00 pm and will follow a westerly route, for about half an hour, along Boduthakurufaan Magu, ending at Licence Sarahahdhu near IGMH.

A full schedule of events will be available at the WHO website and the Ministry of Health and Family website from tomorrow.


Comment: Urbanisation is a challenge for public health

Historically, Malé city has been an engine of economic growth, a centre of culture, and a generator of ideas. But while human potential is infinite, resources are finite.

Urbanisation creates problems, but healthy cities can solve them. A billion people now live in the world’s urban slums. The urban population of Asia is expected to double between 2000 and 2030. The health sector needs to take the lead in calling attention to the enormous implications of this growth in cities for the health of the people who live and work in them.

On 7 April 2010, World Health Day, WHO will focus on the themes of Urbanisation and Health.

With the possibility that over the next 30 years all population growth will be in urban areas, urbanisation becomes a real challenge for public health.

Urbanisation is associated with many health challenges related to water, environment, violence and injury, noncommunicable diseases (NCDs) and their risk factors like tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol as well as the risks associated with disease outbreaks.

In poorly planned cities, the urban poor are the ones who will suffer the burden of these and other health problems, including an increased risk for violence and for some communicable diseases such as tuberculosis and HIV/AIDS.

In 2008, the Human Rights Commission of Maldives (HRCM) carried on a “Rapid Assessment of the Housing Situation in the Maldives”.

In interviews in Malé, the study described issues such as exorbitant rent levels, housing space, size, overcrowding, unaffordable access to clean drinking water, and many other problems like unhealthy living conditions, social problems as a result of overcrowding.

Many of the respondents indicated that these problems were the key causes of rising social issues such as gang warfare and drug abuse.

Furthermore, several social problems are also faced within the household including child abuse, psychological impact in growing up in areas of overcrowding, breakdown of many families due to the hardship faced by them stimulating a ripple effect of social disorder for the families, particularly the children caught in the situation.

The assessment highlighted that the sources of such housing stress are many, but it is mainly attributed by the raising demand for housing as a result of increased migration of Maldivians and foreigners to the capital. There are over 30,000 international migrant laborers now living in Malé under more crowded situations.

In the rapid assessment, local residents reported as many as 30 men sharing 3m x 3m flats without running water or sanitation facilities. These workers have to queue at public water taps to access clean water and often have to sleep in shifts as not all of them are able to fit into the space they occupy at the same time.

Among nationals, they felt that public services in Malé and to a lesser extent in Hithadhoo, Thulusdhoo and Kulhudhufushi were significantly better than the services they could receive at home or urban centers closer to them, being hospitals, secondary schools and higher education the most commonly mentioned services.

Other important factors for individual and family migration included the availability of employment opportunities and higher wages in Malé and better prospects for developing one’s own business from the capital.

As we can see, it is important to note that the major drivers, or social determinants, of health in urban settings are beyond the health sector, including physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities.

The solution? Proper urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents.

Such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.

The Rapid Assessment of the Housing Situation in Maldives conducted by the HRCM, concluded providing a series of recommendations, which together are designed to kick-start a broader process leading to continuously improving housing conditions in the Maldives.

Dr Jorge Mario Luna is the WHO Representative to the Maldives.