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| Sunday, 2 June 2002 |
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Features |  |
| News Business Features Editorial
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Global move to eradicate polio nears target - WHO With only 537 polio cases reported globally in 2001 efforts to eradicate polio have driven the incidence of the disease to its lowest point in history. However the expert panel overseeing the initiative warns that given the current prevalence of conflict, the last vestiges of polio must be extinguished now, as any delay will jeopardise the success of the entire effort. "When we began the eradication effort in 1988, polio paralysed more than 1000 children each day. In 2001, there were far fewer than 1000 cases for the entire, year," said Dr. Gro Harlem Brundtland, the Director General of the World Health Organisation. "But we're not finished yet. I urge the world to finish the job. Eradicate polio while we still have the opportunity." From 2000 to 2001 efforts of the Global Polio Eradication initiative, spearheaded by the World Health Organisation, Rotary International, US Centers for Disease Control and Prevention and UNICEF have reduced the number of polio-endemic countries from 20 to 10. The number of new cases globally was slashed by more than 80% from 2979 in 2000 to 537 in 2001. This represents a greater than 99.8% reduction since 1988, when polio paralysed more than 350,000 children in 125 countries. However despite progress in the conflict-affected areas, polio eradication could become a victim to recent global events, the Global Polio Eradication Technical Consultant Group (TCG) has warned. Poliomyelitis (polio) is a highly infectious disease caused by a virus that mainly affects children under five years of age. It invades the nervous system and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Amongst those paralysed 5%-10% die when their breathing muscles become immobilised. There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life. Persons at risk: Polio affects mainly children under 5 years of age. Asthma - on the increase but preventable An on-going study carried out by the International Study on Asthma and Allergies in Childhood has recently revealed that between 10-15 per cent of schoolchildren in Sri Lanka are affected by this disease.The estimated number of asthma sufferers (including adults) in this country is said to be around 1 million.Consultant chest physician of the Kandy hospital Dr. Anoma Siribaddana has been quoted as saying that this increase is due to poor knowledge about the disease both by patients and healthcare personnel, under-estimation of the disease and poor assessment of the disease by patient and doctor. Failure to use prophylactic medication and poor compliance with drugs are some of the other contributory factors, cited by doctors at a seminar held at the Health Education Bureau. Dr. Sampath H. Nanayakkara discusses the symptoms, treatment and most importantly the methods of preventing this debilitating illness. Only a patient with asthma can understand the agony of an acute attack, when every breathing effort becomes a life and death struggle. Even the healthcare providers in the country do not seem to know about the feelings and suffering of the asthmatic during an acute attack period. Many countries are now giving priority to the prevention and treatment of asthma because its morbidity and mortality rates have increased sharply in recent years. Asthma has become the commonest chronic disease in many countries today with 15 per cent - 20 per cent of child population and 2 per cent - 6 per cent of adult population affected by this illness. The impact of asthma on the quality of life of the people is enormous. Loss of working hours for adult patients and schooling for young children is considerable. Ancient Egyptian writing reveals that asthma was a condition known to have existed since 1500 BC. Hippocrates defined asthma as an altered state of breathing. For long, asthma was thought to be a disease characterised by acute episodes of spasm of the smooth muscle of the airways. Accordingly, the treatment was aimed only at relieving this spasm. However our understanding of asthma has undergone a major change over the last few years. Scientific evidence reveals asthma to be a chronic inflammatory condition due to hyper responsiveness of the inner lining of the lower down airways, causing spasm and swelling of the inner lining, as a result producing the symptoms due to narrowing of the airways. The increased prevalence of asthma may be due to changing lifestyles, atmospheric pollution, design of modern houses, rapid industrialisation and mental stress. In the context of Sri Lanka asthma is often under-diagnosed, and treatment is delayed until the patient develops obvious symptoms. On the other hand there is a resistance on the part of the patient to accept a diagnosis of asthma. Symptoms The principal symptoms are episodic cough, wheezing, chest tightness and shortness of breath, which are frequently worse at night, waking the patient from sleep during the early hours of the morning. The narrowing of the airways in asthma is usually reversible except in some patients in whom the permanent damage of the innerlining may result an irreversible impediment to airflow. The presentation of asthma may be very mild to severe life threatening form. In the other case which is also called 'acute severe asthma', the patient is very distressed by severe breathlessness and feeling of tight chest. They may be seen seated with shoulder muscles braced, leaning forward in an attempt to improve breathing. He may be too wheezy or breathless unable to complete a sentence or is unable to get up from a bed or chair. All such patients should be admitted to hospital, immediately, to prevent death. The other type of asthma is called chronic persistent asthma which is mild but lifelong and needs long term management to prevent complication. Treatment The treatment failure as commonly seen in asthma, may be attributed to poor understanding of the disease and rational basis of treatment of both doctors and patients. Therefore patient education is important. The preventive factors as also important as dry treatment. There are some trigger factors which cause airways to become irritated and precipitate airway obstruction. These include chemical allergens like penicillin, viral infections, household dust, industrial dust, smoke, cold air exercise, and extreme emotional changes. Patient need to be educated to reduce exposure to such factors. How to reduce household allergies 1. Enclose one's pillow and mattress in a polythene cover. 2. Remove soft toys from the child's bed room. 3. Don't allow pets to sleep in the bedroom. 4. Use a straw mat aA’%’,„ to cover the bed sheet. 5. Wash bed linen very often in warm water. 6. Keep the bed rooms well ventilated. 7. Eliminate cockroaches and house dust mites (faeces of these insects are potent asthma inducers). 8. Household pets should be washed at least weekly. 9. Cigarette smoke, cooking fumes, and wood smoke should also be avoided. 10. Avoid those drugs that commonly precipitate asthma in susceptible individuals. Eg. some blood pressure lowering drug ie. propranecol, atenocol. Some drugs used in rheumatic conditions. 11. Avoid processed food containing metabisulphites as preservatives. 12. Avoid strong odours and sprays produced by cosmetics, perfumes, from paints and polishes, thinner. The hazards of smoking Tobacco smoke is packed with poisons that can damage the heart and blood vessels. Nicotine - an addictive poison, makes the heart beat faster, and makes blood pressure soar temporarily. It also increase the risk of blood clots. Carbon monoxide - a poisonous gas released when tobacco burns. Inhaled by the smoker, it dramatically cuts the amount of oxygen the blood can carry around the body and to the heart. So when you smoke, your heart is having to work harder and is getting less oxygen. Risks Smoking dramatically increases the risk of developing heart disease, lung cancer and many other diseases. These diseases are not always fatal but can seriously affect your quality of life. Smoke and you're more likely to die before you retire, 40% of heavy smokers (those smoking over 20 cigarettes a day) die before retirement age, compared to only 15% of non-smokers. Women are as much at risk as men of developing diseases from smoking - smoking-related diseases in women are still on the increase. The risk of heart disease is dramatically increased for women who are over 35, smoke and who take the contraceptive pill. But now, thankfully people are more aware of the health hazards and women, like men are choosing to quit smoking. Why not join them? Cigarettes give off two types of smoke - 'mainstream smoke' is filtered by the cigarette and inhaled by the smoker. The other type is sidestream smoke which goes directly from the end of the cigarette into the air. As it is not filtered it contains higher concentrations of harmful substances than the mainstream smoke. It is therefore potentially dangerous to non-smokers, especially when they are exposed to it for long periods of time. Children who are exposed to their parents' sidestream smoke are more prone than other children to serious chest illnesses such as pneumonia, lung cancer and bronchitis. They are also more likely to smoke if their parents do. Six ways to help yourself to quit 1. Stop day - choose a day to stop and stop completely on that day. 2. Identify times when you particularly crave a cigarette and make sure you have something to occupy your hands (worry beads, a pencil to doodle with, sewing). 3. Ash cash - work out how much you're saving and plan how to spend it. 4. Think positively you're a non-smoker, not a smoker who's given up. When you're offered a cigarette say 'No thanks, I don't smoke,' - every time! 5. When you feel the urge to smoke, remember how well you've done so far and how hard it was to give up in the first place. 6. Find out what's available locally. Ask your family doctor about the availability of techniques like nicotine chewing gum, stop-smoking groups, hypnosis, acupuncture, aversion therapy and relaxation classes. Risk factors - the big 6 Remember that smoking is one of several factors causing heart disease - there are five others to bear in mind. Your best bet for minimising the risk of heart disease is to tackle all six together. Help your heart by making healthier food choices Excess weight puts a strain on your heart Avoid a higher blood pressure. Relax and reduce your stress levels Take regular exercise You should try to give up smoking. (Courtesy Flora) |
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