Founded in 1948, WHO is a United Nations agency whose charter is to plan and coordinate the international response to health emergencies and help countries monitor, prepare for, and recover from disease threats. 

While not without controversy, WHO is the single best forum for predicting and planning for events affecting the health of humans across the planet.

Media coverage of the US withdrawal has focused on political rancor (Trump believes WHO mishandled the pandemic) and funding (While the US is one of 194 participating countries, it funds almost 20% of the agency’s $6.8 billion budget).[i]

As the new Administration gives up America’s seat for global health planning, its important to shine a light on real issues impacting Americans’ health and well-being. They are worth public scrutiny and debate, starting with this statement:

America is a First-World Nation Battling its Own Third-World Health Crises

America’s health care system is the most expensive in the world. It’s staffed with some of the world’s best health and medical talent. Despite this, we are at the bottom of the list in overall health compared to all developed nations. This includes access to care, administrative efficiency, equity, and health care outcomes. ^[ii]

• Americans are among the least healthy people in the rich world and among the most likely to die early.
• The richest men in America live longer than the average man in any country. The poorest have life expectancies comparable to men in Sudan and Pakistan.[iii] 
• If you are a citizen of Mississippi, you probably won’t live as long as someone from Bangladesh. [iv] [v] [vi]

• Maternal mortality rates for American women are worse than in most third-world countries. Even more unexplainable is that Black women are three times more likely to die of childbirth than White women. This gap is worse today than it was when we began keeping records in the early 1900’s.[vii] 
• America is a global leader in avoidable amputations. This is mainly due to the improper management of diabetes, which impacts 38.4 million Americans.[viii]
• 30 million Americans die prematurely each year from preventable diseases. Twenty-seven percent of US health-care spending goes to managing health conditions that are preventable.[ix]

As the World Health Organization focuses on increasing its investments in global Public Health, it’s important to note that America’s investment in similar Public Health services is declining.

Winston Churchill once said, “Healthy citizens are the greatest asset any country can have.”  And so, as we discuss and debate America’s role in creating a healthier world through organizations like WHO, let us actively debate and decide what priorities we will invest in to improve the health of the 330 million people who call America home.

[i] https://www.msn.com/en-us/politics/government/what-is-the-world-health-organization-and-why-does-trump-want-to-leave-it/ar-AA1xFf0l?ocid=BingNewsSerp

[ii]Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System,  Commonwealth Fund, September, 2023, https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024

[iii] Raj Chetty, Michael Stepner, Sarah Abraham, Shelby Lin, Benjamin Scuderi, Nicholas Turner, Augustin Bergeron, and David Cutler,  Income and Life Expectancy in the United States: Executive Summary,  The Health Inequality Project, April 2016, https://www.healthinequality.org/documents/paper/healthineq_summary.pdf 

[iv] NICHOLAS KRISTOF, How Do We Fix the Scandal That Is American Health Care? New York Times, https://www.nytimes.com/2023/08/16/opinion/health-care-life-expectancy-poverty.html?smid=em-share

[v] Life Expectancy at Birth by State, National Center for Health Statistics, https://www.cdc.gov/nchs/pressroom/sosmap/life_expectancy/life_expectancy.htm (cdc.gov)

[vi] Life Expectancy at Birth – Bangladesh, World Bank Group https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=BD

[vii]Achievements in Public Health, 1900-1999: Healthier Mothers and Babies, Centers for Disease Control (CDC), Achievements in Public Health, 1900-1999: Healthier Mothers and Babies (cdc.gov)

[viii] NICHOLAS KRISTOF, How Do We Fix the Scandal That Is American Health Care? New York Times, https://www.nytimes.com/2023/08/16/opinion/health-care-life-expectancy-poverty.html?smid=em-share

[ix] Sandro Galea, Nason Maani, The Cost of Preventable Disease in the US,  The Lancet, October, 2020, https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext

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Malaria has long been an indelible part of Egypt’s history, with evidence of the disease traced back to around 4000 BCE. The same malady that once plagued the pharaohs is now consigned to history, no longer a spectre haunting Egypt’s future. The certification by WHO is an accolade for Egypt’s dedication to public health. It is particularly noteworthy in a nation with over 100 million residents, where eradicating a deeply entrenched disease requires perseverance, innovation, and unity.

As Dr Tedros Adhanom Ghebreyesus, WHO Director-General, eloquently stated, “Malaria is as old as Egyptian civilisation itself, but the disease that plagued pharaohs now belongs to its history and not its future. This certification of Egypt as malaria-free is truly historic and a testament to the commitment of the people and government of Egypt to rid themselves of this ancient scourge.”

Egypt’s Journey to Eradication: A History of Determination

Egypt’s odyssey towards eliminating malaria is a saga of collective willpower. It began in the early 20th century when the government introduced measures to reduce human-mosquito contact. As early as the 1920s, Egypt implemented agricultural reforms, including restricting rice cultivation near residential areas — a strategy designed to minimise breeding grounds for malaria-spreading mosquitoes.

However, it wasn’t until 1930, when malaria was declared a notifiable disease, that systematic public health interventions began in earnest. Establishing the first malaria control station, focusing on diagnosis, treatment, and surveillance, paved the way for structured disease management. Yet, despite these early efforts, Egypt faced major setbacks during the Second World War, when a spike in cases reached over three million due to population displacement, service disruption, and the proliferation of *Anopheles arabiensis*, a highly efficient mosquito vector.

The post-war era, marked by the construction of the Aswan Dam in 1969, introduced a new challenge. The dam’s vast water reservoirs became fertile breeding grounds for mosquitoes, intensifying the risk of malaria outbreaks. Egypt responded with a robust public health and vector control initiative, collaborating with neighbouring Sudan to manage this new threat.

By 2001, Egypt had brought malaria under control, and in 2014, when a small outbreak emerged in Aswan, the country demonstrated its resilience. The outbreak was swiftly contained through early case identification, immediate treatment, and heightened public education, proving the effectiveness of Egypt’s surveillance and response systems.

A Symbol of Hope for the Region

Egypt’s certification as malaria-free by WHO is not just a personal victory for the country but also a beacon of hope for other nations still grappling with malaria. Egypt is only the third country in the WHO Eastern Mediterranean Region to achieve this status, following in the footsteps of the United Arab Emirates and Morocco, and the first to do so in over a decade.

This success reflects the country’s unwavering commitment to public health. Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, celebrated Egypt’s achievement: “Today, Egypt has proven that with vision, dedication, and unity, we can overcome the greatest challenges. This success in eliminating malaria is not just a victory for public health but a sign of hope for the world, especially for other endemic countries in our region.”

Egypt’s sustained investment in robust health systems, particularly its focus on integrated disease surveillance, has been the cornerstone of its achievement. Moreover, community engagement and regional collaboration have played critical roles. Egypt’s partnerships with neighbouring countries, especially Sudan, have been crucial in preventing cross-border malaria transmission, helping to secure the nation’s malaria-free status.

Sustaining the Success: A Vigilant Future

Though Egypt has won the battle against malaria, the war on maintaining its malaria-free status is ongoing. The WHO certification is not an end but a new beginning, as highlighted by Dr Khaled Abdel Ghaffar, Egypt’s Deputy Prime Minister. He emphasised the importance of vigilance in sustaining this milestone, stating, “Receiving the malaria elimination certificate today is not the end of the journey but the beginning of a new phase. We must now work tirelessly and vigilantly to sustain our achievement through maintaining the highest standards for surveillance, diagnosis, and treatment.”

Egypt must continue its robust strategies to uphold its malaria-free status, including integrated vector management, rapid responses to imported cases, and a comprehensive early case detection and treatment system. The cross-border collaborations integral to achieving certification will remain essential in preventing a resurgence of the disease as Egypt continues to engage with endemic countries in the region.

A Legacy of Public Health Triumph

Egypt’s certification as malaria-free serves as a reminder of what can be achieved when a nation unites behind a common goal. It symbolises the end of an ancient battle and a future where public health can continue to flourish in the face of adversity. The lessons from Egypt’s journey provide invaluable insights for the global fight against malaria, offering a roadmap for other countries striving to eradicate the disease.

With this achievement, Egypt joins a distinguished group of nations that have successfully interrupted malaria transmission, providing inspiration and hope for a world where the elimination of this ancient disease is no longer a distant dream but a realistic possibility. The journey continues, but the future is bright for a malaria-free Egypt.

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At the forefront of these preventable tragedies is pneumonia, a leading cause of death that can often be averted through inexpensive vaccines and antibiotics. Immunisation campaigns and community health programs can ensure that treatments reach those in need, transforming a potential death sentence into a manageable condition. Simple practices, such as promoting exclusive breastfeeding, can also bolster a child’s immune system against pneumonia and other diseases.

Diarrheal diseases, closely linked to poor sanitation and unsafe water, are another major threat to young lives. However, the provision of oral rehydration solutions (ORS) and zinc supplements offers a beacon of hope. These treatments, costing mere cents per dose, can swiftly restore hydration and save lives. Moreover, investing in clean water initiatives and basic hygiene education provides a sustainable path to disease prevention.

Malaria, a relentless killer in many low-income regions, particularly Sub-Saharan Africa, can be effectively combated with insecticide-treated mosquito nets and prophylactic antimalarial medications. These interventions, surprisingly affordable, can drastically reduce malaria incidence and mortality among vulnerable infant populations.

Neonatal conditions, such as complications from preterm birth, infections, and birth asphyxia, highlight the critical need for improved maternal and newborn care. Skilled birth attendance, a cost-effective strategy, can prevent many such deaths. Additionally, kangaroo mother care (skin-to-skin contact) and basic neonatal resuscitation techniques offer low-cost, high-impact solutions to neonatal mortality.

Lastly, malnutrition — a pervasive threat to child survival — can be addressed through nutrition education, support for exclusive breastfeeding, and the provision of vitamin A and micronutrient powders. These interventions prevent death and promote healthy development, all at a minimal cost.

The narrative of child mortality in low-income countries is not solely one of despair but also one of hope and opportunity. By implementing these low-cost interventions, the global community can make significant strides in saving lives and nurturing the potential of millions of children. It is a testament to the power of simple, affordable solutions facing daunting challenges, offering a brighter future for the world’s most vulnerable populations.

Low-cost interventions that save lives

Pneumonia

• Vaccination: The pneumococcal and Hib vaccines can prevent many pneumonia cases. The cost can vary, but Gavi, the Vaccine Alliance, has negotiated prices as low as USD 1.5 per dose for some vaccines in low-income countries.
• Exclusive Breastfeeding: Encouraging exclusive breastfeeding for the first six months of life can significantly improve a child’s immunity. The costs here are more about education and support systems for mothers.
• Access to Antibiotics: For cases where pneumonia develops, timely administration of antibiotics can save lives. A full course of antibiotics for pneumonia treatment can cost less than USD 0.50 per child.

Diarrheal Diseases

• Rotavirus Vaccination: Rotavirus vaccines effectively prevent the most common cause of severe diarrhoea in children, with costs in Gavi-supported countries around USD 1–3 per dose.
• Clean Water and Sanitation (WASH): Providing access to clean water and promoting handwashing can drastically reduce diarrheal diseases. The cost per child can be very low when spread across communities but varies widely depending on the specific intervention and infrastructure development.
• Oral Rehydration Salts (ORS) and Zinc Supplementation: These are highly effective treatments for diarrheal diseases, costing as little as USD 0.50 for ORS packets and zinc supplements for one treatment course.

Malaria

• Insecticide-Treated Nets (ITNs): Mosquito nets treated with insecticide are a simple, effective way to prevent malaria. The cost per net is typically around USD 2–3, and each net can protect up to two children for up to three years.
• Indoor Residual Spraying (IRS): Spraying the inside of homes with insecticides can also reduce malaria transmission. The cost varies but is generally between USD 3–7 per person per year.
• Antimalarial Drugs: Prophylactic antimalarial drugs for pregnant women and young children in high-risk areas can prevent illness. The cost per treatment is around USD 0.50 to USD 1.
• Artemisinin-based combination therapies (ACTs) are the cornerstone of malaria treatment recommended by the World Health Organization (WHO) for uncomplicated Plasmodium falciparum malaria. The cost of ACTs in low-income countries varies, influenced by factors such as local policies, subsidies, the involvement of global health initiatives, and whether the drugs are purchased in the public or private sector. A typical course is just three days of treatment, and the cost to the healthcare system is less than USD 1.
• Anti-malarial vaccines: The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine, which received a WHO recommendation in 2021. Both vaccines are shown to be safe and effective in preventing malaria in children and, when implemented broadly, are expected to have a high public health impact. Three to four doses are administered at USD 2 — USD 4 per dose.

Neonatal Conditions

• Skilled Birth Attendance: Ensuring that births are attended by skilled health personnel can significantly reduce neonatal deaths. Training community health workers can be relatively low-cost, with significant returns in reduced mortality.
• Thermal Care: Simple practices like kangaroo mother care (skin-to-skin contact) can prevent hypothermia in newborns with negligible cost.
• Basic Neonatal Care: Including clean delivery practices, proper cord care, and early breastfeeding initiation. The cost here is more about training and education than direct intervention costs.

Nutritional Deficiencies

• Exclusive Breastfeeding: Promoted for the first six months to provide all necessary nutrients and improve immunity.
• Vitamin A Supplementation: This can significantly reduce child mortality from all causes, with each dose costing as little as USD 0.02 to USD 0.30.
• Micronutrient Powders: Sprinkle on foods can combat malnutrition, costing about USD 0.03 to USD 0.10 per sachet.

How many children between the ages of zero to five live in low-income countries

Unfortunately, there isn’t a single, definitive source with data on the exact number of children aged 0 to 5 living in low-income countries. This is due to a few reasons:

• Defining “low-income countries”: Different classifications are used by organisations like the World Bank. These classifications can change over time.
• Data collection challenges: Gathering accurate data in low-income countries can be difficult due to resource limitations and infrastructure issues.

However, we can look at child poverty data as a proxy. UNICEF reports that 333 million children live in extreme poverty worldwide, meaning they lack necessities like food, shelter, sanitation, healthcare, and education. This data can give us a general idea of the magnitude of the problem.

What can be done?

Governments, NGOs, and civil society play pivotal roles in mitigating child mortality in low-income countries, leveraging their unique positions to initiate, support, and scale up various interventions. Here are ways these entities can collaborate and contribute effectively:

Strengthening Healthcare Systems

• Governments can allocate increased funding to health services, ensuring that healthcare facilities are adequately staffed, equipped, and accessible to the population, including remote areas.
• NGOs often work to fill gaps in healthcare provision, providing training for healthcare workers, supplying medical equipment and medications, and setting up mobile clinics to reach underserved communities.
• Civil Society can advocate for improved healthcare policies and transparency in healthcare funding, ensuring that resources are allocated effectively and equitably.

Promoting Preventative Measures

• All three can collaborate on vaccination campaigns to protect against pneumonia and measles. Education campaigns to promote breastfeeding, proper nutrition, and hygiene practices can also substantially impact the situation.
• NGOs and civil society can support the distribution of mosquito nets and conduct awareness campaigns on their use to prevent malaria, a leading cause of child mortality.

Improving Water, Sanitation, and Hygiene (WASH)

• Governments can invest in infrastructure to provide clean water and sanitation facilities, which are crucial for preventing diarrheal diseases and improving overall health.
• NGOs frequently engage in WASH projects, constructing toilets and facilitating access to clean water through wells and filtration systems.
• Civil Society can mobilise community involvement in maintaining and protecting water and sanitation infrastructure and promote hygiene practices.

Ensuring Food Security and Nutritional Support

• Initiatives to improve access to nutritious food can significantly impact child health. Governments can implement policies and programs to support agricultural productivity, subsidise essential foods, and ensure nutritional programs reach vulnerable populations.
• NGOs may provide direct food aid, support school feeding programs, and teach sustainable farming techniques to communities.
• Civil Society can raise awareness about malnutrition, advocate for policy changes, and support community-based nutrition and gardening projects.

Education and Empowerment

• Educating girls and women has a profound impact on child health outcomes. Governments can ensure equal access to education, while NGOs can provide scholarships or support for girls’ education.
• Civil society, including local communities and parent groups, can advocate for educational reforms and support initiatives that empower women and girls.

Advocacy and Policy Influence

• Civil society organisations can lobby for policies prioritising child health, including environmental protections to reduce pollution and combat climate change, which impacts children’s health.
• They can also be crucial in holding governments and international bodies accountable for their commitments to child health and rights

Collaboration across these sectors is crucial for creating sustainable change. By pooling resources, sharing knowledge, and coordinating efforts, governments, NGOs, and civil society can significantly reduce child mortality rates and improve health outcomes for children in low-income countries. Their combined efforts can address the root causes of child mortality, ensuring that children have the chance to lead healthy, productive lives.

Concluding

The stark reality of child mortality in low-income countries, particularly among infants aged 0 to 5, represents a profound global health challenge. Yet, as outlined, the breadth of low-cost, highly effective interventions available to combat this crisis offers a beacon of hope. These interventions, ranging from vaccinations and exclusive breastfeeding to access to clean water and nutritional supplements, underscore a critical truth: the power to reduce child mortality significantly is well within our grasp.

Moreover, the detailed strategies for pneumonia, diarrheal diseases, malaria, neonatal conditions, and nutritional deficiencies illustrate a clear path forward. The low-cost solutions presented are feasible and offer a high return on investment regarding lives saved and improved health outcomes. The role of artemisinin-based combination therapies (ACTs) in treating malaria, the impact of skilled birth attendance on neonatal survival, and the potential of vitamin A supplementation to bolster child health further highlight the array of tools at our disposal.

The task ahead requires a concerted effort from governments, NGOs, and civil society. Through increased funding, the implementation of health programs, advocacy, and education, these stakeholders can change the trajectory of child health in low-income countries. The call to action is clear: by embracing these low-cost interventions and fostering collaboration across sectors, we can address the root causes of child mortality and ensure that every child has the opportunity to thrive.

This collective endeavour presents a compelling opportunity to redefine the future for millions of children in low-income countries. As we move forward, let the narrative of child mortality be one not of despair but of hope, action, and profound transformation. Together, we can turn the tide against these preventable tragedies, paving the way for a healthier, brighter future for the world’s most vulnerable populations.

The post Main Cause of Death in Infants Ages Zero to Five in Low-Income Countries; Hope for a Better Future appeared first on Medika Life.

Here are the American statistics for gum:

And here are mouthwash numbers from Scotland:

The prevalence of mouthwash use declined with age. Women used mouthwash more than men, and never-smokers appeared less likely to use mouthwash (40 versus 53 percent). Daily alcohol consumers tended to use mouthwash daily more than abstainers (42 versus 37 percent).

Halitosis is common, affecting nearly one in three individuals around the globe. A research study that combined the results of 13 medical journal articles reported that halitosis affects about 32 percent of the population.

Halitosis (bad breath) causes

A primary cause of halitosis is the buildup of volatile sulfuric compounds in the mouth. Anaerobic bacteria, feeding on the food we leave behind, produce these odor-producing substances.

Potential causes of halitosis include the following:

• Poor dental hygiene. Skip the proper, regular brushing and flossing (and dental cleanings), and you leave food in your mouth. This detritus creates a breeding ground for bacteria. Moreover, the food around your tongue, teeth, and gums can rot. The result? An unpleasant odor in the mouth.
• Certain foods. Diet is associated with our oral health. In addition, our bodies absorb garlic, onions, and other consumed food. Until the food leaves the body, it can affect breath.
• Tongue bacteria. Certain bacteria interact with food’s amino acids, producing smelly sulfur compounds.
• Dry mouth (xerostomia). With decreases in saliva, the mouth cannot optimally cleanse itself. Food debris is left behind. Xerostomia can be the product of some medicines, radiation therapy that hits salivary glands, a primary salivary gland disorder, or always mouth breathing.

• Periodontal disease. A primary symptom of periodontal disease is bad breath. Please seek immediate care from an oral health professional.
• Tobacco products. Consume cigarettes, cigars, smokeless tobacco, or snuff, and you stain your teeth while putting yourself at risk of numerous diseases. In addition, tobacco products cause bad breath, periodontal disease, irritated gums, taste loss, and more.
• Certain health conditions. The problems that can cause bad breath include nose, windpipe, or lung infections. Chronic bronchitis, postnatal drip, chronic sinusitis, diabetes, a gastrointestinal disorder, or a liver or kidney disorder can cause halitosis. Please see your healthcare provider for an evaluation.

The main halitosis symptom is a foul odor from the mouth that is considered beyond socially acceptable. This odor may worsen in the morning or after drinking coffee, smoking, or eating foods such as garlic.

Diagnosing halitosis begins with a history and physical examination. A clinician checks the mouth to see if a cause (such as infection) is present. Diagnosing halitosis begins with a history and physical examination. The mouth is checked to see if a cause (such as infection) is present.

Halitosis (bad breath) conventional treatment

The Mayo Clinic (USA) has some recommendations about reducing the chances you will suffer from halitosis (bad breath):

• Brush your teeth after you eat. In addition to my home toothbrushes, I have a toothbrush at the office to use after eating. Toothpaste with antibacterial properties can reduce bad breath odors.
• Floss at least once a day. Get those tiny food particles and plaque out from beneath your teeth.
• Brush your tongue. Your tongue has bacteria, so carefully brushing it may reduce odors. Some benefit from a tooth scraper, while others use a toothbrush with a built-in tongue cleaner.
• Clean dentures or dental appliances. If you wear a denture or bridge, clean it thoroughly at least once daily (or as directed by your dentist). If you have a mouth guard or dental retainer, clean it each time before you put it in your mouth. Your dentist can recommend the optimal cleaning product.
• Avoid dry mouth. Consume lots of water (not coffee, alcohol, or soft drinks). Try chewing gum or sucking on candy (ideally sugarless) to stimulate saliva. For chronic dry mouth, your physician or dentist may recommend an artificial saliva preparation or an oral medication that stimulates saliva flow.
• Adjust your diet. Avoid foods such as garlic and onions that can cause bad breath. Eating a lot of sugary foods is also linked with bad breath.
• Regularly get a new toothbrush. Change your toothbrush every three or four months, and choose a soft-bristled toothbrush when it becomes frayed.
• Schedule regular dental checkups. See your dentist regularly — typically twice annually — to have your teeth or dentures cleaned and examined. Your care provider may also suggest that you use an antimicrobial mouth rinse.

Halitosis (bad breath) and probiotics

A new meta-analysis discovered that consuming four probiotics can reduce bad breath-causing compounds, at least in the short term.

The beneficial probiotics (for the nerds amongst us) include Lactobacillus salivarius, Lactobacillus reuteri, Streptococcus salivarius, and Weissella cibaria. These substances, present in fermented foods, may benefit gut health. Probiotics may work magic by eliminating smelly volatile sulfur compounds (VSCs) buildup for up to four weeks.

Researchers recently published the study results in BMJ Open. For the research investigation, they analyzed seven randomized controlled trials. You might be surprised at how scientists detected halitosis levels. They had subjects close their mouths for one minute before exhaling into an evaluator’s nose from 10 centimeters away.

They then measured volatile sulphuric compounds using a halimeter, an instrument designed to measure gases.

Compared to control groups, subjective halitosis scores dropped by 58 percent. The volatile sulfuric compound scores dropped by about one-quarter (26 percent).

The probiotic-related improvements in volatile sulfuric compound scores did not last more than four weeks. However, the subjective improvements continued beyond four weeks.

One analyzed study showed probiotics led to less plaque buildup at 12 weeks. The meta-analysis authors appropriately note that the studies have varying methods, data reported, and bias risks.

There were significant differences between the studies regarding methodology, data reported, and risk of bias in their assessments.

Halitosis (bad breath) and food

Many individuals try to improve bad breath with gum chewing, but there may be more effective long-term strategies. Chewing gum without food may increase the chance of developing gastroesophageal reflux (GERD; heartburn).

Probiotic supplements may help reduce halitosis (bad breath), but what about consuming probiotic-containing foods?

Some sources of the probiotics Lactobacillus salivarius, Lactobacillus reuteri, and Streptococcus salivarius include fermented foods such as kefir, yogurt, kimchi, or pickled beetroot.

Other good food sources of probiotics include miso, real sauerkraut, sourdough bread, and fermented cheeses. How about kombucha? It is a type of sweetened black tea that uses fermentation to promote the growth of good bacteria. Consume any of these goods, and you are on your way to favorably changing your gut microbiome. Weissella cibariais bacteria in these foods allow them to ferment.

Certain health conditions and foods can cause bad breath, and many can improve their breath with proper dental hygiene. If simple self-care approaches daily to solve the problem, please see your dentist or other healthcare providers to ensure a more serious condition is not causing the halitosis.

The post Here’s What You Should do to Dodge Bad Breath (Halitosis) appeared first on Medika Life.

Now, Amanda leads a global team working to make the world safer from the next epidemic while also urgently responding to COVID-19. Medika Life Editor-in-Chief Gil Bashe spoke with Amanda on the challenges facing public health efforts around the world.

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Gil Bashe:  Amanda, I would like to talk about the core problems that you and Resolve to Save Lives work to address. Let’s talk about why these problems are critical to public health globally, why we have to be much more aware of them, and what’s at stake for the world if we neglect to address the challenges that Resolve to Save Lives has decided to shoulder?

To start, what brought you to global public health? I know you’ve worked with very established organizations like the International Red Cross in the past. Can you talk a little bit about the mindset and transition for a moment?

Amanda McClelland: It’s a good question. Like many people who worked in West Africa during the Ebola epidemic, it raised several issues centered around how to make sure something like that didn’t happen again.

As part of the International Federation of the Red Cross, our work needed to scale across 90 – 100 countries with 17 million volunteers. The work is at the community level, which is so critical. Yet, it was missing a connection point into government systems and structures. We’ve led a lot of advocacy and tried to put communities at the center of our efforts, but it didn’t move beyond the kind of rhetoric of “communities are important.”  There was nowhere for communities to engage inside the existing architecture, whether that be at a domestic or global level.

After 15 years of responding to outbreaks, I’ve been going back to the same countries for different reasons. I worked in Sierra Leone from 2012–to 2013 during a very large cholera outbreak. I was back there in 2014–2015 for Ebola. And despite this, the recovery that we talked about didn’t fit sustainably.

Dr. Thomas Frieden approached me about joining Resolve to Save Lives with a focus on strengthening community systems and targeting preparedness as a full-time position, tapping into my real-world experiences. This was an opportunity to try to make sure that we weren’t going back to the same countries over and over again, and that we were building systems that could detect diseases and respond sustainably.

Bashe:  You and Resolve to Save Lives recently launched an important campaign.  You’ve just taken on non-communicable disease and specifically cardiovascular disease. That is rare when people are frightened about the next pandemic.  Too often we forget to recognize that 70 to 80% of people around the world perish from non-communicable diseases such as heart disease, diabetes, respiratory disease, and mental health illnesses.  Now you are elevating the conversation around cardiovascular disease, why?

McClelland: So often people think it’s a bit strange that we work in two areas, preventing epidemics and cardiovascular illnesses. You’re right, we picked two problems where we think we can save the most lives. COVID-19 has shown us the absolute relationship between infectious diseases and the health of a population.

The impact of COVID’s abilities or mortality from COVID is a stark reminder that a healthy community is critical. Social cohesion and community engagement are at the center of all public health problems. And that comes through in cardiovascular disease and epidemics.

Bashe: I find this to be fascinating because when talking about people most at risk for COVID severity or death, tragically often we talk about people with chronic illnesses, it could be obesity, it could be cardiovascular disease, it could be diabetes. Together these comorbidities are tipping points leading to COVID-related death.

McClelland:  I’m a primary health care nurse by training, so I go one step further and look at those individuals who have chronic conditions—those people who get asked to come back in six months.

What’s the root cause of that? Many of these people, don’t have access to care promptly. They don’t necessarily have good health literacy, good nutrition advice, or access to nutritious food. We know that COVID is disease oriented. But we need to understand that there is a relationship in many countries between low socio-economic indicators, access to care and the increasing amounts of chronic diseases that can easily become acute—like they did during COVID-19—and overwhelm the health system.

We must provide clinical care along with public health interventions for those diseases and start collaborating more effectively. And we think about this as a spectrum, from prevention to early detection and early treatment, all the way through to chronic care and palliative disease. If we don’t start working together, we’re going to lose people through the cracks and that’s where it becomes acute.

Bashe: Great answer. I know you recently had a campaign in Africa and as a global organization, could you talk a little bit about the work you’re doing in Africa?

You know I’m a very big believer that when we look at health, we tend to look at the health of the developed world. There are many problems in ensuring health in the developed world, and among developing nations. They are working to put together infrastructure. I would appreciate your perspective about developing and developed but also why Africa specifically?

McClelland: So, my opinion on this is changing quite a lot and I’ll give you one example. When COVID started, I was working in lower-middle-income developing countries.

For the last 15 years, even in Australia, I worked with indigenous communities that you could say were sometimes worse. I lived in an Aboriginal community, which had massive health challenges and an inexcusable disparity between aboriginal health and the white population in Australia. But when we started the COVID-19 response, Dr. Frieden came to me and said we were going to start responding in the U.S. because New York was getting hit extremely hard.

I said I can’t. I haven’t worked in a high-income country for many years, I don’t understand the American health system. We don’t have anything to add in this context. But we did it. We mobilized a team of 45 people and supported numerous activities at the local level across partner jurisdictions. We ran two different teams—a U.S. team and a global team. We wrote two different sets of guidance—guidance for high-income countries and guidance for low-income countries.

After the first eight weeks, we realized the challenges were similar. High-income countries don’t necessarily have highly resourced public health departments. The public health departments here in the United States are completely underfunded and understaffed. The challenges that we face in Uganda, Liberia and Nigeria were actually to manage because there was a lack of bureaucracy. Teams knew how to collaborate with partners and how to accept outside help. They were able to accelerate through the challenges, trying to supplement like high-income countries.

Across the board, the fundamental challenges remain the same—poorly paid and under-staffed public health systems. Core data infrastructure, the ability to manage data and the ability to make good decisions on that data are commonalities that we all face. We have more in common than we think. There are different challenges in terms of access and cost of care, but not from an epidemic prevention perspective, and also from a chronic disease perspective. Moreover, the under-resourcing of public health is common across many, many developed and developing countries.

Bashe: Could you talk a little bit about what you’ve been doing in Africa, specifically?

McClelland: When we were first starting Resolve to Save Lives, we looked across the globe at where we, as a small but nimble non-governmental organization (NGO), could add the most value. Through an initial assessment, we realized the burden of infectious diseases in Africa, so that was a logical place to start.

When the COVID-19 pandemic began, it became clear that the missions and social measures that developed countries were going to put in place to control COVID would have a significant secondary impact in low-income countries that would make it extremely difficult to maintain.

And so very early on in our work in the pandemic, as early as 2020, we joined up with Africa CDC, WHO Africa, World Economic Forum and several product companies, including IPSOS, as part of the Partnership for Evidence-Based Response to COVID-19 (PERC) to collect data on how public health and social measures would be implemented on the continent.

We wanted to measure both the epidemiology and the secondary impacts such as food insecurity and education disruptions. So, we started our work in Africa with regular large-scale surveys during the pandemic, which we did in four waves across 20 countries. We were able to provide decision-makers with enough data to make balanced decisions. Balancing risk and corporate control against the secondary impacts that those measures caused, strengthened our understanding that the pandemic was not just a health issue. It was also a political and social issue that required data and information from all sides to be able to make informed decisions.

Bashe: And what have been some of the results, I mean that’s the program but how do you see the impact of your efforts?

McClelland: We spoke to the World Bank on global funding and others in terms of where we were seeing change on the ground. We noticed that countries that did very well at the beginning of the pandemic were those that leveraged their public health to enforce social measures. They quickly had political support.

There was a large amount of public trust in most of the countries with the initial government response. But we also saw economic impacts in those countries along with security incidents. While strong trust in the public health system improves outcomes, people’s behavior was also impacted by their ability to meet their daily needs. You can only protect yourself from COVID if you still have enough food and enough fuel, etc.

We have to make decisions based on risk, and we saw the risk perception of the community go up and down with the various waves of the COVID Delta wave. We also see political disruption move up and down with the epidemic curve, along with secondary impacts, as governments turned on and off safety measures. It reinforced the idea that we cannot make these types of decisions just based on cases or deaths.

Every country must find a balance for what works for them in terms of balancing out access to economic opportunities and food and security against what they will accept as a level of COVID. And we’ve seen examples of that. New Zealand versus the United States varies in terms of how they managed COVID and the economic impacts, but also the absolute mortality that caused them.

There are varying thresholds of what is acceptable in different communities. Some communities accepted zero deaths and, in some places, 1,500 deaths a week is still the norm and things are getting back to normal. It is important to understand that pandemic control is a choice that’s driven by politics and communities. And that was a difficult realization for many, that the dependency wasn’t wholly and solely within the health domain, that we were one actor of many trying to influence how this was controlled.

Bashe: When you look at the next six months to a year, what do you hope to achieve?

McClelland: We hope to have this recognized as a once-in-a-generation opportunity to build forward better and to make sure that we recognize the threat that biology still has to us—that we haven’t outsmarted the germs, so to speak.

There are things that you can do to control the risk to make sure that we’re better prepared, to make sure that individuals and systems are more resilient. We have this opportunity in the next six months. We must harness the political will, the financial resources required and the lessons that we’ve learned during COVID to make sure that we build a more protected and healthier world. There is a significant risk that we don’t learn any of these lessons and then we go back into this cycle of panic and neglect. The next six months are so critical for us.

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The next six months may be critical for us.  Keep watching the work of Resolve to Save Lives and their in-the-trenches team to see the progress that they are making to sustain and save lives around the world.

The post Is the Developed World Lightyears Ahead in Public Health? Maybe not! appeared first on Medika Life.

It is estimated that as many as 8 million people in Mexico, Central America, and South America have Chagas disease, most of whom do not know they are infected. If untreated, infection is lifelong and can be life threatening.

The impact of Chagas disease is not limited to only rural areas of Latin America in which vectorborne transmission (diseases transmitted by insects) occurs. Large-scale population movements from rural to urban areas of Latin America and to other regions of the world have increased the geographic distribution and changed the epidemiology of Chagas disease.

In the United States and in other regions where Chagas disease is now found but is not endemic, control strategies should focus on preventing transmission from blood transfusion, organ transplantation, and mother-to-baby (congenital transmission).

What are the symptoms?

Much of the clinical information about Chagas disease comes from experience with people who became infected as children through contact with triatomines. The severity and course of an individual infection can vary based on a number of factors, including the age at which a person became infected, the way in which a person acquired the infection, or the particular strain of the T. cruzi parasite.

There are two phases of Chagas disease: the acute phase and the chronic phase. Both phases can be symptom free or life threatening.

Acute phase

During this phase, which lasts for the first few weeks or months infection, a person may have no symptoms or mild ones, such as fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting. Because these symptoms are similar to those of other illnesses, most people do not know their illness is from infection with the T. cruzi parasite.

However, a doctor may be able to pick up other signs of infection, including mild enlargement of the liver or spleen, swollen glands, or swelling at the site of the bite (called a chagoma), where the parasite entered the body. Some people with acute phase infection may have swelling of the eyelids on the side of the face near the bite wound or where the bug poop was accidentally rubbed into the eye, called Romaña’s sign.

Even if a person develops symptoms during the acute phase, they usually feel well within a few weeks or months but if the person is not treated with antiparasitic medication, the infection remains in the body. Rarely, young children (less than 5%) die from severe inflammation and infection of the heart muscle (myocarditis) or brain (meningoencephalitis). The acute phase also can be severe in people with weakened immune systems, such as patients taking chemotherapy or those with advanced HIV infection.

Chronic phase: During this phase, which can last for decades or even for the entirety of someone’s lifetime, most people have no symptoms. Approximately 20–30 percent of infected people develop

• Cardiac complications, which can include an enlarged heart, heart failure, altered heart rate or rhythm, and cardiac arrest (sudden death); and/or
• Gastrointestinal complications, which can include an enlarged esophagus (megaesophagus) or colon (megacolon) and can lead to difficulties with eating or pooping.

How do you contract Chargas

People can become infected in several ways. In areas where Chagas disease is common, the main way is through vectorborne transmission. The insect vectors are called triatomine bugs. These blood-sucking bugs get infected with T. cruzi by biting an infected animal or person. Once infected, the bugs pass the parasites in their feces. The bugs are found in houses made from materials such as mud, adobe, straw, and palm thatch. During the day, the bugs hide in crevices in the walls and roofs.

During the night, when the inhabitants are sleeping, the bugs emerge. Because they tend to bite people’s faces, triatomine bugs are also known as “kissing bugs”. After they bite and ingest blood, they defecate (poop) on the person. The person can become infected if T. cruzi parasites in the bug feces enter the body through mucous membranes or breaks in the skin. The unsuspecting, sleeping person may accidentally scratch or rub the feces into the bite wound, eyes, or mouth.

People also can become infected through

• Congenital transmission (from a pregnant woman to her baby);
• Blood transfusions;
• Organ transplantation;
• Consumption of uncooked food that is contaminated with feces (poop) from infected triatomine bugs; and
• Accidental laboratory exposure.

It is generally considered safe to breastfeed even if the mother has Chagas disease. However, if the mother has cracked nipples or blood in the breast milk, she should pump and discard the milk until the nipples heal and the bleeding resolves.

Chagas disease is not transmitted from person-to-person like a cold or the flu or through casual contact with infected people or animals.

How does the disease develop

Chagas disease has an acute and a chronic phase. If untreated, infection is lifelong.

Acute Chagas disease occurs immediately after infection, and can last up to a few weeks or months. During the acute phase, parasites may be found in the circulating blood. This phase of infection is usually mild or asymptomatic. There may be fever or swelling around the site of inoculation (where the parasite entered into the skin or mucous membrane). Rarely, acute infection may result in severe inflammation of the heart muscle or the brain and lining around the brain.

Following the acute phase, most infected people enter into a prolonged asymptomatic form of disease (called “chronic indeterminate”) during which few or no parasites are found in the blood. During this time, most people are unaware of their infection. Many people may remain asymptomatic for life and never develop Chagas-related symptoms. However, an estimated 20–30% of infected people will develop severe and sometimes life-threatening medical problems over the course of their lives.

Complications of chronic Chagas disease may include

• Heart rhythm abnormalities that can cause sudden death;
• A dilated heart that doesn’t pump blood well; and
• A dilated esophagus or colon, leading to difficulties with eating or passing stool.

In people who have suppressed immune systems (for example, due to AIDS or chemotherapy), Chagas disease can reactivate with parasites found in the circulating blood. Reactivation can potentially cause severe disease.

How is Chagas disease treated?

Two approaches to therapy, that can be life-saving include:

• Antiparasitic treatment, to kill the parasite; and
• Symptomatic treatment, to manage the symptoms and signs of infection.

Antiparasitic treatment is most effective early in the course of infection but is not limited to cases in the acute phase. In the United States, there are two types of treatments available. Benznidazole is approved by FDA for use in children 2–12 years of age and is commercially available at http://www.benznidazoletablets.com/en/.

Nifurtimox is not currently FDA approved and is available under an investigational protocol from CDC. Your health-care provider can talk with CDC staff about whether and how you should be treated. Most people do not need to be hospitalized during treatment.

Symptomatic treatment may help people who have cardiac or gastrointestinal problems from Chagas disease. For example, pacemakers and medications for irregular heartbeats may be life saving for some patients with chronic cardiac disease.

Protecting yourself against Chagas

No drugs or vaccines for preventing infection are currently available. Travelers who sleep indoors, in well-constructed facilities (for example, air-conditioned or screened hotel rooms), are at low risk for exposure to infected triatomine bugs that usually live in poor-quality dwellings and are most active at night.

Preventive measures include spraying infested dwellings with long-lasting insecticides, using bed nets treated with long-lasting insecticides, wearing protective clothing, and applying insect repellent to exposed skin. Travelers should observe food and beverage precautions and avoid consuming salads, uncooked vegetables, unpeeled fruits, and unpasteurized fruit juices.

Where are triatomine bugs typically found?

Triatomine bugs (also called “kissing bugs”, cone-nosed bugs, and blood suckers) can live indoors, in cracks and holes of substandard housing, or in a variety of outdoor settings including the following:

• Beneath porches
• Between rocky structures
• Under cement
• In rock, wood, brush piles, or beneath bark
• In rodent nests or animal burrows
• In outdoor dog houses or kennels
• In chicken coops or houses

They are typically found in the southern United States, Mexico, Central America, and South America (as far south as southern Argentina). The map below details triatomine occurrence by U.S. state.

Eleven different species of triatomine bugs have been found in the southern United States: The links below will take you to the CDC website

• Paratriatoma hirsuta
• Triatoma gerstaeckeri
• Triatoma incrassata
• Triatoma indictiva
• Triatoma lecticularia
• Triatoma neotomae
• Triatoma protracta
• Triatoma recurva
• Triatoma rubida
• Triatoma rubrofasciata
• Triatoma sanguisuga

Triatomines are mostly active at night and feed on the blood of mammals (including humans), birds, and reptiles. Triatomine bugs live in a wide range of environmental settings, generally within close proximity to an animal the bug can feed on, called a blood host. In areas of Latin America where human Chagas disease is an important public health problem, the bugs nest in cracks and holes of substandard housing.

Because most indoor structures in the United States are built with plastered walls and sealed entryways to prevent insect invasion, triatomine bugs rarely infest indoor areas of houses. Discovery of the earlier stages of the bug (wingless, smaller nymphs) inside can be a sign of a triatomine infestation. When the bugs are found inside, they are likely to be in one of the following settings:

• Near the places your pets sleep
• In areas of rodent infestation
• In and around beds and bedrooms, especially under or near mattresses or night stands

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