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The World Health Organisation Urges China to Continue the Search for the Source of the New Virus As New Case Emerges in Thailand



|| Tuesday: January 14: 2020 || ά. It is essential for China to continue investigating the source of a previously unknown strain of coronavirus, the World Health Organisation:WHO declared on Monday, following confirmation that an infected patient is being treated in Thailand. In its statement, WHO identified the patient as a traveller from Wuhan, China, who was hospitalised in Thailand on January 08. According to Thai authorities, the patient is recovering from the illness.

The novel coronavirus is believed to have originated in Wuhan, infecting dozens of people in China and, on Saturday, Chinese media reported the first known death from the virus. Coronaviruses rely on animal to human transmission and the Chinese health commission in Wuhan has reportedly declared that there was no evidence of any spread between humans. However, given recent developments, Dr Tedros Adhanom Ghebreyesus, WHO Secretary-General is planning to consult with the members of the agency’s Emergency Committee, and could call for a meeting of the Committee at short notice.

In its Monday statement, WHO noted that it has been expecting cases to be reported in countries other than China, underscoring the importance of monitoring and preparedness in other countries. The work of WHO and the Chinese authorities in containing the new coronavirus will be made more complicated by the Spring Festival or Chinese New Year, which begins on January 25 and sees hundreds of millions criss-crossing the country.

WHO has issued guidance on how to detect and treat persons ill with the new virus: standard recommendations for halting the spread of coronaviruses include regular hand washing; covering one’s mouth and nose when coughing and sneezing; thoroughly cooking meat and eggs and avoiding close contact with anyone, showing symptoms of respiratory illness, such as, coughing and sneezing.

What is a coronavirus: Coronaviruses are described by WHO as a large family of viruses, that cause illness, ranging from the common cold to more severe diseases. Probably, the best known is Severe Acute Respiratory Syndrome, commonly known as, SARS, which broke out in Asia in 2003 and spread to countries in North America, South America and Europe, before being successfully contained later that year. 

Coronaviruses are transmitted between animals and people, and there are several known coronaviruses currently circulating in animals, that have not yet infected humans.

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

::: Caption: The MERS coronavirus, digitally imaged: Image: US National Institute of Allergy and Infectious Diseases :::

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The Spread of Polio Is Still an International Public Health Concern: WHO Stands Advised



|| Wednesday: January 08: 2020 || ά. The spread of polio internationally remains a global public health concern, experts meeting in Geneva have concluded. The opinion comes in a statement released on Tuesday following the latest meeting of the Emergency Committee, convened by the World Health Organisation:WHO, that provides technical advice on international public health emergencies.  

“The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern:PHEIC and recommended the extension of Temporary Recommendations for a further three months.” the Committee said. The Emergency Committee, which met in December, expressed concern over ‘the significant increase’ in cases of wild poliovirus one:WPVI, the last of three strains to be eliminated. There were 28 cases in 2018, compared to 113 as at mid-December last year, with no significant success yet in reversing this trend.

Members of the Committee said that recent progress appears to have reversed, as international spread of WPV1 is at the highest point since the declaration of a public health emergency of international concern:PHEIC in 2014.

Transmission remains widespread in Pakistan, where challenges include continued refusal to accept vaccination by individuals and communities.  There was, also, evidence of further spread to neighbouring Afghanistan, where on-going instability makes scores of children inaccessible, particularly, in the south.

Meanwhile, WPV1 has not been detected in Nigeria for three years, meaning that the African region could this year be certified as being virus-free.  The Emergency Committee, also, commended efforts to reach children in Borno state in the north, which has been in the grip of a Boko Haram terrorist insurgency for a decade.

Regarding circulating vaccine derived polioviruses:cVDPV, the Emergency Committee recalled that outbreaks have occurred in Africa, the Eastern Mediterranean, South-East Asia and the Western Pacific regions, while seven countries have reported outbreaks since its last meeting.

Additionally, spread of cVDPV2 was recorded in West Africa and the Lake Chad area, reaching Cote d’Ivoire, Togo and Chad, while cVDPV1 moved from The Philippines to Malaysia.  “The rapid emergence of multiple cVDPV2 strains in several countries is unprecedented and very concerning, and not yet fully understood.” said the statement.

Overall, countries affected by wild poliovirus one or strains of circulating vaccine-derived poliovirus, should officially declare that stopping their spread is, also, a national public health emergency, the Committee said in its temporary recommendations.

Residents, long-term visitors and travellers to these areas, also, should be protected against the disease. The experts further recommended that intensifying co-ordination to increase vaccination coverage of people travelling, who, regularly, cross borders and to improve monitoring of the quality of vaccination at transit points, as well as, tracking of unvaccinated travellers.

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More Than One in Three Low and Middle Income Countries Face Both Extremes of Malnutrition: Obesity and Under Nutrition


|| Sunday: December 15: 2019 || ά. A new approach is needed to help reduce under nutrition and obesity at the same time, as the issues become increasingly connected due to rapid changes in many countries’ food systems. This is, especially, important in low and middle income countries, according to a new four-paper Report, published in The Lancet.

More than a third of such countries had overlapping forms of malnutrition, 45 of 123 countries in the 1990s and 48 of 126 countries in the 2010s, particularly, in sub-saharan Africa, south Asia, east Asia and the Pacific. Under nutrition and obesity can lead to effects across generations as both maternal under nutrition and obesity are associated with poor health in offspring. However, because of the speed of change in food systems, more people are being exposed to both forms of malnutrition at different points in their lifetimes, which further increases harmful health effects.

“We are facing a new nutrition reality.” said the Lead Author of the Report Dr Francesco Branca, the Director of the Department of Nutrition for Health and Development, World Health Organisation. “We can no longer characterise countries as low income and under-nourished or high income and only concerned with obesity. All forms of malnutrition have a common denominator,  food systems, that fail to provide all people with healthy, safe, affordable and sustainable diets.

Changing this will require action across food systems, from production and processing, through trade and distribution, pricing, marketing and labelling, to consumption and waste. All relevant policies and investments must be radically re-examined.”

In a Lancet editorial, accompanying the Report, Dr Richard Horton, the Editor in Chief of The Lancet, says, “Today’s publication of the WHO Series on the Double Burden of Malnutrition comes after 12 months of Lancet articles exploring nutrition in all its forms… With these and other articles across Lancet journals throughout 2019, it has become clear that nutrition and malnutrition need to be approached from multiple perspectives, and although findings have sometimes converged, there is still work to be done to understand malnutrition’s multiple manifestations… With 6 years remaining in the UN Decade of Action on Nutrition (2016-2025), this Series and Comment define the future direction required to achieve the global goal of eradicating hunger and preventing malnutrition in all its forms.” 

Globally, estimates suggest that, almost, 02.3 billion children and adults are overweight and more than 150 million children are stunted. However, in low and middle income countries these emerging issues overlap in individuals, families, communities and countries. The new Report explores the trends behind this intersection, known as the double burden of malnutrition, as well as, the societal and food system changes, that, may be, causing it, its biological explanation and effects and policy measures, that, may, help address malnutrition in all its forms.

The authors used survey data from low and middle income countries in the 1990s and 2010s to estimate which countries faced a double burden of malnutrition, i.e, in the population, more than 15% of people had wasting, more than 30% were stunted, more than 20% of women had thinness and more than 20% of people were overweight.

In the 2010s, 14 countries with some of the lowest incomes in the world had newly developed a double burden of malnutrition, compared with the 1990s. However, fewer low and middle income countries with the highest incomes were affected than in the 1990s. The authors say that this reflects the increasing prevalence of being overweight in the poorest countries, where populations still face stunting, wasting and thinness.

High-quality diets reduce the risk of malnutrition in all its forms by promoting healthy growth, development and immunity and preventing obesity and non-communicable diseases:NCDs throughout life. The components of healthy diets are: optimal breastfeeding practices in the first two years; a diversity and abundance of fruits and vegetables, wholegrains, fibre, nuts and seeds; modest amounts of animal source foods; minimal amounts of processed meats and minimal amounts of foods and beverages high in energy and added amounts of sugar, saturated fat, trans fat and salt.

“Emerging malnutrition issues are a stark indicator of the people, who are not protected from the factors, that drive poor diets. The poorest low and middle income countries are seeing a rapid transformation in the way people eat, drink and move at work, home, in transport and in leisure.” said Report Author Professor Barry Popkin, University of North Carolina, USA.

“The new nutrition reality is driven by changes to the food system, which have increased availability of ultra-processed foods, that are linked to increased weight gain, while, also, adversely affecting infant and pre-schooler diets. These changes include disappearing fresh food markets, increasing supermarkets and the control of the food chain by supermarkets and global food, catering and agriculture companies in many countries.”

Exposure to under nutrition early in life followed by becoming overweight from childhood onwards increases the risk of a range of non-communicable diseases, making the double burden of malnutrition a key factor driving the emerging global epidemics of Type Two Diabetes, High Blood Pressure, Stroke and cardiovascular disease. Negative effects can, also, pass across generations, for example, the effect of maternal obesity on the likelihood of the child having obesity may be exacerbated, if, the mother was undernourished in early life.

Despite physiological links, actions to address all forms of malnutrition have historically not taken account of these or other key factors, including, early-life nutrition, diet quality, socio-economic factors and food environments. In addition, there is some evidence that programmes, addressing under nutrition have unintentionally increased risks for obesity and diet-related NCDs in low income and middle income countries, where food environments are changing rapidly.

While it is critical to maintain these programmes for under nutrition, they need to be redesigned to do no harm. Existing under nutrition programmes, delivered through health services, social safety nets, educational settings and agriculture and food systems present opportunities to address obesity and diet-related NCDs.

The Report identifies a set of ‘double-duty actions’, that simultaneously prevent or reduce the risk of nutritional deficiencies, leading to underweight, wasting, stunting or micronutrient deficiencies and obesity or NCDs, with the same intervention, programme or policy. These range from improved antenatal care and breastfeeding practices, to social welfare and to new agricultural and food system policies with healthy diets as their primary goal. 

“Continuing with business-as-usual is not fit for purpose in the new nutrition reality. The good news is that there are some powerful opportunities to use the same platforms to address different forms of malnutrition. The time is now to seize these opportunities for ‘double duty action’ to get results.” said Professor Corinna Hawkes, Centre for Food Policy, City, University of London, UK.

To create the systemic changes, needed to end malnutrition in all its forms, the authors call on governments, the UN, civil society, academics, the media, donors, the private sector and economic platforms to address the double burden of malnutrition and bring in new actors, such as, grass-roots organisations, farmers and their unions, faith-based leaders, advocates for planetary health, innovators and investors, who are financing fair and green companies, city mayors and consumer associations.

“Given the political economy of food, the commodification of food systems and growing patterns of inequality worldwide, the new nutrition reality calls for a broadened community of actors, who work in mutually reinforcing and inter-connected ways on a global scale.” says Dr Branca. “Without a profound food system transformation, the economic, social, and environmental costs of inaction will hinder the growth and development of individuals and societies for decades to come.”

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New World Health Organisation Report: Stronger Focus on Nutrition Within Health Services Could Save 03.7 Million Lives by 2025


|| Wednesday: September 05: 2019|| ά. Health services must integrate a stronger focus on ensuring optimum nutrition at each stage of a person’s life, according to a new Report, released by the World Health Organisation: WHO. It is estimated that the right investment in nutrition could save 03.7 million lives by 2025.

Essential health packages in all settings need to contain robust nutrition components but countries will need to decide which interventions best support their national health policies, strategies and plans. Key interventions include providing iron and folic acid supplements as part of antenatal care; delaying umbilical cord clamping to ensure babies receive important nutrients they need after birth; promoting, protecting and supporting breastfeeding; providing advice on diet, such as, limiting the intake of free sugars in adults and children and limiting salt intake to reduce the risk of heart disease and stroke.

“In order to provide quality health services and achieve Universal Health Coverage, nutrition should be positioned as one of the cornerstones of essential health packages.” said Dr Naoko Yamamoto, the Assistant Director-General at WHO. “We, also, need better food environments, which allow all people to consume healthy diets.”

Investment in nutrition actions will help countries get closer to their goal of achieving universal health coverage and the Sustainable Development Goals. It can, also, help the economy, with every US$01 spent by donors on basic nutrition programmes returning US$16 to the local economy. 

The world has made progress in nutrition but major challenges still exist. There has been a global decline in stunting, low height for age ratio: between 1990 and 2018, the prevalence of stunting in children, aged under five years, declined from 39.2% to 21.9% or, from 252.5 million to 149.0 million children, though, the progress has been much slower in Africa and South-East Asia.

Obesity, however, is on the rise. The prevalence of children considered overweight rose from 04.8% to 05.9% between 1990 and 2018, an increase of over nine million children. Adult overweight and obesity are, also, rising in nearly every region and country, with 01.3 billion people overweight in 2016, of which 650 million, 13% of the world’s population, are obese. 

Obesity is a major risk factor for diabetes. cardiovascular diseases, mainly, heart disease and stroke, musculoskeletal disorders, especially, osteoarthritis, a highly disabling degenerative disease of the joints and some cancers, including, endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon.

An increased focus on nutrition by the health services is key to addressing both aspects of the ‘double-burden’ of malnutrition. The Essential Nutrition Actions publication is a compilation of nutrition actions to address this ‘double burden’  of underweight and overweight and provide a tool for countries to integrate nutrition interventions into their national health and development policies.

Read the Report:::ω.

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