This week in the BMJ
Volume 328, Number 7443, Issue of 3 Apr 2004Maternal and child health vital to progress of South Asia
Maternal and child health vital to progress of South Asia
South Asia has an unacceptably high maternal and perinatal mortality, but simple and cheap investments in primary care may change things dramatically. Rates of maternal malnutrition are among the highest in the world, say Bhutta and colleagues (p 816), infectious diseases are common, and there is a lack of clean water, sanitation, and hygiene awareness; providing contraception, improving the status and rights of women, and improving quality of services are critical. Shift of expenditures from defence to public health are paramount; Sri Lanka and Kerala, which now have health and demographic indicators far ahead of the national average, have shown the way forward (p 777). Tackling maternal depression, say Patel and colleagues (p 820), is vital, and it is important to deal with sexual discrimination, argue Fikree and Pasha (p 823).
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The double burden of diseases in South Asia
Almost half of all deaths in South Asia are now attributable to non-communicable diseases, accounting for 47% of global burden of disease. On page 807 Ghaffar and colleagues analyse how obesity, the rising prevalence of diabetes, higher tobacco consumption among the lower socioeconomic groups, and outdoor and indoor air pollution contribute to the rise of cardiovascular diseases, chronic respiratory diseases, and cancer in the region. Rich people will develop chronic diseases but poor people will die earlier. Meanwhile common infectious diseases, such as neonatal infections, diarrhoea, and acute respiratory infections, remain major child killers, as Zaidi and colleagues report (p 811); 4.58 million people are infected with HIV, tuberculosis is endemic and poorly controlled. Antibiotic resistance is common, and only half of children receive routine immunisation. Tackling these diseases will require innovation, political commitment, and partnership between individuals, communities, and healthcare providers, say Basnyat and Rajapaksa in an editorial (p 781).
In Pakistan, one in three people are anxious or depressed
Socioeconomic adversity and relationship problems are major risk factors for anxiety and depressive disorders in Pakistan. In a review of 20 studies, Mirza and Jenkins (p 794) found that the prevalence of anxiety and depression in Pakistan was 33%. Being anxious or depressed was associated with female sex, middle age, low level of education, difficulties with finances, being a housewife, and relationship problems; a supportive family and friends may be of help. The authors were concerned with the methodological quality of the studies, and results should be interpreted with caution.
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Acetazolamide is better than ginkgo biloba for mountain sickness
Acetazolamide reduces acute mountain sickness when climbing at high altitude. Gertsch and colleagues (p 797) randomised 614 Western trekkers climbing Mount Everest to acetazolamide, ginkgo biloba, a combination of the two drugs, or placebo. They found that only acetazolamide reduced the symptoms of acute mountain sickness. Ginkgo biloba did not have any effect, and when it was combined with acetazolamide the incidence of headache was greater than when acetazolamide was taken alone.
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Three days of amoxicillin are enough for non-severe pneumonia
Treating children with non-severe pneumonia with oral amoxicillin for three days, rather than five, is as effective, cheaper, and more likely to be adhered to by patients. In a randomised trial conducted by the ISCAP Study Group (p 791), 2188 children with non-severe pneumonia received oral amoxicillin for three days or standard care (five days' treatment). Clinical cures and relapses were no different in the two groups. Clinical failure was more likely with non-adherence to treatment at day 5, a respiratory rate of > 10 breaths/minute, and infection with respiratory syncytial virus. As well as being cheaper and as effective, a three day course may decrease antimicrobial resistance, the authors say.
Who smokes in India?
Consumption of tobacco is more common among poorer people in India, but there are differences between regions, religions, and castes. Analysing data on more than 300 000 adults from the 1998-9 national family health survey, Subramanian and colleagues (p 801) found that older men, married people, and poorly educated people were more likely to consume tobacco by smoking, chewing, or both. Muslims and Hindus were more likely to smoke than Christians, and a greater proportion of the population in the north east than in the southern and western states consumed tobacco, independent of socioeconomic status. Differences in tobacco consumption may increase the imbalance of adult health in future, conclude the authors.
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Student BMJ
Intimate examinations
Israeli students are refusing to perform intimate examinations on anaesthetised women without their informed consent.
