First things First

Infectious diseases are one of the major public health problems in developing countries. Interestingly, families in developing countries care for their loved ones at home before taking them to the hospital and it is during these early days that the disease can be easily spread to other family members. It is in this regard that I would like to focus on how families can take care of patients with infectious diseases at home.

With infectious diseases it is very important to remember that the disease is always transferred/ transmitted from a sick individual (infected person) to the healthy individual (person not infected by disease). Therefore it is very crucial to protect the infected individual first to make sure that they do not spread the disease to the healthy individuals.

Since infectious diseases are transmitted in various ways, I will present scenarios which represent a mode of transmission of disease as this is crucial when handling the patient.

  

SCENARIO 1; Patient with Malaria/Dengue (Diseases transmitted by mosquitoes)

Having suffered from malaria myself and all my family members, I know what the risk of transmission is within the household. When one person got malaria, we knew that there is going to be one or two more people who are also going to fall sick in the coming days or weeks.  With mosquitoes roaming around the house, there is a high possibility that the infected mosquito will bite someone else in the house thereby transmitting the disease.  Therefore, with infectious diseases transmitted by mosquito bites, it is very important for the patient to sleep under a treated bed net and that the patient wears insect repellent so that he/she is not bitten by mosquitoes. Make sure that each family member also sleeps under a treated bed net and is using repellent to protect themselves from bites. Make sure that the patient is taken to hospital to get treatment, the earlier they start taking medication the better. 

SCENARIO 2; Patient with Diarrhoea and Dysentry(Diseases spread by contact)

Yes Diarrhoea, it can be a result of food poisoning, contaminated water/food, and so on. These are the most challenging infectious diseases because they can be easily transferred from the patient to the whole family.  It is very crucial to explain the risk of spread of diarrhoea to the whole family and that if any member of the family has got it, they have to notify the rest of the family.  I remember taking care of a patient who had a viral diarrhoea infection and vomiting. I was doing my best to wash my hands as often as I could but in less than 24hours I got it too. When we went to the hospital the doctor said I had to clean my hands thoroughly and make sure I scrubbed my nails. Even if we wash our hands, the nails (if you have long nails) can harbour infectious material.  Therefore washing hands properly and thoroughly is crucial.

Make sure that the patient’s room is always clean and dry and if there is any contaminated material it has to be disinfected and cleaned immediately. Take the patient to the hospital immediately do not wait until they get very sick. The earlier the diarrhoea is stopped, the lower the risk of spreading it to everyone and the risk of dehydration of the patient. Wash your hands before and after going into the patient’s room and after changing the patient or cleaning up after the patient. Wash your hands thoroughly; scrub your nails to get rid of anything that may be stuck in your nails.  It is very important to take the patient to the hospital so that they can identify what is causing the diarrhoea because there are other types of diarrhoea which are very dangerous and can kill in less than 48hours. 

SCENARIO 3; Patient with Mumps (Transmitted through Saliva)

Just like I mentioned in diarrhoea, it is important to wash your hands before and after touching the patient.  Do not eat any food left over by the patient. I remember growing up and one of us got mumps. Mumps are a rare infection and they usually occur once in early childhood before the age of 10 years. I remember my mother telling us not to eat in the same plate with the infected person and not to eat anything left over in their plate. We were not to use the same spoon, plate or cup.  She explained to us that the disease is spread through the saliva.

It is therefore very crucial to wash the plates, cups, spoons, any utensils used by the patient separately with hot water. You can still hug and cuddle the child but no kissing.

SCENARIO 4; Patient with HIV and AIDS

Many are the times that patients with HIV and AIDS are taken care of at home and they are in and out of the hospital. Since with the infection, the patient’s immune system is compromised as such they can catch all sorts of infections around them. These include tuberculosis, malaria, diarrhoeal infections and many more. It is therefore very important to reduce the risk of spread of the HIV virus among the family members. HIV is spread through body fluids (especially blood, vaginal and seminal fluids, saliva (minimal but probable) and it is important to reduce the risk of contact to these fluids. Wear appropriate protective wear, such as gloves whenever you are cleaning after the patient and cleaning the patient. It is very important to explain to the patient why you have to protect yourselves, so that they do not feel stigmatised.  

Always disinfect contaminated material and wash utensil with hot water.

The challenge still remains disseminating this information to the remote areas in developing countries and even to most populations who have no idea on the risks of spread of these diseases in both developed and developing countries.

Infectious Diseases and Family

For the rural communities in developing countries, health care and sanitation are always one of the major public health challenges. When it comes to infectious diseases and caring for the sick, they have limited resources and knowledge. As such they rely on information passed on down the family from generation to generation as a way of caring for a patient with such and such a disease. The problem comes in as some of the ideas that are used to care for these patients result in putting the whole family at high risk of contracting the disease.

In as much as there are many organisations that are helping in disseminating information on how to prevent the risk of spread of disease, it is crucial that training is carried out to bring awareness on infectious diseases and their effects.  Many are the times that we focus on prevention of the disease but not on how to take care of a patient when they are infected by the disease. We focus so much on how the patient is affected but on the family that is around this patient and how the infectious disease can actually spread to them as well.

It is high time that organisations involved in public health awareness also put focus on how a family with a patient carrying an infectious disease can be affected/ infected. It is important that organisations focus on the infectious diseases that exist in a particular area and their risks to the family. In addition to prevention of the disease, advice on the correct ways to care for patients with a particular disease may reduce the risk of spread of infectious diseases within the family hence the community.

I must say, campaigns on prevention of disease have really helped a lot in bringing awareness on the dangers of various diseases. But there is need to also focus on what happens when the disease is in the family, how do we protect the family members and the community at large as they care for their patients from home before they take them to hospital.

As I mentioned area, most of the rural areas in developing countries lack hospitals/ medical facilities, some populations live tens of kilometres away from the nearest hospital. As such families tend to wait for a day or two some even a week whilst they care for the patient at home trying to find a way to get them to hospital. And sadly most of the times some of the patients don’t make it to the hospital, while others make it to the hospital, unfortunately the do not survive the disease because they arrived too late. Well some people may be asking why not call an ambulance? Well with the lack of ambulances, there are areas where they have one ambulance covering an area over 100 square kilometres while others there is no Ambulance at all, hence people have to find their own way to the hospital. Apart from that, there are certain areas that are inaccessible during the rainy season due to flooding and other forces of nature. I can go on and on with the reasons why people don’t make it to the hospital on time in rural areas of most developing countries. But my main focus is the need to train families how to care for their loved ones at home while they are preparing to take them to the hospital. It is important to determine the various infectious diseases that are common in communities and train these communities on how to take care of patients with any of these diseases, while they are preparing to tke them to hospital.

Mosquitoes and You

The beautiful tropical paradises around the globe are a source of great beauty and relaxation. People move from other parts of the world in search for that relaxed beautiful moment but there are also other individuals who enjoy the treat, mosquitoes. Mosquitoes are some of the most irritating insects to be around, their bites are itchy and painful, and those that fly in the night can be loud and noisy, not forgetting that their bite can also transmit some of the deadly and nasty infectious diseases such as malaria and dengue fever.

Mosquitoes transmit diseases by biting a person infected with a disease and thereafter biting another person during their next meal. This cycle is very critical as it is challenging to control the spread of the disease without human intervention. This intervention includes humans protecting themselves from mosquito bites and controlling mosquito breeding.

Today I am going to focus on the second part how do we control mosquito breeding?

Mosquitoes breed in stagnant water, because that is where they can easily lay their eggs hatch and develop to the adult stages. Since the water is not moving, there is plenty of food for the developing mosquito stages. 

Stagnant water is water that is not moving and usually collects in;

1.  holes/pools on the ground,
2.  old utensils that are lying around in the open, e.g. pots, plates, cups, cans, water fountains, etc.
3. plates/base of flower pots, 
4.  on big leaves and  hollow stems,
5.  hollow stems in tree trunks,
6. old tyres,
7. anything that is hollow and can collect water.

It is therefore very important to drain and turn upside down all things that can collect water and be a breeding ground for mosquitoes. Fill all water pools so that there is no water collecting there anymore. As simple as these ways sound, they go a long way to reduce the breeding grounds for mosquitoes thereby reducing the population of mosquitoes hence reducing the risk of spread of diseases transmitted by mosquitoes.

Remember to always protect yourself against mosquitoes when you are in areas that are prone to mosquito borne diseases. Use insect repellents and always sleep under a treated bed net if you can.

If you have flowers or potted plants, fountains and huge plants in your garden, make sure to drain any water that collects and clean them to ensure that mosquito eggs are destroyed.

Your HANDS; Your Best Friend or Worst Enemy.

Our hands, these two hands that we have are one of the most important part of our body. We use them in almost everything and sometimes we do not realise how much they are used and where they have been used. Hands touch different surfaces, for example, picking up a TV/ radio remote control, putting on shoes, selecting vegetables, meat, dairy products and many other items at the Supermarket, pressing buttons in the elevator, cleaning surfaces, greeting people, touching your face, wiping yourself..the list goes on. It is because of this that hands have become our best friend but also our worst enemy. 
Our hands are our best friend because they help us achieve so many things, they are our worst enemy because they can touch and carry infectious material, that can cause serious diseases and transfer it to other surfaces, and people.

That is why it is important to wash our hands every time we;

•  come into the house from outside,
•  when we finish using the toilet, 
• before we start eating, 
• when we have finished eating,
•  before we touch or carry a baby, 
• before cleaning a wound
• before touching your eyes and ears
• before touching your mouth and inside your nose
• after using a computer or any portable device
• after attending a public function which involved shaking hands with different people
• when you feel that your hands are dirty

You can never wash your hands too much, washing your hands reduces the amount of dirt, and other material that can be harmful to our bodies.For example influenza virus is transmitted/spread through three different ways:

1.   by direct contact with infected individuals;
2.  by contact with contaminated objects (called fomites, such as toys, doorknobs, TV/radio remote controls and anything that an infected individual touched (Remember when people sneeze or wipe their nose their hands are involved))
3.  by inhalation of virus-laden aerosols. 

So now you underestand why it is mportant to wash your hands? Influenza is just one example but there are so many diseases that are transmitted by contact, where our hands touch and carry the infectious material and transfer them into our body through the things we handle there after.

Some of the diseases that can be transmitted through contact include;

1. Respiratory illnesses e.g. Bacterial Meningitis, Chickenpox, Common cold, Influenza, Mumps,Strep throat, Measles, Rubella, SARS, and Whooping cough.
2. Food borne illnesses (illnesses transmitted from contaminated food) e.g.Cholera, Hepatitis A, Polio, Rotavirus, Salmonella, Parasites e.g. Ascaris lumbricoides

So next time you hesitate to wash your hands, think of what they may be carrying!
 

Can we ever run away from mosquitoes ?

Mosquitoes are a common nuisance to the human population. In the night when we sleep the mosquito is at work, not only does it wake you up by the noise it makes as it fly’s around the room but also from the pain and itching from the bite it just inflicted on your body. On the other hand during the day, there are those annoying mosquitoes which bite you in the legs under the desk, or in all places hidden from your view like the calf muscles of the legs, the back of your neck and so on. The bite is not only itchy but painful as well. If you took a closer look, or if you are very observant, you will notice that the mosquito that bites during the day is different from the mosquito that bites during the night. The day mosquito is usually black with white dots, while the mosquito which bites during the night is usually brown or plain black.

The interesting thing is that mosquitoes have always evolved to live closer to where they can find their food/nutrition.  Male mosquitoes feed on nectar while the female mosquito of several species, feed on blood, in order to lay eggs and perpetuate the existence of the species. As part of their evolution to associate more with their source of food (humans and other mammals for the blood feeders), mosquitoes have adapted to breed in areas where you would least expect them to. In order to breed, mosquitoes need stagnant water, and shady environments where they can lay their eggs and the eggs can hatch allowing the formation of the mosquito intermediate stages the larvae and nymph in the water which later develop into the adult mosquitoes.

Many are the times that we have allowed mosquitoes to breed in our backyard, literally.  Mosquitoes can breed in water collected in old tyres, unused utensils and items lying about the compound which can collect water, e.g. broken pottery, old dog feeding plates, old plastic containers, gutters, those old things we stack on the roof which are hollow (old pairs of shoes, old basins, pails) and you can add on to the list. Mosquitoes also breed in water collected under flower pot containers, in fountains, in leaf nodes on plants, and sometimes in broken septic tanks.

So what can we do to get rid of mosquitoes? Apart from buying coils and using mosquito repellents and nets to avoid mosquito bites, one of the most important things to do is to destroy the source of the problem, in this case the stagnant water. When we drain these mosquito breeding grounds, we destroy the eggs, larvae and nymph which could develop into adult mosquitoes.  If we can spend some time to sensitize people in our household and together spend time looking for places where water can easily collect, and draining these places dry, we will be able to reduce if not destroy the mosquito population around our homes.

As I said mosquitoes are clever, they have devised clever ways to survive, their eggs can still survive even in the dry conditions without water, therefore it is important to drain stagnant water not only once, but not to allow that water to come back. This can be done by putting sand or soil in hollow places around our homes where water usually collects, but also to turn upside down all utensils around the home where water can easily collect. This will ensure that you do not nurture your “killer”. Mosquitoes carry microorganisms such as viruses, parasites and worms which cause serious diseases such as malaria, dengue, yellow fever and chikungunya just to mention a few. And these diseases are a cause of many deaths around the world.

Please let us start by making our surrounding mosquito free by destroying their breeding grounds.

Can Polio be Eradicated?

Polio or Poliomyelitis was recognized as a condition in the 1840 and the causative agent of the disease was identified in 1908.

The disease well known for its paralysing condition for limbs had affected populations from Asia, Africa, the Americas, and Europe.

Efforts to control and eradicate the disease resulted in the development of the polio vaccine in the 1950’s. Since then vaccinations have been administered to vulnerable populations worldwide.

By the year 2000, the continents of America were declared polio free, and in 2002, Europe was declared Polio free.

What causes polio?

Polio is caused by three virus types/strains, these are wild polio virus 1 (WPV1), WPV2 and WPV3.

Wild polio virus type 2 (WPV2) was eradicated worldwide in 1999 while WPV1 and WPV3 still remain in circulation.

Until March this year, polio was endemic in four countries,  Afghanistan, India, Pakistan, and Nigeria but India was removed from the list by the Global Polio Eradication Initiative being free of any polio cases for 1 year. If there will be no other polio cases in India for another year, that is 2 continuous years then India will be declared free of polio.

Despite this milestone for India, there are still outbreaks of polio in Afghanistan, Pakistan and Nigeria. Re- established transmission and imported transmission cases of polio have been observed in neighboring countries of the endemic areas as well as surrounding countries. For example in Angola, Chad and DRC there has been re-established transmission of the disease while the virus has been imported to Central African republic, China, Congo, Cote d’Ivoire, Gabon, Guinea, Kenya, Liberia, Mali, Niger and Uganda.

What is the difference between re-established transmission and imported transmission?

 Re-established transmission is when an outbreak to the virus re-emerges within the population due to either missed booster vaccinations within a population which was previously free of the virus while imported transmission of the virus is usually outbreaks from a virus brought in from endemic countries to other areas through migration of infected individuals.

Advances in science have allowed for easier identification as well as tracking the origin of the virus during outbreaks. This has been made possible through genome sequencing of polio virus from patients in outbreak areas, by comparing the results with previously sequenced polio viruses from other regions, one is able to track where the virus could have originated from.

Is it possible to eliminate polio globally?

This is the question that was posed many years ago and since the onset of the disease people have been working hard to eradicate the disease. The development of the polio vaccine helped accelerate the efforts of control and eradication of the disease. Despite the milestones in polio eradication in Europe and the Americas there are still challenges to the eradication of the disease in parts of Africa and Asia.

Re-emergence of polio in countries and areas where the disease was eliminated has raised fears especially in the continents where there are still countries where the disease is endemic. 

Porous borders have contributed to some of the outbreaks in areas which were declared polio free. Free movement of people from endemic areas who have not been vaccinated against the disease into disease free areas increase the risk of infection or re-infection, hence countries have to be aware of this risk.

Responses to outbreaks and administration of the polio vaccine are crucial in controlling the spread and elimination of the disease. In India door to door vaccination helped to vaccinate at least 1 million people per month and was proved to be a great success. Even though this method worked for India, vaccination campaigns have been challenged in parts of Pakistan and Afghanistan due to political unrest which present a security risk to both health workers and the people living in the region. Misconceptions such as those that the polio vaccine is meant to sterilize people have also contributed to non-compliance in certain communities.  It has been reported that people in the regions where there is war and political unrests many children have missed out on their polio vaccine and booster vaccine putting the population at risk of contracting the disease.

In Africa, the west Africa region has experienced re-established transmission of polio (Angola, Chad and Democratic Republic of Congo) as well as cases of the virus being imported into neighboring countries (Central African Republic, Congo, Cote d’Ivoire, Gabon, Guinea, Kenya, Liberia, Mali, Niger and Uganda). With Nigeria being the only remaining country in Africa where Polio is endemic, migration and cross border trade with neighboring countries offers a high risk of transmission of the disease. Political unrests in some of the African countries mentioned above have also hampered vaccination campaigns leaving populations at high risk of the disease.  There are still many areas where health works cannot reach to administer the vaccine due to security risks. Non- compliance by certain groups of people also increases the danger of re-infection and affecting the eradication process.

So what should be done to eradicate this disease?

It is crucial for governments and organizations working towards eradication of polio to provide resources and set up measures for surveillance to monitor and administer the polio vaccine. Most important is the involvement of the community through civic education on the dangers of polio and the importance of vaccination.  In several communities it has been observed that people listen more to their local authorities than their health workers especially when there is some negative myths associated with the Polio vaccine.  Village chiefs, religious leaders, tribal leaders, business leaders and other people with authority in the communities are crucial in disseminating information to the communities.

In refugee and natural disaster camps, the UN and their partner Rotary international are working hard to vaccinate children against Polio , an example is that of Somalia, despite all the hardships the country is going through, there are no reported polio cases.

There is still hope that polio will be eradicated, but joint efforts between governments, non -governmental organizations and the population at large is crucial for this to happen. It is our responsibility, each and every one of us to ensure that polio is eradicated globally. Each one of us has to make sure that the people around them, the people they know, friends and family have been vaccinated against polio. Together we can fight polio.

To read more on what is going on around the world regarding polio eradication, visit the Global Polio Eradication Initiative website on http://www.polioeradication.org/