Global Journal of
Medicine & Public Health
ISSN : 2277–9604

Welcome to GJMEDPH
Welcome to GJMEDPH
Welcome to GJMEDPH
Welcome to GJMEDPH
Welcome to GJMEDPH
Welcome to GJMEDPH
The Global Journal of Medicine and Public Health is a peer reviewed, open access journal, with an international editorial board. It is an initiative of the Regional Institute of Health and Family Welfare, Directorate of Health Services, Kashmir, India. The Institute was established under the India Population Project VII (IPP) with assistance from the World Bank, and is meant to serve as an apex institution for the continuing education of in-service health professionals and of staff from non-profit, non-governmental organizations involved in health activities.

Integrating biomedical, social and environmental sciences, we welcome a wide range of contributions from all world regions with an emphasis on development and lower income settings in order to support the evidence base for disease prevention and control. Submissions may include original research, field investigations, review articles, case reports, articles relevant to policy, planning and evaluation, and letters to the editor. Submissions will be evaluated on the basis of their scientific quality and relevance.

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Antibiotic resistance is the resistance of a microorganism to an antibiotic that was effective against the infection caused by the microorganism. The evolution of antibiotic resistance is a natural process when microorganisms replicate. However, the misuse of antibiotics accelerates the development of resistant strains. Inadequate infection control and poor hygiene conditions cause the further spread of resistant strains. The rapid emergence of antibiotic resistance has become a global public health threat. It is a complex problem, which requires a lot of different approaches to tackling it. The World Health Organization recently reported a large survey that involved about 10000 respondents from 12 different countries. Two-thirds of the respondents were aware of antibiotic resistance. However, there were some misunderstandings. 32% of them thought that they should stop taking antibiotics when they started to feel better. One-quarter even believed it was acceptable to take antibiotics that were given to a friend or family. Furthermore, 64% incorrectly believed that viruses could be treated with antibiotics. Those findings raise the concern about public awareness of adequate antibiotic usage. Several recommendations were also provided in the report. Increasing public education is necessary. People should be educated that what diseases can be treated with antibiotics. Also, we should allow the public to understand the importance of taking the full prescriptions and not taking antibiotics prescribed for other individuals. Click Here

The aim of universal health coverage (UHC) is to ensure that all people have equal access to good quality health service and with no financial risk to people who are in need of healthcare. Approximate 400 million people all over the world are not able to receive essential health services. Every year, 150 million people suffer from financial catastrophe due to out-of-pocket spending on health services. Therefore, UHC has become a priority of the World Health Organization to maintain our progress in health globally. To achieve UHC, governments and health authorities must consider factors outside health sectors, which, if not taken into account, may significantly hinder the efficiency and effectiveness. For example, a mother’s education level and the socioeconomic condition of her family affect her children’s health. Apart from developing a reliable health system, those issues should also be identified and addressed. In the issue of Global Health Action this February, Huda et al. identified social determinants that affect neonatal, infant and under-five mortality in Bangladesh. In the study, they harnessed the data from Bangladesh Health and Demographic Survey, which included more than 40,000 children to examine what are the potential determinants. The study found several factors associated with significantly higher risk of childhood mortality, which included the mother’s age, the education level of parents, the mother’s autonomy to take decisions about her child, the household socioeconomic conditions. Moreover, children from selected geographical regions and those from communities with poor road conditions are more likely to suffer from early mortality. The results of this study provide strong epidemiological evidence of the linkage between social determinants and childhood mortality, which can be used to set the priorities to improve population health, particularly where the resources are limited. Huda TM, Tahsina T, El Arifeen S, Dibley MJ. The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh. Glob Health Action. 2016;9:29741. Click Here

Human immunodeficiency virus (HIV) is one of the major fatal infectious pathogens. Currently, 35 million people worldwide live with HIV infection. HIV can be spread through blood or sexual contact. The method of using antiretroviral drugs as a pre-exposure prophylaxis to prevent HIV transmission is promising. However, studies showed the drug adherence of African women was low. Therefore, another approach that can provide better compliance is necessary to control HIV transmission. Baeten et al. conducted a phase three placebo-controlled double-blind study of a monthly vaginal ring containing dapivirine, which involved women of reproductive age in Malawi. More than 2600 women were enrolled with a 1:1 ratio of randomization. Among them, 71 in the dapvirine group and 97 in the placebo group developed HIV infection, respectively. The incidence of HIV infection was 27% lower in the dapvirine group (p-value=0.05). Furthermore, the protection effect was better among participants older than 21 years old. The protection rate was 56% higher with a p-value lower than 0.001. In terms of adverse effects and antiretroviral resistance, there was no statistically significant difference between the two groups. The findings suggest that monthly vaginal ring containing dapivirine is a promising alternative choice to prevent HIV infection. The result was published in the 22 February issue of New England Journal of Medicine. Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women. N Engl J Med. 2016. Click Here

Malaria, despite the global public health effort, remains a major killer of human, particularly vulnerable population. Pregnancy reduces the body’s defenses against Plasmodium falciparum, the parasite causing malaria. Acquiring malaria during pregnancy increases the risk of death for both the mother and the infant. Moreover, Plasmodium falciparum also causes low birth weight, preterm birth, and infant infection. A new study appeared in the New England Journal of Medicine this March found a reliable new regimen to treat malaria for pregnant women. The authors conducted a double-blind, randomized control trial of this new regimen dihydroartemisinin-piperaquine. They enrolled 300 pregnant women from Uganda and divided them into three groups of different treatment. The first was standard preventive treatment sulfadoxine-pyrimethamine; the second group was three-dose dihydroartemisinin-piperaquine regimen; the final group received a monthly dihydroartemisinin-piperaquine. The primary outcome was placental malaria confirmed by histopathology. The prevalence of placental malaria was significantly higher in the standard treatment group (50%), comparing to 34.1% in the three-dose dihydroartemisinin-piperaquine group (p-value=0.03) and 27.15 in the monthly dihydroartemisinin-piperaquine group (p-value=0.001). The prevalence of adverse birth outcome was lowest in the monthly dihydroartemisinin-piperaquine group. During pregnancy, the incidence of symptomatic malaria was higher in the standard treatment group than in the other two groups. In terms of adverse events, there was no difference between the three groups. The researchers concluded that dihydroartemisinin-piperaquine provided better protection again malaria and monthly treatment was superior to three-dose treatment. Kakuru A, Jagannathan P, Muhindo MK, et al. Dihydroartemisinin-Piperaquine for the Prevention of Malaria in Pregnancy. N Engl J Med. 2016;374(10):928-939. Click Here

Chronic obstructive pulmonary disease (COPD) is a global public health issue. It is estimated to be the third leading cause of death in 2030. Tobacco smoking, also an important human health threat, has been proved to be one of the major risk factors for developing COPD. A recent Australian study provides further evidence, which shows that children of mothers who smoke are more likely to have COPD during their adulthood. Perret and her colleagues collected the data from Tasmanian Longitudinal Health Study, a cohort followed for five decades. Comprehensive lung function, maternal and paternal smoking history, and participants’ personal smoking habit in their middle age were analyzed. The results showed that post-bronchodilator airflow obstruction was associated with exposure to heavy maternal smoking during their childhood. The odds ratio was 2.71 (95% confidence interval: 1.3, 5.7; p-value = 0.009) when compared to those without exposure. Furthermore, exposure to maternal smoking significantly increased the adverse effect of personal smoking on gas transfer factor. The findings of this study suggest that early life smoke exposure from mother might increase the risk of COPD in later life, especially related to personal smoking. The authors reported their findings in the March issue of the journal Respirology. Perret JL, Walters H, Johns D, et al. Mother's smoking and complex lung function of offspring in middle age: A cohort study from childhood. Respirology. 2016. Click Here

The neglected tropical diseases (NTDs) are the most prevalent human infections in Sub-Saharan Africa. Almost everyone who lives blow the poverty line is affected by one of the NTDs. The disability and economic loss caused by NTDs are enormous, and control measures have been implemented to tackle the problems. NTD Vaccine developments are underway. They are mainly led by a few product development partnerships Hotez et al. reviewed the up-to-date progress in the article published in the Annual Review of Medicine and the authors emphasized the challenges being faced. Currently, there are several major vaccines in clinical trials, targeting schistosomiasis, visceral leishmaniasis, hookworm and dengue fever. The first challenge is to find the promising antigen targets, which is hampered by the complexity of the parasite genome. Another challenge is that most NTDs are not fatal, which leads to the concern that measuring the reduction of death seems not feasible. However, a broader benchmark to define the potency and effectiveness of an NTD vaccine is sometimes not available. Furthermore, the authors mentioned about the long time required to complete clinical trials and developing human challenge models might provide a quick answer to the performance of the vaccines. Finally, it’s also necessary to initiate a partnership between governments, private sectors and non-profit organizations to ensure the success of vaccine development. Hotez PJ, Bottazzi ME, Strych U. New Vaccines for the World's Poorest People. Annu Rev Med. 2016;67:405-417. Click Here

According to the World Health Organization, over 3000 people die every day on the roads worldwide. Road traffic injury is responsible for many deaths and is also a major cause of disability. Road safety is thereby included in the sustainable development goals. Several risk factors for road traffic injury have been identified, including male gender, young age, and substance use. Recently, Kypri et al. provided the evidence of changing alcohol minimum purchasing age on road traffic injuries. In 1999, New Zealand government reduced the alcohol minimum purchasing age from twenty to eighteen. The authors conducted a controlled before-and-after comparison, and they divided the time into four periods: 1996-1999, 2000-2003, 2004-2007, and 2008-2010. The incidences of road traffic crashes due to alcohol were compared between three age groups: 15-17 years, 18-19 years, and 20-21 years (control group). Compared with the change in injury rates of males in the control group, injuries attributable to 18- to 19-year-old male drivers increased in all post-change periods (significant in the second post-change period, incidence rate ratio: 1.3). For 15- to 17-year-old male drivers, rates also increased in all post-change periods. For females, there was only a short-term relative increase in traffic accidents attributable to 18- to 19-year-old female drivers. The authors concluded that after lowering the alcohol minimum purchasing age, the incidence of road traffic injury increased, particularly among male drivers aged 15 to 19 years old. The findings of this article suggest that legal alcohol minimum purchasing age is associated with the incidence of road traffic injuries. Further studies regarding disability and economic burden might help future policy-making. Kypri K, Davie G, McElduff P, Langley J, Connor J. Long-term effects of lowering the alcohol minimum purchasing age on traffic crash injury rates in New Zealand. Drug Alcohol Rev. 2016. Click Here

A new set of goals to tackle poverty, maintaining human health and protecting the planet has been launched by the United Nations recently. It is called the Sustainable Development Goals (SDGs). The SDGs contain 17 goals, which are adopted based on the Millennium Development Goals (MDGs), a 15-year agenda to end poverty proposed in 2000. While there has been progress achieved, the improvement was uneven, and some countries failed to meet the targets. The SDGs expand on the basis of MDGs but emphasize more on the equity with a more comprehensive approach. The SDGs also focus on the integration of social, economic, environmental and societal aspects to address the issue of sustainability. Targets included gender equality, availability and sustainable management of water, and access to affordable energy. In accordance with the Paris conference on climate change in December 2015, the SDG agenda also include the climate issue, to ensure continuing action to combat climate change and global warming. Click Here

India has the largest number of tuberculosis patients amongst all the countries. Multidrug-resistant tuberculosis (MDR-TB), defined as being resistant to at least isoniazid and rifampicin, accounts for 2-3 percent of new cases and about 15 percent of reinfection patients. Diagnosis of MDR-TB is often difficult and time-consuming. Along with the socioeconomic issues, difficulty in management of drug-resistant tuberculosis poses a big threat to India’s health authorities. However, continuous monitoring of incidence and prevalence is an integral part to reach global target of tuberculosis control. Recently, Prakash et al. reported their finding of the profile of drug-resistant tuberculosis among the Sahariya tribe in the Journal of Infection and Public Health. In their study, a total of 274 sputum confirmed pulmonary tuberculosis patients were included. The odds of drug-resistant tuberculosis was 1.95 times higher in Saharia tribe compared to the non-tribal population. Moreover, smokers in Sahariya were associated with developing MDR-TB when compared to non-smokers (odds ratio: 4.463, p-value: 0.0109). Another finding suggested that Sahariya male has less odds of drug resistance, compared to Sahariya female (odds ratio: 0.3879, p-value: 0.0102). The study indicates that the crude prevalence of drug-resistant tuberculosis is higher in the Sahariya tribe than the non-tribal population. Also, tribal females and smokers are more likely to develop drug-resistant tuberculosis. Though the scale of this study is small, the findings are implicative for future tuberculosis control. Further larger studies are necessary to provide robust epidemiological evidence for policy makers. Prakash R, Kumar D, Gupta VK, et al. Status of multidrug resistant tuberculosis (MDR-TB) among the Sahariya tribe of North Central India. J Infect Public Health. 2016. Click Here

The outbreak of Zika virus in Brazil since last year has become an emerging public health threat, primarily due to its potential to cause microcephaly in babies. Recently, local health authorities in Brazil have observed an increase in babies born with microcephaly, which coincided with Zika virus infections. After the investigation, the authorities found an increasing body of evidence about the link between microcephaly and Zika virus. Though the actual relationship remains to be understood, the finding has drawn public concern. With increasing cases of Zika virus infection in Brazil and other American countries, earlier this year the World Health Organization (WHO) declared the situation a “public health emergency of international concern.” Margaret Chan, chief of the WHO, said the experts of the WHO’s emergency committee had agreed “a causal relationship between the Zika infection during pregnancy and microcephaly is strongly suspected, though not scientifically proven.” In the article published in the latest issue of American Journal of Public Health (April 2016), Teixeira et al. describe the epidemic of microcephaly in Brazil and its causal link with Zika virus infection during pregnancy. The evidence so far is convincing, and Brazil declared that the cause of the epidemic was congenital Zika virus. The challenge ahead, according to the article, is the difficulty of diagnosis so that an accurate prediction of disease burden will be unlikely. Also, further research is urgently necessary to understand the biology and the interaction between host and virus, which are required to develop better diagnostic tools and a potential vaccine. Teixeira MG, da Conceicao NCM, de Oliveira WK, Nunes ML, Rodrigues LC. The Epidemic of Zika Virus-Related Microcephaly in Brazil: Detection, Control, Etiology, and Future Scenarios. Am J Public Health. 2016;106(4):601-605. Click Here