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Posts Tagged ‘London School of Hygiene & Tropical Medicine’

Mental health problems

Posted by African Press International on August 6, 2013

KATHMANDU,  – Gaps in mental health care for men who have sex with men (MSM), a population disproportionately affected globally by HIV, are limiting effective treatment and care for both HIV and mental illness, experts say. 

Mental health problems are an underappreciated barrier to successful treatment and prevention of HIV, and this is doubly true in low-income countries, and even more so for marginalized populations who are dealing with layers of stigma,” Brian Pence, an epidemiologist at the University of North Carolina (UNC)-Chapel Hill in the US, told IRIN.

“Every additional layer of social marginalization increases complexity and raises barriers to treatment for HIV and mental health,” he added.

According to experts, MSM are disproportionately affected by both HIV and mental illness, including depressive, anxiety and substance-abuse disorders.

Yet HIV prevention and treatment programmes fail to address adequately mental health, while mental health programmes often ignore HIV. HIV programme staff often lack training to spot or discuss the symptoms of deteriorating mental health with clients. Mental health programmes may neglect to see HIV status as a possible trigger for significant mental health conditions such as depression.

Advocates are calling for “wrap-around” care and task-shifting to community-based care providers to bridge the oft-siloed fields of care, experts say.

Heavy hidden burden

“Hidden groups like MSM are in many countries – and it is even worse when they are criminalized in some way – more vulnerable to mental health issues,” said Vikram Patel, professor of international mental health and at the London School of Hygiene and Tropical Medicine and director of the Centre for Mental Health at the Public Health Foundation of India.

The UN special rapporteur on the right to health has written that the criminalization of same-sex conduct contributes to deteriorating mental health for sexual and gender minorities, including MSM.

“State-sanctioned criminalization or pathologization of people for their sexual attractions or behaviour can only be seen as damaging in terms of mental health, and deteriorating mental health can certainly be a risk factor for HIV infection,” Patel said, adding that research on MSM and mental health in many countries is a “blind spot”.

Weak overlap

A 2012 global survey by the Men Who Have Sex With Men Global Forum (MSMGF), a US-based advocacy group, identified competent mental health care as a key aspect of successfully getting MSM to access HIV services.

“Although some men did not name their pain as a form of poor mental health, when other men described feelings of depression, all the men recognized and endorsed an urgent need to address this phenomenon,” the survey reported.

In addition to weak mental health care being a barrier to effective HIV testing and treatment for people living with HIV, mental health problems can also significantly impair their ability to continue treatment, experts say.

“We know that depression has high prevalence in people living with HIV, but the integration of mental health treatment into HIV treatment services, which are often peoples’ principal or even sole health care access point, is often minimal or non-existent,” said Pence from UNC-Chapel Hill.

Research from South Africa, where nearly 10 percent of MSM are living with HIV, suggests these gaps in care may be exacerbated by mental health providers’ stigma against HIV, and similarly, by HIV providers who stigmatize mental health illness.

According to Pence, “Poor referral mechanisms and practices between HIV treatment services and mental health services mean many HIV patients miss out on getting the mental health diagnoses and treatment they need.”

Task-shifting

The World Health Organization (WHO) has recommended integrating mental health care into primary care for more than 30 years. However, progress remains piecemeal and even where integration has taken place at a policy level, cross-training is patchy.

But there are signs integration works.

“There is a good evidence base for the integration of psychiatric care – even staff who are not psychiatrists – into a wide range of medical settings, including HIV treatment settings,” explained Pence, referring to a method of integration known as “task-shifting” where primary care and community health workers take on specialized duties.

WHO’s 2013 comprehensive mental health action plan calls for better integration into HIV services and programmes.

According to Patel from the London School of Hygiene and Tropical Medicine, the first step should be to approach civil society groups helping MSM access HIV services “to start a conversation about mental health”.

But, he warned: “Such interventions need to speak the language of the communities they are intended to help. We have to avoid foreign psychiatric labels, for example, and talk about stressors in the environment – that way these men can connect the way they feel to their lives and their environment rather than some sense of shame.”

End

kk/pt/cb  source http://www.irinnews.org

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Have you had your soap and clean water today? .- Study links hygiene and height

Posted by African Press International on August 5, 2013

Have you had your soap and clean water today?

BANGKOK, – Soap and clean water for effective handwashing can help boost a young child’s growth, according to the firstlarge-scale scientific review to link hygiene to height – one measure of child nutrition.

While medical studies have amply proven how improved hygiene can reduce outbreaks of diarrhoea – a leading killer among children under the age of five – they have not systematically measured the impact of water, sanitation and hygiene interventions on a child’s height.

The latest study showed a “small but improved” average growth of half a centimetre among children who received clean water and soap for handwashing as opposed to those who did not. Researchers found clean water and soap reduced stunting by up to 15 percent.

There is growing scientific evidence that repeated bouts of diarrhoea reduce a gut’s ability to absorb life-enhancing nutrients that allow children to develop mentally and physically.

WASH [water, sanitation and hygiene] squarely fits under the heading of an underlying cause of malnutrition,” one of the study’s lead authors, Alan Dangour, a public health nutritionist from the London School of Hygiene & Tropical Medicine, told IRIN.

Researchers identified 14 studies conducted in low and middle-income countries that provided data on the impact of WASH programming on the physical growth of nearly 9,500 children. Included were five studies with control groups of children who did not receive clean water and soap, but who were similar in most other ways to the ones who did.

“This is a scientifically robust study design that largely removes the problems faced by observational studies,” added Dangour.

Chronic malnutrition, as evidenced by stunting (when a child is too short for his or her age group), is a leading cause of preventable mental disability and contributor to three million deaths annually of children who have yet to reach age five (45 percent of all deaths in that age group).

“Until now, we have not had a demonstration of the direct nutrition impact of WASH interventions on nutrition,” said Francesco Branca, the director of nutrition for health and development at the World Health Organization, who was not involved in the study. “This review shows that a multi-pronged approach [to solving undernutrition] is the way to go.”

Researchers noted available studies on which they base their most recent findings were short-term (with none lasting more than one year), and some had data shortcomings.

While Dangour admitted that “we need much more robust evidence to definitely state that WASH is a `cure for stunting’,” the findings are, nevertheless, important, he concluded.

pt/cb source http://www.irinnews.org

 

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TB vaccines: The options in terms of cost-effectiveness

Posted by African Press International on April 1, 2013

CAPE TOWN, 28 March 2013 (IRIN) – As researchers consider who might benefit most from the next wave of tuberculosis (TB) vaccines, some argue that we’re not doing enough with the vaccine we already have. 

The disappointing results of the first infant TB vaccine tested for efficacy in 40 years were published in February 2013, but new research suggests that while babies might be easier to reach, given existing childhood vaccination programmes, new vaccines will be more cost-effective if geared towards teens and adults.The findings by the London School of Tropical Medicine are based on mathematical modelling that compared the cost-effectiveness of potential TB vaccines in the top 22 countries with the highest burden of TB, as listed by the World Health Organization (WHO), including South Africa, India and China, which account for 82 percent of all TB cases globally.

Dr Gwen Knight and colleagues used information like the number of new TB cases recorded annually, population projections, and TB mortality. Where available, they also factored in TB treatment and vaccine delivery costs. Finally, they created various scenarios based on projections of, for instance, how well a future vaccine might protect people from active TB, and how long this protection would last.

Knight’s preliminary results were presented at the TB Vaccines Third Global Forum in Cape Town. They indicate that in most scenarios, TB vaccines given to teens and adults were about seven times cheaper than those administered to infants. The most cost-effective TB vaccine would be designed for adults and teens, and would confer 80 percent protection on recipients – a high level of protection compared to most vaccines today.

The options in terms of cost-effectiveness

The cost per Disability Adjusted Life Year (DALY) for a vaccine for adults and teens could be as little as 85 US cents, making it comparable to the lowest prices for the rotavirus and human papillomavirus (HPV) vaccines. An infant TB vaccine conferring 50 percent protection for five years could cost as much as US$42,617 per DALY.

Vaccines for older people were modelled as much more effective in reducing TB cases, with deaths occurring at an infection level largely determined by the transmission dynamics within the group. For example, a vaccine offering life-long protection against active TB would avert almost eight times as many new cases as a TB vaccine given to babies.

The model may be important in helping researchers prioritize TB vaccine candidates and selecting groups to include in future clinical trials. “Previous modelling has shown that the global TB burden is unlikely to be controlled without new TB vaccines,” Knight told IRIN. “What we didn’t know is whether these vaccines would be economically valid, and what type of vaccine should be an economic priority in relation to others.”

In the absence of a TB vaccine, Knight and her team projected that as many as 19 million people would die from the disease between 2024 and 2050.

Making the most of what we have

The world relies on the Bacille Calmette-Guérin (BCG) TB vaccine, developed almost 100 years ago. Given at birth, BCG’s protective effect wanes as children grow to adulthood, but the vaccine has seldom been considered a candidate for global adult or teen vaccination programmes after poor results in trials.

“While drugs have had a clinical impact, they have failed to control the epidemic – that’s why we need vaccines and other tools”

Now there are growing moves in the vaccine community to move away from approaches based solely on infant immunization and to begin developing policies on immunizing adolescents and adults. Adolescents may also be a prime target for re-vaccination with the BCG TB vaccine, according to Christopher Dye, director of health information in the Office of HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases at WHO.

Dye says the world could do more with the only available TB vaccine in its arsenal. Citing examples from the United Kingdom and Norway, he presented instances in which adult BCG vaccination campaigns in the 1950s and 1960s had not only shown the vaccine to be as much as 80 percent protective, but that it had also reduced new TB cases by 20 percent.

“If those results were obtained today with a TB vaccine, they would be the subject of worldwide acclaim, and they form the basis of my claim that we don’t do enough with BCG,” he told IRIN.

In their search for a cure-all for TB epidemics, policymakers at the time may have dismissed results too readily. “The interpretation was pretty pessimistic,” he said. “In my reading, this was a search for a panacea and when that was not the result obtained, the results were pushed aside.” Disappointing results from India and Malawi could be explained by the presence of other tropical bacterial infections that could reduce BCG’s effectiveness.

Rethinking vaccines, rethinking TB control

Vaccinating teens and adults might also make sense in places like South Africa, where data collected in the Cape Town area in 2010 shows that people between the ages of 16 and 35 experience elevated risks of TB infection when compared to children and older adults.

“Children between the ages of five and ten are extremely resistant to developing active TB, but then become at risk when they move into adolescence,” Dye told IRIN. “Where possible, they need to be re-protected.”

He said adolescent BCG vaccination could easily be added to existing campaigns in countries where girls and, in some instances, boys, are vaccinated against HPV before they become sexually active.

Using mathematical models, Dye proposed that repeated mass vaccination campaigns to protect people as infants, and again as teens or young adults, could cut the annual number of new TB cases in South Africa by 50 percent over a 30-year period. In combination with improved case management and preventative TB therapy for people living with HIV, the models projected that revaccination with BCG could cut TB incidence by more than 90 percent by 2050.

“With all of these intense efforts put into TB control through treatment, the impact at the clinical level has been profound, but the trajectory of the TB epidemic has been [more or less flat],” he told IRIN. “It’s clear from analysis that while drugs have had a clinical impact, they have failed to control the epidemic – that’s why we need vaccines and other tools.”

llg/kn/he  source http://www.irinnews.org

 

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