Poor nutrition to encephalitis outbreak: 2019's biggest health stories

All year round, the level of air pollution in Delhi remains three times higher than the national standard.

Business Standard : From a continued decline in infant and maternal mortality to inadequate funding for healthcare, from poor nutrition to an acute encephalitis syndrome outbreak, and from success in malaria prevention to below-par performance on leprosy control and tuberculosis elimination, here’s a look at 2019’s biggest health stories.

Decrease in maternal mortality, infant mortality

Fewer mothers died during childbirth as India’s maternal mortality ratio (MMR)--maternal deaths per 100,000 live births--fell 27% from 167 in 2011-13 to 122 in 2015-17, according to the Sample Registration System bulletin.

However, India is still a long way from the Sustainable Development Goal for MMR: a target of 70 deaths per 100,000 live births by 2030. Three Indian states have already achieved this--Maharashtra, Tamil Nadu and Kerala.

India’s infant mortality rate--deaths per 1,000 live births--also fell from 42 in 2012 to 33 in 2017, as IndiaSpend reported in June 2019. This rate is higher than the global average (29) and India’s neighbours Nepal (28), Bangladesh (27), Bhutan (26), Sri Lanka (8) and China (8), but better than that of Pakistan (61) and Myanmar (30).

While these reductions are great, a narrow focus on these indicators without tackling the social causes of these problems is pointless, said Rakhal Gaitonde, professor at the Achutha Menon Centre for Health Science Studies in Thiruvananthapuram. “We are too fixated on technical and technological fixes while ignoring basic underlying issues of poverty, hunger, livelihood and childcare which are important,” he said.

This may be the reason why five of India’s poorest states--Bihar, Uttar Pradesh, Uttarakhand, Odisha and Madhya Pradesh--were among nine states that saw their overall health performance decline in 2019, according to government think-tank NITI Aayog’s health index, IndiaSpend reported in June 2019.

Health budget increases, Ayushman Bharat completes a year

The Centre has been increasing its allocation to the health ministry, and this year’s budget of Rs 62,659 crore--2.25% of total expenditure--was the highest till date, as IndiaSpend reported in July 2019.

New compound can prevent growth of malaria parasite, reveals study

The study also noted that the compound was effective against other species of Plasmodium.

An international team of researchers have found that a novel compound can halt the growth of the parasite Plasmodium falciparum known to cause malaria -- the deadly mosquito-borne disease which kills nearly 500,000 people every year across the world.

The study, published in the journal Science, noted that the compound called TCMDC-135051 developed by the multinational pharmaceutical company GlaxoSmithKline can eliminate the mosquito-borne parasite in all the stages of its lifecycle.

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The researchers, including those from Brazil's Sao Paulo Research Foundation (FAPESP), noted that the drug specifically acted on a protein in the the parasite called the cyclin-dependent-like protein kinase -- PfCLK3 -- without affecting human proteins.

The researchers noted that PfCLK3 controlled the activity and production of other proteins required by the parasite to stay alive, and by blocking these, killed P. falciparum.

According to the study, inhibition of PfCLK3 not only affected the parasite's asexual stage of development -- when it proliferated in human cells, and caused symptoms -- but also in the sexual stage, when it can be transmitted back to mosquitoes, repeating the cycle by infecting other humans.

To identify compounds that specifically inactivated the PfCLK3 protein, the researchers conducted a large scale automated chemical analysis -- through a process called high-throughput screening.

In the process, they analysed nearly 25,000 compounds, and selected TCMDC-135051 since it showed the most exclusiveness in binding with the parasite's protein, and had high potency in this regard.

The study also noted that the compound was effective against other species of Plasmodium.

"We also tested it in mice infected with Plasmodium berghei. The results of this in vivo trial showed that the parasite was eliminated from the bloodstream after five days of infection," said Paulo Godoi, co-author of the study from University of Campinas in Brazil.

Since both the parasite and humans have proteins similar to PfCLK3 orchestrating the activity of almost all processes in cells, the researchers performed experiments to confirm that TCMDC-135051 was safe, and did not act on the human forms of the protein.

Travelling to a malaria endemic area? Some simple steps to keep you safe

Several factors influence your chance of getting malaria in a particular area. Understanding these can help you to avoid or least minimise the risk.

Every death from malaria is a tragedy. But many infections can be prevented. This is particularly true for holidaymakers, travellers, or people visiting their families in malaria endemic areas. All they need to do is follow some very simple rules. Malaria is a complicated disease – I should know, after studying it for more than 30 years – but the solutions to avoiding and treating it can be as simple as “ABCD”. If the basics of prevention are followed, a great deal of unnecessary illness and mortality can be avoided.

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Avoidance to detection

A is for Awareness and Avoidance of malaria risk

Several factors influence your chance of getting malaria in a particular area. Understanding these can help you to avoid or least minimise the risk.

The first question to ask is: how much malaria normally occurs in the area, and when? The answer will depend on altitude and climate – generally the lower, warmer and more humid the place, the more suitable it is for malaria vectors, the Anopheles mosquitoes.

In southern Africa, most malaria is seasonal. It increases during warmer and wetter summer months (September to May in the southern hemisphere). The risk in winter is generally lower, but that doesn’t mean it’s absent.

Longer exposure, involving overnight stays, puts you at higher risk than brief visits, for example day trips to game reserves. Hiking and camping outdoors is riskier than staying in air-conditioned accommodation.

Some people are at higher risk for severe malaria and should ideally avoid malaria transmission areas altogether. These include pregnant women, babies and young children, people who’ve had their spleens removed and those with weak immune systems.

B is for mosquito bites – and avoiding them

Avoiding mosquito bites is the most important preventive measure. This is because the mosquito bite is what transmits the parasite. No bite, no transmission.

Contact between mosquitoes and people isn’t random. Mosquitoes actively seek people out. They have sensory organs that detect people’s warmth, exhaled carbon dioxide, and odours from sweat.

There are a number of ways to avoid mosquito bites. These include staying indoors between dusk and dawn and covering up bare skin when outside at night. (Mosquitoes find ankles particularly attractive.)