The New Nation - Internet Edition

Ensuring equal access to life saving drugs

Research confirms available vaccines not reaching countries in greatest need;

Government of Rwanda cited for leadership in fight against leading global killer

More than 100 professional medical societies, institutions and organizations from around the world join the Pneumococcal Awareness Council of Experts (PACE) today to urge governments, donors and industry to assure access to pneumococcal vaccines for every person who needs them worldwide. Their unified Call to Action comes as research released today confirms that available vaccines are not reaching countries in greatest need. As countries around the world consider including pneumococcal vaccine in their national immunization programs, PACE recognizes Rwanda's groundbreaking efforts to introduce the vaccine in Africa and encourages others to make the same commitment.

"Pneumococcal disease takes the lives of 1.6 million people each year-including more than 800,000 children under age 5-making it a leading infectious killer worldwide," said Dr. Ciro A. de Quadros, executive vice president of the Sabin Vaccine Institute and co-chair of PACE, who has led successful efforts to eradicate polio and measles from the Western Hemisphere during his 40-year medical career. "These deaths are unacceptable and unnecessary because effective vaccines are currently available."

Research released today by the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) illustrates that 24 of the 26 countries that routinely protect their children with pneumococcal vaccines are high-income countries that represent less than 1 percent of the worldwide burden of this devastating disease. By contrast, none of the world's low-income countries routinely vaccinate against pneumococcal disease.

"Pneumococcal disease is found all over the globe, but all too often strikes those who are young, poor and without access to health care," said Dr. Samir K. Saha, PACE council member and senior consultant to the Department of Microbiology at Dhaka Shishu Hospital. "PACE is proud to partner with professional medical societies in Bangladesh to advocate for pneumococcal disease prevention here at home and in all countries where life-saving vaccines are needed most."

Historically, the cost to purchase and deliver pneumococcal vaccines has been an obstacle to their introduction. However, global immunization funding could be as much as $8 billion for new vaccines and immunization systems during the next 10 years with the advent of the International Finance Facility for Immunizations and the Advance Market Commitment. And as the result of collaborative efforts by WHO, UNICEF, the GAVI Alliance, academia, foundations, industry and developing country governments, PneumoADIP estimates that developing countries are now able to introduce pneumococcal vaccines at least 10 years faster than historical precedents.

The medical societies supporting the Call to Action on pneumococcal disease represent leading experts in infectious diseases, vaccines and child health from every part of the world. This global effort includes groups from Bangladesh such as the Bangladesh Paediatric Association and the Bangladesh Paediatric Pulmonology Forum. These organizations play a key role in increasing awareness of both the effects of pneumococcal disease and the new opportunities available for each country to play a role in preventing future illnesses.

"Together we call on governments internationally to take advantage of this progress in health care and ensure life-saving pneumococcal vaccines are available to the people who need it most," said Orin Levine, executive director of the GAVI Alliance's PneumoADIP project at Johns Hopkins Bloomberg School of Public Health and co-chair of PACE. "We must take action. We have the vaccines, the technology, the financing and the demand to prevent this disease. The price of action will be measured in dollars. The price of inaction will be measured in child deaths that could have been prevented."

Pneumococcal vaccines are urgently needed in Africa. Rwanda has the second highest risk of pneumococcal mortality in the world and one of the strongest immunization programs in Africa. Thanks to the collaborative efforts of the government of Rwanda and GAVI, the Rwanda Ministry of Health expects to introduce the pneumococcal vaccine into its national immunization program in January 2009. This will make Rwanda one of the first two countries in Africa to vaccinate its children routinely against pneumococcal disease. In recognition of these efforts, the Rwanda Ministry of Health will be presented with the 2008 PACE Global Leadership Award today at an event in Washington, DC.

Pneumococcal disease, a bacterial infection that causes pneumonia, meningitis, sepsis and other life-threatening ailments, kills 1.6 million people globally each year, half of whom are children under the age of 5. Survivors of pneumococcal meningitis can be left with serious disabilities and developmental delays.

Safe and effective vaccines currently exist to prevent pneumococcal deaths in children and adults. In 2000, a new 7-valent pneumococcal conjugate vaccine (PCV7) became available and is currently licensed in more than 90 countries. Since U.S. infants began receiving routine pneumococcal conjugate vaccination in 2000, the country has nearly eliminated childhood pneumococcal disease caused by strains in the vaccine.

It is estimated that with increased awareness and a resulting commitment to purchase and deliver pneumococcal vaccines globally, more than 7 million lives can be saved by 2030. Currently, 10- and 13-valent pneumococcal conjugate vaccine formulations are in late stages of development. These conjugate vaccines are expected to prevent 50 percent - 80 percent of all serious pneumococcal infections worldwide and become available in 2009.

To view a complete list of professional medical societies, institutions and organizations that have joined PACE in issuing a Global Call to Action on Pneumococcal Disease Prevention, visit:

http://sabin.org/programs/pace/supportingsocieties.html

-Internet

For health budget monitoring

Richard M. Gomes & A.H.M Foysoul

Good Health does not only mean free from diseases but it also means more i.e physical, mental and economic well beings. DORP aims to establish rights to health by integrated development with the slogan "Sunte habe tader katha jader katha haini suna'' listen to the words of those who were not heard through implementation of PRSP, MDG and Peoples Health chart. Development Organization of the Rural Poor-DORP, a non-government development organization has been working for the last few years through its Searching for poor Upazila Health and Family Planning Budget project. DORP has been implementing the project as a pilot scheme in 66 Upazilas under 06 Divisions of the country.

DORP prioritizing health sector working to establish health rights to the poor facilitating for providing quality health and health care services in the country along with 06 local NGOs in 06 upazilas with the following slogans. "We want implementation of health care rights and health care services";" Have Poor no health? Where is my share in the budget"; The local Organization and areas where DORP is implementing the project are: SHABOLOMBI, Lohagara upazila of Narail, SCOPE, Bakergonj Upazila of Barisal, DISHARE, Kaliakair upazila of Gazipur, Jana Kalyan Kendra-JKK, Kamalganj upazila of Moulvibazar, Polli Mukti Sangstha-PMS, Sirajgonj Sadar upazila of Sirajgonj and Upakulio Sathijan Parishad-USAP, Ramgati upazila of Laxmipur district. All the above stated NGOs are continuously making the local poor community aware to avail the health and health care services provided at upazila Health Complex and in Union Health & Family Welfare Center. The local NGOs are working on 3 issues. At Union level a 7-member committee through regular contact is activating the Union Health Study Committee and this committee keeps regular contact and enquire about the welfare of the recipient women of maternity allowance Amir Khasro, Program Coordinator asserted that local NGOs are working as a promoting agencies. The tools-format prepared at the National Meeting with the active participation of Experts, UHFP officer, UFPO, Reporters and representatives of NGOs are being used by the local NGOs. The information to be collected in tools--format will help to find out if the expenditures under upazila Health Budget have been expended as per approved budget. Mohammad Zobair Hasan, Researcher, DORP stated that through the application of the tools-format the situation of Neatness and cleanliness, position of stock of medicines, allocation of fund for satellite clinics and up keeping of medical appliances will be ascertained. Already the tools-formats are in use and local organization is regularly holding Advisory Committee meeting at Upazila Health Complex to improve the health and health care services to the public.

In order to aware the people of different professions about the health and health care services at the upazila health complex a "Health and Family Planning Budget Club" has been formed at upazila level. This club is rendering services as a strong civil society platform at local level. The members of the budget club discuss the prevailing problems and issues of union and upazila health and family planning budget and try to solve those locally through different initiatives. The issues & problems those cannot be solved locally the members of the budget club put forward those to DORP for advocacy and lobbying at the national level. Already a significant impact has been noticed at local level on different activities and initiatives of budget club.

AHM Nouman, Secretary General DORP while briefing the activities of the project said that DORP is giving due importance in the activities of health, utilizing its 20 years' experience from 2001. DORP has declared the village as "Health Village" and working through integrated development approach. Following the trend DORP is implementing "Pro-poor Upazila Health and Family Planning Budget. Investigation" project. At same time DORP has introduced Maternity Allowance to the poor pregnant women that has been helping in reducing infant mortality rate, increased feeding colostrums to the infants, increased taking nutritious food during pregnancy period, taking ANC & PNC services, increased utilizing EPI and family planning services, prevention of illegal divorce and child marriage and the birth and marriage registration.

Presently, the government is implementing the maternity allowance project through the Ministry of Women and Child Affairs. AHM Nouman again expressed his thanks and gratitude to the Chief Advisor, Dr. Fakruddin Ahmed for inclusion of Maternity Allowance in the national budget. Nouman as to the next initiative to Maternity Allowance urged the government to prepare and implement an integrated package and Social Assistance Program for Non-Assenters-(SAPNA) in order to make Bangladesh poverty free within 2030. He emphasized that government may introduce a block grant for a family for realizing 5 rights (Health Card, Education Card, A shelter for living house and Tk. 30.000 as living seed money and micro-credit fund). He stated that implementation of 'SAPNA' will be a social investment towards development of women and children. The initiative will help in reducing birth rate and will accelerate the agricultural yield.

The members Budget Club under the "Pro-Poor Public Health & Family Planning Budget Monitoring Investigation" Project have already have put forward some suggestions to the government, which are as follows:

During preparation of health budget at the planning stage the opinion of local people if incorporated then it will be realistic and services oriented one

If discussions are held with the authority and local people before preparation of health budget and their opinions are considered then the poor will receive more privileges in the health and health care services.

Health Budget should be prepared as per the need of each health center.

Health budget should be prepared taking into consideration the privileges and opportunities of the staffs and estimated number of service-recipients.

With the increase of development budget, the accountability and transparency of the same has to be ensured.

Public should know the amount of budget allocated in each health services providing center. Health services should be provided at low cost, with this initiative the patients will get good services; and services providers will give quality services. Residential problems of the staffs to be solved

Due to less number of staffs pressure of works go to the service rendering staffs, so recruitment should be made to fill up vacant positions as early as possible. The structures at the sub-centers are to be repaired & renovated at a living standard, this will enable the poor patients to get better services.

In the Family Planning Office; scarcity of office equipment such as computer telephone etc exist. Supply of the same at an early date is very much needed.

Due to non-existence of own office of the Family Planning department at Upazila, regular office works are being hampered. Woks would be more systematize and regular if separate office structure is constructed/rented.

Participation of NGOs needed to be increased in health sector monitoring activities.

Kathbel pulp useful in the treatment of asthma

Jamayet Ali

Kathbel is a small tree with sharp spines at the base of the compound feathery leaves, red flowers and round whitish hard-shelled fruit of the size of a large apple,which has a strong odour when ripe, and a very acrid taste not unlike that of the Bengal quince. The people of all ages sometimes eat the raw fruit with sugar. A jelly, much resembling black-currant is prepared from the pulp of the fruit which, however, has a very astringent taste. This fruit is also familiar as Elephant-apple. This name proceeds from the fact that the elephant is very fond of the fruit. This tree is planted in almost all the districts of Bangladesh for its pulp. Two types are recognised, one with small acidic fruits and the other with large sweet ones. The fruits ripen generally from November to March. It can be used for making sherbet in the same as bael. The pulp is also used in making chatney.

Analysis of the edible part of the fruit gave the following values: (Raw) - moisture 81.4; mineral matter, 2.0; K calorie 66; protein, 3.1; carbohydrate, 13.5g; calcium, 56; vitamin B-1, 0.04; vitamin B-2, 0.02 and vitamin C, 15mg/ 100g. (Ripe)- moisture, 85.6; mineral matter, .22; fibre, 5.0; K calorie, 49; protein, 3.5; fat, 0.1; carbohydrate, 8.6 g; calcium,59; iron, 0.6; vitamin B-1, 0.80; vitamin B-2, 0.03 and vitamin C, 13 mg / 100g. This fruit also contains phosphorus, 0.11; and riboflavin, 170 mg / 100g. (Food Processes and Analyses, Mohammad Yunus, BARC, Dhaka; Wealth of India, Raw Materials, Vol. IV, 19-20)

Medicinal Properties: The fruit is sour, sweet, acrid, with flavour and taste; difficult to digest; refrigerant, aphrodisiac, alexipharmic; cures cough, dysentery, heart diseases, vomiting; removes biliousness, "vata", "tridosha" , and blood impurities, fatigue, thirst, hiccough; good for throat, asthma, consumption, tumours, ophthalmia, leaucorrhoea, the juice put in the ear cures earache. The unripe fruit is alexipharmic, astringent to the bowels; removes itching of the body; increases "vata" , "pitta" and " and " kapha". The seeds cure heart diseases, headache; an antidote to poisons; the oils is acrid; astringent, alexiteric; stops hiccough and vomiting; cures rat bite and all poisonings; destroys biliousness. The flowers are an antidote to poisons. The leaves are good for vomiting, hiccough and dysentery (Ayurveda).

The fruit is sour, sweet; refrigerant, cardiotonic, tonic to the liver and the lungs, astringent and binding, diuretic; strengthening the gums; the juice is good for stomatities and sore throat; useful in biliousness; topically it relieves the pain due to stings of wasps and other insects. The leaves are very astringent (Yunani).The fruit is aromatic and used as a stomachic and stimulant in diseases of children. The unripe fruit is described as astringent, and is used in combination with bela and other medicines in diarrhea and dysentery. The ripe fruit is said to be useful in hiccough and affections of the throat. The pulp, applied externally, is a remedy for the bites of venomous insects; if not obtainable, the powdered rind may be used. The bark is occasionally prescribed for biliousness. The leaves are aromatic and carminative, and are prescribed in the indigestions and slight bowel affections of children. The fruit, root, bark and leaf are prescribed in the treatment of snake bite (Charaka, Sushruta, Vagbhata). The fruit is recommended in scorpion-sting (Charaka, Sushruta). In Cambodia, the thorns are used as a styptic in metorrhagia, the bark is a remedy for the bites and stings of venomous insects. No part of the plant is an antidate to snake venom (Mhaskar and Caius). The fruit is useless in the treatment of scorpion sting (Caius and Mhaskar) (Indian Medicinal Plants, K.R. Ktrtikar & B.D. Basu, 497-98)

Medicine: The ripe fruit, made into a sort of chatni, with oil, spices, and salt, is esteemed by the natives. The fruit itself is an aromatic antiscorbutic, and in the form of a sherbet is sometimes given to children, alone or in combination with bel fruit, as a stomachic stimulant. It is supposed to increase the appetite and to possess alexipharmic properties. The pulp is reputed to be especially useful in cases of affections of the gums and throat. It is also often applied externally as a remedy in snake bite or employed to remove the pain caused by venomous insects. But for this purpose the powdered rind may be employed if the pulp be not procurable. The Hindus regard the unripe fruit as a useful astringent in diarrhea and dysentery and Muhammadan authors, for example the writer of the Makhzan-el-Adwiya, affirm that the fruit is cold and dry in the second degree, refreshing, astringent, cardiacal and tonic, a useful remedy in salivation and sore throat, strengthening the gums and acting as an astringent. Elephant-apple is often used to adulterate bel fruit, but the two fruits should be easily enough distinguished.

The leaves are aromatic and carminative, and have the odour of anise (Ainslie). The author of the Makhzan-el-Adwiya describes them as very astringent and as possessing the taste and odour of Tarragon. Ainslie remarks that the native practitioners of South India (in his day) prescribed the leaves "in the indigestions and slight bowel affection of children". The bark is said to be sometimes prescribed for biliousness. The gum has already been alluded to. Ainslie was the first writer to affirm that in medicinal properties the gum of this tree came nearest all Indian gums to the true gum Arabic. "The Tamool practitioners prescribe solution of gum Arabic," he says, "to relieve tenesmus in bowel affections, and as we do in other cases requiring demulcents," and he states that for this purpose Feronia gum "is commonly used for medicinal purposes by all the practitioners of Lower India."

A fatty oil has been identically referred to, and although its exact source and nature have not been determined, it may here be stated that, according to some writers, this oil is not only useful in itch and other skin diseases, but in leprosy. A medicated oil is, however, also employed for these purposes which would be more correctly described as sweet oil impregnated with the pulp or powdered rind. It is probable that this preparation may be the so called Feronia oil of medical writers, unless indeed the essential oil distilled from the leaves be the substance alluded to. Considerable ambiguity, it must be admitted, exists in the literature of Feronia oil.

Special Opinions: "Unripe fruit astringent. Gum-Gum Arabic" (Thomas, Ward, Apothecary, Madanapalle, Cuddapah). "Very common in the Mysore jungles. The unripe fruit is much used for dysentery and diarrhea" (Surgeon-Major Jhon North, Bangalore). "The ripe fruit is by some said to promote digestion, by others is regarded as deleterious, bringing on rheumatism and chest complaints" (Assistant Surgeon Shib Chander Bhuttacharji, Chanda, Central Provinces) (Dictionary of the Economic Products of India, Feronia, 326-7)

Properties and uses: Fruit pulp possesses astringent, stomachic, digestive stimulant, diuretic, tonic and aphrodisiac properties. Pulp is applied externally as a remedy for bites of venomous insects and reptiles and the fruit is prescribed for the treatment oe biliousness.

The pulp is also used to cure coughs, dysentery and heart diseases, and is useful in the treatment of asthma, consumption (tuberculosis), tumours, ophthalmia, leucorrhoea and also diarrhea. Leaves are astringent, carminative and given in indigestion, flatulence, diarrhea, dysentery, vomiting, hiccup and haemorrhagic . Seeds cure heart diseases ( Medicinal Plants of Bangladesh, Abdul Ghani, second edition, 229)