India - Late Cancer Diagnosis Linked To Low Survival Rates In Rural India

Women in developed countries survive roughly a decade longer after a breast cancer diagnosis compared to women in poor-to-middle-income countries, says a new study.

Approximately 1 in 22 women in India are expected to develop breast cancer, a statistic that has been steadily increasing over time.

But this is only the tip of the iceberg, say researchers from the University of Michigan in the United States, who showed that women in developed countries survive roughly ten years longer after a breast cancer diagnosis compared to women in poor-to-middle-income countries.

The researchers conducted a study on nearly 300 women in the southern rural district of Udupi, India. Depending on the patient’s stage of cancer, they were treated with one of three possible drug treatments.

Only 27 percent of patients were diagnosed in the early stages of cancer, and after their diagnosis they survived an average of 11 years with treatment. The majority of patients, however, were diagnosed in the later stages of cancer, and subsequently survived only 1 to 2.5 years with treatment.

While the breast cancer rate is much higher in the United States at 1 in 8 women, the survival rate is also much higher. For instance, the five-year survival rate for Indian women is about 60 percent; in developed countries, it is 79 to 85 percent.

In India, many diagnoses occur at later stages because screening is not available in those rural areas, says the study’s principal investigator, Rajesh Balkrishnan, an associate professor at U-M schools of Pharmacy and Public Health.

Fear, poverty, and ignorance about breast cancer also delay treatment and diagnosis. And, if the diagnosis does come early, access and use of breast cancer chemotherapy treatments – even the generic inexpensive options – are not readily available. Only the latest stage patients receive the most current and expensive treatments, says Balkrishnan.

In contrast, women in developed countries have access to earlier screening, leading to early detection of breast cancer, and better access to good health care, which translates into patients adhering to their chemotherapy treatment plans and higher survival rates.

Balkrishnan noted that early diagnosis paired with continued treatment is key to ensuring patient survival.

“I think if the tumor is diagnosed early and treated aggressively, a patient can expect an additional decade of survival,” he said. “But access and adherence to optimal treatment remains very difficult for women in poorer countries.”

Source: University of Michigan.

Kate Tan-Sinha | Health & Medicine

http://www.asianscientist.com

World - Lung Disease and Child Mortality

Unless we breathe well, we cannot live

Millions of people around the world struggle to breathe, and more than 10 million die each year due to lung diseases including tuberculosis, asthma, pneumonia, influenza, lung cancer and chronic obstructive pulmonary disease.

Nonetheless, lung health is less well recognized as a key health indicator as compared to blood pressure or weight. Lung diseases afflict people in every country and every socioeconomic group, but take the heaviest toll on the poor, the old, the weak and the young. There is a critical need to raise awareness of the importance of lung health and bring it to the top of the public health agenda.

Pneumonia is the single largest cause of death in children worldwide. Despite being preventable and curable, it is the world's (and India’s) leading killer of children under five, claiming one young life every 20 seconds -- 4,300 young lives lost every day, which is more than those due to AIDS, malaria and measles combined. Every year, it kills an estimated 1.6 million children under the age of five years, accounting for 18 percent of all deaths of children under five years old worldwide. India is one of the 15 countries which together account for 75 percent of child pneumonia deaths.

Yet children can be protected from pneumonia, which can be prevented with simple interventions and treated with low-cost medication and care. Tragically, only an estimated 1 out of every 5 children with pneumonia receives antibiotics.

Physicians Penny Enarson and Graham Steve of the International Union Against Tuberculosis and Lung Disease (The Union), spoke of some simple, cost-effective interventions at the community/family level to curb pneumonia and other respiratory diseases in children. They say: “Routine immunization against pertussis, diphtheria, measles, (also hib and pneumococcal vaccine where available) is the one of the most equitable interventions globally to prevent childhood diseases.”

Moreover, they write health workers can use these vaccination visits – usually four in the first year of the child’s life – to promote and educate caregivers on the merits of exclusive breast feeding for the first six months of life as it is critical in preventing pneumonia. “There is scientific evidence to support that breast milk contains antioxidants, hormones and antibodies a child needs for growth and development,” they continue. “They should also educate mothers on the dangers of exposing children to indoor air pollution from cooking and second hand tobacco smoke. Improving ventilation inside homes, not having an infant on back during cooking and not permitting smoking close by an infant will go a long way in reducing respiratory diseases in children.”

A child’s exposure to second hand tobacco smoke adversely affects lung functioning, increasing the risk of acute respiratory illnesses by 60 percent; chronic respiratory symptoms by 24 to 40 percent and asthma by 21 percent.

Enarson and Dr Steve Graham also insist upon promoting good hygiene practices and educating mothers of the importance of hand washing in preventing diarrhea and acute respiratory infections. Caregivers should be able to recognize the signs and symptoms of pneumonia and seek/access prompt appropriate care as pneumonia progresses very quickly in severity.

“Pneumonia is one of public health’s most solvable problems”, says Dr Ajay Mishra, Managing Director of the Nelson Hospital for Pediatric and Neonatal Medicine at Aliganj, Lucknow. “We have safe, effective and affordable tools to help children. Children should have access to effective and affordable treatment using antibiotics, which typically cost less than one dollar per dose.”

Gourdas Choudhuri, Vice- Chairman, Institute of Digestive and Hepato-biliary Sciences, Medanta Medicity, Gurgaon and a noted public health expert cautions that, “Lifestyle disorders play a crucial role in upping the risk to pneumonia. Obese children are also malnourished and so have a compromised immune system. So it is important to ensure that children keep an ideal body weight and use the sports field and/or do plenty of exercise to keep their lungs healthy.”

Neelam Singh, Consultant Obstetrician and Gynaecologist and Chief Functionary of Vatsalya Resource Centre on Health says: “Pneumonia is a major life threatening disease of children after diarrhea. However, the kind of awareness drive that is needed for pneumonia prevention is lacking. There is still a lot of ignorance and a special drive needs to be conducted to spread awareness. The government has made great progress in this field and treatments are available in government hospitals too. However, the pressure of large number of patients, shortage of experts, lack of infrastructure, and non-availability of medicines are some of the concerns in the public health system that need attention.”

The forthcoming 43rd Union World Conference on Lung Health to be held in Kuala Lumpur is designed to reinforce the importance of addressing the problem of childhood pneumonia and other respiratory diseases with a view to meet the Millennium Development Goal 4 of reducing child mortality by two thirds.

More than 1 million young lives could be saved annually with vaccines and antibiotics, by reducing indoor air pollution in the form of cook stove gases and tobacco smoke and through exclusive breastfeeding for the first six months of life.

Shobha Shukla

http://www.asiasentinel.com/

Vietnam - Vietnam ranks 108th in world’s under-5 mortality rate

Despite standing at the 108th place in the world’s mortality rate of children under five years of age, Vietnam has made a big leap of progress in the last two decades, according to the latest report by UNICEF on child survival, which was released today.

Of every 1,000 live births in Vietnam, 50 children died in 1990 and the toll was reduced to 22 in 2011, making it a decline rate of 57 percent in the last 20 years. This is far better than the average child mortality reduction rate of 41 percent in the world in the same period.

In general, the global mortality rate of children under the age of five fell from nearly 12 million in 1990 to an estimated 6.9 million in 2011.

Leading causes of child deaths include pneumonia, diarrhea, malaria, neonatal deaths, under-nutrition and HIV/AIDS.

San Marino, an island nation in the Italian peninsula, tops the latest report with only 2 child deaths for every 1,000 live births in 2011.

The next followers on the world’s lowest under-five mortality rates include Singapore, the Nordic countries, small European countries and Japan, each having 3 deaths among 1,000 live births last year. Australia and New Zealand follow with 5-6 deaths.

Sierra Leone in Sub-Saharan Africa stands at the bottom of the list of 207 countries with 185 deaths of children under five per every 1,000 births. Somalia and Mali are slightly better with 180 and 176 child deaths, respectively.

Notably, the report showed that half of all under-five deaths occur in just five countries. They are India with 1.7 million child deaths, accounting for 24 percent; Nigeria with 756,000 deaths at 11 percent; Democratic Republic of the Congo with 465,000 at 7 percent; Pakistan with 352,000 at 5 percent; and China with 249,000 at 4 percent.

“The global decline in under-five mortality is a significant success that is a testament to the work and dedication of many, including governments, donors, agencies and families,” said Anthony Lake, UNICEF Executive Director. “But there is also unfinished business: millions of children under five are still dying each year from largely preventable causes for which there are proven, affordable interventions.

“These lives could be saved with vaccines, adequate nutrition and basic medical and maternal care. The world has the technology and know-how to do so. The challenge is to make these available to every child.”

MINH PHÁT