Not just microbes, missing micronutrients culprits too

October 20, 2010

Countries that have adopted zinc as national diarrhoea treatment programmes (Zinc Task Force, 2007)

Conventional wisdom assumes a clear direct link between a bacterium or virus and the infection it causes. Then how does one explain why the same microbe may not cause much illness in a developed country, but could wreak havoc in a developing country?

The answer lies in deficiency of zinc, a crucial micronutrient (needed by the body in trace amounts). Zinc deficiency weakens immunity against infectious diseases, and could have important implications for not just poor response in developing countries to oral vaccines against polio and cholera; but also other infections such as malaria and tuberculosis, Maharaj Krishan Bhan, secretary of India’s department of biotechnology (DBT), told the TWAS meeting on Tuesday (19 Oct).

“An infectious disease can be initiated by a microbe. But the outcome of an infectious disease in developing countries depends entirely on nutrition, as opposed to a developed country,” Bhan said.

The link between zinc deficiency and weakened immunity came to light thanks to collaboration among nine developing countries that pooled their knowledge together for over a decade; and took part in WHO trials to provide sufficient study data to identify the crucial link between zinc and diarrhoea. Currently, diarrhoea kills over a million under-fives in Africa and Asia.

Zinc deficiency has up to 43 per cent prevalence in India, 68 per cent in Mexico, 80 per cent in Lima (Peru), and 37 per cent in Papua New Guinea. Much of the deficiency in the body and diet can be traced to deficiency in soil — for example, half of arable land in China, India and Turkey is deficient in zinc; and so is 60 per cent in Iran and 70 per cent in Pakistan.

Thanks to the data from different country studies, scientists have now clearly established that zinc supplements can, not only treat diarrhea, but also help reduce pneumonia incidence, and deaths in babies with low birth weight.

Zinc supplements have now been adopted as part of national programmes to treat diarrhoea in several countries across Africa, Asia and Latin America.

That does not mean the problem has been solved. A study in Bangladesh showed that despite mass media campaigns, children still miss out on zinc treatment. And as Bhan observes, zinc deficiency in pregnant women will have implications for the foetus and the new born.

T V Padma, South Asia Regional Coordinator, SciDev.Net

Does social science need rebranding?

November 21, 2009

Some would argue poor living conditions and gender inequity affect health more than the biological causes of disease. Flickr/LivingWaterInternational

As Forum 2009 closed on Friday, we were left with some thoughts on the future direction of global health research. The conference in general was heavily weighted towards the need to drive health systems research and research on the social determinants of health.

Mention these issues to many lab scientists, however, and they would argue that these fields of study are far too “soft” a science for them to engage with.

This is what really damages research into the social factors affecting health. Traditional robust methods of interrogating an issue and gathering data such as randomised controlled trials have no traction when you are thinking about how a health system functions or when you are trying to evaluate a complex health intervention.

These don’t fit into neat scientific boxes in the way that parasite counts or viral loads do.

But transforming these fields will require rigorous evidence – how else will we know what changes to make to improve health systems across the developing world?

It’s good news then that the EU announced yesterday at the meeting that its next call for grants in January 2010 would focus heavily on research into the social determinants of health.

Some would argue that poor living conditions and gender inequity affect health even more than the biological causes of disease. There is only one way to find out, of course: more research, and more robust evaluation of that research.

Priya Shetty,,

Where there is a will…

November 18, 2009
African women

Studying gender inequality won't fix health without the political will

Claudio Schuftan, an advocate for the right to health based in Vietnam, sounded a pessimistic note yesterday in a discussion on research into the social determinants of health.

As participants discussed the best ways to ensure that research into poor living conditions and gender inequality is treated as a rigorous science, Schuftan asked us whether we “were living in a dream world”. His point was that the scientific community talks of the need for more evidence – but what about the political will?

This is an obvious point but one worth making again amidst calls for more evidence-based policies. First, we have a lot of evidence already for what works and what doesn’t. Second, all the evidence in the world will not convince a policymaker who does not see the political will to alter health-care policies.

This was the point that Carlos Morel, director of the Center for Technological Development in Health at FIOCRUZ in Brazil, made when I spoke to him about translating innovation from Cuba to the rest of the world.

Morel said that there would be little point in Cuba transferring knowledge to countries that don’t have the capacity to use that information. Cuba’s political dictatorship – in essence, its unswerving political will – is what ensured that it first developed a robust health system on which to build more advanced scientific institutions, he said.

Africa needs to find a way now to imbue its own democracies with that strong political will for healthcare reform.

Priya Shetty,,

Getting it out there

November 17, 2008

Given the choice, would the average scientist prefer to find a cure for tuberculosis or find a really effective way of getting it to people? It is the concentration on the former that Ok Pannenborg, a senior health advisor at the World Bank, highlighted this morning at Bamako 2008 in a plenary session on research for health challenges.

Health systems research, he said, is unsexy. Health systems are seen as “amorphous, abstract and vast”. How can anyone go about researching such things?

The key, he said, is not to see it as disease versus health systems research, or even disease research alongside health systems research – but focusing on better health systems for the treatment of disease.

Research, he said, is an indispensible tool for improving health systems, from identifying and understanding problems to developing and evaluating new ways of doing things.

But it’s not just in health systems that finding out how to best deliver things to people is key. Health is not just about healthcare, said Michael Marmot, chair of the WHO Commission on the Social Determinants of Health, in a video presentation during a later session.

Research into the social determinants of health has shown what can lead to poor health. It’s acting on this evidence which is the next step, said Marmot. We know that clean water is good for people’s health, let’s find a way of getting it to people.

Katherine Nightingale, SciDev.Net

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