Pratap SinghasivanonSEAMEO TROPMED NETWORK
There are an estimated 1,209 million children of
school-age worldwide (17.8% of 6790 million) with
88% living in poorer countries
School children bear the greatest burden of some of the common diseases that affect education
IN MORE THAN 60 DEVELOPING COUNTRIES,
AT LEAST 90 PER CENT OF PRIMARY-SCHOOL-
AGE CHILDREN ARE IN SCHOOL
World Population EventsTime unit Births Deaths Growth
-------------------------------------------------
Year 131,571,719 55,001,289 76,570,430
Month 10,964,310 4,583,441 6,380,869
Day 360,470 150,688 209,782
Hour 15,020 6,279 8,741
Minute 250 105 146
Second 4.2 1.7 2.4
-------------------------------------------------
21%
8%
23%
46%
1%1%
DEVELOPED WORLD
Total : 12.5 million
Infectious and parasitic diseases
Cancer
Other
Circulatory dis.
Circulatory dis.
Cancer
Infectious and
Parasitic dis. 43%
DEVELOPING WORLD
Total : 42.5 million
WHO (2005)
Tropical zone and Tropical Diseases
Malaria kills 2-3 million humans
every year
Caused by Plasmodium parasite and
transmitted by mosquito
Affects primarily children under age
of five and pregnant women
(Malaria kills a child every 30 sec)
Accounts for 10-20 percent of all-
cause mortality among school-age
children in areas of unstable
transmission (Bundy et al, 2000)
Causes absenteeism
Drains vital nutrients from children
impairing their physical and
intellectual development
Emerging infections: Our world is
changing as never before
Populations grow, and move…urbanization…weak PH infrastructure
Diseases travel fast
Microbes adapt…
Antimicrobial resistance
Crossover from one species to another to man
Global Warming, environmental degradation
Threatening International Public Health
Security …
Persistence of endemic tropical
diseases, malnutrition
HIV/AIDS pandemic
Industrialization
Increased urbanization
Globalization
Environmental degradation
Changing lifestyles
Poverty, inequity, conflicts
Newly emerging diseases and
threat of avian influenza pandemic
Knowledge/technology
explosion
New directions/approaches &
increased demand for quality
healthcare
Population growth
Changing Public Health Landscape
Global warming
Food and energy crisis
Natural disasters & emergencies
The Challenge of emerging and re-emerging
Diseases
Marburg virus
Aedes Aegypti
Male Xenopsylla cheopis (oriental rat
flea) .This flea is the primary vector of
plague
Ebola virus electromicrograph
Vero E6 tissue culture cell infected with an arenavirus.
Mostomys rodent: Lassa fever
deer tick (Ixodes scapularis)
Hantavirus Pulmonary Syndrome
Sin nombre virus
Dengue-2 virus
EMERGING DISEASE HOTSPOTS
zoonotic
pathogens from
wildlife
zoonotic pathogens
from non-wildlife
Source: Jones K et al, Global trends in
emerging infectious diseases, Nature, pp
990-4, vol 451, Feb 2008.
drug-resistant
pathogens
vector-borne
pathogens
EMERGING DISEASE HOTSPOTS
Source: Jones K et al, Global trends in
emerging infectious diseases, Nature, pp
990-4, vol 451, Feb 2008.
Examples of recent emerging
diseases
Marburg
Ebola
Monkeypox
Chikungunya
SARS
E. coli O157:H7
Hantavirus
pulmonary
syndrome
West Nile virus
Hendravirus
Widespread or pandemic:
• MDR tuberculosis
• XDR tuberculosis
• Influenza A (H5N1) and (H7N7)
• MDR malaria
• Dengue
vCJD
Nipah
Rift Valley fever
Plasmodium knowlesi
Natural host
Long tailed macaque (Macaca fascicularis)
Experimentally induced in nonhuman primates
baboon
Callithrix jacchus Aotus monkey
Emerging zoonoses
…SARS 2003
8098 cases,774 deaths, 26 countries affected in just 6 months
0
20000
40000
60000
80000
100000
120000
3/16
3/19
3/22
3/25
3/28
3/31 4/
3
4/6
4/9
4/12
4/15
4/18
4/21
4/24
4/27
4/30 5/
3
5/6
5/9
5/12
5/15
5/18
5/21
5/24
5/27
5/30 6/
2
6/5
6/8
6/11
6/14
6/17
Nu
mb
er o
f p
asse
ng
er
WHO travel recommendations removed
36 116
WHO travel recommendations2 April
14 670
13 May
102 165
25 May27 March 23 June
Screening of exit passengers
SARS: an unknown coronavirus
• 8098 cases/ 774 deaths
• 26 countries affected
• trends in airline passenger
movement drop
• Tourism dropped 40%
• Economic loss: US$ 60 billion
SARS changed the world
A new global concern
Acknowledgment: Mike Perdue
23.5 N Tropic of Cancer
23.5 S Tropic of Capricorn
Tropic expansion
Tropic expansion
Expansion of Tropical Zone
Outbreaks of infectious diseases following
storms and floods (1997-1998)
Source: Hufnagel, L. et al. (2004) Proc. Natl. Acad. Sci. USA 101, 15124-15129
Global Aviation Network
NEED TO BE PREPARED FOR
Cholera, …… leptospirorsis, Nipah, HFMD,
legionella, Dengue 1,2,3,4, Chikungunya, Nipah,
HFMD, ……… JE, Polio virus 1,3, Coxsackievirus (Cox A16)
avian influenza A (H5N1),
Chandipura, EV71,
WHAT’S NEXT ?
Major health improvements have been seen in
the last 50 years but progress has been
uneven
Old challenges (poverty, urbanization, education, equity)
New challenges inside and outside the health sector
New opportunities (partnerships, networks, technology, etc)
Health problems among school children
Malaria
Dengue
Tuberculosis
Avian Influenza
Severe Acute Respiratory Syndrome
Diarrhea
Food Poisoning
Soil Transmitted Diseases
Neglected Tropical Diseases
Issues of safe water and sanitation in the school environment
Dengue and Chikungunya
Vectored by Aedes species (albopictus, aegypti)
Tuberculosis
Each year globally :
• 250,000 children develop TB
• 100,000 children will die
Hand, Foot and Mouth Disease
• 1997 - Sarawak, Malaysia (34 children died)
• 1998 - Taiwan (1.5 million, 78 children died)
• 2006 – Sarawak (7 children died)
– India (Some cases were reported)
• 2008 – China (25,000 cases, 42 deaths)
– Singapore (2,600 cases)
– Vietnam (2,300 cases, 11 deaths)
– Mongolia (1,600 cases)
– Brunei (1,053 cases)
300 students rushed to hospitals because of foods poisoning
Chiang Mai - About 300 students studying and living at a temple in this northern province were rushed to hospitals early Friday morning because of foods poisoning.
Posted On: November 2, 2008
San Diego School Children Sickened by E. Coli
By Prachi Pinglay
BBC News, Mumbai
Officials in the Indian city of Mumbai have stopped supplies of flavoured milk to schoolchildren after it was suspected of causing food poisoning.
About 50 children fell ill in two separate incidents, leading to the milk scheme being suspended in more than 1,000 of the city's schools.
Study reveals classrooms rank#1 for GERMS.
(American Academy of Pediatrics, 2006).
Researchers found that
• bacteria level on surfaces in teachers’ classroom were nearly 20 times higher than those found in lawyers office, and 7 times higher than doctors’ and TV producers’ office
• 40% of parents sent their sick child to school
• People can touch 300 surfaces in 30 minutes, transporting germs from surface to surface in a matter of seconds
Germs in the School Room
The classroom can be breeding ground for germs that cause cold and flu..
Malnutrition problems among
school children:
• stunting (low height for age)
• underweight (low weight for age)
• micronutrient deficiencies (iron, iodine and Vitamin A)
significant positive associations between iron status and
both ability and cognitive achievement of school children
children receiving supplementary feeding generally
performed significantly better in school test, were more
active in the classrooms, and interacted more positively with their classmates
The School is Fat
Under-weight
Normal weight
Over weight
Obese
Bangkok (n=437) 11% 56% 17% 16%
Saraburi (n=225) 7% 60% 10% 23%
Sakolnakorn (n=633) 29% 59% 8% 4%
Prevalence of underweight, normal weight, over-weight and obesity
of children at Grade I in primary schools from Bangkok, Saraburi and Sakolnakorn
Source : J Med Assoc Thai Vol.88 No.6 2005
Under-weight
Normal weight
Over weight
Obese
Bangkok (n=437) 13% 42% 14% 31%
Saraburi (n=225) 7% 46% 17% 30%
Sakolnakorn (n=633) 21% 61% 9% 9%
Prevalence of underweight, normal weight, over-weight and obesity
of children at Grade VI in primary schools from Bangkok, Saraburi and Sakolnakorn
Source : J Med Assoc Thai Vol.88 No.6 2005
Children's illness: Top 5 causes of missed school
1. Common cold
2. Stomach flu (viral gastroenteritis)
3. Ear infection (otitis media)
4. Pink eye (conjunctivitis)
5. Sore throat
RESPONSE
School Health Programme
The School SettingImplement an effective school health
programs
Ready-made infrastructures
Skilled workforce
Why target schools? Schools provide access to a much greater population
than health facilities
Schools provide a low-cost and effective vehicle for a broader range of interventions
Teachers can reach beyond the school walls and work closely with parents and surrounding communities
Effective school health programs…
Contribute to the development of child-friendly schools >>> education for all
Promote healthy practices
Can reach a large number of children during their formative years
Diseases that affect education are preventable and treatable.
Improving children’s health and nutrition brings substantial benefits for education.
Major impact of ill
health and malnutrition
• cognitive development
• learning
• educational achievement
improved health and nutrition
positively associated with
• enrollment at younger age
• less grade repetition
• reduced absenteeism
• increased grade completion
• higher performance on test scores
Source: Am J Infect Control 2000;28:340-6
The flu has caused high
rates of absenteeism
among students and staff
in US’s 119,000 schools.
Influenza is not the only
respiratory infection of
concern in schools --
nearly 22 million schools
days are lost each year
to the common cold
alone
Treatment for worm infections
• children are more ready to learn
• reduced absenteeism by one-fourth(Miguel and Kremer,Kenya, 2004)
FRESH INITIATIVE
Focusing
Resources on
Effective
School
Health
Health topics
nutrition,
HIV and AIDS,
intestinal parasitism,
malaria,
tuberculosis,
mental health,
disaster preparedness, water supply and sanitation facilities
HEALTH
NUTRITION
EDUCATION
SANITATION
Roles of SEAMEO TROPMED Network Training of teachers on health topics and concerns
Provision of technical expertise
Implementation of pilot projects on health for the school population
Development and packaging of teaching/learning materials on health topics
Provision of services