Heart Disease – The Silent Killer

By Kaboni Gondwe and Shaoqing Ge

The heart is an interesting organ in the body; it beats continuously even when asleep. Such a simple thing that signals the presence of life during embryonic period, signals the end of life at its cessation. While important to our survival, cardiovascular disease remains a silent killer. We have come through decades where heart disease was thought to be an issue for people who were overweight and obese or a problem for people with high socio-economic status. However, the burden of heart disease in global affecting people from all walks of life.

Heart disease has thus been described as the number one killer globally. And it is the 2nd leading cause of death in developing countries.

http://www.cdc.gov/globalhealth/healthprotection/ncd/about.html

Dr. Bloomfield mentioned how developing countries are challenged by the dual burden of communicable and non-communicable diseases. The epidemic of non-communicable diseases such as cardiovascular/heart diseases has dramatically increased in recent years. In countries where resources are limited and are unaware of their risks for heart disease the people die without understanding why someone who looked perfectly normal could just collapse one day and die. In Malawi, most sudden deaths in the rural areas are usually thought of as witchcraft and gaining weight was for a long time viewed as a sign of wealth and peace. There was an incident where a man in the urban area felt a sharp pain in his chest while driving, he rushed to the hospital and he was in time to get the best treatment. This man was educated and was aware of the signs and symptoms, thus he knew he needed to seek medical attention and he survived. Other cases form the rural start with complaints of chest pain and headaches. People eventually die in their sleep with blood coming through their nose. “zitheka bwanji munthu oti anali bwino bwino dzuro lero muziti watisiya, ufiti” (How could someone who was fine yesterday die today, this is witchcraft). This lack of sensitization of the signs and symptoms is bound to result into more deaths that could have been prevented.

The problem of increasing cases of cardiovascular disease has equally affected developed countries like China. In China, the prevalence of diabetes among Chinese adult population has increased from less than 1% in 1980 to 11.6% in 2010 (Xu, Wang, He, & et al., 2013). China has the largest population in the world, with an estimated 113.9 million diabetic adults (Yang et al., 2010). Cardiovascular disease has also become a chronic problem for Chinese population and a challenge for older adults whose health is already diminishing. Shaoqing’s grandmother, an 80 year old Chinese lady, has lived with hypertension for 30 years, had stroke around 20 years ago and developed atrial fibrillation around 5 years ago. She now controls her situation with medicines and exercise regularly. However this was not the case when she initially diagnosed with hypertension, she was a regular smoker back then and she absolutely had no idea of self-management. The only thing she knew was she would not die soon only with hypertension. This situation was not changed until she had that stroke tragedy; she then realized the importance of self-management, such as diet, exercise and medicine. However, as age grows, the situation kept deteriorates to arterial fibrillation but just slower.

These stories reveal that behavior change will not happen suddenly; it is highly related to education and self-awareness. Strengthening education is especially valuable for countries with limited resources, which is the case for most developing countries. Back 30 or more years, people were not aware of the relationship between smoking, salty diet and cardiovascular diseases, now even though this can be a common sense to some people but can still be unfamiliar to people in certain lower-income countries and areas.  We believe this is both a challenge and opportunity for stakeholders, practitioners and global health researchers, to provide information, technology, and treatment.

References

Xu, Y., Wang, L., He, J., & et al. (2013). Prevalence and control of diabetes in chinese adults. JAMA, 310(9), 948-959. doi:10.1001/jama.2013.168118

Yang, W., Lu, J., Weng, J., Jia, W., Ji, L., Xiao, J., . . . He, J. (2010). Prevalence of Diabetes among Men and Women in China. New England Journal of Medicine, 362(12), 1090-1101. doi:doi:10.1056/NEJMoa0908292

Mosquitoes, misguiding labels, and poverty

By Emily Esmaili and Daniel Evans

When you go to the grocery store, how can you trust you are getting what you pay for? How confident are you that that the box of Oreos you buy will in fact contain those delicious cream-filled cookies? When you go to the drug store, do you question if the bottle of Tylenol you are buying might actually be a bottle of sugar pills? Most of us in the US would answer no: most consumers are confident that regulatory bodies such as the FDA will ensure the quality of Tylenol sold in pharmacies, and – perhaps more importantly – the quality of Oreos sold in stores. If however, you lived in a developing country, you might not be so confident.

The problem of false advertising and counterfeit drugs in the developing world is a shamefully well-known issue. Pharmaceutical companies lack the close surveillance and regulatory boards necessary to ensure quality products. As a result, drugs with very little (or adulterated) active ingredients will be mass-produced and sold cheaply. This has devastating repercussions in the health care world: serious diseases are left partially or inadequately treated. The unknowing consumer is the victim – and often a fatality – of these capital-driven enterprises. One such disease with a flourishing counterfeit drug industry is malaria.

While it is true that we have made great strides in reducing the global burden of this terrible disease, malaria continues to cause a considerable amount of death and disability – much of which is preventable or avoidable. It is estimated that over one-third of all antimalarials on the market in Southeast Asia and Sub-Saharan Africa are fake, or substandard. To make a bad problem worse, these deceptive industries pray upon the world’s poorest, most vulnerable populations. A family may travel long distances and spend hard-earned wages on treatments that are essentially ineffective. An additional problem is the emerging artemisinin resistance that results from these false or partially effective treatments. Soon, even our genuine first-line treatments may no longer be effective.

In response to this serious problem, a scientist working with the FDA named Nicola Ranieri proposed a solution: CD-3. Though it may sound like a robot name or something you remember from immunology class, CD-3 (Counterfeit Detection Device, Version 3) is our best shot at cracking down on the trouble-makers, in a quick and easy way:

https://youtu.be/mfYUkiKAJvA

While CD-3 makes its way around the globe, cleaning up the streets of pharma industries in the world’s poorest neighborhoods, perhaps we can ponder why these poor neighborhoods are the hardest hit by malaria. Is there a link between poverty and malaria? Sonia Shah in her book The Fever which investigates the different facets of malaria, says that it does.

Malaria is rampant in poor and developing nations such as sub Saharan Africa and Asia. There are a combination of factors that increase malaria risk: inadequate housing that cannot protect against mosquitos, more time spent outside and exposed to mosquitoes, and poor sanitation that creates breeding grounds. All these factors are prevalent in the poor areas and slums of these countries. This means that the poorer someone is, the higher the likelihood they are going to contract malaria.

Not only does poverty increase the risk of malaria, but malaria also causes greater poverty. Sonia Shah explains this in her TED talk.

“What we also know now is that malaria itself causes poverty. For one thing, it strikes hardest during harvest season, so exactly when farmers need to be out in the fields collecting their crops, they're home sick with a fever. But it also predisposes people to death from all other causes. So this has happened historically. We've been able to take malaria out of a society. Everything else stays the same, so we still have bad food, bad water, bad sanitation, all the things that make people sick. But just if you take malaria out, deaths from everything else go down. And the economist Jeff Sachs has actually quantified what this means for a society. What it means is, if you have malaria in your society, your economic growth is depressed by 1.3 percent every year, year after year after year, just this one disease alone.”

Malaria and poverty are directly linked: Eradicate one and you will deal a crushing blow to the other. However, this is not possible if people are out to take advantage of the poor. Dirty pharmaceutical companies pumping out fake or tampered drugs are only furthering this problem. If we want to take on the problem of malaria, we need to tackle poverty and the problems surrounding it as well in order to make a meaningful difference.