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

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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