The People’s Voice Survey on Health System Performance

The Lancet | December 11, 2023

Executive Summary

Understanding how health systems perform is key to improving health service delivery and health outcomes. Like any other service sector, health systems need to learn from the populations who use and fund them. Currently, there are few rapid and comparable approaches that incorporate population views when tracking health system performance. The People’s Voice Survey is a new survey that is rapid, low-cost, and population-representative. With proper adaptation, it is applicable to any country, regardless of national income, health expenditure, or health system structure.

The six papers in this Series highlight the innovative measures featured in the People’s Voice Survey, including confidence in public primary care, system competence in preventive care, and user activation. They examine quality and confidence in health systems as well as people’s experience with several prominent health system initiatives, such as universal health coverage, primary care, and vaccination drives. Given the manifest inequities in health quality and effective coverage, they also examine wealth, location, and gender equity in key aspects of health system performance.

El Nino effect: Cases of dengue have increased globally

Increase in temperature and changes in rainfall patterns to blame

Vibha Varshney

Down To Earth | December 23, 2023

 Photo: iStock12jav.net

There has been a ten-fold increase in dengue cases between the years 2000 and 2019, according to an analysis by the World Health Organization (WHO). The reported cases have gone up from 500,000 to 5.2 million during this period, the WHO said. The actual number of cases would be higher as the infection is asymptomatic in most cases and it is not a notifiable disease in many countries. 

According to the WHO, there is a sharp increase in cases globally after the lull between the pandemic years 2020-2022. In 2019, when the last spike in cases occurred, the disease was reported in 129 countries. In 2023, 80 countries reported over five million cases and more than 5,000 dengue-related deaths. 

“FLip” mutations of SARS-COV-2 may be evading immunity and leading to surge in COVID cases, suggest researchers

India records 752 new COVID-19 cases on December 23

Seema Prasad

Down To Earth | December 24, 2023

The omicron subvariant JN.1. is likely to soon become the dominant lineage of the SARS-CoV-2 virus worldwide, according to researchers at the University of Tokyo. The subvariant has a mutation in its spike protein, L455S, also called a “FLip” mutation.

Experts told Down to Earth that a dominant strain need not necessarily indicate that it is more dangerous, as it is the nature of the virus to mutate.

On December 18, 2023, JN.1, was designated a separate variant of interest (VOI) after a rapid surge in recent weeks. JN.1 is a descendant of the BA.2.86 lineage, which first emerged in August 2023. 

BA.2.86 carries more than 30 mutations in the spike protein. It is distinct from the other omicron XBB lineages, such as EG.5.1 and HK.3 currently in circulation.

The 2023 China report of the Lancet Countdown on health and climate change: taking stock for a thriving future

The Lancet | Open Access | Published: November 18, 2023 | DOI: https://doi.org/10.1016/S2468-2667(23)00245-1

Executive summary

With growing health risks from climate change and a trend of increasing carbon emissions from coal, it is time for China to take action. The rising frequency and severity of extreme weather events in China, such as record-high temperatures, low rainfall, severe droughts, and floods in many regions (along with the compound and ripple effects of these events on human health) have underlined the urgent need for health-centred climate action. The rebound in the country’s coal consumption observed in 2022 reflected the great challenge faced by China in terms of its coal phase-down, over-riding the country’s gains in reducing greenhouse gas (GHG) emissions. Timely and adequate responses will not only reduce or avoid the impacts of climate-related health hazards but can also protect essential infrastructures from disruptions caused by extreme weather. Health and climate change are inextricably linked, necessitating a high prioritisation of health in adaptation and mitigation efforts. The 2023 China report of the Lancet Countdown continues to track progress on health and climate change in China, while now also attributing the health risks of climate change to human activities and providing examples of feasible and effective climate solutions.

Deadly Nursery: More children in Delhi have cancers than any other Indian city; is air pollution to blame?

Is India prepared for the long term impact of poor air quality?

Vibha Varshney

Down To Earth | November 03, 2023

 Smog hangs over a bridge on the Yamuna in Delhi. Photo: Midhun Vijayan / CSE

India’s capital Delhi was the worst-affected among all places that have a cancer registry in the country, according to the latest available data by the National Cancer Registry Programme from 2012 to 2016. In children between the ages of 0 and 14 years, the proportion of childhood cancers relative to cancers in all age groups varied between 0.7 per cent and 3.7 per cent.

Could air pollution be responsible? There is enough evidence to show that exposure to air pollution can lead to cancer in adults. But this correlation is not studied much in children.

Children would be more at risk considering that they breathe more rapidly than adults and absorb more pollutants. Also, they live closer to the ground, where pollutants tend to accumulate.

Nipah virus outbreak: what scientists know so far

India is taking urgent steps to halt the transmission of a rare but deadly virus that spreads from bats to humans.

Gemma Conroy

Nature | September 20, 2023

Nipah virus (green) can be deadly.Credit: National Institutes of Health/Science Photo Library

In the southern Indian state of Kerala, the bat-borne Nipah virus has infected six people — two of whom have died — since it emerged in late August. More than 700 people, including health-care workers, have been tested for infection over the past week. State authorities have closed some schools, offices and public-transport networks.

The Nipah outbreak is the fourth to hit Kerala in five years — the most recent one was in 2021. Although such outbreaks usually affect a relatively small geographical area, they can be deadly, and some scientists worry that increased spread among people could lead to the virus becoming more contagious. Nipah virus has a fatality rate between 40% and 75% depending on the strain, says Rajib Ausraful Islam, a veterinary physician who specializes in bat-borne pathogens at the International Centre for Diarrhoeal Disease Research, Bangladesh, in Dhaka. “Each outbreak is a concern,” he says. “Every outbreak is giving the pathogen an opportunity to modify itself.”

Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data

Lancet | Open Access | Published: October, 2023 | DOI:https://doi.org/10.1016/S2214-109X(23)00348-0

Summary

Background

The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodemographic variation in these activities across LMICs.

Labour exploitation among community health workers

Ashley Wennerstrom, Denise Octavia Smith

Lancet | Open Access | Published: October, 2023 | DOI: https://doi.org/10.1016/S2214-109X(23)00409-6

In The Lancet Global Health, Madeleine Ballard and colleagues1 report on dual-cadre systems, in which unsalaried community health workers work alongside paid health-care workers. The finding that nearly 60% of unsalaried workers and one in ten salaried workers experience labour exploitation is concerning. Considering that community health workers are primarily women of colour, exploitation of this workforce is a predictable consequence of patriarchy, racism, and ongoing legacies of colonisation that must be addressed.

AI detects eye disease and risk of Parkinson’s from retinal images

Researchers have developed a model trained similarly to ChatGPT that can be adapted to evaluate multiple health conditions.

Mariana Lenharo

Nature | September 13, 2013

Retinal imaging allows researchers and physicians to observe small blood vessels whose condition could hint at a health-care issue.Credit: ipm/Alamy

Scientists have developed an artificial intelligence (AI) tool capable of diagnosing and predicting the risk of developing multiple health conditions — from ocular diseases to heart failure to Parkinson’s disease — all on the basis of people’s retinal images.

AI tools have been trained to detect disease using retinal images before, but what makes the new tool — called RETFound — special is that it was developed using a method known as self-supervised learning. That means that the researchers did not have to analyse each of the 1.6 million retinal images used for training and label them as ‘normal’ or ‘not normal’, for instance. Such procedures are time-consuming and expensive, and are needed during the development of most standard machine-learning models.

WHO: More investments needed in Africa to control, eliminate neglected tropical diseases

Around 400 million people in the region are still affected; 99 million in 26 countries at risk of not receiving treatment

Down To Earth | August 31, 2023

The World Health Organization (WHO) has called for increased investments in Africa to control and eliminate neglected tropical diseases.

While the continent has made significant progress, 400 million people in the region are still affected by neglected diseases, health officials and donors meeting for the the global health body’s Regional Committee for Africa have pointed out. 

A group of 20 illnesses, or disease groups, are known as neglected tropical diseases that predominately affect tropical and subtropical regions. An estimated 40 per cent of impacted people globally live in the WHO African Region (which includes 47 Member States).