Better prevention a cure in itself

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Simple interventions go a long way to secure public health, reduce death and illness and cut costs of medical services required by society.

Reminding medical practitioners of this basic truth should be an integral part of the Ministry of Public Health and Sanitation’s work. As the Government strives to improve health and medical care financing, it should not forget the importance of initiatives to reduce the number of people requiring medical attention.

The success of campaigns distributing anti-malaria bed-nets in drastically reducing parasite infections and deaths — by more than 70 per cent in most areas — should inspire efforts to find similar simple interventions that can help keep the country healthy.

Keeping the initiatives targeted at maternal and infant health, particularly among rural and urban low-income households, is likely to have the greatest effect on illness and death rates.

A 2006 study on maternal oral health conclusively linked a microbe called Bergeyella sp to premature births. Now, researchers at Case Western and Yale universities in the United States say the bacterium is responsible for 80 per cent of premature births.

This is even as a new University of North Carolina study reported in January found treating pregnant women for periodontal disease does not lower their risk of premature birth or other foetal complications. Whichever is true, there is an intervention here to be seized. Pre-natal care initiatives routinely advise on proper nutrition for mothers, addressing the most common “poor birth outcome” — smaller-than-average babies. Expanding these to include advice on brushing teeth is inexpensive, cannot hurt and, if the Case Western/Yale people are right, may lower the number of premature births.

A cholera outbreak has been a drain on public health resources in Nyanza for some months now. Considering the cost of containing such outbreaks, it would have been cheaper to have good sanitation, education on hygiene and waste treatment in the first place. A seasonal disease should not be met with costly emergency measures every rainy season: The use of cheap oral vaccines and changing behaviour among food preparers can prevent or reduce the severity of any outbreaks.

Handwashing campaigns, like the World Bank-sponsored HWWS programme in schools, are a great way to prevent diarrhoea-related diseases. Taught right, the simple act can be the single most important tool in keeping the nation healthy.

Attitude Change

The immunisation of children is something of a controversial area, what with parents exposed to scare stories about the dangers. Not long ago, a polio elimination drive found a detractor as formidable as an archbishop of the Catholic Church.

The highly-publicised illness and death of a young boy after the administration of a rabies vaccine does not help matters. Finding and building on successes here, not just in childhood immunisation but also in adults.

The simplest and most effective intervention, however, does not require Government planning or donor funding (although these could be useful here), just a basic change in attitude among healthcare providers: Communication that involves all patients more in their treatment. This is true in a wide range of instances, but is most obvious in the tales of hospital errors that have become the staple of news bulletins.

Every so often, we hear stories of children whose limbs have to be amputated due to ‘negligence’ by overworked hospital staff. In some cases this is due to inexperienced staff administering injections wrongly into muscles or arteries, leading to gangrene. More dismaying are the avoidable instances where a tourniquet is, for whatever reason, left on a child’s limb for hours on end.

Encouraging greater communication can all but end such cases, empowering parents and guardians left with the child. Indeed, studies show good communication appears to reduce the risk of subsequent medical malpractice claims.

State-of-the-art expertise and big-budget healthcare have their place. But so does common sense medicine.

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