Contents

Health in Pakistan ....................................................................................................................................... 2

Health infrastructure .............................................................................................................................. 2
Role of Health .............................................................................................................................................. 3
Problems .................................................................................................................................................. 3
Solutions ................................................................................................................................................... 4
Diseases ........................................................................................................................................................ 5
Asthma ..................................................................................................................................................... 5
Polio .......................................................................................................................................................... 6
Malaria ..................................................................................................................................................... 7
Tuberculosis............................................................................................................................................. 7
Typhoid Fever ......................................................................................................................................... 8
Pneumonia ............................................................................................................................................... 9
Dengue fever .......................................................................................................................................... 10
Cholera ................................................................................................................................................... 11
Jaundice ................................................................................................................................................. 12
Cancer .................................................................................................................................................... 14
Rabies ..................................................................................................................................................... 15
Hepatitis C ............................................................................................................................................. 17
Health in Pakistan

Pakistan as a developing country is struggling in many fields in which the health system has
suffered a lot, resulting in a 122 rank out of 190 countries in a World Health Organization
performance report. Pakistan per capita income (PPP current international $, 2013) is 5,041[2] and
the total expenditure on health per capita (intl $, 2014) is 129, which is only 2.6% of GDP (2014).
The gender inequality in Pakistan is 0.536 and ranks the country 147 out of 188 countries (2004).
The total adult literacy rate in Pakistan is 55% (2014) and primary school enrolment is 73%. Life
expectancy at birth is 66 years (Male 65, female 67),[6] which is the lowest in comparison to south
Asian countries.[7] The proportion of population which has access to improved drinking water and
sanitation is 91% (2015) and 64% (15) respectively.
Pakistan is attributed to the lack of access to basic health care services, poverty, lack of health
infrastructure and personnel, illiteracy, women’s low status, inadequate water supplies and
sanitation. In the urban areas, access to health care clinics and facilities is not a problem, though
the general state and quality of public services is very poor. On the other hand, in the rural areas,
people live far from hospitals and basic health care units. It is for this reason that most women
give birth at home with the assistance of a midwife or woman health worker. Illness pushes people
into poverty through lost wages, high spending for treatment and recurring treatment for their
illnesses. One of the main causes of illness in the rural areas of Pakistan is poor water and sanitation
systems.

Health infrastructure
The health care delivery system includes both state and non-state; and profit and not for profit
service provision. The provincial and district health departments, para-statal organizations, social
security institutions, non-governmental organizations (NGOs) and private sector finance and
provide services mostly through vertically managed disease-specific mechanisms. The country’s
health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in
the health workforce, with insufficient health managers, nurses, paramedics and skilled birth
attendants in the peripheral areas.
Role of Health
“A healthy population is a pre-requisite for successful development” this was the conclusion that
John Strauss and Duncan Thomas came to in their study “health, nutrition and economic
development”, 1998.
Increased productivity is an indicator of economic growth and this can be achieved through greater
investment in labor and capital. However, investment in capital can only be fully utilized if there
is a healthy and educated workforce available in the economy. Thus, health plays a vital role in
improving productivity and economic growth. Due to its role is both inputs and outputs it has a
central role in economic development.
There is a desperate need to raise both health standards in Pakistan including its availability. Good
health not only gives a longer life span but it help in raising return to investments in education, as
a healthy educated persons work adds to the productivity of the economy. Education will also raise
awareness about basic sanitation and hygiene and lower the chances of an individual getting ill.
In the 2000 world health report, the World Health Organization (WHO) concluded that “the
ultimate responsibility for the performance of a country’s health lies with government”. The
government while settings its economic policies should view workforce as human capital and
should invest in human capital as only investment in this can raise productivity.
The government needs to consider this aspect of economic development while formulating
economic policies as a more educated and healthy workforce is bound to improve and raise the
levels of productivity in the economy. This in turn will also benefit the corporate sector of the
economy and for this reason they should also help the government in improving the health and
education standards of Pakistan.

Problems
Emerging communicable diseases: Pakistan is in transitional phase of health problems
particularly; HIV/ AIDS, dengue fever, bird flu, SARS and drug resistance cases of pulmonary
tuberculosis are on increase. The prevalence of such diseases is to be addressed at resource
allocation level. Similarly, resources are needed to be allocated equitably to combat this challenge
by adopting preventive measures, thereof.
Emerging non-communicable diseases: Non communicable diseases like CHD, Diabetes,
Hypertension, Cancer, Accidents and Mental illness have emerged as a threat owing to change in
lifestyle of the community. Multi-faceted challenges in this scenario are posing a great threat to
the community which needs to be addressed to improve the physical quality of life of the citizens.
In health, planning, non-communicable diseases are to be addressed appropriately by establishing
diagnostic, preventive and therapeutic centers.
Environmental threats: Degradation of ecosystem, deforestation, rapid industrialization,
sophisticated technologies, automobiles exhaust, changing life styles. With excessive use of
refrigerators, air conditioners, cosmetics, perfumes, deodorants are increasing greenhouse effect
by producing gases like CFCs, SO2 & NO2, and ozone depletion at stratosphere and increasing
levels at troposphere, causing environmental pollution, global warming and rise in sea level with
impending danger for human and aquatic life.
Regulatory framework: Law is that proportion of the established thought and habit which has
gained distinct and formal recognition in the shape of uniform rules back by the authority and
power of Government. Public Health Law is that branch of jurisprudence, which applies common
and statutory law to the principles of hygiene.
Overwhelming population burden & socio economic development: Following health related
indicators are alarming signals for present and future projections in defining health status of
country:
 Population has quadrupled since 1947 (156 million)
 Population doubling time is 37 years with current growth rate of 1.86%
 Un-met family planning need: 33%
 Total Government expenditure on health per capita = 04% ETC

Solutions
 Public health agencies, policy makers, and academic institutions are not striving to initiate
a national discussion on the role of public health and the steps to strengthen its capacity
building to fulfill its role in the following areas to improve quality of life of a common
citizen:
 Medical care
 Bio medical research
 Strategic plan for public health Eliminate health disparities.
 Advances in information technology Biotechnology.
 Policy, Planning, Development and Regulation of Health Services, facilities and manpower
 Regulation of pure food and drug Acts.
 Control of environmental pollution
 Treaty–making power agreement with other nations on the control of communicable
diseases by exchanging health information.
 Appraisal of community health services based on independent studies and proficiency
through quality assurance and quality control.
 Consumers representation in policy making process of major health facilities and
organizations by reflecting all aspects of community issues i.e., cultural, racial, linguistic
diversities, and protection of the poor segment of the society.
 Data collection and information of resources.
 Health care financing (Health Insurance)
 Safety at work. (Ergonomics)
Diseases
Asthma
Asthma occurs when certain triggers cause inflammation in the lungs. This results in coughing, wheezing,
breathlessness, and tightness in the chest. Severity of the condition and the types of triggers can vary from
person to person. Asthma attacks can occur suddenly and get worse after exposure to a trigger.
Treatments include medication and lifestyle changes to relieve the symptoms of asthma. Asthma has no
one single cause, but genetics are a key factor.
Health impact of asthma in Pakistan over time
The annual mortality rate per 100,000 people from asthma in Pakistan has decreased by 30.3% since 1990,
an average of 1.3% a year. Though this has been the trend overall, adjust the filters at the top of the
visualization to see how the mortality rate for asthma has changed over time for men and women of specific
age groups in Pakistan.
Asthma in Pakistan by sex over a lifetime
For men, the deadliness of asthma in Pakistan peaks at age 80+. It kills men at the lowest rate at age 15-19.
At 317 deaths per 100,000 men in 2013, the peak mortality rate for men was higher than that of women,
which was 186.6 per 100,000 women.
Women are killed at the highest rate from asthma in Pakistan at age 80+. It was least deadly to women at
age 20-24.
Breakdown of asthma risk factors in Pakistan
These risk factors contributed to, and were thought to be responsible for, an estimated 27.4% of the total
deaths caused by asthma in Pakistan during 2013.
Adjust the filters at the top of the visualization to see how which risk factors caused the highest mortality
for men and women of different age groups.
Asthma relative to other chronic respiratory diseases (Pakistan)
The three most deadly chronic respiratory diseases in Pakistan during 2013 were chronic obstructive
pulmonary disease, asthma, and pneumoconiosis respectively.
Though this was the trend in Pakistan overall, different demographic groups are affected differently and is
likely much different between men and women at different ages in life.
Polio
Description
Polio, also known as Poliomyelitis, is caused by one of three poliovirus (PV) serotypes belonging to the
Picornaviridae family. It is a highly contagious illness transmitted by close person to person contact, mainly
through the oral-fecal route – an infected person who does not practice proper hand or body hygiene passes
the infection to another person. It can also spread through infected saliva and respiratory system secretions.
Polioviruses grow in the intestinal system and are shed through feces. The infection typically spreads in
areas with poor water and sewage sanitation; wild poliovirus is found in this type of environment and puts
unvaccinated people at risk.
Risk
As a result of global eradication efforts, Polio is now only endemic in Afghanistan, Nigeria, and Pakistan.
However, countries with low vaccination rates continue to be at risk for re-introduction of the virus due to
imported cases resulting from travel. Unvaccinated travelers, especially children, pregnant women, and
those with a weakened immune system going to areas with Polio outbreaks are at risk.
Symptoms
In the majority of cases, the infection is asymptomatic – persons do not exhibit symptoms. Those that do
have very mild symptoms and the infection may go unnoticed. Symptoms include fever, headache, fatigue,
stiff neck, muscle pain, and vomiting. In some cases, the virus enters the bloodstream to attack the Central
Nervous System which causes paralysis, usually in the legs. This is also known as Acute Flaccid Paralysis
where the limbs become floppy. In severe cases, patients can become quadriplegic when the thorax and
abdomen muscles become paralyzed and have difficulty breathing, swallowing, or speaking. Post-Polio
Syndrome, characterized by muscle weakness, joint and muscle pain, and severe fatigue, can occur in
survivors 15 to 40 years after being exposed to the virus. Treatment includes supportive care of symptoms,
antispasmodic medication, physiotherapy, and even orthopedic surgery.
Impact of polio in Pakistan
Polio has had drastic effects on the health of the population of Pakistan and on the nation's healthcare
infrastructure and economy. The WHO estimates that 65–75% of polio cases in developing countries occur
in children under 3 years of age, with 95% of all cases occurring in children under 5 years of age.
Researchers at the School of Public Health at Johns Hopkins University quantified the disease burden of
various diseases in Pakistan; in the year 1990, a Pakistani person with polio averaged a loss of 1.13 healthy
life years to the disease. The duration of disability of polio, averaged over 1000 people, was 81.84 years,
the equivalent of diseases including diphtheria, childhood meningitis, and measles.
There has been limited research into the impacts of polio in Pakistan in recent years, but a 1988 health
survey found that the most common handicaps among polio sufferers were associated with mobility,
occupation, and social integration. The survey found differences in participants based on whether they lived
in a village or a slum area: there was a higher rate of handicap in the village population, and higher
frequencies of infectious, respiratory, and digestive diseases in the slum area. Both areas saw polio victims
suffer from a higher incidence of musculoskeletal system diseases, as well as infections of the ear, and
respiratory tract. Given 1–2 years with occupational therapists, 80% of patients with handicaps showed
improvement in function.
Prevention
Wash your hands thoroughly and frequently with soap and water. If not available, use an alcohol-based
hand sanitizer. Practice good body hygiene.
Vaccination
People of all ages should ensure that they are up-to-date with their polio vaccination. If you have been fully
vaccinated as a child, you should get a polio booster once as an adult. A primary vaccination series is
necessary for those not previously or only partially vaccinated. The inactivated injectable vaccine is
available in Canada and the USA and the live attenuated oral vaccine is available in some countries. Polio-
containing combination vaccines are also available for children. All provide life-time protection.

Malaria
There are approximately 500,000 cases of malaria in Pakistan per year so malaria is still a risk in Pakistan.
It is prominent throughout the country and malarial transmission occurs all year round. It is estimated that
around 12% of people who live in the rural areas of Pakistan carry the malarial parasite without showing
any symptoms, which is dangerous and so rapid diagnosis is desperately needed in this country.
All areas below 2500m are at risk of malaria. Rural areas are the most at risk due to lack of proper sanitation
in some of these areas. Flood affected areas also have an increased malarial transmission because the large
amounts of water provide a moist environment in which the mosquito thrives. The risk of malaria is greatest
in the July to August period but there is also a peak in October where transmission is at its highest.
The malaria parasites in Pakistan are Chloroquine resistant so this is not an effective malaria tablet in this
region of the world. You will usually be prescribed Mefloquine, Malarone or Doxycycline to protect you
from malaria and you need to complete your full course of tablets to ensure protection. However, malaria
tablets are not 100% protective. You will also need to see insect protection measures and these are essential,
as you want to avoid being bitten as much as possible. Sleep in an air-conditioned room with the doors and
windows shut at all times. If this is not possible, you will need to sleep under a mosquito net. You will also
need to use insect repellent and wear long sleeves to cover as much of your skin as possible. Stay indoors
between dusk and dawn, as this is the time in which the mosquitoes are most active.

Tuberculosis
Description
Tuberculosis (TB) is an air bone bacterial infection caused by Mycobacterium tuberculosis. TB can be
acquired by breathing contaminated air droplets coughed or sneezed by a person nearby who has active
Tuberculosis. Humans can also get ill with TB by ingesting unpasteurized milk products contaminated with
Mycobacterium bovis, also known as Bovine Tuberculosis. The most common form of the infection is
pulmonary TB which affects the lungs. In some cases, the bacteria can also attack the lymphatic system,
central nervous system, urogenital area, joints, and bones.
Risk
Mycobacterium tuberculosis is present worldwide and typically spreads in cramped, overcrowded
conditions. There is no evidence that pulmonary TB is more easily transmitted in airplanes or other forms
of public transportation. Long-term travelers, those with a weakened immune system or visiting friends and
relatives (VFR travelers) in areas where Tuberculosis is endemic are at risk. Humanitarian and healthcare
personnel working in communities with active TB are also at increased risk. Persons with active TB should
not travel.
Symptoms
The majority of persons with the illness (90% to 95%) have latent TB infection (LTBI) and do not exhibit
any symptoms. The bacteria can remain inactive for many years and the chance of developing active TB
diminishes over time.
Persons with active TB have symptoms which include excessive coughing (sometimes with blood), chest
pain, and general weakness, lack of appetite, weight loss, swollen lymph glands, fever, chills, and night
sweats. It can be misdiagnosed for bronchitis or pneumonia. If untreated, active TB can fatal.
Tuberculosis treatment involves taking antibiotics for a minimum of 6 months. Drug-resistant TB is a major
concern as an increasing number of people are no longer able to be treated with previously effective drugs.
Due to misuse of antibiotic therapies, patients can develop multi-drug resistant Tuberculosis (MDR TB).
When a second line of antibiotics fail to cure the multi-drug resistant infection, it is known as extensively
drug-resistant Tuberculosis (XDR TB).
Prevention

 Avoid exposure to people known to who have active Tuberculosis.

 Only consume pasteurized milk products.
 Travelers at higher risk should have a pre-departure tuberculin skin test (TST) and be re-tested
upon their return home.
 Those at increased risk should also consult their healthcare provider to determine if the Bacillus
Calmette-Guérin (BCG) vaccine is recommended.

Typhoid Fever
Description
Typhoid Fever is a gastrointestinal infection caused by Salmonella enterica typhi bacteria. It is transmitted
from person to person through the fecal-oral route where an infected or asymptomatic individual (who does
not exhibit symptoms) with poor hand or body hygiene passes the infection to another person when handling
food and water. The bacteria multiply in the intestinal tract and can spread to the bloodstream. Paratyphoid
fever, a similar illness, is caused by Salmonella enterica paratyphoid A, B, and C.
Risk
The bacteria are present in many Southeast Asian countries as well as in Africa, Central and South America,
and Western Pacific countries in areas where there is poor water and sewage sanitation. Floods in these
regions can also quickly spread the bacteria. All travelers going to endemic areas are at risk, especially
long-term travelers, adventure travelers, humanitarian workers, and those visiting friends or relatives in
areas with poor sanitation. Note that original infection does not provide immunity to subsequent infections.
Symptoms
Usually symptoms appear 1 to 3 weeks after exposure to the bacteria. Depending on the virulence of the
infection symptoms can range from mild to severe. The illness is characterized by extreme fatigue and
increasing fever. Other symptoms include headache, lack of appetite, malaise, and an enlarged liver.
Sometimes patients have diarrhea, constipation, or a rash on their trunk. Severe symptoms may appear 2 to
3 weeks after onset of the illness and may include intestinal hemorrhage or perforation. Some people who
recover from Typhoid Fever and Paratyphoid Fever continue to be carriers of the bacteria and can
potentially infect others. Treatment includes antibiotics and supportive care of symptoms. Antibiotic
resistance to S. typhi is increasing worldwide.
Prevention
Wash your hands frequently and thoroughly, and practice proper body hygiene. Drink purified water (boiled
or unhampered bottled water) and only eat well cooked foods. Use the mantra Boil it, Cook it, Peel it, or
forget it!
Vaccination
There are two types of vaccines available; the inactivated injectable vaccine (lasting 2-3 years) and the live
attenuated oral vaccine (lasting 5-7 years). Discuss your best options with your healthcare provider,
including revaccination schedules which differ in the USA and Canada. A combined Typhoid Fever and
Hepatitis A vaccine is also available in Canada and Europe. Although Typhoid Fever vaccines do not
provide 100% protection, they will reduce the severity of the illness. There is no vaccine available against
Paratyphoid Fever.

Pneumonia
Pneumonia is one such debilitating lung disease. The lung is inflamed by either bacteria or virus and rare
parasites. The alveolar sacs are filled with pus and solidify in case of severe chronic disease. Inflammation
might be present in both or a single lung, depending upon the severity of the disease.
Causes
Deciding the severity of pneumonia depends on risk factors. The cause of lung infection is important
because the treatment depends on that. Different organisms cause pneumonia of different severity. The age
of the patient is also a risk factor. Infants and children till age two, and geriatrics are more at risk of high
severity pneumonia.
Patient’s general health also matters; if they have any other disease, whether they are immune-compromised
due to AIDS, cancer, diabetes etc. or an already existing lung or heart disease also predisposes patients to
pneumonia. Drug abusers are also at higher risk than normal population.
Pakistani citizens who do not have proper homes are also included in high risk groups. This includes people
living on the road side constantly inhaling smoke from vehicles, earthquake victims who recently lost their
homes and are now dependent on donation from others. They are more likely to suffer from pneumonia as
they can catch cold because of the drop in temperature during winters. Colds and flu often lead to bacterial
infection and pneumonia.
Symptoms
No one is a hundred percent immune to pneumonia. The bacteria present in the air can invade anyone with
high risk of acquiring the disease. As previously mentioned, the severity of the disease depends on the risk
factors; it is determined by the symptoms.
Symptoms can be mild to severe. Mild symptoms look like a common cold or flu but last much longer. It
includes high grade fever accompanied by sweating and chills. Coughing occurs with expulsion of phlegm.
Most importantly, there is difficulty in breathing. There is chest pain, shortness of breath and it requires
more effort, leaving the patient feeling fatigued. It is also sometimes accompanied by nausea, vomiting and
diarrhea.
Newborns and infants are often diagnosed a little late in the course of the disease as they do not show
symptoms during mild disease. Fever, cough and chest congestion appear later. They may appear restless
and dull, display lack of energy and refuse feed. Older people, on the other hand, may have lower body
temperature. They may show sudden alteration in mental awareness.
If you are having any of the symptoms specifically chest congestion, coughing up pus with persistent fever,
you should see your doctor. People at higher risk of acquiring the disease should see the doctor immediately
as it is a medical emergency as it may rapidly become a life threatening situation.
Pakistan Synopsis
No disease kills more children aged less than five years than pneumonia, not least in Pakistan where one-
fifth of the population is in this age group. The estimated figures reflected in many Pakistani studies tells
us that the [annual] incidence of ARI [acute respiratory infection] in Pakistani children aged less than five
years is 4% in the community a group constituting roughly 22% of the country’s population of 160 million.
Taking this 4% figure, we can calculate that there are 15 million episodes of ARI every year among under-
fives.
Vaccination and Prevention
Preventing pneumonia in children is an essential component of National Immunization Strategy to reduce
child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the
most effective way to prevent pneumonia. Pneumococcus is a germ that is responsible for causing most
cases of severe pneumonia, and many cases of meningitis and blood stream infections in children in
Pakistan. Infection by this germ is preventable by vaccine, which is given as a shot to infants and toddlers.
It helps prevent pneumococcal disease, and also stops the disease from spreading from person to person.
Three doses of this vaccine are given in the first year, preferably at 6 weeks, 10 weeks and 14 weeks of age,
and the fourth dose is given at 15 months of age. If the vaccine is not given at above ages, it can be given
later as well.

Dengue fever
Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin
three to fourteen days after infection. This may include a high fever, headache, vomiting, muscle and joint
pains, and a characteristic skin rash. Recovery generally takes two to seven days. In a small proportion of
cases, the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low
levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low
blood pressure occurs. Dengue is spread by several species of mosquito of the Aedes type, principally. The
virus has five different types; infection with one type usually gives lifelong immunity to that type, but only
short-term immunity to the others. Subsequent infection with a different type increases the risk of severe
complications. A number of tests are available to confirm the diagnosis including detecting antibodies to
the virus or its RNA.
A novel vaccine for dengue fever has been approved and is commercially available in a number of
countries. Other methods of prevention are by reducing mosquito habitat and limiting exposure to bites.
This may be done by getting rid of or covering standing water and wearing clothing that covers much of
the body. Treatment of acute dengue is supportive and includes giving fluid either by mouth
or intravenously for mild or moderate disease. For more severe cases blood transfusion may be
required. About half a million people require admission to hospital a year. Nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen should not be used.
SIGNS AND SYMPTOMS:
Typically, people infected with dengue virus are asymptomatic (80%) or have only mild symptoms such as
an uncomplicated fever. Others have more severe illness (5%), and in a small proportion, it is life-
threatening. The incubation period (time between exposure and onset of symptoms) ranges from 3 to 14
days, but most often it is 4 to 7 days.]Therefore, travelers returning from endemic areas are unlikely to have
dengue if fever or other symptoms start more than 14 days after arriving home. Children often experience
symptoms similar to those of the common cold and gastroenteritis (vomiting and diarrhea) and have a
greater risk of severe complications, though initial symptoms are generally mild but include high fever.

Cholera
Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even
death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio
cholera.
Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems
eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the
U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in
the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. At least 150,000
cases are reported to the World Health Organization each year.
The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations
include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing
the following cholera facts can help protect you and your family.
Cholera Causes
Vibrio cholera, the bacterium that causes cholera, is usually found in food or water contaminated by feces
from a person with the infection. Common sources include:

 Municipal water supplies

 Ice made from municipal water
 Foods and drinks sold by street vendors
 Vegetables grown with water containing human wastes
 Raw or undercooked fish and seafood caught in waters polluted with sewage
When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that
produces severe diarrhea.
It is not likely you will catch cholera just from casual contact with an infected person.
Cholera Symptoms
Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often,
symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe
watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected
people may have minimal or no symptoms, they can still contribute to spread of the infection.
Signs and symptoms of dehydration include:

 Rapid heart rate

 Loss of skin elasticity (the ability to return to original position quickly if pinched)
 Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
 Low blood pressure
 Thirst
 Muscle cramps
If not treated, dehydration can lead to shock and death in a matter of hours.
Cholera Treatment and Prevention
Although there is a vaccine against cholera, the CDC and World Health Organization do not normally
recommend it, because it may not protect up to half of the people who receive it and it lasts only a few
months. However, you can protect yourself and your family by using only water that has been boiled, water
that has been chemically disinfected or bottled water. Be sure to use the bottled, boiled, or chemically
disinfected water for the following purposes:

 Drinking
 Preparing food or drinks
 Making ice
 Brushing your teeth
 Washing your face and hands
 Washing dishes and utensils that you use to eat or prepare food

Jaundice
Jaundice is a yellow discoloration of the skin, mucous membranes, and the whites of the eyes caused by
increased amounts of bilirubin in the blood. Jaundice is a sign of an underlying disease process .Bilirubin
is a by-product of the daily natural breakdown and destruction of red blood cells in the body.
The hemoglobin molecule that is released into the blood by this process is split, with the portion undergoing
a chemical conversion to bilirubin. Normally, the liver metabolizes and excretes the bilirubin in the form
of bile. However, if there is a disruption in this normal metabolism and/or production of bilirubin, jaundice
may result.
What Causes Jaundice?
Several different disease processes may cause jaundice. It is helpful to understand the different causes of
jaundice by identifying the problems that disrupt the normal bilirubin metabolism and or excretion.
Pre-hepatic (before bile is made in the liver)
Jaundice in these cases is caused by rapid increase in the breakdown and destruction of the red blood cells
(hemolysis), overwhelming the liver's ability to adequately remove the increased levels of bilirubin from
the blood.
Examples of conditions with increased breakdown of red blood cells include:

 malaria,
 sickle cell crisis,
 spherocytosis,
  thalassemia,
 glucose-6-phosphate dehydrogenase deficiency (G6PD),
 drugs or other toxins, and
 autoimmune disorders.
Hepatic (the problem arises within the liver)
Jaundice in these cases is caused by the liver's inability to properly metabolize and excrete bilirubin.
Examples include:

 hepatitis (commonly viral or alcohol related),

 cirrhosis,
 drugs or other toxins,
 Crigler-Najjar syndrome,
 Gilbert's syndrome, and
 cancer
Post-hepatic (after bile has been made in the liver)
Jaundice in these cases, also termed obstructive jaundice, is caused by conditions which interrupt the normal
drainage of conjugated bilirubin in the form of bile from the liver into the intestines.

Causes of obstructive jaundice include:

 gallstones in the bile ducts,

 cancer (pancreatic and gallbladder/bile duct carcinoma),
 strictures of the bile ducts,
 cholangitis,
 congenital malformations,
 pancreatitis,
 parasites,
 pregnancy, and
 newborn jaundice.
Jaundice in newborn babies can be caused by several different conditions, although it is often a normal
physiological consequence of the newborn's immature liver. Even though it is usually harmless under these
circumstances, newborns with excessively elevated levels of bilirubin from other medical conditions
(pathologic jaundice) may suffer devastating brain damage (kernicterus) if the underlying problem is not
addressed. Newborn jaundice is the most common condition requiring medical evaluation in newborns.
The following are some common causes of newborn jaundice:

 Physiological jaundice
 Maternal-fetal blood group incompatibility (Rh, ABO)
 Breast milk jaundice
 Breastfeeding jaundice
Cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other
parts of the body. Not all tumors are cancerous; benign tumors do not spread to other parts of the body.
Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight
loss and a change in bowel movements. While these symptoms may indicate cancer, they may have other
causes. Over 100 types of cancers affect humans. Tobacco use is the cause of about 22% of cancer deaths.
Another 10% is due to obesity, poor diet, lack of physical activity, and excessive drinking of alcohol. Other
factors include certain infections, exposure to ionizing radiation and environmental pollutants. In
the developing world nearly 20% of cancers are due to infections such as hepatitis B, hepatitis C and human
papillomavirus infection. These factors act, at least partly, by changing the genes of a cell. Typically many
genetic changes are required before cancer develops. Approximately 5–10% of cancers are due to inherited
genetic defects from a person's parents. Cancer can be detected by certain signs and symptoms or screening
tests. It is then typically further investigated by medical imaging and confirmed by biopsy.
Many cancers can be prevented by not smoking, maintaining a healthy weight, not drinking too
much alcohol, eating plenty of vegetables, fruits and whole grains, vaccination against certain infectious
diseases, not eating too much processed and red meat, and avoiding too much sunlight exposure. Early
detection through screening is useful for cervical and colorectal cancer. The benefits of screening in breast
cancer are controversial. Cancer is often treated with some combination of radiation
therapy, surgery, chemotherapy, and targeted therapy. Pain and symptom management are an important
part of care. Palliative care is particularly important in people with advanced disease. The chance of
survival depends on the type of cancer and extent of disease at the start of treatment. In children under 15
at diagnosis the five-year survival rate in the developed world is on average 80%. For cancer in the United
States the average five-year survival rate is 66%.
Signs and symptoms
When cancer begins, it produces no symptoms. Signs and symptoms appear as the mass grows or ulcerates.
The findings that result depend on the cancer's type and location. Few symptoms are specific. Many
frequently occur in individuals who have other conditions. Cancer is a "great imitator". Thus, it is common
for people diagnosed with cancer to have been treated for other diseases, which were hypothesized to be
causing their symptoms
People may become anxious or depressed post-diagnosis. The risk of suicide in people with cancer is
approximately double.
Local symptoms
Local symptoms may occur due to the mass of the tumor or its ulceration. For example, mass effects
from lung cancer can block the bronchus resulting in cough or pneumonia; esophageal cancer can cause
narrowing of the esophagus, making it difficult or painful to swallow; and colorectal cancer may lead to
narrowing or blockages in the bowel, affecting bowel habits. Masses in breasts or testicles may produce
observable lumps. Ulceration can cause bleeding that, if it occurs in the lung, will lead to coughing up
blood, in the bowels to anemia or rectal bleeding, in the bladder to blood in the urine and in the uterus to
vaginal bleeding. Although localized pain may occur in advanced cancer, the initial swelling is usually
painless. Some cancers can cause a buildup of fluid within the chest or abdomen.
Systemic symptoms
General symptoms occur due to effects that are not related to direct or metastatic spread. These may
include: unintentional weight loss, fever, excessive fatigue and changes to the skin. Hodgkin
disease, leukemias and cancers of the liver or kidney can cause a persistent fever.Some cancers may cause
specific groups of systemic symptoms, termed paraneoplastic syndrome. Examples include the appearance
of myasthenia gravis and clubbing in lung cancer.
Causes
The majority of cancers, some 90–95% of cases, are due to environmental factors. The remaining 5–10%
are due to inherited genetics. Environmental, as used by cancer researchers, means any cause that is
not inherited genetically, such as lifestyle, economic and behavioral factors and not merely pollution.
Common environmental factors that contribute to cancer death include tobacco (25–30%), diet
and obesity (30–35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to 10%), stress,
lack of physical activity and pollution.
It is not generally possible to prove what caused a particular cancer because the various causes do not have
specific fingerprints. For example, if a person who uses tobacco heavily develops lung cancer, then it was
probably caused by the tobacco use, but since everyone has a small chance of developing lung cancer as a
result of air pollution or radiation, the cancer may have developed for one of those reasons. Excepting the
rare transmissions that occur with pregnancies and occasional organ donors, cancer is generally not
a transmissible disease.

Rabies
Key facts

 Rabies is a vaccine-preventable viral disease which occurs in more than 150 countries and
territories.
 Dogs are the main source of human rabies deaths, contributing up to 99% of all rabies
transmissions to humans.
 Rabies elimination is feasible through vaccination of dogs and prevention of dog bites.
 Infection causes tens of thousands of deaths every year, mostly in Asia and Africa.
 40% of people bitten by suspect rabid animals are children under 15 years of age.
 Immediate, thorough wound cleansing with soap and water after contact with a suspect rabid
animal is crucial and can save lives.
 WHO, the World Organisation for Animal Health (OIE), the Food and Agriculture
Organization of the United Nations (FAO) and the Global Alliance for Rabies Control have set a global
target of “zero human rabies deaths by 2030”
Rabies is an infectious viral disease that is almost always fatal following the onset of clinical symptoms. In
up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. Yet, rabies can
affect both domestic and wild animals. It is spread to people through bites or scratches, usually via saliva.
Rabies is present on all continents, except Antarctica, with over 95% of human deaths occurring in the Asia
and Africa regions.
Rabies is one of the neglected tropical diseases that predominantly affects poor and vulnerable populations
who live in remote rural locations. Although effective human vaccines and immunoglobulins exist for
rabies, they are not readily available or accessible to those in need. Globally, rabies deaths are rarely
reported and children between the ages of 5–14 years are frequent victims. Treating a rabies exposure,
where the average cost of rabies post-exposure prophylaxis (PEP) is US$ 40 in Africa and US$ 49 in Asia,
can be a catastrophic financial burden on affected families whose average daily income is around US$ 1–2
per person.
Every year, more than 15 million people worldwide receive a post-bite vaccination. This is estimated to
prevent hundreds of thousands of rabies deaths annually.
Prevention
Rabies is a vaccine-preventable disease. Vaccinating dogs is the most cost-effective strategy for preventing
rabies in people. Dog vaccination reduces deaths attributable to rabies and the need for PEP as a part of dog
bite patient care.

 Awareness on rabies and preventing dog bites

 Preventive immunization in people

Symptoms
The incubation period for rabies is typically 1–3 months but may vary from 1 week to 1 year, dependent
upon factors such as the location of virus entry and viral load. Initial symptoms of rabies include a fever
with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound
site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and
spinal cord develops.
There are two forms of the disease:
1. People with furious rabies exhibit signs of hyperactivity, excitable behavior, hydrophobia (fear
of water) and sometimes aerophobia (fear of drafts or of fresh air). Death occurs after a few
days due to cardio-respiratory arrest.
2. Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies
runs a less dramatic and usually longer course than the furious form. Muscles gradually become
paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually
death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-
reporting of the disease.
Diagnosis
Current diagnostic tools are not suitable for detecting rabies infection before the onset of clinical disease,
and unless the rabies-specific signs of hydrophobia or aerophobia are present, clinical diagnosis may be
difficult. Human rabies can be confirmed intra-vitam and post mortem by various diagnostic techniques
that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin, urine, or saliva).
Transmission
People are usually infected following a deep bite or scratch from an animal with rabies, and transmission
to humans by rabid Dogs accounts for 99% of cases. Africa and Asia have the highest rabies burden in
humans and account for 95% of rabies deaths, worldwide.
In the Americas, bats are now the major source of human rabies deaths as dog-mediated transmission has
mostly been broken in this region. Bat rabies is also an emerging public health threat in Australia and
Western Europe. Human deaths following exposure to foxes, raccoons, skunks, jackals, mongooses and
other wild carnivore host species are very rare, and bites from rodents are not known to transmit rabies.
Transmission can also occur when infectious material – usually saliva – comes into direct contact with
human mucosa or fresh skin wounds. Human-to-human transmission through bites is theoretically possible
but has never been confirmed.
Contraction of rabies through inhalation of virus-containing aerosols or through transplantation of infected
organs is rare. Contracting rabies through consumption of raw meat or animal-derived tissue has never been
confirmed in humans.
Post-exposure prophylaxis (PEP)
Post-exposure prophylaxis (PEP) is the immediate treatment of a bite victim after rabies exposure. This
prevents virus entry into the central nervous system, which results in imminent death. PEP consists of:

 extensive washing and local treatment of the wound as soon as possible after exposure;
 a course of potent and effective rabies vaccine that meets WHO standards; and
 The administration of rabies immunoglobulin (RIG), if indicated.
Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.
Extensive wound washing
This involves first-aid of the wound that includes immediate and thorough flushing and washing of the
wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances
that kill the rabies virus.

Hepatitis C
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver.
During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine,
abdominal pain, and yellow tinged skin occurs. The virus persists in the liver in about 75% to 85% of those
initially infected. Early on chronic infection typically has no symptoms. Over many years however, it often
leads to liver disease and occasionally cirrhosis. In some cases, those with cirrhosis will develop
complications such as liver failure, liver cancer, or esophageal and gastric variances.
HCV is spread primarily by blood-to-blood contact associated with intravenous drug use, poorly sterilized
medical equipment, needlestick injuries in healthcare, and transfusions. Using blood screening, the risk
from a transfusion is less than one per two million. It may also be spread from an infected mother to her
baby during birth. It is not spread by superficial contact. It is one of five known hepatitis viruses: A, B,
C, D, and E. Diagnosis is by blood testing to look for either antibodies to the virus or its RNA. Testing is
recommended in all people who are at risk.
There’s no vaccine against hepatitis C. Prevention includes harm reduction efforts among people who use
intravenous drugs and testing donated blood. Chronic infection can be cured about 90% of the time with
treatments that include the medications sofosbuvir or simeprevir. Previous to this a combination
of peginterferon and ribavirin was used which had a cure rate around 50% and greater side effects. Getting
access to the newer treatments however can be expensive. Those who develop cirrhosis or liver cancer may
require a liver transplant. Hepatitis C is the leading reason for liver transplantation, though the virus usually
recurs after transplantation.
An estimated 143 million people (2%) worldwide are infected with hepatitis C as of 2015. In 2013 about
11 million new cases occurred. It occurs most commonly in Africa and Central and East Asia. About
167,000 deaths due to liver cancer and 326,000 deaths due to cirrhosis occurred in 2015 due to hepatitis
C. The existence of hepatitis C – originally identifiable only as a type of non-A non-B hepatitis – was
suggested in the 1970s and proven in 1989. Hepatitis C infects only humans and chimpanzees.
Signs and symptoms
Acute infection
Hepatitis C infection causes acute symptoms in 15% of cases. Symptoms are generally mild and vague,
including a decreased appetite, fatigue, nausea, muscle or joint pains, and weight loss and rarely does acute
liver failure result. Most cases of acute infection are not associated with jaundice. The infection resolves
spontaneously in 10–50% of cases, which occurs more frequently in individuals who are young and female.
Chronic infection
About 80% of those exposed to the virus develop a chronic infection. This is defined as the presence of
detectable viral replication for at least six months. Most experience minimal or no symptoms during the
initial few decades of the infection. Chronic hepatitis C can be associated with fatigue and mild cognitive
problems. Chronic infection after several years may cause cirrhosis or liver cancer. The liver enzymes are
normal in 7–53%. Late relapses after apparent cure have been reported, but these can be difficult to
distinguish from reinfection.
Fatty changes to the liver occur in about half of those infected and are usually present before cirrhosis
develops. Usually (80% of the time) this change affects less than a third of the liver. Worldwide hepatitis
C is the cause of 27% of cirrhosis cases and 25% of hepatocellular carcinoma. About 10–30% of those
infected develop cirrhosis over 30 years. Cirrhosis is more common in those also infected with hepatitis
B, schistosoma, or HIV, in alcoholics and in those of male gender. In those with hepatitis C, excess alcohol
increases the risk of developing cirrhosis 100-fold. Those who develop cirrhosis have a 20-fold greater risk
of hepatocellular carcinoma. This transformation occurs at a rate of 1–3% per year. Being infected with
hepatitis B in addition to hepatitis C increases this risk further.
Liver cirrhosis may lead to portal hypertension, ascites (accumulation of fluid in the abdomen), easy
bruising or bleeding, varices (enlarged veins, especially in the stomach and esophagus), jaundice, and a
syndrome of cognitive impairment known as hepatic encephalopathy. Ascites occurs at some stage in more
than half of those who have a chronic infection.
Extrahepatic complications
The most common problem due to hepatitis C but not involving the liver is
mixed cryoglobulinemia (usually the type II form) — an inflammation of small and medium-sized blood
vessels. Hepatitis C is also associated with the autoimmune disorder Sjögren's syndrome, a low platelet
count, lichen planus, porphyria cutanea tarda, necrolytic acral erythema, insulin resistance, diabites
mellitus, diabetic nephropathy, autoimmune thyroiditis, and B-cell lymphoproliferative disorders. 20–30%
of people infected have rheumatoid factor — a type of antibody. Possible associations include Hyde's
prurigo nodularis and membranoproliferative glomerulonephritis. Cardiomyopathy with
associated abnormal heart rhythms has also been reported. A variety of central nervous system disorders
has been reported. Chronic infection seems to be associated with an increased risk of pancreatic cancer.
Occult infection
Persons who have been infected with hepatitis C may appear to clear the virus but remain infected. The
virus is not detectable with conventional testing but can be found with ultra-sensitive tests. The original
method of detection was by demonstrating the viral genome within liver biopsies, but newer methods
include an antibody test for the virus' core protein and the detection of the viral genome after first
concentrating the viral particles by ultracentrifugation. A form of infection with persistently moderately
elevated serum liver enzymes but without antibodies to hepatitis C has also been reported. This form is
known as cryptogenic occult infection.
Several clinical pictures have been associated with this type of infection. It may be found in people with
anti-hepatitis-C antibodies but with normal serum levels of liver enzymes; in antibody-negative people with
ongoing elevated liver enzymes of unknown cause; in healthy populations without evidence of liver disease;
and in groups at risk for HCV infection including those on hemodialysis or family members of people with
occult HCV. The clinical relevance of this form of infection is under investigation. The consequences of
occult infection appear to be less severe than with chronic infection but can vary from minimal to
hepatocellular carcinoma.
The rate of occult infection in those apparently cured is controversial but appears to be low. 40% of those
with hepatitis but with both negative hepatitis C serology and the absence of detectable viral genome in the
serum have hepatitis C virus in the liver on biopsy.[44] How commonly this occurs in children is unknown.
Virology
The hepatitis C virus (HCV) is a small, enveloped, single-stranded, positive-sense RNA virus. It is a
member of the Hepacivirus genus in the family Flaviviridae. There are seven major genotypes of HCV,
which are known as genotypes one to seven. The genotypes are divided into several subtypes with the
number of subtypes depending on the genotype. In the United States, about 70% of cases are caused by
genotype 1, 20% by genotype 2 and about 1% by each of the other genotypes. Genotype 1 is also the most
common in South America and Europe.
The half life of the virus particles in the serum is around 3 hours and may be as short as 45 minutes. In an
infected person, about 1012 virus particles are produced each day. In addition to replicating in the liver the
virus can multiply in lymphocytes.
Diagnosis
There are a number of diagnostic tests for hepatitis C, including HCV antibodyenzyme immunoassay or
ELISA, recombinant immunoblot assay, and quantitative HCV RNA polymerase chain
reaction (PCR). HCV RNA can be detected by PCR typically one to two weeks after infection, while
antibodies can take substantially longer to form and thus be detected.
Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months
based on the presence of its RNA. Chronic infections are typically asymptomatic during the first few
decades, and thus are most commonly discovered following the investigation of elevated liver enzyme
levels or during a routine screening of high-risk individuals. Testing is not able to distinguish between acute
and chronic infections. Diagnosis in the infant is difficult as maternal antibodies may persist for up to 18
months.
  Serology
 Biopsy
 Screening
 Prevention
Treatment
HCV induces chronic infection in 50–80% of infected persons. Approximately 40–80% of these clear with
treatment. In rare cases, infection can clear without treatment. Those with chronic hepatitis C are advised
to avoid alcohol and medications toxic to the liver, and to be vaccinated for hepatitis A and hepatitis
B. Ultrasound surveillance for hepatocellular carcinoma is recommended in those with accompanying
cirrhosis.

Medications
Treatment with antiviral medication is recommended in all people with proven chronic hepatitis C who are
not at high risk of dying from other causes. People with the highest complication risk should be treated first,
with the risk of complications based on the degree of liver scarring. The initial recommended treatment
depends on the type of hepatitis C virus with which a person is infected.