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A joint workshop aimed at reducing blindness due to diabetes
Diabetes mellitus is becoming a major public health problem worldwide, including in the WHO Eastern Mediterranean Region. Due to the lack of physical activity as well as dietary changes, the incidence of diabetes is increasing at an alarming rate. Diabetes affects more than 230 million people worldwide. If the current trend continues, 370 million people worldwide are expected to have diabetes by the year 2030.
In the WHO Eastern Mediterranean Region the numbers are alarming, especially in Gulf Cooperation Council and Arab states (15%–25%). Diabetic retinopathy is the most common complication of diabetes and a leading cause of visual loss in the working age group. People with diabetes are estimated to be 25 times more likely to develop blindness than people without diabetes.
It has been estimated that at any given time, 33% of the total diabetic population will suffer from some form of diabetic retinopathy, and a third of these will have sight-threatening complications. The recognition of diabetic retinopathy in its earlier, asymptomatic stages is important, and can save many eyes from blindness. Available data in many randomized clinical trials have proven that the risk of visual impairment and blindness is substantially reduced by a care programme that combines methods for early detection with effective treatment with laser photocoagulation.
Many studies have observed that early detection and treatment of diabetic retinopathy is hampered by the lack of awareness among diabetic patients about the potential of sight threatening eye complications and poor compliance with periodic eye examinations. Thus, prevention of visual disability from diabetic retinopathy must go beyond the purely clinical domain to include patient education and early detection, including screening of target populations. Screening priority should be given to known diabetic populations. Effective detection and management of diabetic retinopathy can be accomplished only with the full cooperation of all members of the diabetic care provider team.
Aware of these facts, concerned international agencies such as WHO, the International Agency for Prevention of Blindness and IMPACT/EMR along with the International Diabetic Federation and others are working to develop a regional strategy to prevent loss of sight due to diabetes. To this effect, a workshop will be held at the WHO Regional Office for the Eastern Mediterranean from 20 to 22 November 2006. The workshop will be attended by HRH Prince Abdel Aziz Bin Ahmed Al Saud, Regional Chairperson of IMPACT/EMR and IAPB, and H.E. Dr Hatem El-Gabali, Minister of Health and Population, Egypt along with Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean. The workshop will focus on patient education and early detection as well as screening of target populations and integrating diabetic care provider team into the management system of diabetic retinopathy.
Participants in the workshop will include experts from 14 countries with a known burden of diabetes: Bahrain, Egypt, Islamic Republic of Iran, Iraq, Jordan, Lebanon, Libyan Arab Jamahiriya, Morocco, Pakistan, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia and Yemen. Also attending are representatives from WHO collaborating centres and regional and international nongovernmental organizations, such as IMPACT/EMR, IAPB, International Diabetes Federation, Al-Noor Foundation, Lions Clubs International Foundation, Sight Savers International, The Fred Hollows Foundation, Al-Bassar International Foundation, Al Manhal Charitable Organization, Layton Rahmatullah Benevolent Trust, Al-Shifa Trust Eye Hospital, King Khaled Eye Specialist Hospital, Federation Of Islamic Medical Association and Arab Medical Union.
“Prevention of blindness due to diabetic retinopathy is an important issue and a priority area in need of urgent attention from all of us, we need to work together as team to fight blindness”, notes Dr Gezairy. Diabetes and sight threatening complications pose health and financial burdens on countries affected by high diabetes prevalence. For example, such conditions cost Saudi Arabia more than US$ 400 million a year. Recently, the WHO Regional Office in collaboration with HRH Prince Abdulaziz Bin Ahmed Al Saud held a workshop in Qatar on prevention of sight loss from diabetic retinopathy in the Member State of the Gulf Cooperation Council.
Many countries of the Region, including Egypt, are currently focusing greater attention on preventing blindness, including diabetes-related blindness. H.E. Mrs Suzanne Mubarak, First Lady of Egypt, is patronizing the avoidable blindness programme VISION2020 “Right to Sight” under her direct auspices.
The most important message of the workshop is that “unless we pay urgent attention to primary prevention, diet, physical activity, tight blood glucose control and tight blood pressure control, blindness due to diabetes will continue to rise”.
World AIDS Day 2006
The World Health Organization has warned that the coverage rate of antiretroviral therapy in the Eastern Mediterranean Region is the lowest among the six WHO regions. Only 5% of people who need this therapy are receiving it, despite the fact that the therapy is now available and has been recognized to dramatically improve survival of HIV-infected individuals.
In the context of the global AIDS campaign 2006 and on the occasion of World AIDS Day, observed annually on 1 December, a media kit will be issued by the WHO Regional Office for the Eastern Mediterranean. This kit shows that the HIV epidemic is building in the Eastern Mediterranean Region, with the estimated number of people living with HIV approaching 620 000, 100 000 of whom were infected in 2005 alone.
An estimated 75 000 people in the Eastern Mediterranean Region need antiretroviral therapy; however, only 4000 are receiving it. In December 2005, 1.3 million people in developing countries around the world were receiving antiretroviral therapy, compared with only 400 000 in December 2003. This improvement is attributed to the impact of the 3×5 Initiative, a global collaborative effort initiated by WHO and its partners in 2003 in recognition of the success of antiretroviral therapy.
The target of 3×5 Initiative was to treat with antiretroviral therapy 3 million people, or 50% of those needing treatment, by the end of 2005. Although only 20% of those in need were reached, the initiative created enormous momentum for scaling up prevention and treatment. Drawing on this momentum, a new global initiative is now being undertaken: the Universal Access Initiative. In line with this new initiative, the slogan “towards HIV prevention, treatment and care for all” was chosen by WHO as the regional slogan for the global AIDS campaign 2006. Five strategic priorities were set for achieving universal access to prevention, treatment and care in the health sector: expanding access to HIV testing and counselling, delivering preventive services in health care settings, improving prevention and management of opportunistic infections, tackling weaknesses in health services that were brought to light by the 3×5 Initiative and improving the availability and quality of information on the HIV epidemic in all countries.
As of mid 2006, 25 years have passed since the first cases of AIDS were reported. During that period, over 65 million people were infected with HIV, and 25 million died. In 2005, around 47 000 people died of AIDS in the Eastern Mediterranean Region and 2.8 million died worldwide.
The majority of HIV infections in the Region are due to heterosexual transmission. Injecting drug use is becoming an important mode of transmission, and almost all countries in the Region have reported HIV transmission among injecting drug users.
Nevertheless, the chances for controlling the epidemic are better now. In 2005, the leaders of the G8 group of industrialized countries made a commitment to “working with WHO, UNAIDS and other international bodies to develop a package of HIV prevention, treatment and care, with the aim of as close as possible universal access to treatment for those who need it by 2010”.
Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, believes the coming period will witness bring success in expanding antiretroviral coverage in the Region, as well as in delivery of prevention and care services for people living with HIV. This success will lead to more successes. But we have to remember that success is never achieved without continuous work, extensive efforts, strong partnership and proper planning.
The Regional Office has developed a regional strategic plan for strengthening health sector response to HIV/AIDS in 2006–2010. By implementing this strategy, national HIV/AIDS programme managers will work to strengthen and expand prevention, treatment and care towards achieving the goal of universal access.
Delayed polio immunization campaign gets underway in Iraq
A national polio immunization drive to protect 4.2 million Iraqi children was launched on the 12th of November by the Iraq Ministry of Health in collaboration World Health Organization (WHO) and UNICEF, after being postponed for a week because of security concerns.
The polio National Immunization Days (NIDs) will send over 5400 mobile vaccinators house-to-house across the country to immunize every child under five in a bid to maintain Iraq’s polio-free status. UNICEF has supplied five million doses of oral polio vaccine (OPV) for the campaigns and is assisting transport and communication efforts to help vaccinators reach children in Iraq’s most remote and insecure areas. The World Health Organization (WHO) has provided vital support for planning and training of local health staff and volunteers in additions to incentives for vaccination teams and supervisors.
Some parts of northern Iraq that were able to launch the campaign last Sunday as scheduled are reporting a high turnout. WHO Iraq Country representative who is leading the United Nations Health Cluster for Iraq, traveled to Irbil during the period 7-9 November to support the efforts of the Iraq Ministry of health in ensuring the quality and monitoring the National immunization days (NIDs).
This is Iraq’s second polio drive of the year. The first NIDs were held in April and May and immunized over 96% of the target population. The current campaign will last five days and be repeated in December.
Polio is a highly infectious and incurable disease that can cause lifelong paralysis. Most of its victims are children under five years old. Iraq’s last polio case was reported in 2000. But a recent global resurgence of the disease has brought a renewed threat to the region. Yemen, Saudia Arabia and Sudan have all been re-infected since 2004, making this campaign critical to safeguard Iraq’s children.
Iraq is part of the Global Polio Eradication Initiative, the world’s largest public health drive spearheaded by WHO, Rotary International, the U.S. Centre for Disease Control and Prevention and UNICEF. This international effort has reduced the incidence of polio by more than 99 per cent. Only four countries have yet to stop polio transmission – Nigeria, India, Pakistan and Afghanistan – the lowest number in history.
For further information please contact:
Claire Hajaj, Communication Officer
UNICEF Iraq Support Centre in Amman
+962 (0) 6 551 5921
Dr. Omer Mekki, WHO Medical officer
WHO Iraq Country Office in Amman
+962 (0) 6 5510438
