Assessment of Road Safety Campaign by Islamabad Traffic Police, using key performance indicators

World Health Organization's (W.H.O) World report on Road Traffic Injury prevention defines “A road traffic injury as fatal or non-fatal injuries incurred as a result of a road traffic crash. A road traffic crash is defined as a collision or incident that may or may not lead to injury, occurring on a public road and involving at least one moving vehicle” Of the four main modes of travel – road, rail, air and marine – travel by road puts people at the greatest risk of injury. Among males of the economically active age group, motor vehicle injuries are the third most important cause of death in developing countries. Compared with a person in a car, a person on a motorized two-wheeler is 20 times more likely to be killed for each kilometer traveled; a person on foot 9 times more likely; and a person on a bicycle 8 times more likely to be killed. A person in a car is 10 times more likely to be killed than a passenger in a bus or coach and 20 times more likely to be killed than a passenger in a train. It is projected that road traffic Injury (RTI) will be the second most common cause of disability-adjusted life years(DALYs) in developing countries in the year 2020 estimated economic cost of road accidents is 1 % of GNP in low-income countries, accounting for US$ 65 billion, more than they receive in development assistance. Despite this, there is little recognition of the health and economic burden of this problem at both the international and national levels. W.H.O. in its international conference on RTI noted the importance of adequate data on traffic injuries. Yet, accurate epidemiological data from many of the developing countries are difficult to find in the literature. Pakistan have large road network of 259, 758km. Thousands of people die on the roads in Pakistan every year with most of the victims being pedestrian, bicyclist, motorcyclists and passenger of public transport riders and with more than half of them between ages of 15 to 44 years. In Pakistan 10,125 crashes were reported to police including 4193 fatal cases in 2006 The estimated economic cost of road crashes and injuries is to be over 100 billion rupees for Pakistan According to W.H.O. for Pakistan Age-standardized mortality rate for injuries (per 100 000 population) is99.0 years (2002) and Years of life lost to injuries (%) 8.0 years (2002). The annual growth rate of vehicles is 17.18%in Islamabad. With this high influx of car on the roads of Islamabad every day, road traffic injuries and offenses has become a major problem. With added poor road engineering, inadequate road furniture, ineffective and out dated traffic signals the problem has intensified. Evidence from some highly motorized countries has shown that integrated approach involving "three E's": Engineering, Education, and Enforcement produce a marked decline in road deaths and serious injuries. Transport systems developed in high-income countries may not fit well with the safety needs of low income and middle-income countries for a variety of reasons, including the differences in traffic mix. transfer, therefore, needs to be appropriate for the mix of different vehicle types and the patterns of road use. The priority in developing countries therefore should be the import and adaptation of proven and promising methods from developed nations, and a pooling of information as to their effectiveness among other low-income countries.
Most of the work done in Pakistan has focused on the magnitude and impact of injuries from motor vehicle crashes in Pakistan. Multiple factors involve in the causation of road traffic accident include road, road user and vehicles. Because of the complexity of road accident causes, there is temptation to embark on policies and countermeasures that are visible but superficial and with little ultimate effect on the level of road safety.
Educational or training interventions have a potential for preventing traffic crashes. Traffic Awareness Campaign was launch by Islamabad traffic police (ITP) to address the current traffic problems and to enhance road safety among public. The effectiveness of Traffic Awareness Campaign on road traffic injuries and how Islamabad Traffic police (ITP) achieved the set targets so it can be replicated nationwide to make road travel safe in Pakistan.

Jaroka at Women Deliver Conference 2010

We are extremely excited and eagerly looking forward to attend global Women Deliver 2010 ( www.womendeliver.org ) conference and Women Deliver youth pre-conference session. On behalf of our project “Jaroka -Mobile based Tele-Healthcare for rural Pakistan” , Ms. Shamila is provided with an opportunity to attend Young Women Speak and Young Women Deliver (8:30 – 10:30am June 9th) plenary as a panelist. There she will be sharing strategies, practices, success and failures etc faced by our team during the implementation of Jaroka in a resource deprived village (Zahidabad) of Pakistan. We are looking forward to replicate this affordable and effective model in other developing countries. Learn about Jaroka at (www.tele-healthcare.org)

During the Youth pre-conference session We will take part in discussing different technologies to use for advocacy purpose with Youth social entrepreneurs. We will definitely learn a lot from the wonderful youth doing amazing work all around the world. Do join , learn more about Jaroka and share your words of wisdom at Women Deliver 2010.

PREVENTION AND CONTROL OF PREVALENCE OF MALARIA IN SCHOOL CHILDREN

“ Malaria is defined as an infectious disease characterized by cycles of chills, fever, and sweating, caused by a protozoan of the genus Plasmodium in red blood cells, which is transmitted to humans by the bite of an infected female anopheles mosquito. “

Malaria is the most important of the parasitic diseases of humans, with 107 countries and territories having areas at risk of transmission containing close to 50 percent of the world’s population .

2.Magnitude of the problem.

a) Global:

More than 3 billion people live in malarious areas. and the disease causes between

Malaria accounts for one in five of all childhood deaths in Africa.

.

1 million and 3 million deaths each year. Recent estimates of the global falciparum malaria morbidity burden have increased the number to 515 million cases, with Africa suffering the vast majority of this toll. In addition, almost 5 billion clinical episodes resembling malaria occur in endemic areas annually, with more than 90 percent of this burden occurring in Africa .The disease has resurged in many parts of the tropics, and nonmalarious countries face continual danger from importation. Accoeding to CDC Contributing to this resurgence are the increasing problems of Plasmodium falciparum resistance to drugs and of the .Anopheles vectors’ resistance to insecticides... Over 40% of the world’s children live in malaria-endemic countries. Each year, approximately 300 to 500 million malaria infections lead to over one million deaths, of which over 75% occur in African children

b) Pakistan

According to the United Nations World Health Organization (WHO), Pakistan has been classified as a country with moderate malaria prevalence and relatively well-established control programme. Despite this, the disease is estimated to cause at least 50,000 deaths out of an estimated 500,000 reported malaria cases every year.

Malaria continues to be a major public health problem in Pakistan. A. Culicificies and A. Stefensi are main Mosquitoes prevalent in Pakistan. Plasmodium Falciparum and Plasmodium Vivax are main parasites prevalent in Khyber Pakhtunkhwa and Balochistan Provinces of Pakistan.

3) Key determinants:

a) Biologic:

Agent:

The Primary determinant or the causative agent of Malaria is the Malarial Parasite.

Vector:

The vector or the secondary determinant of Malaria is Anopheles Mosquito.

The various types include

1. Anopheles culicifacies

2. Anopheles stephensi

3. Anopheles Fluvitalis

Host
There areTwo different types of hosts of Malarial Parasite

1. Definitive Host ; Anopheles Mosquito

2. Intermediate Host ; Man

b)Environmental:

• Malaria is prevalent in tropical and warmer countries. Warm and moist climate encourages breeding of mosquitoes.

• Pools of unclean stagnant water harbor mosquitoes laying eggs and larvae.

• With global warming and gradual increase in temperature those regions which do not have this disease problem are likely to become vulnerable specially the children.

c) Socio- Cultural and behavioral Factors:

Many people do not know what causes malaria or how it is spread, so they are not able to protect themselves from the disease.

• Some parents do not bring their children for treatment until they are very ill because:

  • they do not realize they might have malaria (people often think they have a cold, influenza or other common infection);

  • they do not realize that malaria is very dangerous; or

  • they live far away from health care facilities.

• People living far from health services will often go to local medicine vendors (sellers) for advice, which is not always appropriate, or to buy medicines, which are not always effective and would rather treat it in children according to home remedies.

4. ADMINISTRATIVE MEASURES

Organizations involved in eradication of malaria in children are :

• World Health Organization

• Global Fund

• Unicef

• National Malaria Control Program

• UNDP

• World Bank

. Organizational and administrative capabilities

• 1950- Malaria Control Activity

• 1961 –Malaria Eradication Programme

• 1973- National Malaria Control Program

• 1978 -MCP integrated with health services.

• 1999 with WHO strategy of Roll Back Malaria(RBM) Govt of Pak developed a plan to reduced malaria burden of 50% by 2010.

National policy for malaria control:

• To develop guidelines for malaria control in children.

• Monitoring and evaluation of Provincial malaria control programs by developing standard procedures and protocols.

• Strengthening of a set-up of Federal reference laboratory for control of malaria in children.

• To develop the training modules on diagnosis , case management, vector control activities and epidemic preparedness.

• Conduct annual national level epidemiological surveys to : Monitor disease trends, evaluate impact of malaria control activities/interventions, promote and implement insecticides Treated Bed Nets (ITNs) , identify private partners and establish mechanisms for the promotion correct treatment and ITN use in the country.

• Malaria cases will be reduced by 50%.by carrying out above mentioned interventions.

Successes:

• Pakistan has sufficiently developed drug manufacturing industry that can help in fighting malaria.

• Health sector still enjoys interventions like Roll Back Malaria.

Failures:

• Low epidemic preparedness at Federal and Provincial level.

• Low levels of Monitoring and Evaluation of malaria control activities due

to financial and human resources strains.

• Weakness in human recourses capacities and logistics especially at district and provincial; levels for qualified and experienced malaria staff

Plan:

Goal:

To prevent the prevalence of Malaria in School Children

Objectives:

• To create awareness amongst schoolteachers and parents to protect schoolchildren from Malaria.

• To educate children to protect themselves from Malaria.

• To promote the use of Insecticide Treated Nets.

5) Interventions/Prevention strategies:

Strategies Matrix:

Area Prioritized	Strategies	Assigned to	Primary Health Outcomes	Secondary and Non Medical Outcomes	Why
.Creating awareness among parents and schoolteachers 2 Creating awareness in schoolchildren 3.Promoting the use of ITNs	Health Education of parents and schoolteachers through seminars, media. Educating children to protect themselves from mosquito bites and to stay away from stagnant water ponds Promoting the use of insecticide treated nets and spraying	Doctors, School Health Service, LHWs. Teachers DHMT, Taluka Municipality	Increase in the level of awareness amongst parents and school teachers regarding knowledge of Malaria Safety from mosquito bites Protection of children from Malaria	Not having to suffer from spending heavily on treatment Healthy life Simple measure that protects against the disease	Parents and teachers do not realize the dangers of Malaria in Children Schoolchildren will learn to protect themselves from mosquito bites It is not costly and prevents from mosquiti bites

Monitoring:

• Monitoring of the sessions conducted by Health Officials, School health Service Doctors in Schools.

• Monitoring the establishment of the laboratories making sure that optimum quality standards are followed.

• Following strict merit criteria in hiring the staff.

Evaluation :

• No. of cases detected

• No. of cases referred

• No. of training sessions conducted at schools

• No. of complicated cases treated at Tertiary Care Hospitals

The Three Delays:Dangers faced by women during child birth in rural areas of Pakistan

The Rural Health Care System of Pakistan is highly under developed. According to a Report by World Health Organization in 2009, Pakistan comes under the category of Low Income Group Country. Pakistan’s GDP on Health Sector is merely 0.6%. The Utilization of Basic Health Units by rural population is 90% but government spends merely a fraction of its total health budget on Basic Heath Units compared to its allocation of funds on Tertiary Care Hospitals.

The gender bias is another major issue faced by female population seeking Health Care.In a Rural set up, where a woman is requiring Anti-Natal Care is usually denied access to avail it. Then there are issues of Affordability, Accessibility, and Availability of Health Care.

The head of the family, in our patriarchal set up, is usually a man. He is also the wage earner for the family. It is he who decides where to allocate resources. For him, to buy a new buffalo may be of more importance than to spend on fees on Medical Consultation. When condition for the woman becomes critical, the family wastes time in taking timely decision. This is also referred to as First Delay.

The issue of The Second Delay arises when there is delay in arranging for the transportation to the nearest possible Health Facility. The family may not be able to arrange for an ambulance or even a private vehicle. There have been cases where the patient had to be transported on Donkey Cart or Bull Cart.

The Third Delay is problem which is faced by the patient, even when she makes it to the Health Facility, is the absence of the Doctor and Paramedical Staff at the facility.

The Three Delays Problem, which put in danger life of not only the patient, but also her to be born child.

The role of LHWs can play an important role in visiting the homes on regular basis and assessing the state of pregnancy, to look for danger signs and to educate and counsel the parents in seeking Medical Care on priority basis.

The improvement in transportation mode will help in addressing the Second Delay. The person owning a Private Motorized Four Wheeler Vehicle in the village can provide the transportation facility. The Village Elders can play an important role in implementing these interventions in their regular Jirgas or Panchayats.

The improvement of the quality of the Health Facility can be carried out with Public- Private Partnership. This would not only ensure availability of diligent and committed Doctors and Paramedical staff and State Of The Art Equipment. This will also help in dealing with the issue of
The Third Delay

Improving the quality and scope of care available at existing medical facilities—will have the greatest impact in reducing needless maternal deaths.