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Wednesday, February 13, 2013

Childhood Malnutrition in India
Today’s post is number three in the run-up to my International Reporting Project trip to India where I will be part of a team of 10 journalists covering the topic of child survival. First, I addressed Infectious Diseases, then Vaccinations. Today, we will look at Malnutrition. What is the state of malnutrition in India? How has scientific understanding of what good nourishment means helped us work on the malnourishment issue particularly in developing nations? Can science put an end to world hunger? How are sanitation and hygiene related to malnutrition?
 
Before we go on, let’s define a few terms so there is no confusion:
 
  • Malnutrition is the condition that occurs when your body does not get enough nutrients.
  • Starvation is a severe deficiency in caloric energy, nutrient, and  vitamin  intake.
  • Famine is a widespread scarcity of food, usually accompanied or followed by regional malnutrition, starvation, epidemic, and increased mortality.
  • Emaciation is abnormal thinness caused by lack of nutrition or by disease.
  • Marasmus is chronic wasting of body tissues, especially in young children, commonly due to prolonged dietary deficiency of protein and calories.
  • Kwashiorkor is a syndrome occurring in infants and young children soon after weaning. It is due to severe protein deficiency, and the symptoms include edema, pigmentation changes of skin and hair, impaired growth and development, distention of the abdomen, and pathologic liver changes.
We've all seen disturbing photos of children in the malnourished or starving so I'll not replicate them here.
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Facts about Malnutrition in India
Here are some facts about malnutrition in India from Child In Need India (CINI)
 malnutritionfacts.jpg
 
The World Bank conducted an analysis of the problem of malnutrition in India and introduced a long document, "Undernourished Children: A Call for Reform and Action" with this statement:
 
The prevalence of underweight among children in India is amongst the highest in the world, and nearly double that of Sub-Saharan Africa. In 1998/99, 47 percent of children under three were underweight or severely underweight, and a further 26 percent were mildly underweight such that, in total, underweight afflicted almost three-quarters of Indian children. Levels of malnutrition have declined modestly, with the prevalence of underweight among children under three falling by 11 percent between 1992/93 and 1998/99. However, this lags far behind that achieved by countries with similar economic growth rates.  Undernutrition, both protein-energy malnutrition and  micronutrient deficiencies, directly affects many aspects of children’s development. In particular, it retards their physical and cognitive growth and increases susceptibility to infection, further increasing the probability of malnutrition. Child malnutrition is responsible for 22 percent of India’s burden of disease. Undernutrition also undermines educational attainment, and productivity, with adverse implications for income and economic growth.”
 
Across India, not all children are malnourished and some are more extremely malnourished than others. The numbers of those affected vary between remnants of the caste system, between Indian states, and gender where girls are more likely to be undernourished because of their lower status in society.  
 
 
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Malnutrition and Disease go Hand in Hand 
 
Malnourishment and emaciation can be caused by disease. As you can imagine, severe diarrhea (such as from cholera or rotavirus) will interrupt the absorption of nutrients while the feeling of deep malaise will leave a child not wanting to eat. Diseases and disorders associated with emaciation include malaria, cholera, tuberculosis, other infectious diseases with prolonged fever, and parasitic infections.
 
Malnutrition also increases the risk of infection and infectious disease, and weakens every part of the immune system. It is a major risk factor in the onset of active tuberculosis.  Protein and energy malnutrition and deficiencies of specific micronutrients (including iron, zinc, and vitamins) increase susceptibility to infection.
 

Providing adequate nutrition during the first 1000 days can ensure that children are less susceptible to disease.
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The Science of Nutrition and Malnutrition 
 
Clearly, malnutrition is a severe issue in India and has longterm implications for children and the future of the country. Let’s look at how scientific discovery helps us understand nutrition and good nutrition keeps us healthy.
 
There are six major classes of nutrients
carbohydrates
fats
minerals
protein
vitamins
water
 
These nutrient classes can be categorized as either:
 
Macronutrients, which are needed in relatively large amounts, and include carbohydrates (including fiber), fats, protein, and water.
 
OR 
 
Micronutrients, which are needed in smaller quantities, and are minerals and vitamins.
 
 
You probably remember the stories of how lack of vitamin C was discovered to be the cause of scurvy of men on ships or how the cause of Beriberi was the lack of thiamine (vitamin B1). The field of nutrition is full of scientific studies that have provided further understanding into what our bodies need to thrive. This list ( modified from Wikipedia) shows us what may result from various nutrient deficiencies.
 
impropernutrition.jpg 
Many Nobel prizes have been awarded for nutrition research, with heaviest emphasis on the discovery or synthesis of vitamins.
 
Take a look at this list from nobelprize.org. You will want to read this fascinating article from which this information is taken from, too, as it discusses in more detail how some of these scientists made their findings. 
 
vitaminnobels.jpg 

There was an interesting Nobel awarded to a tireless researcher in the field of nutrition research. In 1949, Lord Boyd Orr from United Kingdom, who studied Biology, Medicine and Nutrition, won the Nobel Peace Prize (Yes, PEACE) "for his scientific research into nutrition and his work as the first Director-General of the United Nations Food and Agriculture Organization (FAO)". He was passionate about understanding malnutrition and metabolism.
 
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Malnutrition and Sanitation 

What if children seem to have enough of the appropriate nutritive food, yet still exhibit signs of malnutrition? Could there be something else going on here? Indeed. In the past few years, scientist have discovered a phenomenon called ENVIRONMENTAL ENTEROPATHY which is caused by prolonged exposure to food and water contaminated with feces

Environmental enteropathy, (EE) also known as gut dysfunction, affects up to 50% of children in the developing world, and causes no overt symptoms or signs in children.
While EE is known to reduce nutrient absorption and to be a significant contributor to child stunting worldwide, there still is no effective treatment for this nor do we understand why it occurs. EE has been recently highlighted as the single most important barrier to achieving normal growth and development of children worldwide.
 
This chart is a bit hard to see, but if you click on it you will be taken to the article from the prestigious medical journal, The Lancet,  where the authors indicate primary and secondary pathways microbes enter the enteric (digestive) system. We will come back to this when we talk about sanitation and maternal-fetal health over the next few days (From the paper, Child undernutrition, tropical enteropathy, toilets, and handwashing):
 
hygieneenteropathy.jpg

A more recent study was published in Science just a few weeks ago and NPR's All Things Considered covered it in a podcast/article called, Gut microbes may play deadly role in malnutrition. Click on the image to listen to the four minute story.
 
 
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Can science and engineering help solve world hunger?
 
Here is a partial answer from wiseGEEK:

“One way to solve world hunger would be to develop new ways to grow food on a worldwide scale. Many people today live in areas of the world which were never capable of producing sufficient food crops or are nearly impossible to irrigate. Some arable land remains underused because it is under the control of rogue governments or is currently too inaccessible for farming. By developing new methods for maximizing crop growth on substandard land, inhabitants can grow enough food to meet their needs.

Creating new farming technologies could also help solve world hunger. If food can be grown in large hydroponic farms, for example, there would less strain put on traditional soil farms. Farmers in poorer countries could be trained to rotate their crops in order to keep the soil healthier season after season. Better seeds with higher yields or resistance to insect or weather damage could help farmers grow more usable crops on the same amount of arable land. A renewed emphasis on agriculture as a career could also encourage more young people to start their own farms and produce more food for others.

Genetically modified food crops (if accepted by a nation--and there is a lot of resistance to this across the world) may grow better in areas of the world where soil is poor or insects besiege the crops. We can also modify the crops so they are more nutritious. The most promising of these is a vitamin A rich rice called Golden Rice:

800px-Golden_Rice.jpg
“Genetically modified rice could be a good source of vitamin A for children in countries where deficiency in the vitamin is common. A new study tested so-called Golden Rice against both spinach and supplements in providing vitamin A to 68 six- to eight-year-olds in China. Researchers found that the rice was as effective as the capsules in giving kids a boost of vitamin A, based on blood tests taken over three weeks. And it worked better than the natural beta-carotene in spinach, the researchers report in the American Journal of Clinical Nutrition.” Read more HERE.

With the tools of biotechnology, we can grow more crops on less land, grow new, more nutritious crops, and find new uses for existing crops.

Wed, February 13, 2013 | link 

Tuesday, February 12, 2013

Childhood Vaccines in India
In 2008, WHO estimated that 1.5 million of deaths among children under 5 years were due to diseases that could have been prevented by routine vaccination. This represents 17% of global total mortality in children under 5 years of age.
 
Hygiene, proper nourishment and sanitary conditions make for a healthy community, with lowered incidence of infectious disease, but since much of this is lacking in developing countries, vaccination is very helpful to giving the immune system a boost.
 
We can thank scientists, physicians and engineers for their work in understanding the immune system and how to make it work for us against disease by using vaccinations. 

Famous Scientists in the field of vaccine development: Most of you have heard the stories of how vaccinations came about starting with Edward Jenner (cowpox) to Louis Pasteur (rabies) then to Jonas Salk and Albert Sabin (polio). A story you may not have heard in school was about Maurice Hilleman and his team at Merck who developed several dozen of the most common efficacious and cost-effective vaccinations and has saved millions of lives. I highly recommend this book by Paul Offit, Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases.  There are many good books and websites on the lives Jenner, Pasteur, Salk and Sabin as well.
 
For a quick, fun way to learn about scientists who have made vaccination discoveries, click on this image to go to this matching game of pioneers in vaccine development.
 

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 How Vaccines Work 
Vaccines manipulate the immune system of the recipient. Thus, to understand how vaccines work (or how to create new vaccines), we must first understand how the immune system prevents and fights infections. It is also a good idea to understand how infectious agents cause disease. This to me sounds like an entire college career! 
 
Clicking on the image below will take you to a colorful tutorial to learn more. Go ahead and check it out!
 
howvaccineswork.jpg
 
The goal of vaccination is to stimulate the adaptive immune system to make memory cells that will protect the vaccinated person against future exposure to a pathogen, without causing the symptoms of the disease.
There are several types of vaccines which can stimulate the immune system to provide memory and protect against future exposure to a pathogen. 
 
According to the CDC, the GENERAL RULE is:
The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine. 

What are the requirements for an effective vaccine?
They vary according to the nature of the infecting organism.
 
For extracellular organisms, antibodies against the organism (or part of it, some antigen) prove to be the most adaptive mechanism of host defense, whereas, for control if intracellular organisms (such as polio virus) an effective immune cell (CD8 t-lymphocyte) response is also essential.
 
The ideal vaccination provides host defense at the point of entry of the infectious agent; stimulation of mucosal (these are the moist nose, mouth, eye surfaces) immunity is an important goal.
 
Effective protective immunity against some organisms requires the presence of pre-existing antibody at the time of exposure to the infection, and booster shots are a great way to boost the presence of antibody.
 
Features of an effective vaccine
 
 
Safe  

Vaccine must not itself cause illness or death 

Protective

Vaccine must protect against illness resulting from exposure to live pathogen 

Gives sustained protection

Protection against illness must last for several years 

Induces neutralizing antibody

Some pathogens (such as poliovirus) infect cells that cannot be replaced. Neutralizing antiboody is essential to prevent infection of such cells. 

Induces protective T cells 

Some pathogens, particularly intracellular, are more effectively dealt with by cell-mediated responses 

 Practical considerations

low cost per dose, biological stability, ease of administration, few side-effects

 
 
Want to learn more about how vaccines are made? Go to this tutorial by clicking on the image.
 
 
 
Listed here are the types of vaccines that can be produced based on the organism and type of response required.

1) Inactivated organism vaccines
Whole organism
Viral — polio, hepatitis A, rabies, influenza*
Bacterial — pertussis*, typhoid*, cholera*, plague*

Fractional (portion of the organism)
protein-based
toxold --diphtheria, tetanus
subunit-- — hepatitis B, influenza, acellular pertussis, human papillomarvirus, anthrax
polysaccharide-based->induces antibody production against the "sugarcoat" of certain organisms
--pneumococcal, meningococcal, Salmonella Typhi (VI), haemophilus influenzae type B
**polysaccharide based vaccines usually won't work in children younger than 2 years. Boosters are ineffective and the antibody is less functional than with other types of vaccines.

2) Live attenuated vaccines
Uses an attenuated (weakened) form of the "wild" virus or bacterium
Must replicate to be effective
Immune response similar to natural infection
Usually produce immunity with one dose
 
Viral — measles, mumps, rebella, vaccinia, varicella, zoster, yellow fever, rotavirus, intranasal influenza, oral polio
Bacterial — BCG (against TB), oral typhoid
 
Drawbacks to live attenuated vaccines
Severe reactions possible
Interference from circulating antibody
Fragile — must be store and handled carefully

Challenges of Vaccination in Developing Countries

Developing countries generally wait an average of 20 years between when a vaccine is licensed in industrialized countries and when it is available for their own populations.Economic, infrastructural and scientific hurdles all contribute to this long delay. The Global Alliance for Vaccines and Immunization (GAVI) is a partnership between many public and private organization, including UNICEF, The WHO, the Bill and Melinda Gates Foundation, members of the vaccine industry and NGOs. GAVI was formed in 1999 to address the long delay between vaccine availability in industrialized countries and developing countries. Scientific advances that would help make more vaccines available in developing countries include the development of temperature stable vaccines, development of vaccines that required less than three doses to immunize and the development of needle free methods to administer vaccines.

Vaccines are complex biological substances and can lose their potency over time. They are sensitive to too cold or too hot temperatures and some are sensitive to exposure to UV light.

The "cold chain system" ensures that vaccines are kept cold from the time they leave the manufacturer all the way through to administration to the patient, but 
vvm.gif
maintaining the cold chain is especially challenging in developing nations where lack of infrastructure can make it difficult to maintain proper storage temperatures. To this end, vaccine manufacturers engineered Vaccine Viral Monitors (VVMs) based on technology used in the food industry. Since March 1996, all polio vaccine through UNICEF carry VVMs, at minimal cost. As of January 2001, ALL of UNICEF's vaccine supplies are required to have VVMs. 

As most of us are "painfully" aware, many vaccines must be given by injection. In developing countries, healthcare workers may not have access to an adequate supply of sterile needles, and sometimes disposable syringes are saved and reused. This could lead to the spread of blood borne diseases. This is where bioengineering really shows its strength of creating solutions to problems. I could create a very long list of devices that have been created and are considered as innovative including nasal delivery, needle free, patches with dissolvable microneedles made of sugar embedded with the vaccine. Check out what bioengineers have done for the field of vaccine administration!

"One shot" locks after one use to prevent re-use and spread of blood borne disease.Oral liquid has been used for the OPV (oral polio vaccine) and also for rotavirusIntranasal spray is an excellent way to work at the site most viruses enterThis patch has vaccine embedded and moves slowly into the skin Air gun (BioShot) uses force of air to push liquid into skin rather than needle. Very hygienicDissolvable needles made of sugar with vaccine embedded are placed on a patch and painlessly deliver the vaccine
 BD_SoloShot.jpgphoto_boy_receiving_oral_polio_vaccine.jpg art.marti.vaccine.cnn.jpg patch-vaccine.jpg Bioject1.jpg sugarneedles.jpeg 
 
For India specifically, I found this information related to vaccine production:  "Vaccine production by indigenous manufacturers needs to be encouraged to bring down costs, reduce dependence on imports and ensure availability of vaccines specifically needed by India (e.g. typhoid) and custom made to Indian requirements (rotavirus and pneumococcal vaccines). The recent vaccination related deaths signal a need for improving immunization safety and accountability and setting up of an adverse event monitoring system. Finally setting up a system for monitoring incidence of vaccine preventable diseases and conducting appropriate epidemiological studies is necessary to make evidence based decisions on incorporation of vaccines in the national schedule and study impact of vaccines on disease incidence, serotype replacement, epidemiologic shift, etc." (source)
 
 
 What Are Some Diseases That Do Not Have a Vaccine?
 
Malaria: Malaria is a protozoan parasite and while tiny it is still much larger than the bacteria or viruses that cause most other diseases.
 
According to "Professor Adrian Hill, ... at the University of Oxford, whose group is working on malaria vaccines. "You can't really use the whole malaria parasite to make a vaccine, but you still need to generate immunity to it. That means that we have to design a subunit vaccine, which is always difficult, and in this case the major problem is to induce a big enough immune response to kill the parasite." (source)
 
Tuberculosis: There has been a TB vaccine for nearly 100 years, the BCG vaccine. It is not highly effective. There are several types of TB. Most of us think of the TB that affects the lungs but it can also affect bone, the bladder, and the gastrointestinal tract. The life cycle of Mycobacterium is complex and the disease can lay dormant and sequester itself in the human body for quite some time, making it difficult for the body to launch an immune attack even if it is given a boost with a vaccine. The vaccine works well in some populations but not others and is not effective in infants. Essentially the complexity of the disease and its manifestations is outfoxing our own knowledge of how to create a vaccine. You can read a story about the work on new vaccines here at NPR.
 
HIV: There are many reasons that a vaccine has proven so difficult to develop. HIV represents a unique challenge: our body can eliminate most acute viral infections. In contrast, our natural immune system does not destroy HIV. In fact, HIV infection results in the production of large amounts of virus, even in the presence of killer T cells and antibody. In developing a vaccine, we are faced with the challenge of tyring to elicit an dimmune response that does not exist in nature. Therefore, we don't know exactly what type of immune response a vaccine should develop. In addition, HIV virus mutates at a high rate and allows it to escape destruction by the immune system.


A note about Polio Eradication in India
 
Thankfully India has been declared Polio free for two years thanks to a very strong initiative, but there are still countries that struggle with its eradication. 
 
Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized. Polio mainly affects children under five years of age.
 
Treatment: There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.
 
Books: A very popular book about Polio is not about it's worldwide impact but its effect on America in Polio: An American Story by David M. Oshinsky. 
 
Famous Scientists: Jonas Salk and Albert Sabin both made great strides towards the development of the polio vaccine. Their feud was famous as to whether a live of killed virus was the best way to inoculate against polio.
 
If we were able to eradicate smallpox and are on our way to eradicating polio, why can't we do this with every disease?
 
We were able to eradicate smallpox because its virulence was specific to humans only. If enough people are vaccinated, there will not enough of a threshold level of hosts (us) to sustain the pathogen. Once vaccination strategies can be implemented more forcefully in areas that still have polio, it can be eradicated fully.
 
Diseases caused by organisms that live in the environment, like Clostridium tetani, that causes tetanus, could never be eradicated, even though we have an effective vaccine unless we were able to eliminate all Clostridium tetani from the planet. Not easily done. 
 
Any disease that is zoonotic, meaning, can jump from animal to animal to human and back again will never be eradicated. If you want to learn about zoonotic diseases like Ebola, hantavirus, influenza and more, I HIGHLY recommend Spillover: Animal Infections and the Next Human Pandemic by David Quammen.  


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Resources 
 
An excellent source about everything vaccine related is at the CDC 2012 Epidemiology & Prevention of 
Vaccine-Preventable Diseases 

Learn more about vaccinations in India at this very comprehensive website

A great educational site explaining vaccines in complete details is A History of Vaccines  by the College of Physicians in Philadelphia. It has games, interactive timelines, videos and more. I highly recommend this site!

The WHO maintains an excellent website related to vaccinations for most infectious diseases in developing countries here and definitely check out their massive Immunization Profile page for India
 
Tue, February 12, 2013 | link 

Monday, February 11, 2013

Pediatric Infectious Diseases in India

This is the first in a series of five posts leading up to my trip to India to examine issues of child survival with the International Reporting Project via Johns Hopkins University with significant funding from the Bill and Melinda Gates Foundation. For the duration of the trip, I am to consider my self a New Media Journalist with IRP.

Infectious diseases are common all over the world. You probably know them as generally communicable diseases of bacterial, viral or protozoan origin, that will enter the body, and infect it, causing illness and sometimes leading to death, especially if the body is weakened by malnutrition or stressful environmental factors. 

Doctors and healers for a very long time could recognize symptoms of illness and would classify the illness and eventually name them, but they didn't know what caused these illnesses. A big breakthrough in understanding that certain diseases were caused by extremely tiny organisms came through the work of Louis Pasteur and also Robert Koch. They both can be credited with establishing the Germ Theory of Disease. Koch applied rigorous scientific methods to understanding how microorganisms invade the host and cause disease. He determined what are known as Koch's Postulates.

kochspostulates.gif

This long post will talk about diseases common to children in India that have a causautive agent and whose increased prevalence often has to do with issues of poverty, lack of education, unclean water, poor sanitation and malnutrition. 

Let's look at several diseases: diarrheal diseases (cholera, rotavirus), respiratory diseases (Pneumonia and Tuberculosis) and what I will just call "other" (Malaria, and HIV). Since Polio has been eradicated from India, I will address this in the vaccination post tomorrow.

I will describe the disease, it's causative agent, how it is contracted, they symptoms and most often the occurrence in the children of India if I have that information. This information comes from several sources including WHOUNICEFThe Gates Foundation and more. Note that the numbers, percentages, and other analyses to help us understand the rates of infection or mortality are necessarily a critical part of knowing how severe a disease is in any given population and if prevention and treatment tactics are working. Working with the "M" of STEM, Mathematics, especially statistics, but also including GIS (global information systems) and other types of mathematical modeling helps us paint a picture of the severity of a disease now and determine our next course of action. If numbers excite you, you could be of assistance in the improvement of conditions in developing nations such as India by providing the data to decision makers in health policy, for instance.

The description will include a few of the more notable scientists who have played a role in helping us understand the disease, including Nobel Prize winners. If you feel I've left someone out, be certain to send a note via my contact page, I'd love to hear from you.

How a disease is treated or prevented will be touched on briefly. Note that tomorrow's post is about vaccinations and since many of the diseases I will discuss have vaccines, I will address those in more detail in that post. Some diseases are just more common where sanitation is poor so their solutions will be examined in the post on sanitation.

Finally, I will suggest books for further reading on the topic if I know of them. These will be what I consider adult popular science books, which a bright middle schooler or high schooler could read as well. But if you are looking for something at a middle reading level, there are many fantastic books at your library and I highly recommend you check them out. (BTW, I LOVE LiBRAIRIES!) 

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Diarrheal Diseases

  • Diarrheal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.
  • Diarrheal disease kills 1.5 million children every year and account for >10% if child mortality in India.
  • Globally, there are about two billion cases of diarrheal disease every year.
  • Diarrheal disease mainly affects children under two years old.
  • Diarrhea is a leading cause of malnutrition in children under five years old.
  • Diarrhea can be of bacterial origin (ex: cholera), viral origin (ex: rotavirus) or parasitic (ex: ameobic dysentery)

Preventing diarrheal diseases requires the following:

  • access to safe drinking-water
  • improved sanitation
  • exclusive breastfeeding for the first six months of life
  • good personal and food hygiene
  • health education about how infections spread
  • rotavirus vaccination. (source)

"Cholera is a disease spread mostly through contaminated drinking water and unsanitary conditions. It is endemic in the Indian subcontinent, Russia, and sub-Saharan Africa. It is an acute infection of the intestines with the bacterium Vibrio cholerae. Its main symptom is copious diarrhea. Between 5% and 10% of those infected with the disease will develop severe symptoms, which also include vomiting and leg cramps. In its severe form, cholera can cause death by dehydration. An estimated 200,000 cases are reported to WHO annually." Learn more.

Best bet treatment: Most cases can be treated with rehydration salts. A vaccine exists but clean water and proper sanitation are the most effective measures to prevent the disease from taking hold in communities in the first place.

ghostmap.jpg

Book to read about Cholera: The Ghost Map: The Story of London's Most Terrifying Epidemic--and How It Changed Science, Cities, and the Modern World by Steven B. Johnson. Click on this image to watch a video about this book!

Famous Scientists: John Snow, who discovered the source of the main cholera infection in England and whom The Ghost Map book is about, and Robert Koch who discovered that Vibrio cholerae was the infectious agent. 

 

Rotavirus is the most common cause of viral gastroenteritis (inflammation of the stomach and intestines) worldwide. It kills more than 600,000 children each year, mostly in developing countries. Symptoms include vomiting, watery diarrhea, fever, and abdominal pain. In India,

"The health burden of rotavirus in India is well established. WHO estimated that 98, 621 Indian children died from rotavirus gastroenteritis in 2008, representing about one third of deaths from diarrhoeal disease and 4% of all child deaths in India. More recent data from the Million Death Study, a nationally representative survey of 1.1 million Indian households, estimated that the virus causes 113 000 deaths a year." (source)

Flewett_Rotavirus.jpg

It was given its name because a scientist viewed it through an electron microscope, and thinking it looked like a wheel, called it rota (think rotation) -virus.

Best bet treatment: Most cases can be treated with rehydration salts. A vaccine exists and is incredibly effective!

Famous Scientists: In 1973, Ruth Bishop and colleagues described related viruses found in children with gastroenteritis. 

Book to read: I don't know of a good one solely about rotavirus, but if you want to learn more about viruses of all types, including RNA based ones like rotavirus, definitely read Carl Zimmer's book, A Planet of Viruses

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Respiratory Diseases 

 I will limit this discussion to pneumonia and tuberculosis (which isn't solely respiratory) for the sake of brevity.

Pneumonia is the leading global killer of children under five, responsible for almost 1.6 million deaths per year. In that vulnerable population, it is a disease of poverty and occurs most commonly when a child’s still-developing defense system is weakened by malnutrition, air pollution, co-infections with HIV/AIDS and measles, and low birthweight, with 43 million cases for children in India alone.

  • Pneumonia is the leading cause of death in children worldwide.
  • Pneumonia kills an estimated 1.2 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined.
  • Pneumonia can be caused by viruses, bacteria or fungi.
  • Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.
  • Pneumonia caused by bacteria can be treated with antibiotics, but around 30% of children with pneumonia receive the antibiotics they need. (source)

Pneumonia occurs when the sacs of the lungs, known as alveoli, become filled with pus and fluid, limiting oxygen intake and making it hard to breathe. 

Causes

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:

  • Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;
  • Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia;
  • respiratory syncytial virus is the most common viral cause of pneumonia;
  • in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.(source)

  • Best Bet Treatments: There are many treatments based on the cause of the pneumonia.
  • Famous Scientists: (This information is modified from Wikipedia here:) 
  • "Edwin Klebs was the first who observed bacteria in the airways of persons who died of pneumonia in 1875.
  • Initial work identifying the two common bacterial causes Streptococcus pneumoniae and Klebsiella pneumoniae was performed by Carl Friedländer and Albert Fränkel Friedländer's initial work introduced the Gram stain, a fundamental laboratory test still used today to identify and categorize bacteria. 
  • Christian Gram's paper describing the procedure in 1884 helped to differentiate the two bacteria, and showed that pneumonia could be caused by more than one microorganism."
I can't think of a book to recommend to you, but there is a funny music video made by some medical students about different types of bacteria put to a Rhianna song you might recognize. Click on the image to be taken to a new page to watch the video.
SKL.jpg
 

Tuberculosis: "Tuberculosis causes nearly 2 million deaths every year, and WHO estimates that nearly 1 billion people will be infected between 2000 and 2020 if more effective preventive procedures are not adopted. The TB bacteria are most 

Tuberculosis_symptoms.jpg

often found in the lungs, where they can cause chest pain and a bad cough that brings up bloody phlegm. Other symptoms include fatigue, weight loss, appetite loss, chills, fever, and night sweats." (source) It is caused by Mycobacterium tuberculosis.

Childhood or pediatric tuberculosis is often unrecognized due to lack of health care and lack of education on symptoms to look for (watch this video about recognizing TB in kids). Tuberculosis has a safe haven in HIV patients, unfortunately, so eradication is difficult. Many cases of tuberculosis are also multi-drug resistant making it very difficult and expensive to treat.

Best Bet Treatment: Generally a cocktail of antibiotics, though this is becoming more difficult as the bacteria mutate and become resistant.

Prevention:There are several vaccines but the most common is the BCG vaccine which is only partially effective. New vaccines are constantly being tested.

Famous Scientists: The 1905 Nobel Prize in medicine and physiology went to Robert Koch for his investigations and discoveries in relation to tuberculosis. He  is one of the founders of bacteriology. He discovered the anthrax disease cycle (1876) and the bacteria responsible for tuberculosis (1882) and cholera (1883)

The 1952 Nobel Prize in Medicine and Physiology went to Selman Abraham Waksman for his discovery of streptomycin, the first antibiotic effective against tuberculosis.

Book to Read: Spitting Blood: A History of Tuberculosis by Helen Bynum (horrible title, very well done book!)

Of interest about India and TB is that there was an India-initiated crowd-sourced effort to map and annotate the genome of the bacteria that causes TB. In other words, effort was put in to read and evaluate the DNA sequence, hoping that if this information is freely available online, it might be of use to those who design drugs and maybe a cure could be found. Of such importance to the people of India to eradicate this disease that thousands of smart people volunteered their time to finish this project. Very impressive!
 
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Other diseases 
 

"Malaria is a mosquito-borne disease that affects more than 500 million people annually, causing between 1 and 3 million deaths. It is most common in tropical and subtropical climates and is found in 90 countries—but 90% of all cases are found in Sub-Saharan Africa. Most of its victims are children. The first stage consists of shaking and chills, the next stage involves high fever and severe headache, and in the final stage the infected person's temperature drops and he or she sweats profusely. Infected people also often suffer from anemia, weakness, and a swelling of the spleen. Malaria was almost eradicated 30 years ago; now it is on the rise again." (source)

The causative agent is the Plasmodium parasite with a complicated life cycle which

MalariacycleBig.jpg

 is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.

Treatment: There are many antimalarial drugs, many derived from natural sources, but can also be chemically synthesized. If you want to know more, check out the Wikipedia page on the topic. Again, like the organism that causes tuberculosis, plasmodium is becoming increasingly resistant to drugs.

Prevention: Insecticides to control the vector mosquitoes, netting around beds at night, proper sanitation and drainage of water in the environment, and anti-malarial drugs taken in small doses as a preventative.

Famous Scientists: n 1902Sir Ronald Ross received the Nobel Prize in Medicine and Physiology for his work on malaria, by which he has shown how it enters the organism and thereby has laid the foundation for successful resesarch on this disease and methods of combating it. He made his discovery while stationed in India in 1897.

In 1948, Paul Hermann Muller received the Nobel Prize in Medicine and Physiology for his discovery of the high efficiency of DDT as a contact poison against several arthropods. Unfortunately, it is also toxic to humans and use had to be discontinued, but until then it was very good at eliminating mosquitoes that carried the malarial parasite. 

Cutting Edge Science: Of interest is a company called Amyris that has used synthetic biology to create yeast that can produce artemisinic acid — a precursor of artemisinin, an effective anti-malarial drug. Learn more at their page.

Books to Read: I recommend two recent books. First, The Fever: How Malaria has ruled human kind for 500,000 years by Sonia Shah and The Imaginations of Unreasonable Men: Inspiration, Vision, and Purpose in the Quest to End Malaria, which examines scientists' quest to find a malaria vaccine.

 

HIV/AIDS

Progress for children is slower

"Of the 4.8 million people living with HIV in Asia, nearly half (49%) are in India. Acquired Immune Deficiency Syndrome (AIDS) is a fatal and incurable disease 

Symptoms_of_acute_HIV_infection.jpg

caused by HIV (human immunodeficiency Virus), AIDS attacks and destroys the immune system, gradually leaving the individual defenseless against illnesses that lead to death." (source)

"While there have been gains in treatment, care and support available to adults, we note that progress for children is slower," says Leila Pakkala, Director of the UNICEF Office in Geneva. “The coverage of HIV interventions for children remains alarmingly low. Through concerted action and equity-focused strategies, we must make sure that global efforts are working for children as well as adults”. (source)

Treatment: The introduction of highly active antiretroviral (ARV) therapy in 1996 was a turning point for those with access to sophisticated health-care systems. The cost of these drugs are out of reach for the 95% of people living with HIV/AIDS in developing countries. Progress has recently been made in India, however, as Indian pharmaceutical companies are producing generic versions of ARVs and selling them for less than $1 a day. Another obstacle is that not everyone can tolerate the potent medications and their side effects. (source)

Books to Read: I have not read any of these seven suggested books, so cannot personally recommend any of these, but if I had to choose, I think I would start with The Epidemic: A Global History of Aids by Jonathan Engel.

Famous Scientists: The 2008 nobel prize in Medicine and Physiology was awarded to Francoise Barre Sinoussi, and Luc Montagnier for their discovery of human immunodeficiency virus.

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Conclusion

There are many more diseases that afflict children in India, but I believe this post is a decent treatment of many of them. Some of these will reappear as I post further topics over the next few days.

 All images are creative commons sourced.

I offer huge thanks to the School of Integrative Biology at the University of Illinois for their support of my outreach. A huge dose of appreciation for GoPro cameras which has outfitted me with a new Hero3 with which I will share with you both the opulence and poverty of India in the upcoming days. This trip is fully funded by the International Reporting Project and the Gates Foundation. 

Mon, February 11, 2013 | link 

Sunday, February 10, 2013

Why am I going to India?

I will be leaving in just a matter of days to go to India with the International Reporting Project as a New Media Journalist to examine the issues of child survival. We will be in Mumbai, Nagpur, and New Delhi with visits to rural and slum areas. The IRP has a full schedule for the ten of us chosen to share our findings with our audiences within social media and blogs.

I made a video explaining why I'm going and what I plan to do to further the understanding of STEM (Science Technology, Engineering and Mathematics) during this trip in relation to child survival issues.

Click on the image to go to the video, please. 

IRPvidtitle.jpg

Many of the issues surrounding child survival in India; malnutrition, maternal and fetal care, sanitation, infectious diseases, and vaccinations, can be viewed as social issues, ones that stem from the difficulties of being a developing nation with a tremendously large population, and many of them living below the poverty levels and without education.  Segments of India are thriving and growing and on the cutting edge of technology, with some of the most highly educated people in the world, making India a land of disparities. 

Geek_Nation-book.jpg

 

If you want to know more about the rise of science and engineering in India, I highly recommend, Angela Saini's excellent book, Geek Nation: How Indian Science Is Taking Over the World

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The child survival issue is significant. The organization, Save the Children, indicates that India lags behind most countries in children’s health. This is not an unrecognized problem, just a massive one that requires concerted effort to address the issues. As I write, currently in India is the UNICEF and USAID Child Survival Summit . Visit the site to see how leaders in the field are evaluating, and aiming to tackle, the myiad of issues that underlie child survival.

I understand that many of the people we are slated to meet in India will be NGO leaders, and persons within governmental and charitable organizations who are working to implement the much needed changes, but my thoughts, as always, turn to the STEM topics: Science, Technology, Engineering and Mathematics.  How do these topics explain, inform, and attempt to solve the massive issues related to child survival plaguing India and other impoverished areas of the world? 

In these few days leading up to the trip, I will provide an introductory series of posts about the issues we will be examining from a STEM perspective and explain these issues towards a general audience. 

I will, in turn, look at the following issues related to child survival in India:

Infectious Diseases—Monday, February 11

Vaccinations—Tuesday, February 12

Malnutrition—Wednesday, February 13

Sanitation/Environmental Issues—Thursday, February 14

Maternal-Fetal Health—Friday, February 15

These issues are quite inter-related and separating them will most likely result in a loss of the fluidity in explaining the complexity of child survival, but surely you will bear with me there.

For each topic, I will attempt to answer the following questions:

  • How has science furthered our understanding of these topics? Who are some notable scientists who have played a role in our understanding?  (An entire encyclopedia could be written on Infectious Diseases alone and books have been written about individual diseases, but understandably I will have to keep my discussions and explanations much briefer.)
  • How do these topics relate specifically to children in India, as far as I understand them?
  • How has scientific knowledge been applied, either through medicine or engineering via technologies, pharmaceuticals and common sense measures to solve these issues?
  • What type of scientists and engineers work on these types of topics? I think it will not be an all-inclusive list as my knowledge is still limited, but I hope to provide some insight into the fields of science and engineering that one could choose and potentially make significant impacts in improving health and survival across the world.

What I hope to do is to highlight STEM and demonstrate how science and engineering are meaningful fields. I’d like to think that this information could be a source of inspiration to those considering STEM fields.

I appreciate you following my adventures in India and will help me raise awareness by sharing my posts if you are so inspired. You can follow me on twitter  facebook and/or google plusas well as this blog or my site at Scientific American. That's a lot of places to keep up with, but I know different people enjoy one social media site over others, so I hang out on all of them! 

See you again soon! 
Sun, February 10, 2013 | link 


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