HIV/AIDS

From 1980 to June 2018, 926,742 HIV positive cases were identified in Brazil, with an annual record of 40,000 new cases. In 2012, detection rate was 21.7 cases per 100 thousand inhabitants, whereas in 2017, detection rate was 18.3, representing a decrease of 15.7%. In four years, there was also a decrease of 16.5% in the mortality rate from the disease, from 5.7 per 100 thousand inhabitants in 2014 to 4.8 deaths in 2017.  Around 73% of new HIV infections occur among males, 70% of whom are aged between 15 and 39 years (Brazilian Ministry of Health, 2018f). Such decline might be related to more accessible treatment for all, better diagnosis rates, reduced time between diagnosis and start of treatment, and better access to testing (Brazilian Ministry of Health, 2018f).

Tuberculosis

In 2017, 69,569 new cases of tuberculosis were reported in Brazil. Incidence rate equalled 33.5 cases per 100 thousand inhabitants. From 2008 to 2017, this coefficient showed an annual average decrease of 1.6%. In 2016, 4,426 deaths from tuberculosis were recorded, resulting in a mortality rate equal to 2.1 deaths per 100 thousand inhabitants, reflecting an annual average decrease of 2.0% from 2007 to 2016. The distribution of both indicators was heterogeneous by regions, states, and capitals. However, the tuberculosis situation in the capitals of the country requires attention, since 70.4% of them (19 capitals) had an incidence rate higher than that recorded in the entire country. The highest mortality rates in 2016 were recorded in the north and northeast cities -in Recife (6.4 per 100 thousand inhabitants), Belém (5.3 per 100 thousand inhabitants) and Manaus (4.7 per 100 thousand inhabitants) (Brazilian Ministry of Health, 2018c), possibly given to lower socioeconomic status in these cities. In 2017, 13.347 relapse cases/treatment were registered in the country, equivalent to 16.1% of total cases reported in the period. The states with the highest proportion of retreatments were Rio Grande do Sul (23.3%), Rondônia (19.9%) and Paraíba (19.5%). This result is similar to that observed in the capitals, among which the highest proportion of retreatment was recorded in Porto Alegre (31.2%), Campo Grande (25.8%), João Pessoa (23.8%) and Porto Velho (23.3%) (Brazilian Ministry of Health, 2018c).

Dengue /Zika Virus/ Chikungunya

Brazil faces epidemic levels of mosquitoes-transmissible diseases (e.g. Aedes aegypti), such as dengue, zika virus, yellow fever and chikungunya, all of which take a great proportion of financial and human resources in the primary, secondary and tertiary care sectors in Brazil, in both private and public health services. According to a report published in March 2019 by the Ministry of Health comparing the epidemiological situation of dengue, chikungunya and zika in 2018 and in 2019, the number of cases with such diseases has increased considerably, as per information below (Brazilian Ministry of Health, 2019f).

Dengue: In 2019 (up to week 11), there were 229,064 probable cases of dengue in the country, with an incidence rate of 109.9 cases per 100 thousand inhabitants. In the same period of 2018, there were 62,904 probable cases. The South-Eastern region had the highest number of probable cases (149,804 cases, 65.4%) in relation to the country rates, followed by the Midwest (40,336 cases, 17.6%), the North (15,183 cases, 6.6%), the Northeast (17,137 cases, 7.5%) and the South (6,604 cases, 2.9%). The incidence rate of probable dengue cases (per 100 thousand inhabitants) up to week 11 of 2019 shows that the Centre-West and Southeast regions had the highest incidence rates: 250.8 cases per 100 thousand inhabitants and 170.8 cases per 100 thousand inhabitants, respectively (Brazilian Ministry of Health, 2019f).

Chikungunya: In 2019 (until week 11), there were 12,942 probable cases of chikungunya in the country, with an incidence rate of 6.2 cases per 100 thousand inhabitants. At the same week of 2018, 23,484 probable cases were registered. In 2019, the Southeast region had the highest number of probable cases of chikungunya (8,536 cases, 66.0%) in relation to the total of the country. The North (2,139 cases, 16.5%), the Northeast (1,786 cases, 13.8%), the Central Region (293 cases, 2.3%) and the South (188 cases, 1.5%). The incidence rate of probable cases of chikungunya in 2019 shows that the North and the Southeast regions had the highest incidence rates: 11.8 cases per 100 thousand inhabitants and 9.7 cases per 100,000 inhabitants, respectively (Brazilian Ministry of Health, 2019f).

Zika virus: In 2019 (until September 9), 2,062 probable cases of Zika were registered in the country, representing an incidence rate of 1 case per 100 thousand people. During the same period of 2018, 1,908 probable cases had been registered. In 2019, the northern region has had the highest number of probable cases (912 cases, 44.2%) in relation to the country’s total figures – the Southeast: 584 cases, 28.3%; the Midwest: 176 cases, 8.5%; the Northeast: 343 cases, 16.6%; the South: 47 cases, 2,3 %. The incidence rate of probable Zika cases shows that the Northern region has had the highest incidence rate: 5 cases per 100 thousand inhabitants. Among the UFs, Tocantins (47 cases per 100 thousand inhabitants) and Acre (9.5 cases per 100 thousand inhabitants) have had the highest numbers (Brazilian Ministry of Health, 2019f).

Yellow fever: With regards to yellow fever, between January and May 2019, 68 cases were confirmed in the state of São Paulo, 12 in Paraná and one case in Santa Catarina (total=81 cases). The majority of the cases were among rural workers and/or among people with higher exposure to the mosquitos, of which 72 (88.9%) were males, aged between eight and 87 years. Among the confirmed cases, 14 led to death (17.3%). The total number of human cases recorded in the same period of 2018 was 1,309, showing an important decrease in the number of cases in the country (Brazilian Ministry of Health, 2018d).

Influenza: Brazil has also epidemic periods of influenza, which the country has been trying to control through vaccination and education (e.g. hand washing). It affects mostly vulnerable populations such as babies, pregnant women, older adults, health professionals, carers, bed-bound people, and people with potentially compromised immune systems – HIV, cancer, lupus, etc.). Brazil has a national online system for compulsory registration of Influenza cases (SINAN, 2019).

References:

Brazilian Ministry of Health. (2016b). Panorama da tuberculose no Brasil: A mortalidade em números.

Brazilian Ministry of Health. (2018c). Implantação do Plano Nacional pelo Fim da Tuberculose como Problema de Saúde Pública no Brasil: Primeiros passos rumo ao alcance das metas (Vol. 49).

Brazilian Ministry of Health. (2018d). Monitoramento do Período Sazonal da Febre Amarela Brasil – 2017/2018 (Issue Figura 1).

Brazilian Ministry of Health. (2018f). Pará está entre os estados com redução de óbitos por AIDS. Ministério Da Saúde.

Brazilian Ministry of Health. (2019f). Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes (dengue, chikungunya e Zika) até a Semana Epidemiológica 11 de 2019 (Vol. 50, Issue Tabela 1).

SINAN. (2019). Sistema de Informação de Agravos de Notificação. http://www.portalsinan.saude.gov.br/

HIV and AIDS

In 2018, there were 624 HIV reports and 139 AIDS report in Hong Kong. A cumulative total of 9,715 reports of HIV infection and 1,996 AIDS cases was identified under the voluntary and anonymous HIV/AIDS reporting system of the Department of Health launched since 1985. In 2018, 1 in every 9,850 new blood donors, 1 in every 264 attendees in Sexually Transmitted Diseases (STD) Clinics, and 1 in every 110 users in methadone clinics were tested HIV positive. Most of the HIV reports were male (85%) and Chinese (72%). Most infected people (78%) were diagnosed at the age between 20 and 49. People infected with HIV progress to AIDS when they suffer from clinical complications of severe immunodeficiency due to HIV. The most common illnesses presenting at AIDS were pneumocystis pneumonia and tuberculosis.

Tuberculosis

Tuberculosis (TB) is an important infectious disease in Hong Kong. In 2018, there was a total of 4,326 TB notifications with male to female ratio of 1.7:1 (Centre for Health Protection, 2019, February 4a). It was rare in children under 15 years old but more common among old people. The total number of deaths caused by TB was 179 (132 male and 47 female) (Centre for Health Protection, 2019, February 4b) respectively.

Seasonal influenza

Seasonal influenza is a common respiratory tract infection caused by human seasonal influenza viruses. In Hong Kong, it is more common in periods from January to April and from July to August (Centre for Health Protection, 2020a). Centre for Health Protection has been closely monitoring the weekly numbers of institutional influenza-like illness outbreaks and influenza-associated admission rate in public hospitals (Centre for Health Protection, 2020a). In 2019, there were 24,215 positive detections of seasonal influenza viruses under laboratory surveillance (Centre for Health Protection, 2020c).  In 2018/2019 winter, it caused 5,217 cases of adult ICU admission and 2,942 cases of adult death with laboratory confirmation (Centre for Health Protection, 2020b).

References:

Centre for Health Protection. (2019, February 4a). Notification & death rate of tuberculosis (all forms), 1947-2018. Retrieved from https://www.chp.gov.hk/en/statistics/data/10/26/43/88.html

Centre for Health Protection. (2019, February 4b). Tuberculosis notifications (all forms) and rate by age group and sex, 2018 (Provisional). Retrieved from https://www.chp.gov.hk/en/statistics/data/10/26/43/6825.html

Centre for Health Protection. (2020a). Explanatory notes on the intensity levels for seasonal influenza in Hong Kong. Retrieved from https://www.chp.gov.hk/files/pdf/explanatory_note_for_flux_mem_eng.pdf

Centre for Health Protection. (2020b). Flu Express. Retrieved from: https://www.chp.gov.hk/files/xls/flux_data.xlsx

Centre for Health Protection. (2020c). Flu Express-Weekly surveillance data Retrieved from: https://www.chp.gov.hk/files/xls/flux_data.xlsx

Virtual AIDS Office of Hong Kong. (2019, May). HIV/AIDS Situation in Hong Kong [2018]. Hong Kong Retrieved from https://www.aids.gov.hk/english/surveillance/sur_report/hiv_fc2018e.pdf.

HIV/AIDS

Using state level survey data, the National Aids Control Organization and Indian Council of Medical Research-National Institute of Medical Sciences (NACO and ICMR-NIMS, 2019) report estimated that the adult (15–49 years) HIV prevalence was 0.22% (0.17-0.29%) in 2019. The report found that rates differed by gender, with prevalence being higher among males at 0.24% (0.18-0.32%) compared to 0.20% (0.15-0.26%) among females. There is also a wide variation in the prevalence of HIV by State/UTs. As per the NACO and ICMR-NIMS 2019 report, the highest young adult HIV prevalence rate was reported in Mizoram, [2.32%, [1.85–2.84%]), followed by Nagaland (1.45% [1.15–1.78%]), and Manipur (1.18% [0.97–1.46%]). The lowest prevalence rates were found in Arunachal Pradesh (0.06%), Jammu and Kashmir (0.06%), and Sikkim (0.07%).

TB

According to the Global TB Report (WHO,2019a), 10 million people are infected with TB globally in 2018. India accounts for 27% of the global tuberculosis cases (WHO, 2019a).

State variations in TB:

As per GBD 2019 data, the prevalence of TB in India varies across the states. In 2019, the lowest prevalence rate was in Goa, which has a prevalence rate of 14,835.37 cases per 100,000 people (13,185.25 – 16,832.76) and the highest being in West Bengal with 37,351.82 prevalent cases per 100,000 people (33,258.47 – 41,758.29) (ICMR, PHFI and IHME, 2019). In terms of burden, the measures of the number of deaths and DALY’s are described. The least number of deaths was in Kerala 10.53 deaths per 100,000 people (8.2 – 13.15) and the highest number of deaths was in Uttar Pradesh with 45.24 deaths per 100,000 people (37.23 – 55.08 (ICMR, PHFI and IHME, 2019). With respect to DALY’s (Disability Adjusted Life years), Kerala again had the lowest number of DALY’s per 100,000 people 333.92 (268.22 – 407.48) and Uttar Pradesh had the highest number of DALY’s with 1,744.52 per 100,000 people (1,461.91– 2,074.18) (ICMR, PHFI and IHME, 2019).

According to the Burden of Disease report (National Commission on Macroeconomics and Health (NCMH), 2005), the Health and Development Initiative states that those at the greatest risk of TB are those from a lower socioeconomic status, since the disease spreads in crowded places such as schools, marketplaces, households etc. Moreover, there are also several social and economic costs of being diagnosed with TB. According to the Burden of Disease report (NCMH, 2005), if an adult is diagnosed with TB, on average, they lose 3–4 months of work time, which results in a 20%–30% loss in annual household income (NCMH, 2005). This is of significant concern as the portion of the population which is most affected by TB in India is of working age, with 89% of cases occurring amongst those 15-69 years of age (Central TB Division, 2019). This loss of household income due to illness along with paying for the costs associated with treatment could lead many households to experience catastrophic health expenditures.

 Malaria

There were approximately 228 million cases of malaria reported globally in 2019 (WHO, 2019b). Out of the 15 countries that contribute to the global malaria burden, India accounts for 3% of global malaria burden (WHO, 2019b). However, with national programs and other interventions, the country has reported a decline in malaria, with its incidence having decreased by 24% in 2017 in comparison to the previous year (WHO, 2019b).

State wise variations in Malaria:

As per GBD 2019 data, prevalence of malaria varies across the states in India. In 2019, the lowest prevalence rate was in Sikkim, which had a prevalence rate of 48.82 cases per 100,000 people (37.82 – 63.49) and the highest being in Chattisgarh with 1745 prevalent cases per 100,000 people (905.05– 3389.51) (ICMR, PHFI and IHME, 2019). With respect to burden, the number of deaths and DALYs associated with malaria are also described. The least number of deaths was in Sikkim with 0.0018 deaths per 100,000 people (0.00045 – 0.0075) and the highest number of deaths was in Odisha with 23.51 deaths per 100,000 people (8.1 – 58.11) (ICMR, PHFI and IHME, 2019). In terms of DALYs– Sikkim had the lowest number of 2.55 DALYs per 100,000 people (1.94 – 3.3) and Odisha had the highest number of DALYs with 1,455.04 per 100,000 people (540.73 – 3,375.05) (ICMR, PHFI and IHME, 2019).

Other communicable diseases

Apart from these, emergence of new forms of infections and re-emergence of several infectious diseases, mainly due to viruses are a matter of concern for India. Respiratory viral infections (e.g., H1N1, Avian influenza, H5N1, and Covid-19), arboviral infections (e.g., Chikungunya, Japanese encephalitis, and Kyasanur forest disease [KFD]) and bat-borne viral infections (e.g., Nipah viral disease and severe fever with thrombocytopenia virus [SFTV]) are the three major categories of emerging viral infections in India (Mourya et al., 2019).

The Integrated Disease Surveillance Programme (IDSP) in their 2017 surveillance report stated that a total of 1683 outbreaks were due to epidemic prone diseases (Mourya et al., 2019). Of these, 71% were caused due to viral pathogens (Mourya et al., 2019).

COVID-19:

The COVID-19 pandemic has caused unprecedented challenges to the Indian health system. While the first case in the country was confirmed on January 30^th in 2020, there has been a significant rise in cases with a total of 43 million cases and 521,691 total deaths confirmed in the country as of 30^th April 2022 (Johns Hopkins University, 2022). People with co-morbidities and the elderly have been the most affected (MoHFW, 2020; Press Information Bureau, 2020). The government has taken multiple measures to protect vulnerable populations and reduce disease spread including a complete nationwide lockdown from March 25^th to May 31^st in 2020. The government also introduced a mass vaccination campaign in phases and 633 million doses have been provided as of 30^th August 2021 (MoHFW, 2021).

References:

Central TB Division. (2019). Revised National TB Control Programme, Annual Report. Available from https://tbcindia.gov.in/WriteReadData/India%20TB%20Report%202019.pdf

Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation (ICMR, PHFI and IHME). (2019). GBD India Compare Data Visualization. Available from: https://vizhub.healthdata.org/gbd-compare/

Johns Hopkins University (2022). Coronavirus Resource Centre. Available from: https://coronavirus.jhu.edu/map.html

Ministry of Health and Family Welfare (2020a). It is more important now to follow COVID Appropriate Behaviours because of the upcoming festival season, arrival of winter, opening up of economy: Dr. V.K. Paul [Press Information Bureau Website]. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1664105

Ministry of Health and Family Welfare. (2021). Ministry of Health and Family Welfare. Available from: from https://mohfw.gov.in/

Mourya, D., Yadav, P., Ullas, P., Bhardwaj, S., Sahay, R., Chadha, M., …& Singh, S. (2019). Emerging/re-emerging viral diseases & new viruses on the Indian horizon. Indian Journal of Medical Research, 149(4), 447. https://doi.org/10.4103/ijmr.ijmr_1239_18

National Aids Control Organization and Indian Council for Medical Research-National Institute of Medical Science. (2019). India HIV Estimates 2019. Available from: http://naco.gov.in/sites/default/files/INDIA%20HIV%20ESTIMATES.pdf

National Commission on Macroeconomics and Health, Ministry of health & Family Welfare, Government of India. (2005). Burden of disease in the India: Background Papers, NCMH. Indian Journal of Medical Research, 124(3), 235–244.

Press Information Bureau (2020). India’s case fatality rate is 1.53% compared to 17.9% with comorbid people and 1.2% for people without comorbidities: Secretary [PIB Twitter].  Available from: https://twitter.com/pib_india/status/1315978147792211970

World Health Organization (2019a). Global Tuberculosis Report. Available from: https://www.who.int/publications/i/item/9789241565714

World Health Organization (2019b). World Malaria Report. Available from: https://www.who.int/india/health-topics/malaria#:~:text=According%20to%20the%20WMR%202019,of%2050.5%25%20compared%20with%202017.

The prevalence and burden of communicable diseases, particularly that of HIV/AIDS and TB, are considerable in Indonesia.

HIV/AIDS

Indonesia experiences the ‘fastest growing HIV epidemic’ among southeast Asian countries  (Agustina et al., 2019, p. 83). According to UNAIDS, approximately 630,000 (lower to upper estimates 540,000-740,000) people lived with HIV in 2016. By 2018, this number was estimated to have reached 640,000 (550,000-750,000). The majority of people living with HIV were aged 15 or over (620,000). Among these, an estimated 17% (15%-20%) accessed antiretroviral therapy. Furthermore, there were an estimated 48,000 (43,000-52,000) new HIV infections and 38,000 (34,000-43,000) AIDS-related deaths in Indonesia (UNAIDS, 2018).

By December 2019, cases of HIV/AIDS have been reported in 93.2% of districts and in 34 provinces across Indonesia. The provinces with the highest number of HIV infections were DKI Jakarta (65,578), followed by East Java (57,176), West Java (40,215), Papua (36,382), and Central Java (33,322) (Ditjen P2P Kementerian Kesehatan RI, 2020).

TB

According to WHO, Indonesia is ranked among the countries with the highest burden of tuberculosis (WHO, 2019) . It is estimated that there are about 1 million new cases of TB per year and prevalence is estimated to be at almost 400 cases per 100,000 people (Agustina et al., 2019, p.83; WHO, 2017, p.1). According to the WHO TB report 2019, notifications of TB in Indonesia increased from ‘from 331 703 in 2015 to 563 879 in 2018 (+70%), including an increase of 121 707 (+28%) between 2017 and 2018’ (WHO, 2019, p.2).

Mortality of TB was substantial, as Indonesia was estimated to be among the group of five countries where 40 or more deaths per 100,000 population were associated with TB (WHO, 2017, p.35). This is paired with low levels of TB treatment. The WHO reports that Indonesia belongs to the group of countries with 50 per cent of less treatment coverage in 2016 (WHO, 2017, p.78). Furthermore, ‘high levels of underreporting of detected TB cases’ was found following the 2013-2014 national TB prevalence survey with Indonesia ranging among the top three countries (16% gap between TB incidence and reported cases) (WHO, 2017, pp.180).

The WHO report further shows a substantial gap between the funding required for prevention, diagnosis, and treatment and the actual funds available. In Indonesia this funding gap is estimated to amount to US $98 million (WHO, 2017, p.115). Of the available funds, 61 per cent were provided from domestic sources and 39 per cent by donors (WHO, 2017, p.117).

The previously reported growing burden of HIV/AIDS together with the high burden of TB further complicates the situation in Indonesia. In combination with the described underreporting, this leads to a situation where only 14% of people with TB had a reported HIV status and ‘less than 50% of HIV patients were started [on the recommended] ART’ treatment in 2016 (WHO, 2017). In 2019, Indonesia remained among the 20 high TB/HIV burden countries as well as among the ‘20 countries with highest estimated numbers of incident [multi-drug resistant TB] (MDR-TB) cases’ (WHO, 2017). Despite low reporting and high burden, it is reported that Indonesia had an ‘85 per cent treatment success among people with new and relapse TB’ and ’60 percent treatment success among people with new and relapse HIV-positive TB’ in 2015 as well as ’51 per cent treatment success among people with rifampicin-resistant TB in 2014’ (WHO, 2017, pp. 88,90).

Other relevant infectious diseases are malaria, with approximately 40,000 death per annum as well as arboviruses, dengue fever, chikungunya, nipa, avian influenza, and Zika (Agustina et al., 2019, pp.83).

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

Ditjen P2P Kementerian Kesehatan RI. (2020). Laporan Perkembangan HIV AIDS & Penyakit Infeksi Menular Seksual (PIMS) Triwulan IV Tahun 2019.

UNAIDS. (2018). Country factsheets: Indonesia. https://www.unaids.org/en/regionscountries/countries/indonesia

WHO. (2017). Global Tuberculosis Report 2017.

WHO. (2019). Global Tuberculosis Report 2019. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1

Tuberculosis (TB)

There were 1,659 notifications of suspected cases of tuberculosis between 2011 and 2015 in Jamaica. Of these, 32.6% were confirmed, with the highest confirmation rate (51.2%) in 2015. Most of the cases were in young adults (25–34 years old), with the fewest in the 5 to 14-year age group. In 2015, all age groups recorded an increase in cases, with an average of 114.7 new cases per annum from 2006-2015. Non-compliance and inadequate monitoring of Directly Observed Therapy, Short Course (DOTS), a strategy used to reduce TB prevalence, had a negative impact on treatment success rates (PAHO, 2017).

HIV/AIDS

PAHO also estimates Jamaica’s HIV prevalence to be at 1.6% among the general population. It also estimates that 29,000 persons are currently living with HIV in Jamaica, with approximately 16% of those persons being unaware of their status (PAHO, 2017). Between 1982 and 2015, 34,125 cases of HIV were reported to the Ministry of Health. Of these, 9,517 (27.9%) are known to have died (MOH, 2016).

PAHO also notes that Jamaica has improved its HIV prevention program with the adoption of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets and now provides increased access to treatment and care services (PAHO, 2017). However, factors such as inconsistent follow-ups, inconsistent condom use, and poverty have been found to be challenges to combating the epidemic (MOH, 2016).

Malnutrition

The 2016 Global Nutrition Report highlights that Jamaica saw success with only one of the global nutrition targets, reducing wasting in children. However, some progress is being made in meeting the targets of reducing stunting and overweight and achieving exclusive breastfeeding. Unfortunately, the country is yet to see success with reducing anaemia in women of reproductive age (International Food Policy Research Institute, 2016).

Other significant communicable diseases in Jamaica include vector-borne diseases, namely Dengue Fever, Chikungunya (CHIKV) and Zika virus (ZIIKV)

As of October 2019, there were 88 dengue-related deaths for 2019, almost double the amount recorded for 2018. A Dengue outbreak was declared on the island by Prime Minister Andrew Holness in January 2019, with 4,400 confirmed cases being reported by October 2019 (Statement of the Minister of Health Dr. The Hon, 2019).

CHIKV first emerged in Jamaica in 2014. During the JHLS-III between 2016 and 2017, the prevalence rate of CHIKV among Jamaicans was 48.8%; however, 8 out of 10 Jamaicans had a positive serum (blood) test for the disease. Zika emerged in Jamaica in 2016. Only 6% of Jamaicans reported that they had Zika, with the highest rate of self-reporting occurring within the 45-54-year-old age group (Ministry of Health Jamaica, 2018).

The top 3 leading causes of death in the English and Dutch speaking Caribbean between 2000-2016 were cerebrovascular disease, diabetes, and ischemic heart disease, which, collectively, accounted for 29.6% of all deaths over the period (CARPHA, 2017).

References:

Caribbean Public Health Agency (CARPHA). (2017). State of Public Health in the Caribbean Region 2014-2016: Building Resilience to Immediate and Increasing Threats: Vector-Borne Diseases and Childhood Obesity. Port of Spain, Trinidad and Tobago. https://carpha.org/Portals/0/Documents/State-of-Public-Health-in-the-Caribbean-2014-2016.pdf

International Food Policy Research Institute. 2016. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Washington, DC.

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Ministry of Health Jamaica. (2016). HIV EPIDEMIOLOGICAL PROFILE 2015 , Facts & Figures Ministry of Health. https://moh.gov.jm/wp-content/uploads/2017/05/2015-Epi-Update-Revised-Final.pdf

PAHO. (2017). Salud en las Américas+, Edición del 2017. Resumen: panorama regional y perfiles de país. Available from: https://iris.paho.org/handle/10665.2/34322

Statement of the Minister of Health Dr. The Hon. Christopher Tufton on the Dengue Outbreak in Jamaica Parliament -. (2019, January 8). Jamaica Information Services. https://jis.gov.jm/speeches/statement-of-the-minister-of-health-dr-the-hon-christopher-tufton-on-the-dengue-outbreak-in-jamaica-parliament-8-january-2019/

HIV/AIDS, neonatal disorders, diarrheal diseases, lower respiratory infections, congenital defects, tuberculosis, stroke, ischemic heart disease, meningitis, cirrhosis were the top 10 causes of death and disability-adjusted life years (DALYs) combined in 2017 in Kenya (all ages and sexes combined) (Institute for Health Metrics and Evaluation, 2017)

Although HIV prevalence in Kenya reduced from 7.2% (excluding North-Eastern region) in 2007 to 5.6% and an incidence of 0.5% in 2012 with similar decline across males and females, it continues to be a public health concern due to the annual transmission rate of 8.9 per 100 HIV-infected persons. In 2012, HIV prevalence peaked (9.8%)  among those aged 45-49 while in 2007 the highest prevalence (11.9%) was seen among those aged 30-34 (Kimanga et al., 2016).

Kenya was also hit by the global pandemic of corona virus disease (COVID-19) which was first detected in China on 31^st December 2019. In March 2020, the first case was confirmed. Older people have experienced a double blow during the pandemic as they are at a higher risk of developing dementia and are vulnerable to frailty and comorbid conditions. By 12^th April 2020, 7% of COVID-19 cases (out of 197) were aged 60 years. In addition, most deaths across the globe were older adults with underlying health issues (Lloyd-Sherlock et al., 2020).  Unfortunately, non-governmental organizations (NGOs) offering support to persons with dementia and their caregivers remain scarce in  Kenya, yet that is the only face-to-face and practical option for the increasing cases of dementia (Comas-Herrera et al., 2020).

The World Health Organization (WHO) and the government of Kenya has continuously put in strict safety measures to reduce further infection of COVID-19 such as physical distancing, wearing masks, hand washing and other sanitization procedures. In some countries like Kenya, measures to reduce public gatherings and crowds included government curfew and minimal movement outside major counties affected by COVID-19. Some of the measures may pose difficulties for persons with dementia such as remembering these instructions since decline in memory is a key presentation for dementia. As a result, persons with dementia may be predisposed to infection (Wang et al., 2020) or experience legal consequences because there have not been exceptions or guidelines that have been put in place for persons with disability such as dementia.

References:

Comas-Herrera, A., Lorenz-Dant, K., Ferri, C., Govia, I., Sani, T., Jacobs, R., … The STRiDE Team. (2020). Supporting people living with dementia and their carers in low- and middle-income countries during COVID-19. LTCcovid.Org, International Long-Term Care Policy Network, CPEC-LSE, April, 7–10. https://ltccovid.org/2020/04/10/supporting-people-living-with-dementia-and-their-carers-in-low-and-middle-income-countries-during-covid-19/

Institute for Health Metrics and Evaluation. (2017). Country profiles: Kenya – What causes the most death and disability combined? https://www.healthdata.org/kenya

Kimanga, D., Ogola, S., & Umuro, M. (2016). Prevalence and Incidence of HIV Infection, Trends, and Risk Factors Among Persons Aged 15–64 Years in Kenya: Results From a Nationally Representative Study. Journal of Acquired Immune Deficiency Syndromes, 1999(66(Suppl 1)), 13–26. https://doi.org/10.1097/QAI.0000000000000124

Lloyd-Sherlock, P., Ebrahim, S., Geffen, L., & McKee, M. (2020). Bearing the brunt of covid-19: older people in low and middle income countries. BMJ, 368, 1–2. https://doi.org/10.1136/bmj.m1052

Wang, H., Li, T., Barbarino, P., Gauthier, S., Brodaty, H., Molinuevo, J. L., … Tang, Y. (2020). Dementia care during COVID-19. Lancet (London, England), 395(10231), 1190. https://doi.org/10.1016/S0140-6736(20)30755-8

Infectious diseases continue to represent a Public Health problem in Mexico, because of emerging and re-emerging infections, due to increased population mobility, overcrowding, inadequate basic sanitation, social marginalization, modification in the composition or behaviour of some infectious agents, drug resistance, and comorbidity, particularly acute respiratory, intestinal, and urinary tract infection (Soto-Estrada et al., 2016). Communicable diseases are major causes of premature death such as acute respiratory infections, and in some age groups, AIDS and tuberculosis appear as relevant causes along with Chagas disease, which stands out as a major cause of disability in older adults (Lozano Asencio et al., 2014).

HIV

Mexico has a National AIDS Cases Registry, which is the main tool for monitoring this epidemic in the country, which has led to an improvement in the registration of cases, as well as greater access to antiretroviral treatments, which in turn have been improving, giving people with HIV/AIDS a greater opportunity to live longer (Secretaría de Salud, 2015b).

The most recent epidemiologic data on HIV comes from the ENSANUT 2012 where in addition to survey questions, spot-blood tests for HIV (Western-blot) were taken from a sample of population 15-49. A prevalence of 0.15% was identified (95% CI 0.09-0.21); 0.07% (95% CI 0.03-0.11) in women, and 0.24% (95% CI 0.11-0.36) in men. The HIV positive population are more likely to be young men, with a higher socioeconomic level in relation to the general population and are also more likely to be covered by social security (49.9% in HIV positive versus 34.5% in non-positive) (Gutiérrez et al. 2014).

It was estimated that approximately 104,000 people 15 to 49 years were living with HIV in Mexico in 2012, and of these, 75% are men. Of those tested, 50.6% did not know their serological status before being tested as part of the survey. The estimated prevalence among individuals 15 to 49 years was adjusted both for selection bias correction and the usual difficulty to capture some population groups, which resulted in a slightly higher HIV serology of 0.23% and an estimated number of people with HIV of 140,000 (Gutiérrez et al., 2014).

Table 7. Serology prevalence of HIV, in population 15 to 49 years. Mexico, 2012

Source: ENSANUT, 2012

Tuberculosis and other infectious diseases

In Mexico, the Ministry of Health estimates that there are at least 2,000 to 2,500 deaths per year due to tuberculosis, as well as more than 19,000 new cases annually. Tuberculosis affects groups of all ages, but it predominates in young people and in mid-life. Not all treated cases of tuberculosis should be considered officially reported, because mistakes in clinical records should be considered, such as mix the prevalent cases (therapeutic failures, relapses, and chronic or multi-drug resistant cases) with the incidents, so it continues to be a major public health problem (Báez-saldaña et al., 2003).

Other relevant diseases are rotavirus, which is a virus that causes diarrheal disease, especially in infants between 6 and 24 months of age. Since 2006, children in Mexico have free access to rotavirus vaccine because it has been included in the basic vaccination table. Pneumonia causes bacterial meningitis in adults and is the second most common cause of meningitis in children over 2 years of age.

Vector-borne diseases

It is estimated that close to 60% of the national territory presents favourable conditions for the proliferation of insects that transmit pathogens. Malaria is about to be eradicated, dengue persists, while chikungunya and zika have recently appeared. In relation to dengue fever, it has increased in the last years in 30 states of the country. Finally, the Chagas disease, a condition caused by the protozoan parasite Trypanosoma cruzi, is among the top ten causes of life years associated with disability in older adults (Lozano Asencio et al., 2013).

References:

Báez-saldaña, A. R., Cm, M., Pérez-padilla, J. R., Salazar-lezama, M. A., Ar, B., Jr, P., & Ma, S. (2003). Discrepancias entre los datos ofrecidos por la Secretaría de Salud y la Organización Mundial de la Salud sobre tuberculosis en México , 1981-1998. 45(2).

Gutiérrez, J. P., Sucilla-Pérez, H., Conde-González, C. J., Izazola, J. A., Romero-Martínez, M., & Hernández-ávila, M. (2014). Seroprevalencia de VIH en población mexicana de entre 15 y 49 años: Resultados de la Ensanut 2012. Salud Publica de Mexico, 56(4), 323–332. https://saludpublica.mx/index.php/spm/article/view/7352/10303

Lozano Asencio, R., Gómez Dantés, H., Pelcastre Villafuerte, B. E., Montañez, J. C., Campuzano, J. C., Franco, F., & González Vilchis, J. J. (2013). Carga de la Enfermedad en México 1990-2010: Nuevos resultados y desafíos Contenido. 122.

Lozano Asencio, R., Gómez-Dantés, H., Pelcastre, B., Ruelas, M., Montañez, J., Campuzano, J., Franco, F., & González, J. (2014). Carga de la enfermedad en México 1990-2010. Nuevos resultados y desafíos (Vol. 91). Instituto Nacional de Salud Pública, Secretaría de Salud, 2014.

Secretaría de Salud. (2015b). Prontuario de la Salud. Informe sobre la salud de los Mexicanos 2015.

Soto-Estrada, G., Moreno-Altamirano, L., Pahua Díaz, D., Soto-Estrada, G., Moreno-Altamirano, L., & Pahua Díaz, D. (2016). Panorama epidemiológico de México, principales causas de morbilidad y mortalidad. Revista de La Facultad de Medicina (México), 59(6), 8–22. http://www.scielo.org.mx/pdf/facmed/v59n6/2448-4865-facmed-59-06-8.pdf

As described in the preceding tables, communicable diseases do not confer a significant burden of disease in NZ, only accounting for ~4% of disability and mortality.

In 2018 an estimated 7.52 million people were living with HIV in South Africa, with 18.99% of adults between the ages of 15 and 49 being infected, and 22.32% of women (StatsSA, 2018d).

In 2015, HIV/AIDS (1 365 000) and TB (849 000) were identified as the country’s two leading causes of YLLs to premature mortality (Groenewald et al., 2017). The table below ranks the top ten causes of YLLs, including both communicable and non-communicable diseases or conditions:

Table 5: Top ten causes of years of life lost (YLLs) for South Africa, 2015

Source: Adapted from Groenewald et al., (2017), p.214

South Africa has seen an increase in the burden of HIV/AIDS and TB and other communicable diseases, perinatal, maternal and nutritional conditions (i.e., comm/mat/peri/nutr) from 37.8% in 1997 to 62.1% in 2006 (Groenewald et al., 2017). However, for 2015 there has been a decline (45.4%) in HIV/AIDS, TB and Comm/mat/peri/nutr and this is attributed largely to an increase in the burden of non-communicable diseases (i.e., from 29% in 2006 to 40% in 2015). Despite these gains, the increase of cases of multiple drug resistant, TB (MDR-TB) has placed strain on the health system to cope, with rates for TB alone increasing from 3.2% total DALYs in 2010 to 3.7% in 2015 (EMERALD, 2017).

References:

EMERALD. (2017). Moving towards Universal Health Coverage for Mental Disorders in South Africa.

Groenewald, P., Bradshaw, D., Day, C., & Laubscher, R. (2017). 14 Burden of disease. October 2012, 206–226. Availabe from: https://www.hst.org.za/publications/District%20Health%20Barometers/14%20(Section%20A)%20Burden%20of%20Disease.pdf

StatsSA. (2018d). Quarterly Labour Force Survey. Available from: https://www.statssa.gov.za/?p=11882