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Primary health care: hope and challenges for public health in Maldives

Sulaiman AI, Abu Bakar SH, Wahab HA

J Community Health, 2014 Jun;39(3):627-31.
PMID: 24488646 DOI: 10.1007/s10900-013-9809-3

The government of Maldives considers that the enjoyment of the highest attainable level of health is a basic right of every citizen. Thus it lays emphasis on the accessibility and affordability of health care services. In order to achieve these objectives, it is very important to expand curative services as well as preventive services in the country. The major hurdles faced by the country are result of the inherent structural problem faced by the county which leads to sever diseconomies of scale in the provision of healthcare services. Community and individual involvement and self-reliance are very important to achieve Health for All by the Year 200 AD. Community participation is one of the domains of community capacity building in a small island country. It is one of the mechanisms to empower people to take part in community development. In this paper, the nature, the dimensions of community participation, and its role and scope in implementation of different components of primary health care have been described. The health services in public and curative care have been briefed. Some of the achievements in health sector have also been briefly presented.

Matched MeSH terms: Indian Ocean Islands/epidemiology
Oral healthy conditions in Cocos (Keeling) and Christmas Islands children

Riordan PJ, Panaeff C

Community Dent Oral Epidemiol, 1996 Feb;24(1):85-6.
PMID: 8833521
Matched MeSH terms: Indian Ocean Islands/epidemiology
RADIATION DOSE TO MALDIVIANS VIA THE CONSUMPTION OF TUNA FISH CAUGHT FROM THE COASTAL WATERS OF INDIAN OCEAN

Nadhiya A, Khandaker MU, Mahmud S, Yarima MH

Radiat Prot Dosimetry, 2019 Oct 01;184(3-4):302-306.
PMID: 31034553 DOI: 10.1093/rpd/ncz085

Recognising the consumption of tuna fish as a major foodstuff in Maldivian diet, the presence of naturally occurring radionuclides in Yellowfin and Skipjack tuna are determined by using HPGe gamma-ray spectrometry to evaluate the health hazards to Maldivians. The samples were collected from different atolls of Maldives adjacent to the coastal waters of Indian Ocean. The activity concentrations (Bq kg-1) in Yellowfin tuna for 226Ra, 232Th and 40K are in the ranges of 4.2 ± 1.8-10.5 ± 1.1, 1.3 ± 0.3-3.2 ± 0.7 and 589 ± 29-697 ± 34, respectively while in Skipjack tuna the respective ranges are 3.9 ± 0.5-13.2 ± 1.1, 1.3 ± 0.3-2.7 ± 0.6 and 511 ± 28-681 ± 35. The committed effective dose (mean 263 μSv y-1) received by an individual due to the dietary intake of Yellowfin tuna falling below the UNSCEAR referenced global internal dose limit of 290 μSv y-1; while for Skipjack tuna, the estimated dose (mean 365 μSv y-1) exceeds the world average limiting value. The carcinogenic risk was found to be well below the ICRP referenced acceptable limit of 2.5 × 10-3. The present study indicates that the radiation dose to Maldivian via the consumption of Yellowfin tuna poses an insignificant threat to the public health. However, prolonged consumption of Skipjack tuna fish from the studied areas may pose a cumulative risk to the public health.

Matched MeSH terms: Indian Ocean Islands/epidemiology
Molecular basis of beta-thalassemia in the Maldives

Furuumi H, Firdous N, Inoue T, Ohta H, Winichagoon P, Fucharoen S, et al.

Hemoglobin, 1998 Mar;22(2):141-51.
PMID: 9576331

We have systematically analyzed beta-thalassemia genes using polymerase chain reaction-related techniques, dot-blot hybridization with oligonucleotide probes, allele specific-polymerase chain reaction, and sequencing of amplified DNA fragments from 41 unrelated patients, including 37 beta-thalassemia homozygotes, three with beta-thalassemia/Hb E, and one with beta-thalassemia/Hb S. Four different beta-thalassemia mutations were detected in 78 alleles. These are the IVS-I-5 (G-->C), codon 30 (AGG-->ACG) [also indicated as IVS-I (-1)], IVS-I-1 (G-->A), and codons 41/42 (-TTCT) mutations. The distribution of the beta-thalassemia mutations in the Maldives is 58 alleles (74.3%) with the IVS-I-5 (G-->C) mutation, 12 (15.4%) with the codon 30 (AGG-->ACG) mutation, seven (9%) with the IVS-I-1 (G-->A) mutation, and one with the codons 41/42 (-TTCT) mutation. The first three mutations account for 98.7% of the total number of beta-thalassemia chromosomes studied. These mutations are clustered in the region spanning 6 bp around the junction of exon 1 and the first intervening sequence of the beta-globin gene. These observations have significant implications for setting up a thalassemia prevention and control program in the Maldives. Analysis of haplotypes and frameworks of chromosomes bearing each beta-thalassemia mutation suggested that the origin and spread of these mutations were reflected by the historical record.

Matched MeSH terms: Indian Ocean Islands/epidemiology
Fulltext Association between the spread of COVID-19 and weather-climatic parameters

Carta MG, Scano A, Lindert J, Bonanno S, Rinaldi L, Fais S, et al.

Eur Rev Med Pharmacol Sci, 2020 08;24(15):8226-8231.
PMID: 32767354 DOI: 10.26355/eurrev_202008_22512

OBJECTIVE: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared.
MATERIALS AND METHODS: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVID-John Hopkins University website. Lethality of countries located within the 5th parallels North/South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate.
RESULTS: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01-0.51). This result does not seem to be totally related to the differences in age distribution of different sites.
CONCLUSIONS: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.

Matched MeSH terms: Indian Ocean Islands/epidemiology