Community health: Another Aspect for Concern [Archives:1997/39/Health]

September 29 1997

By: Abdulrahman H. Al-Harazi, M. D.
Health promotion and host protection from various types of infectious or non-infectious diseases are the main function of what is called “Primary Health Care” (P.H.C). It is well known that “health” does not mean simply the absence of disease, rather, it means; a state of well-being both physiologically, mentally and socially for the human being. P.H.C. is the first and direct contact between the health authorities and family members. It is part of the epidemiological survey, in other words; it is the process that prevent the disease before its occurrence in the community through many steps which start with the protection of the community from what ever source which leads ultimately to disease such as: 1- Contaminated food or its products. 2- No sanitation of water supply 3- No vaccination of children 4- No protective measures against some local diseases. 5- Non-safety of some drugs 6- Non-availability of some necessary drugs and resuscitation.
These are typically the areas that are first to be identified by implementing general and control preventive measures which could be divided into three categories according to the period and natural history of the disease during which they are applied. They are preventive, control and international measures. As prevention is better than cure, the preventive measure is the cornerstone for any health program. The preventive measures are applied during the pre-pathogenesis period in the natural history of disease through health promotion and host protection which include: – Health education. – Good standard nutritional adjustment. – Provision of adequate housing. – Provision of adequate recreational facilities. – Provision of agreeable working conditions. – Provision of marriage consulting units. – Periodic selective examination. – Use of specific immunization. – Chemoprophylaxis. – Attention to personal hygiene. – Protection against occupational hazards. – Protection against accidents.
However, in Yemen, unfortunately, we do not have any access to these preventive measures although our community is being full with diseases almost of infectious nature. Let me give some examples: ý
Contaminated food and its products: In our country both in urban and rural areas all supermarkets and mini-supermarkets sell all types of sweets, cheese, dairy products, fruit and even drugs without supervision. Some of them are out dated. Some of them are badly handled by sellers which result definitely in contamination. The same applies to the restaurants, most of which have not met the minimum requirements of health conditions.
Infectious diseases: In our country hepatitis i.e.. infection of the liver is an example of a very common infectious disease. It prevails in rural areas. The causative agent is a virus mainly of type A which is transmitted via feco-oral route. Also the hepatitis B virus is not uncommon, but for the reason that it is transmitted parentally via blood Transfusion or its products, it occurs mainly at hospitals accidentally for those patients who receive blood for managing other illnesses. It should be remembered here that type A is safe and self-limited while type B is dangerous because it leads to chronic infection and the patient may carry the virus many years till the host immunity decreases by any debilitating factor. In some areas of Yemen there is usually one case infected with hepatitis virus. however, due to absence of the local health authority’s role to educate and control such case, it acts as a common source for epidemic outbreak of hepatitis disease, especially in families, institutions, summer camps and among troops. The most likely mode of transmission under these conditions is through close personal contact. Advanced countries, and to some extent some of the third world countries, have active and well-prepared local health authorities. The health authority must be notified promptly, consequently all efforts must be taken to prevent and control further spread of the disease among the community. Moreover, the next step is to discuss the occurrence of this disease from the global and local points of view; its seasonal fluctuation, and its age and sex distribution; putting into consideration the following relevant questions:
– What is known of its world-wide occurrence ? – Does the disease exhibit a special feature of geographical distribution? – Is it prevalent in the community or country? – If so, what are the figures concerning its local endemic and/or epidemic frequency during the past few years? – If not, has it been prevalent at a time in the history of the country? – Does the disease show a regular seasonal fluctuation? – Does it show any definite pattern of age incidence? etc.
So, a lot of studies, research and statistical analysis must be done so as to permit more accurate disease surveillance and to identify epidemiologic trends. Let me discuss in few words what is going on in our country. Of course the Ministry of Public Health has a specific administration for managing such vital issues. Throughout the governorates, there are specialists in epidemiology and health survey who have a lot of knowledge in all aspects of the community health. Unfortunately, they are outright un- productive, either because of feeling that they are being ignored as part of the regime’s ignorance policy towards all educated people, or they see our miserable situation of corruption and instability as not helpful in providing more enthusiasm. The resultant in both probable causes is that community health remains out of concern and full with all types of diseases that indicate we failed to achieve practically even the basic definition of health for our citizens!