Anil Aggrawal's Internet Journal of Forensic Medicine, Vol 3, No. 2, (July - December 2002); Trauma, Hunger And Communicable Disease, Leading Causes Of Death In The Developing World, Are Preventable (Editorial by Ndubuisi Eke)
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Ref: Eke N. Trauma, hunger and communicable disease, leading causes of death in the developing world, are preventable (Editorial). Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology, 2002; Vol. 3, No. 2 (July - December 2002): ; Published: July 1, 2002, (Accessed: 

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Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology

Volume 3, Number 2, July - December 2002

Editorial

Trauma, hunger and communicable disease, leading causes of death in the developing world, are preventable

-Ndubuisi Eke,
Urology Unit, Department of Surgery,
University of Port Harcourt Teaching Hospital,
Port Harcourt, Nigeria
Email: eke.obowu@alpha.linkserve.com


Ndubuisi Eke
Ndubuisi Eke, Nigeria

Mankind and the world were coasting along innocently ignorant until September 11, 2001. On that fateful early morning, two tall towers of the World Trade Center in New York, New York came crumbling down following a terrible terror attack. The ordnance were humans in the bellies of two aircraft fully loaded with aviation fuel. It is perhaps no longer doubtful that the undeclared war was hatched in Afghanistan by a Mr. Osama bin Laden now at large or in a cave or dead. It is unlikely that the world would ever be the same again. It may get better in the very long term but it is certainly going to get worse in the short term for most of mankind. Most of mankind has usually borne the brunt of afflictions and disasters natural or contrived. The developed world controls more than its fair share of the world's resources but the developing world has usually acquired more than its share of the world's afflictions and disasters. While the affluent developed world is threatened by a falling population, uncontrolled exploding population continues to destabilize the impoverished developing world. Among the scourges of mankind, three leading causes of death worldwide include malnutrition 1,2, infections and infestations 3,4 and trauma 5.

Malnutrition is a factor of poverty 6. It has afflicted many societies in history. Several famines including The Great Famine of 1845-1850 7 have been notable. While individuals in all societies may suffer malnutrition sporadically, large population malnutrition now occurs mainly in the developing world. The causes include both natural disasters such as famine and pestilence and contrived disasters such as traffic accidents, riots and wars. Famine from draught and pestilence has ravaged Afghanistan 8 and Somalia repeatedly for decades without end. War inflicted Kwashiorkor, a protein-energy malnutrition, in Biafra during the war in Nigeria from 1967 to 1970. During these tragic events, the most vulnerable in society including children, pregnant women and the elderly suffered mass deaths 1.

In spite of abject poverty and ignorance occasioning unhygienic habitation environments, it has been suggested that developing world inhabitants have some increased resistance to infections 9. This argument falls flat in the face of HIV/AIDS now ravaging the black African continent. HIV/AIDS has reenacted the resurgence of tuberculosis 10. Tuberculosis, also known as the white plague 11, was the scourge of the poor in all societies in medieval times 12 and has been referred to as 'the captain of all these men of death' 13. The galloping rate of spread of HIV/AIDS in central and Southern Africa portends a human disaster of dreadful and unimaginable proportions 14. Malaria is perhaps the world's greatest killer 15. Its largest victims are in the developing world of Asia, Africa and the jungles of South America. Infestations such as leprosy, guinea worm and schistosomiasis directly or indirectly cause mortality.

Trauma ranks closely with malaria as a major cause of deaths in the developing world. The agents of trauma are legion. Trauma in industries, public places and homes is often the consequence of inadequate safety facilities. Trauma from traffic on the roads, rivers and rails imposes a high mortality in the developing world. The factors responsible for traffic accidents are attributable to man, the road and the machine 16. Traffic accidents afflict the mobile and economically virile members of the society. A death among this population further impoverishes the community with the consequences on trail. Collapse of buildings attributable to poor civil engineering as well as fires in hostels, offices and markets generate trauma that may result in untimely deaths. Social unrests manifesting in repression by terror, riots and wars 17 are responsible for a significant proportion of traumatic deaths in the developing world. Karl Max is credited with saying that religion is the opium of the masses. Certainly religion and opium have brought ruin to Afghanistan and the rest of mankind. Also religious zealotry has ignited and fanned the embers of conflagration from Northern Ireland through Egypt and Algeria in North Africa to Nigeria and Sudan in the belly of Africa. Kashmir continues to pose a threat to mankind along the lines of a religious divide. Unfortunately accurate statistics of the death tolls in these conflicts is difficult to ascertain, as controlling authorities are wont to conceal the truth in the circumstances. With the sophisticated ordnance now available to legitimate and illegitimate authorities, there may now be a thin line separating a riot from a war.
Editorial by Eke - Pullquotes
...The agents of trauma are legion. Trauma in industries, public places and homes is often the consequence of inadequate safety facilities. Trauma from traffic on the roads, rivers and rails imposes a high mortality in the developing world. The factors responsible for traffic accidents are attributable to man, the road and the machine...

Currently available scientific and technological advances can address the above major causes of mortality in the developing world. Some advanced countries produce more food than they can consume or are willing to sell. From the poverty low ground of the developing world, it is distressing to note that excess agricultural products are often destroyed or wasted for the mere exigency of preventing fall in prices. It is not difficult to imagine that this practice flies in the face of the religious strictures of Islam, Christianity, Hinduism or others in the present reality of hunger in the world. A large proportion of the developing world continues to engage in peasant farming in spite of available mechanized farming that can be pursued through cooperatives. Pesticides are available to control plant and animal pestilence. Irrigation methods can ameliorate or contain the effect of droughts. In addition to mechanized farming in the developing world, innovative diversified agriculture and the application of biotechnology to produce genetically modified agricultural products have been advocated to assure both food and nutrition securities for mankind 18. The problem of malnutrition should be tackled globally through another form of international coalition. Economic poverty is in a vicious circle with poor education, poor health, low productivity and inappropriate allocation of resources by dispensers of political power. Governments in the developing countries have continued to allocate less of their GNP to education and health than recommended by the appropriate UN agencies 19. To prop up unpopular regimes, a large chunk of their wealth is spent on military hardware raged against their citizenry. This is euphemistically christened defense spending. The industrial sector is neglected as middlemen and their sponsors make quicker short-term profits by patronizing foreign goods, often with the incentive that their loots are secured in foreign bank vaults in dollar, sterling and now, euro accounts. Brazen acts of state kleptocracy remain unchallenged in spite of the recent concern of the World Bank on corruption in high places. Perhaps the present focus of terrorism and its funding will offer an opportunity to redress this issue of corruption in high places.

Medical advances are slow to filter through to the developing world. The costs of these advances are beyond the means and reach of most of the inhabitants of the developing world. A clear example is the cost of medication for HIV/AIDS. This has generated some tension in South Africa. A lot of research is conducted on malaria, away from the endemic areas. Dividends accruing from these research efforts are slow to reach the areas of endemicity. When they reach, they may be unaffordable. The level of prevailing ignorance may make these dividends unacceptable to the intended beneficiaries. Research into diseases should be conducted mainly in the endemic areas to reduce the cost of the efforts and subsequently, the costs of the products. It is encouraging that genuine efforts to control malaria in Africa and other developing countries can be fruitful 20, 21. If mosquitoes cannot be eradicated, it may be possible to sterilize the insect and rid it of plasmodium parasites. Immunological approach through the development of the malaria transmission-blocking vaccines may hold prospects for this sterilization 4, 15. Thus the mosquito can have its bite while man can retain his health. Guinea worm eradication was championed by Jimmy Carter in Nigeria not long ago. The program now appears to have suffered the fate of projects in the developing world. They remain permanent as projects while the anticipated result eludes the potential beneficiaries. It ought not be so.
Editorial by Eke - Pullquotes
...United, we stand. Mankind must rise, like phoenix, from the ashes of September 11 2001 terror attack and emerge a finer breed of humanity in a safer world...

Trauma in all its ramifications is preventable. Road, river and rail traffic accidents result from factors largely under the control of man. Appropriately adequate investments to build and maintain transportation infrastructure will drastically reduce the carnage on road, river and rail tracts. The world has endorsed (and quite rightly too) the American proposition that terrorists and those who harbor them should be treated the same way. As the world strives to define terrorism, perhaps wars should be defined from riots. The lack of preventive and therapeutic facilities in human and material resources compounds the outcome of trauma in the developing world. Even in the developed world, present Accident and Emergency facilities have been found to have evolved in 'fragmented and poorly coordinated fashion' and have been subjected to unexpected demands. These facilities are thought to be inadequate to cope with patients with very severe injuries 22. In spite of the teeming population of the third world, human resources are lacking due to management bereft of moral and visionary attributes. The UN general assembly seat for a nation should be earned by the attainment of certain basic social standards for health care, health facilities and security for human life. Those who do not meet the minimum standards should be sanctioned. It is time to halt the abuse of the politics of sovereignty to excuse the excesses of dictatorships on mankind. Perhaps now is the time to adopt Paul Robeson's charge that there is only one race: the human race. United, we stand. Mankind must rise, like phoenix, from the ashes of September 11 2001 terror attack and emerge a finer breed of humanity in a safer world.

References


1. Lumey LH, Van Poppel FW. The Dutch famine of 1944-45: mortality and morbidity in past and present generations. Soc Hist Med 1994; 7:229-246.
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3. Dgedge M, Novoa A, Macassa G, Sacarlal J, Black J, Michaud C, Cliff J. The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994. Bull World Health Organ 2001; 79:546-552.
4. Leke RG. The state of immunology in Africa: HIV/AIDS and malaria. Curr Opin Immunol 2001; 13:523-527.
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6. Hay RW. The political economy of famine. Nutr Health 1986; 4:71-82.
7. Froggatt P. Doctors in the Great Famine, 1845-1850. J Ir Coll Physicians Surg 1995; 24:291-294.
8. Assefa F, Jabarkhil MZ, Salama P, Spiegel P. Malnutrition and mortality in Kohistan District, Afghanistan, April 2001. JAMA 2001; 286:2723-2728.
9. Thomas HO. Idiopathic gangrene of the scrotum in West Africans. Br J Urol 1953; 25:60-63.
10. Hansell DA. The TB HIV epidemics: history learned and unlearned. Law Med Health Care 1993; 21:376-381.
11. Min KK. The white plague returns: law and the new tuberculosis. Wash Law Rev 1994; 69:1121-1142.
12. Das RK. Tuberculosis-historical landmarks. J Indian Med Assoc 2000; 98:112-114.
13. Rubin SA. Tuberculosis. Captain of all these men of death. Radiol Clin North Am 1995; 33:619-639.
14. Kaul R, Makadzange T, Rowland-Jones S. AIDS in Africa: a disaster no longer waiting to happen. Nat Immunol 2000; 1:267-270.
15. Stowers A, Carter R. Current developments in malaria transmission-blocking vaccines. Expert Opin Biol Ther 2001; 1:619-628.
16. Eke N. Road traffic accidents in the developing world: who are liable? Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology 2000; Vol.2, No.1 (Jan-June, 2001):../../../vol_001_no_002/paper006.html
17. Kiros GE, Hogan DP. War, famine and excess child mortality in Africa: the role of parental education. Int J Epidemiol 2001; 30:447-455.
18. Krishnaswamy K. Perspectives on nutrition needs for the new millennium for South Asian regions. Biomed Environ Sci 2001; 14:66-74.
19. Sivard RL. World military and social expenditures. Washington DC: World Priorities Inc, 1986.
20. Utzinger J, Tozan Y, Singer BH. Efficacy and cost-effectiveness of environmental management for malaria control. Trop Med Int Health 2001; 6:677-687.
21. Akhavan D, Musgrove P, Abrantes A, d'A Gusmao R. Cost-effective malaria control in Brazil. Cost-effectiveness of a Malaria Control Programme in the Amazon Basin of Brazil, 1988-1996. Soc Sci Med 1999; 49:1385-1399.
22. Kivell P, Mason K. Trauma systems and major injury centers for the 21st century: an option. Health Place 1999; 5:99-110.


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