Tuberculosis affects many millions in the South-East Asia Region.

This intravenous drip replaces the fluids lost by the constant drain of cholera diarrhoea. Today, oral rehydration therapy is usually effective and the case- fatality ratio has been reduced from 20 per cent to less than 5 per cent.

Demonstration of how to mix oral rehydration salts (ORS) at an Oral Rehydration Therapy Corner in Bangladesh.

Places like these are ideal breeding grounds for a range of communicable diseases.

Tuberculosis

Throughout the 1970s, national tuberculosis control programmes focused on case-finding and treatment and BCG vaccination through basic health services. Infants and children were vaccinated as part of the Expanded Programme on Immunization (EPI). However, in spite of all these efforts, the impact was marginal. Until 1983, globally, tuberculosis continued to be a serious health problem, particularly in developing countries.

The World Health Assembly accepted the fact that the epidemiological target of interrupting TB transmission and in substantially reducing the magnitude of the problem required a sustained effort. It was recognized that the programme must be integrated into comprehensive health systems based on primary health care.

Sexually transmitted diseases

Venereal diseases had staged a comeback in the mid and late 1970s. By that time, WHO had changed the terminology from venereal diseases to sexually transmitted diseases, a terminology which did not involve any value judgement. The recrudescence of sexually-transmitted diseases was associated with the rapid changes in traditional codes and norms of sexual behaviour of the people in the 1960s and 1970s. WHO’s support to national programmes on STD was through strengthening of diagnostic facilities, organization of treatment centres, training of health staff and promotion of health education.

Diarrhoeal diseases

In 1978, the World Health Assembly authorized WHO to establish a global programme on Control of Diarrhoeal Diseases (CDD) aimed at reducing mortality and morbidity from diarrhoeal diseases and their associated ill-effects, particularly malnutrition in infants and young children.

At the time, medical science rightly recognized that diarrhoea victims were dying essentially from a loss of precious body fluids and salts. It was logical to reverse the dehydration by administering a sophisticated replacement fluid through an intravenous drip.

Unfortunately, however, few lives were saved by this treatment. Intravenous drips were expensive and could be set up only in a health centre or hospital to which millions of families had no ready access.

WHO, therefore, promoted the idea of rehydrating the child suffering from diarrhoea by means of a simple fluid given by mouth. Only extremely dehydrated children needed a drip. The effectiveness of oral rehydration therapy (ORT) was unmatched in its simplicity and accessibility to even the poorest families.

WHO launched the CDD programme in the Region in 1979 with good results. Improvement in management strategies resulted in a dramatic fall in mortality. The programme placed within the reach of the community a simple, safe and effective tool to combat a serious public health problem.

Viral hepatitis

The countries of the South-East Asia Region have a high prevalence of viral hepatits. Outbreaks of hepatitis A result most frequently from faecal contamination of drinking water and food, though it has, in general, a low mortality. In the South-East Asia Region, hepatitis A virus (HAV) infection is common in Bangladesh, Bhutan, Myanmar, India, Maldives, and Nepal. Hepatitis B infection is acquired from blood and body fluids of an infected person, usually through sex or sharing injection needles. It can also be passed on from mother to baby. Besides producing a severe, and sometimes fatal liver condition, hepatitis B infection is a major cause of liver cancer. In the SEA Region, every year roughly 14 to 16 million people are infected with hepatitis B virus (HBV).

DPR Korea, Indonesia, and Burma are producing hepatitis B plasma-derived vaccine, and India and Thailand are planning to produce a DNA recombinant HB vaccine.

Higher life expectancy has led to greater emphasis on care of the elderly and control of cardiovascular diseases.

Environmental health

During the period 1978-1987, WHO supported activities related to the Water and Sanitation Decade. Member Countries were also supported in monitoring and review, municipal waste management, air water pollution as well as industrial and chemical pollution-related activities. Due to growing urbanization, increasing urban population, urban health deteriorated in most SEAR countries. To address this problem, the Healthy City Project was initiated.

Research on dengue vaccine

A WHO Collaborating Centre for Research in Dengue Vaccine Development was established in 1980, at the MahidolUniversity, Bangkok, Thailand, under the leadership of Professor Natth Bhamarapravati.

WHO also supported the establishment of the Aëdes Research Unit in Thailand to study the bionomics of A.aegypti, the main vector of dengue haemorrhagic fever. Support was also given for studies on A. aegypti in Indonesia. The WHO Collaborating Centre in Virology at the National Institute of Virology, Pune, India, was supported in the development of rapid diagnostic techniques.

Epidemiological studies on dengue fever, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) were supported in Indonesia, Myanmar, Sri Lanka and Thailand.

Control of cardiovascular diseases

Heart diseases – both coronary and rheumatic – were on the rise in most countries of the Region. WHO’s activities in this area were aimed at fostering national and international action by encouraging countries to (i) develop improved methods and strategies for preventing cardiovascular diseases, and (ii) to assess the extent of the problem of cardiovascular diseases in their populations.

Community-based, comprehensive cardiovascular disease control programmes were initiated in Member Countries. The cardinal factor in primordial prevention of cardiovascular diseases was to eliminate lifestyle-related risk factors. Towards this end, WHO led educational campaigns on ‘smoking and health’ and advocated physical exercise, balanced nutrition and avoidance of stress.