Researchers are reporting a link between a climate phenomenon know as El Nino and the number of cholera cases in eastern Africa. Predicting when there’s going to be an El Nino event could improve public health preparedness.

El Ninos are a global climate phenomenon that occurs at irregular times, approximately every two to seven years.

During an El Nino, surface ocean temperatures in the eastern Pacific off the coast of South America become warmer than usual. The warming trend begins around Christmas time.

The following year, in the fall, sea surface temperatures also warm, if somewhat less, in the western Pacific, leading to extreme weather events like flooding and droughts, conditions that are ripe for cholera outbreaks.

Approximately 177 million people reside in areas where the incidence of cholera increases during El Nino.

But there’s been scant evidence of El Nino’s health impact in Africa.

A study published in the Proceedings of the National Academy of Sciences found the incidence of cholera increased in countries in East Africa.

“Because they can either lead to surface flooding that washes contamination into drinking water in areas where there’s open defecation,” said epidemiologist Sean Moore, who led the study. “It also can lead to overflowing of sewer systems in urban areas which again can lead to contamination of drinking water.”

There are approximately 150,000 cases of cholera per year, mostly in sub-Saharan Africa, according to Moore, an epidemiologist at Johns Hopkins School of Public Health in Baltimore.

But during El Ninos, researchers found the incidence swelled by some 50,000 cholera cases in eastern Africa, although the overall number of cases on the continent did not change — for reasons that are not completely understood, said Moore.

Patterns of shift in the number of cholera cases were measured during El Ninos between the years 2000 and 2014. There also were 30,000 fewer cases reported in southern Africa during El Nino years compared to non-El Nino years, researchers found..

Scientists also saw a slight increase in the number of cholera cases in areas hit by drought due to El Nino.

Moore said that’s because when water becomes scarce, available drinking water can become contaminated by bacteria in human waste.

Without treatment, mortality rates from cholera can climb as high as 50 percent.

To the extent that the climate phenomenon can be predicted six to 12 months ahead of time, Moore said public health officials can prepare for outbreaks, which tend to occur early on.

“An advance warning could, even if it doesn’t prevent outbreak, it could at least prevent the deaths that tend to occur during the early part of an outbreak,” he said.

With oral rehydration therapy, Moore said the risk of death from cholera drops to 1 percent. He said there are now cheap cholera vaccines that could be used to prevent the disease when it’s known that an area is going to be hit by an El Nino.
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Nearly five million children under age five have been successfully vaccinated against polio in war-torn Yemen almost two-months after a nationwide immunization campaign was launched by the World Health Organization (WHO), the U.N. Children’s Fund (UNICEF) and the World Bank.

The campaign, which began on February 20, has taken much longer than usual to complete because of security challenges.  The logistics involved in reaching millions of children with life-saving vaccines in war-torn Yemen are immense and complicated.

WHO spokesman, Tarik Jasarevic, told VOA different parts of the country are controlled by different warring parties.  He said informing them of the campaign, organizing health teams and transporting the polio vaccines takes a lot of time.

“For this campaign, more than 5,000 vehicles have been rented, more than 40,000 health workers were mobilized…. This is a big operation, obviously.  But, with the support of local religious leaders, political leaders, that element is absolutely crucial that it is being accepted by the population and that vaccination teams are being trained and prepared in advance,” he said.

Jasarevic said health workers only recently were able to bring the campaign to Yemen’s Sa’ada governorate.  Despite intensifying violence, he said more than 150,000 children under age five were vaccinated against polio and nearly 370,000 children between the ages of six months and 15 years were immunized against measles there.

He said the war has made routine immunizations in Yemen impossible, making nationwide immunization campaigns against polio and other killer diseases necessary.

“We have seen for example in Syria that polio came back because there were areas where children were not immunized for some time.  We do not want this to happen in Yemen.  Yemen is still polio-free and we want to keep it polio-free and these campaigns are one of the ways to make sure that the virus cannot find a host,” Jasarevic said.  

The United Nations reports Yemen’s two-year-long conflict has all but destroyed the country’s health system.  It says the situation of Yemen’s children continues to worsen and many are dying from preventable diseases.
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Getting a vaccine without the shot has always been one of the greatest hopes of medicine. For people in the developed world it means getting a vaccine can be as simple as taking an aspirin. For people in the developing world, or in isolated rural areas, it means they can get vaccines without a doctor or nurse. VOA’s Kevin Enochs reports.
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Malaysian customs officials said Monday they have confiscated 18 rhino horns, weighing more than 51 kilograms, and valued at over $3 million.

Customs said they found the horns in a crate Friday at the Kuala Lumpur International Airport cargo terminal after receiving an anonymous tip.

The haul had been shipped from Mozambique via a Qatar Airways flight with false documentation, classifying the the horns as “obre de arte” — or work of art.  

Rhino horn global trade is banned under a United Nations convention.  

Malaysian officials say the case is under investigation and no suspects have been arrested.

Rhino horns have been used for centuries in traditional Asian medicine, but they have not been proven to cure any illnesses.  

The wild rhino population at the start of the 20th century was 500,000, but has since dwindled to 29,000.  
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A cyclone that left a trail of destruction in northeast Australia and New Zealand has also damaged one of the few healthy sections of the Great Barrier Reef to have escaped large-scale bleaching, scientists said on Monday.

The natural devastation adds to the human and economic toll of Cyclone Debbie, which killed at least six people in recent weeks and severed rail transport lines in one of the world’s biggest coal precincts.

The damage caused when the intense, slow-moving cyclone system struck a healthier section of the reef outweighed any potential beneficial cooling effect, scientists from the ARC Center of Excellence for Coral Reef Studies said.

“Any cooling effects related to the cyclone are likely to be negligible in relation to the damage it caused, which unfortunately struck a section of the reef that had largely escaped the worst of the bleaching,” ARC said in a statement.

The World Heritage site has suffered a second bleaching event in 12 months, triggered by unseasonably warm waters, ARC added. Higher temperatures force coral to expel living algae and turn white as it calcifies.

Mildly bleached coral can recover if the temperature drops, and an ARC survey found this happened in southern parts of the reef, where coral mortality was much lower, though scientists said much of the Great Barrier Reef was unlikely to recover.

“It takes at least a decade for a full recovery of even the fastest-growing corals, so mass bleaching events 12 months apart offers zero prospect of recovery for reefs damaged in 2016,” said James Kerry, a senior research officer at the ARC.

Repeated damage could prompt UNESCO’s World Heritage Committee to reconsider a 2015 decision not to put the Great Barrier Reef on its “in danger” list.

Tourists drawn to the unique attraction spend A$5.2 billion ($3.9 billion) each year, a 2013 Deloitte Access Economics report estimated.
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More and more Americans are interested in consuming healthy food and products. Retailers are feeding this growing demand by offering new products or introducing old ones in brand new ways. Coconut is currently one of the hottest trends in the U.S. food market. VOA’s Faiza Elmasry has more. Faith Lapidus narrates.
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Most people have likely heard about the dangers of microplastics, the particles less than 5 millimeters in size that deteriorate from larger plastic pieces that have entered the oceans. Scientists are beginning to realize the effect this plastic is having on all kinds of sea life, from the smallest to the largest, and even those that live in the deepest darkest parts of the Mariana Trench. VOA’s Kevin Enochs has details.
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A relatively large asteroid will cross Earth’s orbit around the sun this month. Astrophysicists and astronomers say there is no chance of a collision, but it will be the closest flyby of an asteroid that large for at least another 10 years.

Asteroid 2014 JO25, discovered three years ago, is about 650 meters (2,100 feet) in diameter, 60 times as large as the small asteroid that plunged into our atmosphere as a meteor and exploded over the Russian city of Chelyabinsk in 2013. That blast was felt thousands of kilometers away and caused havoc on the ground, damaging more than 7,000 homes and offices and injuring 1,500 people.

Asteroid 2014 JO25’s pass by Earth on April 19 will be a near miss, cosmically speaking. The U.S. space agency NASA said no one should worry: “There is no possibility for the asteroid to collide with our planet, [but] this will be a very close approach for an asteroid of this size.”

The Minor Planet Center of the International Astronomical Union classifies 2014 JO25 as a “potentially hazardous asteroid.” (Astronomers classify asteroids as “minor planets”; when they pass close to Earth they are termed “near Earth objects.”)

WATCH: NASA Animation: Asteroid 2014 JO25’s Orbit

An animation of the intersection of Earth’s orbit and that of 2014 JO25, prepared by the Jet Propulsion Laboratory, a unit of the California Institute of Technology, makes it look like an awfully close call, but the hard facts are more reassuring: At its closest point, the asteroid will be about five times as far from Earth as the moon is, more than 1.75 million kilometers away (1,087,400 miles).

Although the asteroid is expected to be twice as reflective as our moon, it will be difficult to spot in a night sky filled with stars, and certainly not without help. Scientists say the sort of telescope amateur astronomers use should be adequate to pick out the space rock as it whizzes across the sky at 120,000 kilometers per hour (74,500 mph).

EarthSky.org, a website that follows developments in the cosmos and throughout nature in general, has posted an article with detailed information to help sky-watchers find the asteroid on April 19, and for a day or two afterward.

Professional astronomers also will be tracking 2014 JO25 closely. Puerto Rico’s Arecibo Observatory, an extremely powerful radio telescope center, will study the asteroid for five days.

After all, it’s not often that something as big as this comes along, even a couple of million kilometers from home. NASA says 2014 JO25 hasn’t been this close to Earth in the past 400 years, and it will be at least 500 years before it comes back for a repeat close encounter with our planet.

Asteroids actually pass close to Earth fairly often, but it’s their size that matters. Asteroid 2017 GM made one of the closest passes by Earth ever seen — 16,000 kilometers (9,900 miles) above sea level — less than a week ago, on April 4. Little notice was taken, however, because that chunk of space rock was about the size of a small car.
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When Arnaud Laillou, a nutrition specialist with UNICEF, led a salt iodization study in 2014, he wanted to be sure that salt producers were not adding too much iodine.

Just four years earlier, UNICEF had stopped providing iodine to salt producers at the end of a decade-long, largely successful government-run iodization program.

Laillou was stunned to find that 90 percent of coarse salt and 40-50 percent of fine salt was now not iodized. And all of it was labeled as iodized.

“It was a real shock for us,” says Laillou of the findings of the paper that was published last year in the online journal Nutrients.

Serious public health problem

That paper said iodine deficiency in Cambodia had become “a serious public health problem” just years after the issue had largely been dealt with, and warned that poorer families and rural families were worst affected.

That was at odds with a study carried out three years earlier that showed salt producers were adding iodine, and that authorities were enforcing a 2003 subdecree that mandated iodization.

Iodine is essential to brain development and hormonal functions. If a pregnant woman is iodine-deficient, for example, her baby’s brain will not develop properly. The mineral is vital for brain development in children, too, and for proper hormone functioning in all ages. Iodine is so important that the World Health Organization has described iodine-deficiency as “the [world’s] single greatest preventable cause of mental retardation.”

Iodizing salt is widely regarded as one of the cheapest and most effective public health measures: it costs 2 cents per kilogram of salt.

Children hurt most

Iodine-deficiency, Laillou said, is particularly damaging for children.

“For example, Cambodia is investing a lot of money at the level of the Ministry of Education to improve the education of their children,” he said. “But having a lack of iodine in the brain, it decreases [their] IQ by 13 points.”

That, he points out, compares with the loss of three IQ points for a child who is not breastfed for the first six months of life.

Wholesale failure

In theory, adding iodine to Cambodia’s annual output of 80-100,000 tons of salt should be simple: close to 100 percent is produced by the SPCKK cooperative in the southern province of Kampot. SPCKK produces coarse salt, which it sells in bulk to middlemen who operate boilers that refine that into fine salt.

By law, SPCKK must iodize all of its salt output. But over the years several of the iodizing machines it was given have broken down, and SPCKK has not sourced spare parts. Now it has four working machines and that’s not enough.

And so, as SPCKK’s technical chief, Bun Narin told VOA, its workers often spray iodine by hand, a method that is at best imprecise.

“Large companies [outside Cambodia] use machines to monitor, whereas we are still using labor and so it’s not always accurate,” he said.

That is putting it mildly, given that Laillou’s research found 90 percent of the country’s coarse salt lacks any iodine. Despite that, SPCKK’s output is labeled as containing the mandated amount of iodine.

If boilers don’t test for the concentration of iodine in the coarse salt that they buy, and if, further along the production line, salt repackagers, like 57-year-old Koy Rithiya, don’t test for the concentration in the fine salt that they buy from the boilers and then add iodine where needed, the result is noniodized salt.

Which is exactly what has happened.

Routine testing

When Rithiya set up his business in Phnom Penh 15 years ago, he didn’t know he needed to add iodine; he started doing that a decade ago after being advised by UNICEF.

These days he uses an electronic monitor to test the concentration of iodine in the 500 kilograms of fine salt that he repackages each day, and adds iodine where needed to meet the mandated standard of 30-60 parts per million.

He doesn’t yet use the monitor to test his daily output of 400 kilograms of coarse salt; instead he relies on a test that merely shows whether iodine is present or not. That test, however, does not measure the concentration.

Rithiya reckons the problem of iodine-deficiency has emerged in part because some producers use expired iodine, “but also because some producers combine salt with iodine without correctly balancing it.”

“And some don’t bother to use it correctly,” he said.

A lack of enforcement

The report makes clear where the problem lies: on the production side is SPCKK, as well as some boilers and salt repackagers; on the enforcement side are the authorities for failing to ensure that producers follow the law.

The irony is that by 2010, the government’s program meant the health problems associated with iodine deficiency in Cambodia were largely a thing of the past. A decade earlier, nearly 1 in 5 primary school children had goiters, a condition where the thyroid in the neck swells up. Many adults did, too. By 2010, that was no longer the case.

But when iodine prices tripled after the 2011 Fukushima nuclear disaster in Japan, many salt producers in Cambodia stopped buying the additive, and the authorities failed to make sure they were iodizing. The result: a re-emergent public health issue that has, to date, remained largely invisible.

The situation, though bad, should start to improve. UNICEF is working with a government subcommittee to devise a certification standard for all producers, although that could take two years to implement.

Ven Keahak, who heads the subcommittee on salt iodization, says the new licensing system will mean producers “have to have a machine, iodine powder [in stock], a brand name, and salt with proper quality in order to get a license.”

“It’s a legal enforcement that the ministry has to conduct,” he said.

A lack of enforcement has been part of the problem, but Keahak would not comment on the failure of government agencies to apply the current law. He did confirm that no one has been prosecuted for failing to add iodine or for failing to monitor the system.

The difficulty for concerned Cambodians is that every bag of salt carries the logo stating that it is iodized. To deal with that, the Ministry of Planning will now test all salt brands and will place advertisements in newspapers to tell people which brands they can trust.

Until then, the failure to police the country’s salt output will keep damaging lives in what experts say was an entirely avoidable public health issue.
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With the right attachment, a smartphone can be used as a diagnostic tool for infectious diseases like tuberculosis. Faith Lapidus reports.
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