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Wednesday 21 September is World Alzheimer’s Day. The day is observed to reignite awareness of the debilitating disease, its sufferers, the families of those affected, and hopes for cures or treatment. It’s also put in place to debunk myths and strive to resolve stigma. Purple is the official color of the Alzheimer’s movement.

What is Alzheimer’s disease?

Named after Alois Alzheimer, it was first described in 1906 after he encountered a patient that had started to exhibit irrational behaviour and memory loss. Alzheimer’s is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. 

Dementia vs. Alzheimer’s

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer’s is the most common cause of dementia. Alzheimer’s is a specific disease. Dementia is not.

Other causes of dementia include:

• Vascular dementia
• Parkinson’s disease
• Dementia with Lewy bodies
• Frontotemporal dementia
• Severe head injury dementia

Other symptoms of Alzheimer’s

As the disease progresses, other symptoms will appear and can include:

• Problems with language
• Disorientation (including easily getting lost)
• Mood swings 
• Loss of motivation
• Self-neglect
• Behavioral issues

As the disease worsens, the sufferer often withdraws from family and society. Bodily functions are gradually lost, which ultimately leads to death. The life expectancy following diagnosis is three to nine years. However, the speed of progression varies from person to person.

How Alzheimer’s can be treated/managed

Alzheimer’s is a very complex disease, and there is little chance of one single drug treating the whole spectrum of the disease or indeed helping everyone who tries it. However, advances are being made, and several drugs are in late-stage clinical trials.

The currently available medications focus on alleviating symptoms, although one drug is being fast-tracked for approval as it aims to stop plaque forming in the brain. It’s still undetermined whether the drug will help with symptoms already present.

Unfortunately, one must keep in mind that no cure currently exists.

Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors prescribed for mild to moderate Alzheimer’s symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.

A medication known as memantine, an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe Alzheimer’s. This drug’s main effect is to decrease symptoms, enabling some people to maintain certain daily functions a little longer than they would without the medication. For example, memantine may help a person in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both the person with Alzheimer’s and caregivers.

Common behavioral symptoms of Alzheimer’s 

These include sleeplessness, wandering, agitation, anxiety, aggression, restlessness, and depression. Scientists are learning why these symptoms occur and are studying new treatments — drug and nondrug — to manage them. Research has shown that treating behavioral symptoms can make people with Alzheimer’s more comfortable and makes things easier for caregivers.

Side effects of Alzheimer’s disease medications

Patients are usually started on a relatively low dose of a medication and then monitored to see how well they cope with it. The strength is then later increased.

Side effects include nausea, vomiting, diarrhea, allergic reactions, and loss of appetite. You must be aware of the usual symptoms so you can report anything unusual to the health care provider immediately.

Where you can seek help/get support

• Clinical research FAQs
• Tips for caregivers
• Planning for the Future After a Dementia Diagnosis
• ADN – Alzheimer Dementia Namibia

The purpose of World Suicide Prevention Day

Suicide can affect every one of us. Each suicide is devastating and a tragedy. It has a profound effect on those around the victim. By raising awareness, reducing stigma and encouraging well-informed action we can reduce the prevalence of suicde globally. World Suicide Prevention Day seeks to educate and give hope. The theme this year is “Creating Hope Through Action” and furthermore the Internations Association for Suicide Prevention says:

By encouraging understanding, reaching in and sharing experiences, we want to give people the confidence to take action. To prevent suicide requires us to become a beacon of light to those in pain.

Suicide statistics and facts (IASP, 2022)

• An estimated 703 000 people die by suicide worldwide each year.   
• Over one in every 100 deaths (1.3%) in 2019 were the result of suicide.
• The global suicide rate is over twice as high among men than women.
• Over half (58%) of all deaths by suicide occur before the age of 50 years old.
• A previous suicide attempt is the strongest risk factor for death by suicide.
• Globally, suicide is the fourth leading cause of death in 15-29-year-olds.  
• Suicide occurs across all regions in the world, however, over three quarters (77%) of global suicides in 2019 occurred in low- and middle-income countries.
• Approximately one fifth (20%) of all suicides are the result of pesticide ingestion, particularly in rural agriculture settings. Hanging and firearms are also common methods of suicide.
• While the global rate of suicide is showing signs of a decline, this is not the case in all countries and may be indicative of greater surveillance or access to data.  
• Experiences of conflict, disaster, violence, abuse, or loss and a sense of isolation are risk factors associated with suicidal behaviour. 
• Suicide rates are high within vulnerable groups who are subjected to discrimination including refugees, migrants, prisoners, indigenous people, and individuals from the LGBTI+ community.
• An individual suffering with depression is twenty times more likely to die by suicide than someone without the disorder.
• Suicide remains illegal in over 20 countries, while people who engage in suicidal behaviour may be punished in some countries that follow Sharia law, involving legal penalties that range from a small fine or short prison sentence to life imprisonment. 

When you should be concerned (WebMD, 2022)

There are certain signs that can help the possible victim be identified before they do something to themselves:

• Severe sadness or moodiness. 
• Hopelessness. 
• Sleep problems.
• Sudden calmness. 
• Withdrawal. 
• Changes in personality or appearance. 
• Dangerous or self-harmful behavior
• Recent trauma or life crisis. 
• Making preparations. 
• Threatening or talking about suicide.

Who is most at risk? (WebMD, 2022)

• Older people who have lost a spouse through death or divorce
• People who have attempted suicide in the past
• People with a family history of suicide
• People with a friend or co-worker who have killed themselves
• People with a history of physical, emotional, or sexual abuse
• People who are unmarried, unskilled, or unemployed
• People with long-term pain or a disabling or terminal illness
• People who are prone to violent or impulsive behavior
• People who have recently been released from a psychiatric hospitalization (This often is a very frightening period of transition.)
• People in certain professions, such as police officers and health care providers who work with terminally ill patients
• People with substance abuse problems

Where you can get help

There are many resources online and in-person that you can consult. If you are suicidal – tell someone! 

• CALM
• Choma
• Call the police
• Take the person to the nearest hospital – never leave them alone.
• Contact the following helplines available in Namibia:
• Lifeline/Childline Namibia (Toll free for youth): 116
• Lifeline/Childline Namibia (SMS Line for adults): 0811400222

You can call the Social Workers at Ministry of Health and Social Services (MOHSS) if you need to talk to someone that will understand. At Regional Level:

• Zambezi Region: 066-251400
• Hardap Region: 063-245521
• Erongo Region: 064-4106070
• Karas Region: 063-2209068
• Kavango Region: 066-265544
• Rundu Hospital: 066-265575
• Khomas Region: 061-2033320
• Katutura Hospital: 061-2034105
• Kunene Region: 065-272800
• Ohangwena Region: 065-263023/5
• Omaheke Region: 062-577000
• Omusati Region: 065-251824
• Otjozondjupa Region: 067-224050
• Oshana Region: 065-221391
• Oshikoto Region: 067-224050

You can also contact the Employee Assistance Programme Coordinator: D/COMM Platt A.E at 0811679770 or 061-2846903.

It is very important to look after you eyes– 80% of what we perceive comes through our sense of sight. Some diseases may cause you to lose your sight and therefore it’s very important to keep on top of your eyes’ health. 

What does 20/20 vision mean?

If you can see an object that is 20 feet away clearly you have 20/20 vision. The term refers to average, normal vision. If your vision doesn’t measure 20/20, you may need to wear contact lenses or glasses to see clearly.

How can I look after my eyes?

There are many things you can do to look after your eyes. Keeping your general health up is the most basic way of looking after your eyes. A healthy body helps you to maintain healthy eyes.

Here is a list of things you can do to stay healthy. As you will see it is important for all your systems to work well for your eyes to do so.

• Eat a healthy, balanced diet.  A diet that includes fruits and vegetables, especially deep yellow and green leafy vegetables. Add fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.
• Wear sunglasses. Your eyes may be damaged by exposure to the sun and raise your risk of cataracts and age-related macular degeneration. Wear sunglasses with 99 to 100% blocking of both UV-A and UV-B radiation.
• Maintain a healthy weight. Extra weight puts you at greater risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
• Get regular exercise. Certain diseases like diabetes, high blood pressure, and high cholesterol may be prevented by exercise. These diseases can lead to some eye or vision problems. 
• Know your other risk factors. You should know your risk factors, especially as you age as you develop a higher risk of getting certain diseases. 
• Wear protective eye wear. It almost goes without saying that certain sports and jobs require you to wear protective eyewear. This applies to DIY too!
• Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
• Give your eyes a rest. Believe it or not you can forget to blink! If you spend a lot of time staring at a screen your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.
• Know your family medical history. Some eye diseases such as (macular degeneration) are inherited, fiding out whether anyone in your family has it helps to determine if you are at risk and will help with diagnoses. 
• If you wear contacts, take steps to prevent eye infections. Follow the instruction on how to clean your lense and when you should get them replaced. Always remember to wash your hands well before you put in or take out your contact lenses.

Common Eye Disorders and Diseases

Myopia — Short-sightedness

Hyperopia  — Long-sightedness.

Astigmatism — A defect in the eye or in a lens caused by a deviation from spherical curvature, which results in distorted images, as light rays are prevented from meeting at a common focus.

Presbyopia — Long-sightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age.

Age-Related Macular Degeneration — A degenerative condition affecting the central part of the retina (the macula) and resulting in distortion or loss of central vision. It occurs especially in older adults, in which case it is called age-related macular degeneration.

Cataracts — A medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision.

Diabetic Retinopathy — Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight.

Glaucoma — A condition of increased pressure within the eyeball, causing gradual loss of sight.

World Breastfeeding Week is celebrated in the first week of August to mark the anniversary of the Innocenti Declaration. However, some countries choose to celebrate it at different times of the year. This year there will be a focus on strengthening the capacity of actors that have to protect, promote and support breastfeeding across different levels of society. These actors make up the warm chain of support for breastfeeding. There are specific target audiences, these include: governments, health systems, workplaces and communities. They will be informed, educated and empowered to strengthen their capacity to provide and sustain breastfeeding-friendly environments for families in the post-pandemic world. Visit breastfeedingpartners.org for details on themes and how to get involved!

Benefits of breastfeeding for mothers & babies

Breastfeeding is when you feed your baby breast milk, usually directly from your breast. It’s also called nursing. However, mum can also “express” the milk into a bottle if the baby has trouble latching on or if she has to work. 

Many medical experts, recommend breastfeeding exclusively (no formula, juice, or water) for 6 months. Even after introduction of other foods it is recommended that mum breastfeed for the whole first year of baby’s life. 

Benefits for baby:

• Provides ideal nutrition – has a nearly perfect mix of vitamins, proteins and fat.
• Is easier to digest than formula.
• Contains antibodies that help fight off bacteria and viruses.
• Lowers risk of having asthma or allergies
• Fewer infections, respiratory illnesses and diarrhea.
• The closeness (skin to skin contact and eye contact) also helps mum and baby bond and helps baby feels secure.
• According to the AAP it also plays a role in preventing SIDS (sudden infant death syndrome).
• It’s been thought to lower the risk of diabetes, obesity, and certain cancers as well, but more research is needed.

Benefits for mum:

• Promotes weight loss after birth – burning about 50 extra calories per day to build and maintain a milk supply.
• Helps stimulate the uterus to contract and return to normal size.
• Less postpartum bleeding
• Fewer urinary tract infections, less chance of anemia, and postpartum depression.
• Breastfeeding produces the naturally soothing hormones oxytocin and prolactin that promote stress reduction and positive feelings in the nursing mother.
• Increased calmness. Breastfed babies cry less overall, and have fewer incidences of childhood illness. Breastfeeding can support the wellness of body, mind, and spirit for the whole family.
• Breastfeeding makes travel easier. Breast milk is always clean and the right temperature.
• Breastfeeding mothers learn to read their infant’s cues and babies learn to trust caregivers. This helps shape the infant’s early behavior.

Breastfeeding and COVID-19

“Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life” –  WHO.

The WHO recommends that breastfeeding should continue or be initiated whether the mother or child have suspected or confirmed COVID-19 or not. The benefits of breastfeeding substantially outweigh the potential risks for transmission. Mother and infant should remain together and still practice skin-to-skin contact (including kangaroo care). This is especially important immediately after birth and during the establishment of breastfeeding.

What are the risks of breastfeeding?

However, there are risks associated with breastfeeding. For example, certain foods (caffeine, alcohol) and medications can make their way to the milk and harm the infant:

Amiodarone	May affect thyroid function of the infant
Antineoplastics	Leukopenia, bone marrow suppression
Gold salts	Rash, nephritis, haematological abnormalities
Iodine	High doses lead to a risk of infant hypothyroidism
Lithium	Breastfeeding is only feasible with rigorous monitoring
Retinoids (oral)	Potential for serious adverse effects

There is also the issue of being HIV positive. An HIV positive mother may pass on the virus to the child through breastmilk. Although, the risk is much reduced if the mother is put on a regime of ARVs. If you are HIV positive and pregnant or have an infant, you must immediately speak to your health care provider.

The liver is responsible for processing nutrients, filtering the blood, and fighting infections. When the liver is damaged (or inflamed) these functions are impaired. This can happen due to several reasons. A big one is alcohol misuse, of course, but other factors can weigh in: toxins, some medications and certain medical conditions. However, it is often caused by a virus such as the hepatitis A, hepatitis B, and hepatitis C viruses. 

“Hepatitis” simply means inflammation of the liver. An inflamed liver has become enlarged past the size of a normal organ of its type. It is typically a sign of a more serious health condition. Illnesses or diseases that lead to an inflamed liver could also produce other symptoms.

Signs of liver inflammation:

However, when referring to “hepatitis” one immediately thinks of the viral hepatitis variants and that is also what World Hepatitis Day focusses on. There are five main hepatitis viruses, referred to as types A, B, C, D and E. We’ll discuss A, B and C – the most common three.

Hepatitis A

Symptoms:

• Fatigue.
• Sudden nausea and vomiting.
• Abdominal pain or discomfort, especially on the upper right side beneath your lower ribs (by your liver)
• Clay-coloured bowel movements.
• Loss of appetite.
• Low-grade fever.
• Dark urine.
• Joint pain.

Treatment:

There is no specific treatment of hepatitis A. It is usually a self-limiting condition. This means that it normally gets better without any treatment. Any treatment given is usually aimed at easing the symptoms of the illness.

Hepatitis B

Symptoms:

• Diarrhoea 
• Bowel movements may become pale
• Urine may turn dark
• Jaundice 

Treatment:

People with the acute phase of hepatitis B, do not require treatment. For the majority of people, the symptoms resolve and the person can ‘clear’ the infection, usually within six months, meaning they are no longer infectious; their blood will always show the hepatitis B antibodies but they should never be infected again (they are considered ‘immune’).

Long term infection is chronic hepatitis B which often requires treatment to stop or reduce the activity of the virus from damaging the liver, by limiting the replication (reproduction) of the virus. This all depends on your “viral load.”

Hepatitis C

Symptoms:

Hepatitis C infection can go through two stages: acute and chronic. In the ‘acute’ stage, symptoms can include: 

• Flu-like symptoms, fatigue, high temperature and aches and pains 
• Loss of appetite 
• Abdominal pain 
• Yellowing of the eyes and skin (jaundice). 

In most cases an acute infection will develop into long-term ‘chronic’ infection. Symptoms vary but some of the most common include: 

• Problems with short-term memory, concentration and completing complex mental tasks (‘brain fog’)  
• Depression or anxiety  
• Mood swings 
• Constantly fatigue
• Nausea, vomiting or tummy pain 
• Dark urine  
• Pale faeces  
• Jaundice  
• Itchy skin 
• Feeling bloated 
• Joint and muscle pain.

Treatment:

This will depend on how long you have had the virus. 

People with acute (short-term) infection do not always need treatment because their immune system may clear it on its own. If you test positive during the acute stage, your doctor may ask you to come back after a few months to re-test and to see if you need any treatment. If you develop a chronic (long-term) infection, you will need treatment to help clear the virus. Treatment with drugs called direct-acting antivirals (DAAs) can cure hepatitis in most cases. These are usually taken for 8-12 weeks. Your doctor will also check your liver for any damage. If you’ve had hepatitis C in the past, you’re not immune to future. You can also still get other types of hepatitis and having hepatitis C together with another type is more serious. If you’ve already had hepatitis C, it’s advisable to have the vaccination against hepatitis A and B to protect your liver from further damage. 

Oral health refers to the general health of your mouth and most notably your teeth. It is an indicator of overall health and quality of life. It encompasses a range of diseases and conditions that include dental cavities, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, and birth defects such as cleft lip and palate.

Practicing good oral and dental hygiene can help prevent bad breath, tooth decay and gum disease. It can help you keep all your teeth as you grow older! Good oral hygiene and dietary habits have been shown to be essential for overall physical and emotional well-being throughout life.

The flip side of good oral hygiene can see you getting not only dental cavities, gum disease but has even been linked to heart disease, cancer, and diabetes. Maintaining healthy teeth and gums is a lifelong commitment.

Adult oral health 

You can keep your teeth for your lifetime. Here are some things you can do to maintain a healthy mouth and strong teeth.

Children

Cavities are one of the most common chronic diseases to affect children. These little holes can cause pain and infection. In turn, these can lead to problems with daily life – eating, speaking, playing and learning. 

For Babies

You can wipe the gums with a soft cloth twice a day. After the first feeding of the day and right before bed. This removes bacteria and sugars that can cause cavities.

When baby teeth appear, start brushing twice a day with a soft, small-bristled toothbrush and plain water. Consult with a doctor before using fluoride toothpaste.

It may sound very early but visit the dentist by your baby’s first birthday to spot signs of problems early.

For Children

Luckily, cavities are preventable. Children who brush daily with fluoride toothpaste will have fewer cavities, similarly those with fluoridated tap water also have fewer cavities. Dental sealants can also prevent cavities for many years. Applying dental sealants to the chewing surfaces of the back teeth prevent 80% of cavities.

If your child is younger than six, watch them brush. Make sure they use a pea-sized amount of toothpaste and always spit it out rather than swallowing it. Help your child brush until they have good brushing skills.

Risk factors for cavities

Everyone who has teeth is at risk of getting cavities, but the following factors can increase risk:

• Tooth location. 
• Certain foods and drinks. 
• Frequent snacking or sipping. 
• Bedtime infant feeding. 
• Inadequate brushing. 
• Not getting enough fluoride. 
• Younger or older age. 
• Dry mouth.
• Worn fillings or dental devices. 
• Heartburn. 
• Eating disorders. 

Your tongue

It’s also extremely important to clean your tongue. Benefits include:

• Reduces sulfur compounds that cause bad breath
• Reduces bacteria on the tongue
• Contributes to a fresher-feeling mouth
• Reduces plaque