Global public health part 2

Female Genital Mutilation

Estimated 125 million females worldwide have had some form of genital cutting Very closely related to ethnicity Practice appears to be diminishing Can initially cause shock, infection, or hemorrhaging Many girls do die from bleeding out Long-term problems include retention of urine, infertility, and obstructed labor Interventions Promote female empowerment, education, and control over economic resources Tailored to local practices and beliefs

Women and HIV

Every week, around 7000 young women aged 15-24 years become infected with HIV. In sub-Saharan Africa, three in four new infections are among girls aged 15-19 years and young women aged 15-24 years are twice as likely to be living with HIV than men. More than one third (35%) of women around the world have experienced physical and/or sexual violence at some time in their lives. In some regions, women who experience violence are one and a half times more likely to become infected with HIV. Caribbean, north america → more men 25% ish percent women Sub-saharan have 62% women living with HIV

Facility-based intrapartum care Strategy:

Expedite obstetric care-seeking among low-literate women and their families, incentivize care

Risk Factors for HIV transmission

Exposure to blood, semen, vaginal secretion or breast milk from an infected individual, direct contact with mucous membranes or a break in the skin. That have HIV virus Risk factors are tied to high exposure to these fluids Paid sex, (34-69% HIV+ depending on region in S. Africa) Sex: HIV prevalence twice as high in women than men. Incidence in women 15-24 four times greater men, and accounted for 25% of new infections in South Africa. Men who have sex with men (MSM), highly stigmatized Sexually behaviors Lack of pregnancy Unprotected sexual contact (Especially during pregnancy, anal sex, BCP, STD's) Concurrent partnerships—(high viral load during acute phase and low level of male circumcision—contribute to the and prevalence of HIV in southern Africa) Particular bad if lots of virus in blood plasma when doing behavior Substance abuse, (altered judgment, needle sharing)

Strategies to prevent maternal mortality

Family planning, healthy timing and spacing of births Quality and comprehensive antenatal care Facility-based intrapartum care, including emergency obstetric care Postnatal care for mother and newborn

Antenatal care strategy

Free maternity health care policy in Ghana covers the costs of antenatal care

Causes of child mortality

Great chunk = neonatal 45% (preterm complications, hypothermia, sepsis, etc.) Pneumonia Undernutrition causes 45% of child deaths Resulting in 3.1 million deaths annually

HPV

HPV is a group of more than 150 related viruses that is mostly asymptomatic HPV causes cervical cancer, which is the fourth most common cancer in women, with an estimated 266,000 deaths and 528,000 new cases in 2012 Around 85% of the global burden occurs in the less developed regions, where it accounts for almost 12% of all female cancers Three HPV vaccines are now being marketed in many countries throughout the

barriers to seeking professional delivery care:

High costs Long distances to health facilities Lack of knowledge about danger signs during pregnancy Don't know that ur pregnancy is abnormal Tradition of using untrained local practitioners during delivery Cultural norms that delay and sometimes stop women from seeking professional care during childbirth Family dynamics, including spousal communication and support Traveling hours Meaning someone else will have to pick up their duties

Postpartum care

Highest risk of maternal mortality is during the first 2 days after birth All postpartum women should have regular assessment within 24 hours At least three additional postnatal contacts are recommended for all mothers and newborns, on day 3, between days 7-14, and six weeks after birth Rates of provision of skilled care are lower after childbirth when compared to rates before and during childbirth

Pathophysiology

Over months to years, the virus affects cellular immunity, resulting in opportunistic infections, neurologic disease, and wasting. Primary HIV infection may be asymptomatic. Only 30% -50% develop acute febrile syndrome with high level viremia. Display symptoms that are characterized by high levels of virus in bloodstream The concentration of plasma viremia is kept low for <= 10 years after primary infection through suppression of viral replication, and sequestration of virus within the reticuloendothelial system. Kept low due to viral suppression

Top severe childhood illnesses

Pneumonia and diarrheal diseases are the two major killers of children under 5 Each year, 1.3 million children die from pneumonia and 800,000 from diarrhea Globally, malaria caused an estimated 453,000 under-five deaths in 2013

Research and human rights

Post trial benefits - after doing the trial, they receive no benefits Community inclusion and empowerment

Strategies to prevent child mortality

Prenatal care Immediate newborn care Improvement of nutrition for infants and young children Detection and management of severe childhood illness Vaccination during childhood Environmental hygiene

Elimination of mother to child transmission of HIV

Programs are multistep Antenatal clinic promotion Encouraging women to get tested → know status When they test positive, regularly monitored throughout pregnancy Retained in each step of system Adherence to ART, giving birth with skilled Testing infants and return for treatment if positive

Nutrition for infants and young children

Promotion of breastfeeding: early initiation, exclusive (no water or other food) for 6 months , continued for at least 18 months Benefits beyond nutrition Passes antibodies Appropriate complementary feeding between 6 and 24 months of age Vitamin A supplementation Iron supplementation in areas with high rates of anemia Many children who live in poverty simply don't get enough food—or the right kind of food—to support normal growth and development

Management of malnutrition for infants and young children

Rehabilitate malnourished children Sustain rehabilitation in the home Prevent future child malnutrition The "positive deviance" approach is used to find uncommon, beneficial practices by mothers or caretakers of well-nourished children from impoverished families. A "hearth" is the setting where the nutrition education and rehabilitation part of the program is carried out.

Immediate newborn care

Requires simple technology that can be effectively provided by a single skilled birth attendant in home Care of all newborns includes: immediate and thorough drying (prevent hypothermia), delayed bathing (hypothermia), skin-to-skin contact (transfer body heat), clean cord care, Prevent sepsis early initiation of breastfeeding, eye care, immunizations First 24 hours are susceptible to cold Have a coat when they come out to protect them Newborn resuscitation for those who do not start breathing on their own by one minute after birth Mucus in mouth that is apart of preventing breathing Clear it out so babies can breathe on their own

Family planning

a process by which women and men make informed decisions about how many children they want to have, how many years apart they want those pregnancies to be, and the actions they will take to achieve these goals. All women and men of reproductive age need to have access to information about reproduction and contraception. The goal of family planning is to minimize unplanned pregnancies (to reduce gravidity) and to maximize the health of babies from pregnancies that do occur (so that parity is as close as possible to gravidity).

fertility transition

a reduction in the average number of offspring the typical female gives birth to.

Demographic transition =

a shift toward lower birth and death rates that often occurs as populations move from being lower-income economies toward being middle-income and then higher-income economies Lower birth and death rates comes with lower fertility rates Death rates fall first as countries get wealthier, then birth rates fall Rise in population, but then plateaus

Barriers to child nutrition include:

ability for women to sustain breastfeeding Don't know how to breastfeed or malnourished so can sustain supply Inconsistent access to safe and affordable nutritious food If not cows milk feeding porridges - in Kenya Lack of awareness and understanding of healthy diets among those most at risk Low agricultural productivity Poor-health from other diseases

Maternal and child health (MCH)

programs focus on helping babies and young children get their healthiest start in life Subset of reproductive health Babies be born alive and women survive child birth SDG target 3.7 is to "ensure universal access to sexual and reproductive health care services, including for family planning, information, and education, and the integration of reproductive health into national strategies and programs."

Diarrhea

second-leading infectious cause of young child death Causes dehydration, loss of nutrition or wasting, and damage to the intestines Children under-5 in low- and middle-income countries have around 3-4 cases per year; those aged 6-11 months have almost double that

fertility rate

the average number of children a woman gives birth to during her childbearing years. Countries with high fertility rates have a high percentage of children in their populations, while countries with low fertility rates have about as many older adults as children in their populations

abortion

the termination or loss of a pregnancy

Parity =

the total number of live births. These make a pyramid

Gravidity

the total number of times a woman has been pregnant, including miscarriages, abortions, stillbirths, and live births. Total pregnancies

Birth spacing

waiting until at least 2 years after the birth of one child before conceiving the next child. Closer the pregnancies, the more likely that latter pregnancies have complications Advocate for woman for this

Sexually Transmitted INfections

After pregnancy-related causes, STIs are the second most important cause of healthy life lost in women Infections that woman live with for a long time Lead to cancer STIs (excluding HIV), accounted for 8.9% of all disease burden in women aged 15-45 years, and 1·5% in similarly aged men Sub-saharan has a high HIV burden

Reproductive health remains a hot topic in global health because there is not unanimous agreement on the value of reproductive rights

he advancement of gender equality and equity to empower women To have a say in if they have children and how many they want The elimination of all kinds of violence against women Directly tied to gender empowerment Ensuring women's ability to control their own fertility

Spontaneous abortions

miscarriages First 4-5 months of pregnancies

continuum of care

pre-pregnancy - post pregnancy

IUDs (intrauterine devices)

prevent fertilization of eggs by creating a uterine environment that is unfavorable to sperm

"Global Gag Rule" or Mexico City Policy

prevents organizations receiving U.S. government funding from providing information, referrals or services related to abortion Happens in US too Defunding of planned parenthood

Neonatal mortality rate:

probability of dying between birth and exactly 28 days as expressed per 1000 live births

Under five mortality rate:

probability of dying between birth and exactly 5 years as expressed per 1000 live births

Historical violations of human rights that have shaped today's research ethics

Nazi War crimes - nazi medicial experiment Experimenting on prisoners of war without consent Sexually sterilizing Tuskegee Study Thought were receiving treatment, but wasn't just wanted to study how syphilis killed them 40 years Short-Course AZT trials Intended to stop transmission of HIV from mother to child Lack of consent J. Marion Simms (Father of modern gynecology) Experiments and research on slave aftican american women Held down to do surgery and experiments

syphillis

A bacterial infection caused by the spirochete, Treponemapallidum, can be transmitted sexually or from mother to child in utero Primary syphilis generally has a sore or sores at the original site of infection At genitalia Secondary syphilis include skin rash, swollen lymph nodes, and fever Spreading throughout body In bloodstream → fever Tertiary syphilis is associated with severe medical problems Syphilis-associated adverse pregnancy outcomes include early fetal death, stillbirth, preterm birth, low birthweight, neonatal death, and congenital infection in infants Babies can die within first 28 days with infection In 2012, an estimated 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes ⅓ Contribute a lot to disease burden

Helpful guidelines for ethical research

Nuremberg code Ethical code for human research Declaration of helsinki Most influential and cited for internal research Belmont research Guided for biomedical and behavior Basic principles of ethic: respect, justice, beneficence

HIV/AIDs mechanism of retroviral infection

1. HIV virus infects lymphocytes and macrophage cells expressing the CD4 receptor. Cells of immune system 2. Integrates into host DNA. 3. Takes over cell replication machinery to copy itself. 4. Packages its own genetic material into nucleocapsids. 5. Capsids escape from cells to infect new cells. Buds off host cells Go on to infect new cells

Estimated number of adults and children newly diagnosed

1.8 million 10 fold higher in south africa than in US

Children ( <15 years) estimated to be living with HIV

2.1 million children Highest in sub-saharan africa

hat home-based newborn care interventions can prevent

30-60% of newborn deaths in high mortality settings under controlled conditions

Adults and children estimated to be living with HIV

36.7 million living worldwide Eastern and southern african is very high

Replacement population

= each woman has, on average, about 2 children, so those 2 parents will produce 2 offspring, "replacing" themselves but not increasing the size of the population If the total fertility rate is greater than 2, then the size of the population will increase over time If the fertility rate is less than 2, then the number of people in the total population will begin to decrease

Abstinence

= refraining from sexual intercourse and other types of genital contact.

Infertility

= the inability to become pregnant when sexually active and not using contraception or the inability to maintain a pregnancy through to a live birth More than 50 million couples worldwide with a female partner of childbearing age are unable to have a child after 5 years to become pregnant Treatments for infertility include stimulation of egg production through medications, surgery to remove fibroids in the uterus and blockages in the fallopian tubes, medication or surgery to improve male reproductive function, and procedures like intrauterine insemination Can do pre-conception to help baby implant Can do once conceived to be able to keep baby

Contraception

= the intentional prevention of pregnancy

Fertility

= the total number of births, whether the result was a stillbirth or a live birth.

Sterilization

= the use of surgical or medical procedures to intentionally make it difficult or impossible for a person to reproduce

Sentinel Symptoms for HIV

Acute infections Fever Fatigue Lymphadenopathy Infection of LN Pharyngitis Maculopapular rash Malaise Arthralgias Established infections Herpes zoster, (shingles) Candidiasis, Fungi Diarrhea, Weight loss Lymphadenopathy Periodontal disease, leukoplakia Skin (KS, Bacillary angiomatosis) Sinusitis Cervical dysplasia TB, Pneumocystis, Listeriosis CMV

Universal declaration of human rights

Outlines the articles of universal human rights Some rights are provisional and others are protective Provisional: All people have the right to medical care and basic needs no matter where they live vs. Protective: the right to privacy and safety Due to high cost many rights are aspirational Sometimes not be able to meet (cost, culture differences, difference in health ethics)

Family Planning

Births at high parity and births to very young or older women pose higher risks of maternal mortality Many babies when young and pregnancy when old Use of contraception contributes to reducing the number of unintended pregnancies, unsafe abortions and maternal deaths Unmet need: women of reproductive age who are married or in-union and want to delay or avoid pregnancy but are not using any method of contraception

Disparities in maternal mortality

Black and indigenous die more often

Challenges in MCH remain

By the end of class, approximately 1,563children under the age of five will have died and 86 women will have died during childbirth 99% of these deaths occur in the developing world Inequalities in maternal and child health outcomes persist within and between countries

The healthiest babies are born to women who were healthy before they conceive their offspring

Woman who have low BMI in teens are much more likely to have adverse pregnancy outcomes

Condom =

a physical barrier used to prevent sperm from coming into contact with an egg after sexual contact Oral contraceptives (birth control pills) prevent ovulation when taken as prescribed

Leishmaniasis

Caused by protozoa from the Leishmania genus Occurs across parts of Asia, North Africa, Middle East, and South America Two common presentations of Leishmaniasis Cutaneous: causes lesions that can lead to permanent disfigurement, but not life-threatening About 700,000 to 1.2 million people develop Cutaneous Leishmaniasis Look like bad blister Visceral (Kala-azar): causes chronic fevers, weight loss, anemia, and swelling of the spleen and liver. Without treatment is fatal within a couple years Approximately 200,000-400,000 people develop Visceral Leishmaniasis and 20,000-40,000 people die from this disease Can affect kidneys Not neglected tropical disease, but still affects so many people

Estimated impact of aids on under 5 child mortality rates

Children who were orphaned had a higher risk of dying from malnutrition etc. Can be transferred from mother to child Children dying from both HIV and because orphaned

Some barriers to postnatal care include

Crowds and the practice of early discharge often hinder mothers from receiving proper postnatal care Requires sufficient human resources to provide home-based postnatal care Tradition of keeping mothers and newborn babies indoors for a few days after birth in a period of seclusion

Approximately 225 million women in developing countries would like to delay or stop childbearing, but are not using any method of contraception Reasons for this include:

Limited choice of methods Limited access to contraception Fear or experience of side-effects Cultural or religious opposition Poor quality of available services Gender-based barriers Whether is woman's partners accept use of contraceptives

zoonotic diseases - "if you can be infected by it, it is probably zoonotic"

Lyme Disease Influenza Leishmania Rabies Highly lethal Cat Scratch Fever Anaplasmosis Ehrlichiosis Babesiosis Rocky Mountain Spotted Fever Zika - 2016's West Nile - Early 2000's Eastern Equine Encephalopathy - affects horses Ebola Coronaviruses SARs, MERs, COVID Anthrax Toxoplasmosis

Biomedical HIV prevention interventions

Male circumcision (MC) - meta analysis 65% effective Meta analysis (study of studies) Highly Active Antiretroviral Therapy (HAART) RCTs on HAART* reported 60% to 80% reductions in new infections Microbicides and cervical barriers - some results 30% effective/no evidence Prevention of mother to child transmission (PMTCT) best evidence - reduce from 35% to 1% Treatment of Sexually Transmitted Infections (STI) limited evidence - 40% effective HIV vaccine - promising evidence in Thailand A couple in trials

arbovirus

Meaning it is spread by the bites of infected mosquitoes Animal → animal → person Etc. Person wont be able take Culex genus mosquitos for this virus in particular

Low infant birth weight

Defined as <2.5 kg weight at birth About 6 lbs About 23 million LBW infants born each year with LBW 4-10x risk for under 5 disease risks Less developed immune system Less body weight Preterm and LBW infants at much higher risk for other < 5 year diseases

Preterm birth

Defined as birth occurring at < 37 weeks gestational age Leading cause of newborn death A Lot of maturation occurs beeter 25 and 37 weeks Yes can survive, but 37 is critical point Mortality drops dramatically

Rise in AID and AIDs related deaths increased until late 1990's

Dramatic drop due to programs Behavior change and primary prevent Effect of the efficacy of antiretroviral drug

Postpartum care Strategy:

Misoprostol (recognized in the WHO Model List of Essential Medicines) provision at home by a healthcare worker, or the woman herself, to prevent postpartum hemorrhage

Timing of maternal mortality

Most maternal deaths occur between the third trimester and the first week after the end of pregnancy

and antibiotic treatment Malaria prevention and treatment

Improve malaria disease recognition and case management Prevent and treat malaria in pregnant women through antenatal services Reduce malaria transmission by distributing insecticide treated nets (ITNs), promoting use of ITNs, and using artemisinin-based combination therapy (ACT) treatment Promote indoor residual spraying with DDT

Sexual and reproductive healthaddresses:

Improvement of antenatal, perinatal, postpartum, and newborn care Provision of high-quality services for family planning, including infertility services Between pregnancies or prior to pregnancy Elimination of unsafe abortions Provided by unqualified persons Prevention and treatment of sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer, and other gynecological morbidities Promotion of healthy sexuality Menstrual hygiene management

Distributive justice

In order to meet this ethical responsibility, we turn to distributive justice If you have rural population they can have access to health care Look different

Mother to Child HIV Transmission

In the absence of any intervention, 25-35% of HIV positive pregnant mothers will pass HIV to their children 90% of children with HIV acquired it during pregnancy, birth, or breast feeding 30% of transmission in utero 70% during delivery, risk factors: Amniotomy Forceps, vaccum extractor Vaginal tears or episiotomy Scalp electrodes C-Section controversial, (may well decrease risk of transmission if done before membrane ruptures This rate can be reduced to below 5% with effective interventions during the periods of pregnancy, labor, delivery and breastfeeding

barriers to ANC

Inability to pay for ANC or the treatment prescribed in ANC Underestimation of the importance of ANC since pregnancy is perceived as a natural process Providers in ANC clinics fail to respect the privacy, confidentiality, and traditional beliefs of women distance

emerging infectious disease

Infectious diseases that have recently appeared within a population of those whose incidence or geographic range is rapidly increasing (or threatens to increase in the near future) Often zoonotic in nature

neglected tropical diseases

Infectious diseases that primarily affect the poorest regions of the world and have not historically been a priority for funding agencies, pharmaceutical companies, or global policymakers What are the main 3 diseases that have received the bulk of attention? HIV, TB, and Malaria Neglected doesn't mean non-impactful or infrequent Describes conditions that that were previously overlooked, disregarded or ignored Still affect millions of individuals globally Highest burden in lowest-income countries Affect more than 1 in 6 of the world's population

Pneumonia and diarrhea prevention and treatment

Interventions for both: breastfeeding; water, sanitation, and hygiene; and zinc supplementation Breastfeeding feeds both AB and boost nutrition Diarrhea-specific interventions: vaccination (rotavirus, cholera); oral rehydration solution; antibiotic treatment Pneumonia-specific interventions: vaccination (measles, Hib, pneumococcal)

Microbiocide vaginal gel: CAPRISA 004 Study Inserted into vaginal prior to sex

Kills sperm and viruses in sperm Sexually active women in South Africa, ages 18-40 not using barrier contraception Estimated HIV incidence rate of 15.6% (at starting point) and 11.2% (after) Administration of TDF (Tenofovir) gel: Insert 1 dose within 12 hours Before sex Insert 1 dose ASAP, within 12 hours After sex No more than 2 doses within 24 hours Tenofovir prevented 39% of HIV infections

Barriers to the prevention and treatment of diarrhea, pneumonia, and malaria

Lack of knowledge about symptoms of illness Attitudes and beliefs about the effectiveness of prevention and treatment strategies Lack of availability of health workers and essential medicines Access to environmental interventions: latrines, clean water, soap, bednets

Pneumonia

Leading infectious cause of death globally in children under-5 Children under-5 in low- and middle-income countries average 3-6 acute respiratory infections per year More severe and cause higher rates of death in low- and middle-income countries Upper respiratory tract infections include the common cold and ear infections, and lower respiratory infections include bronchiolitis and pneumonia

Antenatal care

Less about mortality, more about improving health Limited (if any) impact on maternal mortality Improve maternal nutrition, monitor weight Benefits to the baby in terms of growth, risk of infection (HIV, malaria, tetanus), and survival Emphasizes the promotion of health and health-seeking behavior, including birth preparedness A means of distribution for other packages (e.g., the roll-out of antimalarial drugs or of antiretroviral therapy for maternal HIV/AIDS) ANC coverage is lower among women who need it the most: those who are poor, less educated, and living in rural areas

Barriers to vaccine development

Sequence variation In HIV virus Make difficult to make vaccine to target all strains of virus Protective immunity in natural infection not clearly established Lack of adequate animal model to study vaccine protection with HIV Latency and integration of HIV into host genome Transmission by cell-associated virus Limited knowledge about mucosal transmission and immune responses Financial disincentives Ethical issues

What should clinical research satisfy

Social value Cultural acceptance Scientific validity Ethical sound Fair subject selection Acceptable risk/benefit ratio Informed consent Respect for enrolled subjects

Stillbirths

Stillbirths have declined by only 15% since 1995 Carried past 25 weeks Viably a fetus, but died An estimated 2.6 million stillbirths occurred globally in 2009, of which 76.2% occurred in South Asia and sub-Saharan Africa, mostly among rural populations In addition to prolonged and obstructed labor, untreated infections such as syphilis are an important cause of stillbirths in low resource settings

Male circumcision

Sustained protection (54 months) of male circumcision in 2,784 Kenyan men between 18 and 24 years of age Relative risk of seroconversion in circumcised versus uncircumcised men 64% protection (RR = 0.36, 95% CI 0.24, 0.55) Rising amount of men participating in intervention in sub-saharan interventions

Reproductive Rights

The International Conference on Population and Development (ICPD) was a United Nations (UN) meeting that emphasized reproductive rights, calling for women and their partners to have the freedom to decide how many children they want without interference from governments or other organizations.

Maternal mortality ratio:

The number of women dying due to any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42

Kenya HIV prevalence rate has declined from 10% in the mid 90's to 6.1% in part due to:

The percentage of 20-24 year old men with more than one sexual partner dropped from 35 percent to 18 percent Age of first sex among women increased from 16.7 to 17.8 'High' levels of previously sexually active people had been abstinent for at least one year at a recent survey Condom use increased among women who engaged in risky behavior

Access to Health Services

There is so much packed into access of health services Availability, money to pay, acceptability

Multifactorial methods for prevention of mother to child transmission

These interventions primarily involve antiretroviral treatment for the mother and a short course of antiretroviral drugs for the baby Barriers Antiviral creams perinatal antiretroviral medication (AZT and Nevirapine) AZT after 14 weeks gestation decreases transmission 70-90%. Antiretroviral coverage among pregnant women with HIV reached 62% in 2012. Thanks to PMTCT programs Formula instead of breastfeeding Risk from breast feeding must be weighted against loss of maternal antibody protection against other infectious diseases. Losing maternal AB C-section Controls exposure of fetus to virus

Malaria

Third leading cause of death in children under-5 in Asia and sub-Saharan Africa Extremely high morbidity; estimate some people in sub-Saharan Africa have about five episodes per year

Health workforce

Uneven distribution of health care workers across the world Us - one health care worker per 81 Ethiopia - one health care worker per 3571 Brain drain: if healthcare professional were to be trained in LMIC and then to leave

West Nile Virus

West Nile is a Flavivirus + sense, enveloped, non-segmented RNA genome As soon as infect cells they can make proteins Really prevalent by early 2000's arbovirus ypically results in a febrile illness but can develop into neuroinvasive disease and death Approximately 80% of infections are asymptomatic Less than 1% of individuals develop encephalitis Birds are the main reservoir for this virus Humans and horses are considered dead-end hosts We don't make virus at high enough capacity for mosquitos to take it back up We are able to be infected by the virus but do not keep sufficient viral titers to infect mosquitoes upon subsequent blood meals. Want to eliminate virus in birds If not in birds, mosquitos won't be able to pick it up Different subpopulations Different type in US than australia Started in florida and spread over entire US

Facility-based intrapartum care

Whether or not a woman dies from bleeding during or after childbirth depends largely on access to timely and competent obstetric care While there has been an increase in skilled health personnel, still low in asia and africa Ensure that every birth occurs with the assistance of skilled health personnel, meaning a medical doctor, nurse or midwife Need to focus on high quality care that is safe, effective, timely, efficient, equitable, people-centered, and respectful Nearly 90% of maternal health services can be provided by health workers with midwifery skills, yet midwives make up only 36% of the maternity care workforce Effective referral systems are needed to ensure seamless coordination across time, disciplines, and facilities

What is a zoonotic disease WHOL

animals have to play a critical role in pathogens available to stay in live Dengai would not fit since it the human strain is only in humans

Unsafe abortion

causes more than 30% of maternal deaths All but 3% of 19 million unsafe abortions occur in developing countries each Lack of access to health care providers Morality is high in low income countries Legality Not legal everywhere in the world Either banned or no policy so it's hard to get funding for programs Of the estimated 68,000 deaths from unsafe abortions, half arise in Africa, where one in four are done in teenagers Urbanization adds to unsafe abortions Young woman move to urban areas for schooling don't have money so go into prostittution Also finding males to be able to provide financially for them Unintended pregnancy and unsafe abortion are associated with violence and sexual coercion Restrictive legislation is usually associated with a high incidence of unsafe abortion

Induced abortions

chemically or surgically terminated pregnancies Not a form of contraception, because they end a pregnancy rather than prevent it Increased access to contraception reduces the number of induced abortions by preventing unplanned pregnancies

Antiretroviral therapy

drugs that prevent growth of virus and slow disease progression. Not a cure. Does not eliminate virus from body Improve quality of life and delay time of becoming full blown AIDS More than 14 million people are now receiving HIV treatment ARV treatment contributed to a 19% decline in deaths from HIV between 2004 and 2009. In 33 countries with ARV campaigns (22 in sub-Saharan Africa), HIV incidence has fallen by more than 25% between 2001 - 2009. Epidemics in Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe have stabilized or are declining. Needed most in sub-saharan africa and asia

Reproductive health

encompasses issues of fertility and infertility, contraception, pregnancy and childbirth, gynecologic and urologic health, and the prevention and treatment of sexually transmitted infections