International Health FINAL
Addressing the Burden of HIV/AIDS
90-90-90 goals by 2020: •90% of the people with HIV will know their HIV status •90% of those with HIV will be receiving antiretroviral therapy •90% of those being treated will have suppressed viral loads
Key Risk Factors
Adolescent girls in low- and middle-income countries may face particular challenges that adolescent girls face much less in high-income countries. These include very time-consuming home-related chores, being married at a young age, or family barriers to continuing schooling
Key Terms, Definitions, and Concepts
Different control measures: •Vaccination •Mass chemotherapy •Vector control •Improved water, sanitation, hygiene •Improved care seeking, disease recognition •Case management (treatment) and improved caregiving •Case surveillance, reporting, and containment •Behavioral change
Addressing the Burden of Diarrheal Disease
Disease prevention strategies: •Promotion of exclusive breastfeeding for the first six months •Improved complementary feeding, after six months •Rotavirus and measles immunization •Improving access to clean water supply and sanitation, coupled with handwashing with soap
Key Adolescent and Young Adult Health Burdens
Early Pregnancy and Birth •There were 44 births per 1,000 older adolescent girls worldwide in 2017 •Three million girls aged 15-19 undergo unsafe abortions every year •Adolescent girls who give birth are at increased risk for birth complications, infant, and maternal mortality
Key Health Services and Interventions for Improving Adolescent Health
HIV and other STIs •Promote awareness of risk factors •HIV testing and counselling •Voluntary medical male circumcision •PMTCT •ART •Contraceptive services
Key Adolescent and Young Adult Health Burdens
HIV/AIDS and other STIs •Two million adolescents are living with HIV/AIDS •In some countries, 60% of new HIV infections occur in 15 to 24-year-olds •Concentrated in sub-Saharan Africa •Alcohol and drug use leading to risky sexual behavior increase the risk of HIV infection •Girls are at increased risk because of biological differences and gender norms
Key Adolescent and Young Adult Health Burdens
Interpersonal Violence •A leading cause of adolescent and young adult mortality, resulting in an estimated 180 deaths every day •Among adolescent males in low- and middle-income countries, 1 in 3 deaths are caused by violence •Thirty percent of girls aged 15-19 are victims of violence by a partner
Key Adolescent and Young Adult Health Burdens
Iron-deficiency Anemia •Anemia is closely linked to undernutrition during childhood •Undernutrition and stunting are prevalent in South Asia, sub-Saharan Africa, and indigenous areas in Latin America •Leading cause of DALYs among 10 to14 -year-olds •Long-term consequences: loss of productivity, impaired immune function, cognitive impairment
Key Adolescent and Young Adult Health Burdens
Key Facts concerning differences in cause of death by sex and age group •Young Adulthood: •Males: 20% from road injuries, 12% from interpersonal violence, 10% from self-harm •Females: 13% from maternal disorders, 10% from self-harm, 8% from road injuries
Key Adolescent and Young Adult Health Burdens
Key Facts concerning differences in cause of death by sex and age group: •Older adolescence: •Males: 19% from road injuries, 10% interpersonal violence, 7% from self-harm •Females: 10% from self-harm, 9% from maternal disorders, 8% from road injuries
Key Health Services and Interventions for Improving Adolescent Health
Key Health Services and Interventions for Improving Adolescent Health
Addressing the Burden of Malaria
Key interventions: •Prompt treatment of those infected, based on confirmed diagnosis •Intermittent preventive therapy for pregnant women •Seasonal malaria chemoprevention for children under-5 in selected areas •Long-lasting insecticide-treated bednets for people living in malarial zones •Indoor residual spraying in malarial zones
Key Health Services and Interventions for Improving Adolescent Health
Mental Health •Community-based approach to psychosocial support •Management of emotional, behavioral, developmental disorders •Self-harm and suicide prevention
Key Adolescent and Young Adult Health Burdens
Mental Health •Depression is a leading cause of DALYs and self-harm is a leading cause of deaths •Common mental health issues include anxiety, depression, and conduct disorders •Related risk factors include violent behavior, risky sexual behavior, and substance abuse
Key Adolescent and Young Adult Health Burdens
Noncommunicable Diseases •Less than 1 in 4 adolescents meet the recommended guidelines for physical activity •In some countries, as many as 1 in 3 adolescents have obesity •Rate of smoking is decreasing among adolescents and young adults in high-income countries but increasing in middle-income countries
Key Health Services and Interventions for Improving Adolescent Health
Nutrition •Ensure food security and nutritional support for children •Iron and folic acid supplementation •Health education for adolescents, parents, caregivers •BMI-for-age assessment
Key Adolescent and Young Adult Health Burdens
Other Communicable Diseases •Increased coverage of childhood vaccinations have decreased measles infections significantly •Diarrhea, lower respiratory infections, meningitis, and TB remain leading causes of mortality of adolescents and young adults
Tuberculosis
People with TB disease need to take four drugs daily for the first 2 months of treatment and two drugs daily for 4 months after that.
Key Health Services and Interventions for Improving Adolescent Health
Reproductive and Sexual Health •Pre- and post-natal care for adolescent mothers and newborns •Improve access to comprehensive contraceptive information and services •Provide sexual and reproductive health services without requiring parental involvement, especially safe abortion care
Key Adolescent and Young Adult Health Burdens
Road Injury •Road traffic injuries are the third leading cause of death among those aged 10 to 14 years, and the second leading cause of death among those aged 15-24 •Males are at increased risk because of cultural and behavioral factors
Key Health Services and Interventions for Improving Adolescent Health
Road injuries •Develop and implement policies to prevent intoxicated driving •Set blood alcohol concentration (BAC) limits to less than 0.05g/dl for the general population and less than 0.02 g/dl for young/novice drivers •Graduated licensing programs for young/novice drivers
Addressing the Burden of HIV/AIDS
Successful efforts will involve: •Condom promotion •Screening and treatment for STIs •Prevention of mother-to-child transmission •Voluntary male medical circumcision •Interventions that target populations that transmit the virus from high-risk to low-risk populations
Malaria
The increasing and proper use of insecticide-treated bed nets has had a major impact on the burden of malaria
Key Health Services and Interventions for Improving Adolescent Health
Tobacco and Alcohol •Raise tobacco taxes and prohibit tobacco sales to minors •Encourage total elimination of smoking and tobacco smoke in public places •Establish and enforce an appropriate minimum age for purchase and consumption of alcoholic beverages
Key Terms, Definitions, and Concepts
Transmission paths for communicable diseases: •Foodborne: Salmonella, E. coli •Waterborne: Cholera, rotavirus •Sexual or bloodborne: Hepatitis, HIV •Vector-borne: Malaria, onchocerciasis •Inhalation: Tuberculosis, influenza, meningitis •Nontraumatic contact: Anthrax Traumatic contact: Rabies
Global Immunization Efforts: Expanded Programme on Immunization (EPI)
•1974: the World Health Assembly launched the Expanded Programme on Immunization (EPI) •In its first phase, EPI focused on six diseases: tuberculosis (TB), poliomyelitis (polio), diphtheria, tetanus, pertussis (whooping cough), and measles •When the EPI was launched, only about 5% of all children were vaccinated against these diseases
Global Immunization Efforts: Expanded Programme on Immunization (EPI)
•2000: the Global Alliance for Vaccines and Immunization (Gavi) was created as a public-private partnership to promote and strengthen immunization programs Gavi-supported programs have vaccinated 440 million children
Global Immunization Efforts: Expanded Programme on Immunization (EPI)
•2002: EPI introduced the Reaching Every District strategy (RED), which sought to achieve 80% coverage of DTP3 •2005: WHO and UNICEF launched the Global Immunization Vision and Strategy (GIVS)- the first 10-year framework •2012: the Global Vaccine Action Plan (GVAP) was endorsed by the 194 WHO member states at the World Health Assembly
Neonatal Mortality
•46% of annual under-5 deaths occur within the first month of life •73% of deaths in first month occur in first week •Why many children are not named, nor registered, until after first month • •Every day that a child lives increases the likelihood that he or she will stay alive • •Must consider the link between the health of the mother and the health of the baby •Between 60-80% of neonatal deaths are in low-birthweight babies
The Importance of Child Health
•5.4 million children under 5 years of age die each year •Almost all of these deaths are preventable •Children are a particularly vulnerable population •Child health closely linked with poverty • •Insufficient progress is being made in certain parts of the world in reducing childhood morbidity and mortality
Mortality and the Burden of Disease: Children under 5 years
•99% of childhood deaths are in low- and middle-income countries •Half (50%) of these deaths occur in India, Nigeria, Democratic Republic of the Congo, Pakistan, and China •46% of under-5 child deaths occur among neonates • •General trend is on the decline, but rates of decline vary considerably by region
Addressing the Neglected Tropical Diseases
•A lot of progress has been made with many NTD's •New Guinea worm, trachoma, lymphatic filariasis, etc. •Rapid-impact package of drugs for the seven most common NTDs •Importance of public-private partnerships, such as pharmaceutical companies donating the drugs for rapid-impact package •Periodic deworming of young children is also a "best buy" in global health •Opportunities to integrate NTD treatment programs with existing HIV and malaria control programs
Mortality and the Burden of Disease: HIV/AIDS
•A newborn has a 15-45% chance of being infected from an HIV-positive woman who is not receiving antiretroviral therapy (ART) • •In 2017, there were 180,000 newborns infected with HIV and more than 90% of them were in sub-Saharan Africa •Causes 1.2% of deaths in children under-5 • •ART, if started by 12 weeks of age, can reduce mortality by up to 75% •Otherwise, 1/3rd die before their first birthday •And half risk dying before their second birthday
Key Risk Factors
•Alcohol use •Unsafe sex •Lack of contraception •Iron deficiency •Illicit drug use •Unsafe water, sanitation, and hygiene
The Importance of Adolescent Health
•An adolescent is a person between the ages of 10 and 19 (WHO) •Early adolescence: 10-14 •Older adolescence: 15-19 •Youth are persons between the ages of 15 and 24 (UN) •The UN also refers to a child as anyone under the age of 18 • •There are 1.2 billion adolescents (10-19) in the world (about 16%, or 1 in every 6 people) •Important health behaviors are set during adolescence •Burden of disease for adolescents is unique Important links to the SDG's
The Burden of TB
•An untreated person with active pulmonary TB can infect 10 to 15 people annually •About two-thirds of those with active TB disease will die of the disease if not treated properly •TB remains latent in the bodies of about 90% of those infected •They are not sick, but can develop TB later
Addressing the Burden of Tb
•Bacillus Calmette-Guérin (BCG) vaccine has limited impact on incidence or prevalence •It is only effective in children •Control of TB depends on effective treatment of active tuberculosis and social determinants •WHO recommends a 6-month regimen for drug-susceptible disease; includes four drugs; highly cost-effective: $5-$50 per DALY averted Patient adherence with TB regimen is essential
The Importance of Noncommunicable Disease
•Burden of noncommunicable diseases (NCDs) is now greater than burden of communicable diseases in low-, middle-, and high-income countries •The burden of NCDs will continue to increase as countries develop economically •The risk factors relate in significant ways to lifestyle, much of which is within people's control •Often preventable at low cost, but very expensive to treat
Key Terms and Definitions
•Cardiovascular Disease: disease of the heart or blood vessels. This term encompasses both ischemic heart disease and stroke •Blanket term for all diseases of the heart •Cholesterol: a fatlike substance that is made by the body and is found naturally in animal-based foods such as meat, fish, poultry, and eggs •Diabetes: an illness caused by poor control by the body of blood sugar
Addressing the Burden of Diarrheal Disease
•Case management interventions include oral rehydration therapy, zinc supplementation, and, selective antibiotics (as appropriate) •Zinc supplementation for 10 to 14 days could reduce duration of diarrhea by 25%
The Importance of Communicable Diseases
•Cause 40% of deaths and 40% of DALYs in low- and middle-income countries •Disproportionately affect the poor •Enormous economic consequences •Relevance to SDGs •Much of the burden of communicable diseases is avoidable, many can be prevented or treated
Key Terms, Definitions, and Concepts
•Communicable disease: are diseases that can be transmitted via animal-animal, animal-human, or human-human •Also called "infectious disease" •Includes parasitic diseases •Case: an individual with a particular disease •Case fatality rate: the proportion of persons with a particular condition (cases) who die from that condition
The Costs and Consequences of Communicable Diseases
•Constrain health and development of children •Affects schooling and adult productivity •Strong stigma and discrimination associated with HIV, TB, and others such as leprosy •Limit productivity and income of adult workers •Costs of treatment burden families •High rates of communicable diseases reduce investment in a country's development
Key Terms, Definitions, and Concepts
•Control (disease control): reducing the incidence and prevalence of a disease to an acceptable level • •Elimination (of disease): reducing the incidence of a disease in a specific area to zero. Example: Neonatal tetanus • •Eradication (of disease): termination of all cases of a disease and its transmission globally. Example: smallpox • •Extinction (of disease): The specific infectious agent no longer exists in nature or in the laboratory. Example: none.
Critical Challenges in HIV/AIDS
•Developing a vaccine •Cost-effective approaches to prevention in different settings •Universal treatment for all those who are eligible •Financing treatment •Management of TB and HIV co-infection
The Cost and Consequences of Child Morbidity and Mortality
•Direct and indirect costs of caring for a sick child are very high •Potential long-term disability as a result of the illness/disease •Growth retardation and retardation of mental development can result in poor school attendance and performance •High fertility to compensate for deaths
Global Immunization Efforts: Expanded Programme on Immunization (EPI)
•EPI released guidelines set by the WHO for countries to create and implement their own national immunization program: •Create and maintain a reliable cold supply chain •A transport system to deliver doses of the vaccine to health facilities •Vaccine stockpiles •Hire, train and supervise healthcare workers •Develop outreach methods to educate the public •Create a system for documenting which child received which vaccine •Countries were required to monitor their immunization programs using an administrative method and a community-based survey method 1980s: the program became universal
Key Terms, Definitions, and Concepts
•Emerging infectious disease: a newly discovered disease •Reemerging infectious disease: an existing disease that has increased in incidence, spread to new place, or has taken on new forms •Parasite: an organism that lives in or on another organism and takes its nourishment from that organism
The Costs and Consequences of HIV/AIDS
•Enormous impacts in high prevalence countries that go beyond morbidity and mortality •Affects family cohesion, business, trade, labor and armed forces, ag production, education, governance, public services, etc. •A person with full-blown, untreated AIDS cannot work and will become dependent on others for care •Creates exceptional number of orphans •Highly stigmatized condition •Direct cost of treatment high for the poorest countries
The Burden of Emerging and Reemerging Infectious Diseases
•Examples of emerging infectious diseases: •SARS, China (2002), MERS, Arabian Peninsula (2012), H5N1 (2003) •Table 12.6 page 318 • •Examples of reemerging infectious diseases: •Cholera, Yemen (2016), Ebola, West Africa (2014), Dengue, S. American and Caribbean
Global Immunization Efforts: Expanded Programme on Immunization (EPI)
•First 20-30 years: WHO vaccine schedule included four vaccines: Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), oral polio (OPV), and measles • •In 2000: vaccines for Hepatitis B (HepB), yellow fever (in countries endemic for the disease), Haemophilus influenzae b (Hib) added to the recommended list
Future Challenges of NTD's
•Hookworm and schistosomiasis vaccine is in progress •Develop new drugs to combat the NTDs more effectively and combat resistance •Work with communities to combat underlying risks such as: •Hygiene •Unsafe water supply •Unsanitary disposal of human waste •Worm and parasite breeding sites
Key Terms and Definitions
•Hypertension: high blood pressure, with a reading of 140/90 or greater •Ischemic heart disease: a disturbance of the heart function due to inadequate supply of oxygen to the heart muscle •Stroke: sudden loss of function of the brain due to clotting or hemorrhaging
The Unique Importance of Immunization to Child Health
•Immunization is one of the most successful and cost-effective child health interventions •Scaling up existing vaccine programs in 72 poor countries, could save 6.4 million lives and save $6.2 billion in tx costs and $145 billion in productivity costs • • •Each year, routine immunization prevents between 2 and 3 million deaths and protects up to 100 million people against illness and disability •WHO Immunization coverage
Future Challenges
•Impact of economic crisis on governments' ability to fund public health functions •Rapidly evolving pathogens, population growth, climate change, etc. will increase number of emerging diseases •Possibility of a major pandemic •Accelerating drug resistance •Limited number of anti-infective drugs being developed
Addressing Antimicrobial Resistance
•Improved global surveillance and laboratory capacity •Uninterrupted access to essential medicines •The regulation of medicines, including in animal husbandry •Improved infection control •Innovation •Improved education regarding over-prescription of antibiotics
The Burden of TB
•In 2013, TB was the 13th most important cause of death worldwide for all age groups and both sexes •75% of TB infections occur in people aged 15-54 •The incidence of TB has fallen by about 2% per year •However, there are still 10 million new cases every year •There has been an increase in TB infections that are resistant to one or more TB drugs
Burden of Malaria
•In 2014, 97 countries had ongoing transmission •½ of the worlds population live in places that are at risk •Leading cause of DALYs in sub-Saharan Africa among all age groups •Pregnant women who contract malaria are at high risk of giving birth to low birthweight children •10th leading cause of death for all ages and sex, globally (2014)
Antimicrobial Resistance
•In 2017, about 558,000 people globally developed multidrug-resistant TB •There is also resistance to all malaria drugs, tx of shigella, etc. •Table 13.8 page 359 • •Factors contributing to development of drug resistance include: •Increasing use of drugs •Poor prescribing and dispensing practices •Inappropriate use •Failure of patients to take correct dosages •Counterfeit drugs
Costs and Consequences of Malaria
•Individuals often have malaria up to 5 times per year • •Indirect costs are greater than direct costs of treatment due to lost days of work • •Roll Back Malaria suggests that economic costs in countries with a high burden are equal to 1.3% of GDP per year •It is a deterrent to trade, business development, tourism and foreign investment
The Burden of NCD: Cardiovascular Disease
•Ischemic heart disease and stroke referred to as cardiovascular disease and makes up 27% of all global deaths • •Ischemic heart disease caused about 10 million deaths in 2016 and is the leading specific cause of death globally for all age groups and both sexes
The Burden of NCD: Cardiovascular Disease
•Ischemic heart disease was the second leading cause of DALYs globally among all age groups and both sexes in 2016 and stroke was the third leading cause of DALYs • •Risk factors include sex, ethnicity, hypertension, tobacco use, high cholesterol, lack of physical activity, and excessive alcohol consumption
Global Immunization Efforts: Expanded Programme on Immunization (EPI)
•It was clear that funding would be a huge barrier for many countries •In 1977, the Pan American Health Organization (PAHO) created the PAHO Revolving Fund for Vaccine Procurement to create a pooled purchasing system to bring down prices to affordable levels •As a result, the Region of the Americas was the first WHO region to eliminate polio and the only region to eliminate indigenous transmission of measles and rubella
Critical Child Health Interventions: Mother and Baby
•Kangaroo mother care •Early and exclusive breastfeeding for six months •Hygienic introduction of diverse complementary foods •Managing pneumonia and diarrhea •Immunization •Bednets for malaria, and regular drug administration for worms
Key Adolescent and Young Adult Health Burdens
•Key Facts concerning differences in cause of death by sex and age group: •Early adolescence: •Males: 11% from road injuries, 11% diarrheal and intestinal infectious diseases, 9% from drowning •Females: 13% from diarrheal and intestinal infectious diseases, 7% from road injuries, 7% from malaria
Critical Child Health Interventions: Mother and Baby
•Life course approach to think about interventions •Start with ensuring a healthy and well-nourished mother •Prenatal care and micronutrient supplementation for the mother-to-be •Prevention of mother-to-child transmission of HIV •Attendance at delivery by a skilled birth attendant and referral for emergency obstetric care if needed •Appropriate care of the newborn and referral if needed
Economic and Social Consequences of Adolescent Health Issues
•Maintaining adolescent health is essential to maintaining gains made in improving child health •The health of adolescents sets the stage for their health as adults •Future losses to adult productivity and potential •High costs associated with morbidity (e.g., HIV and TB treatment) and mental health- both of which can last a lifetime
Malaria: Burden (2017)
•Malaria is caused by a parasite which is transmitted from a mosquito (anopheles) bite •P. falciparum, P. vivax, P. ovale, P. malariae, P. knowlesi •Number of people at risk of infection: 3.2 billion •Number of malaria cases: 219 Million (up from 198 million in 2013) •Number of malaria-related deaths: 548,000 •Burden of malaria-related deaths: 92% in Africa; 61% occurred in children under 5 years of age •Proportion of households owning at least one insecticide-treated bednet: 67%
Mortality and the Burden of Disease: Measles
•Measles is an acute respiratory illness that spreads through droplets in the air or contact with nasal/throat secretions • •Children under-5 years and either vitamin A deficient or HIV-infected are more vulnerable to complications • •Deaths decreased by 80% globally 2000-2016 as a result of vaccination • •Still a leading cause of death of children under-5, causing 1.3% of deaths in children under-5
The Burden of Neglected Tropical Diseases (NTD)
•More than 1 billion people are infected with one or more NTD (1 in 7) •There are 22 parasitic and bacterial infections that are NTD • •Considered diseases of poverty • •Cause extraordinary amount of illness, disability, and disfigurement Often times are deadly
The Burden of Diarrheal Disease
•Mortality has decreased significantly in the past 30 years, from an estimated 4.6 million deaths in the 1980s to 525,000 deaths in 2016 •Most significantly impacts the poor •Diarrheal diseases are the cause of roughly 10% of deaths among children under-5
Mortality and the Burden of Disease: Soil-Transmitted Helminths
•Most common infections: Roundworm, hookworm, and whipworm • •270 million pre-school children and 560 million school-aged children live in intense helminth transmission areas • •Infections can lead to severe morbidity, such as iron deficiency anemia • •Burden of several worms highest for 6 or 7 years old
Addressing Key Challenges in Child Health
•Most progress for 1 to 5 year olds; less progress made in reducing neonate death rates •Insufficient progress in reducing child deaths in sub-Saharan Africa and South Asia •Many low-cost, highly effective interventions are not implemented where they are needed •These interventions could prevent two-thirds of child deaths • •What are the low-cost, highly-effective interventions discussed in the book?
Progress in Coverage of Six Basic Vaccines
•Much of the improvement in child health in the last two decades is attributable to increased immunization coverage •In 2018, about 86% of the world's children received vaccines that would protect them against polio, diphtheria, tetanus, pertussis, and measles. •Immunizations currently prevent 2 million to 3 million deaths every year. •Despite this success, more than 1.5 million people worldwide die from vaccine-preventable diseases each year.
Challenges in Tb Control
•Need for better (and faster) diagnosis and ways to treat latent Tb • •Need safer and easier drug regimens as well as new, more effective vaccine •New drug regiments should be cheaper, shorter regimens and fewer pills • •Better efforts in linking all providers of Tb diagnosis and treatment with national Tb programs •Overall strengthening of the health systems
Key Terms and Definitions
•Noncommunicable diseases: cannot be spread by an infectious agent, they last a long time, and they are often disabling and lead to death if not treated appropriately •Also referred to as chronic diseases and degenerative diseases
Consequences of Neglected Tropical Diseases
•Other possible complications (depending on the disease): blindness, liver cancer, remarkable swelling, and skin problems • Increased susceptibility to other infectious diseases •Impact on productivity, school attendance, and future wage-earning capacity
Consequences of Neglected Tropical Diseases
•Overall, NTD's can have debilitating social and economic consequences •Chronic helminth infection in children can limit the physical and mental development of the child •Pregnant women with anemia, commonly caused by hookworm, are 3.5 times more likely to die during childbirth •Many are stigmatized because of the disability and disfigurement that follows
Key Terms
•Perinatal: first week of life •Neonatal: referring to the first month of life •Infant: referring to the first year of life •Under-5: referring to children 0-4 years old
Broad-Based Measures to Improve Adolescent Health in Low- and Middle-Income Countries
•Policymakers must take a life-course perspective to preventing and treating health issues •Viewing adolescence as one stage in the persons life- which will affect the rest of their lives •Improve educational and employment opportunities •Promote universal health coverage to improve access of adolescents •Make services more friendly to adolescents •Break down data into early adolescence, older adolescence, and young adulthood to better identify group needs
HIV/AIDS: Burden of HIV/AIDS 2017
•Rarely has a single pathogen had a greater impact on the human condition than HIV •Number of people living with HIV/AIDS: 36.9 million •Prevalence among adults aged 15-49: 0.8% •Number of new HIV infections: 1.8 million •Number of HIV-related deaths: 940,000 •Proportion of all adults living with HIV receiving ART: 59% • •Transmission: Unprotected sex, Mother-to-child, blood, transplants (blood and organ)
Addressing Emerging and Reemerging Infectious Diseases
•Reduce pressure on environment and have proper land use planning •Proper medication use •Sensitive surveillance systems and public health laboratories •Global collaboration and willingness to share information with other countries •Rapid detection (and reporting) of new outbreaks •Mexico (H1N1) vs China (SARS) •Mechanisms for effective containment
Antimicrobial Resistance
•Resistant forms of disease can emerge or reemerge when bacteria, parasites, and viruses are altered through: •Mutation •Natural selection •The exchange of genetic material among strains and species
Mortality and the Burden of Disease: Diarrhea
•Second-leading infectious cause of young child death •Diarrhea 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
Key Risk Factors and Social Determinants
•Some Adolescent populations are more vulnerable than others: •Those who are marginalized for their sexuality •Those who are marginalized for their ethnicity •Those who live in rural areas •Those who live in areas with social conflict and natural disasters •Those who are incarcerated
Addressing the Burden of HIV/AIDS
•Strong political leadership, commitment and open communication •Need for a vaccine •Focus on prevention of new infections and 90-90-90 by 2020 •Approach to prevention must vary with nature of epidemic •Efforts need to combine education and behavioral change, bio-medical approaches, structural approaches, and early treatment
Challenges in Addressing Malaria
•Substantial gaps in diagnosis and treatment •National malaria programs must find effective ways of working with private medical providers •Dispersal of counterfeit and low quality drugs •Better diagnostics and development of new drugs •Growing resistance to the insecticides used for indoor residual spraying •A safe, effective, and affordable vaccine
Management of Tb/HIV co-Infection
•TB is an opportunistic infection of HIV • •The WHO recommends "Scaling up the three I's" •Intensified case finding •Giving isoniazid (antibiotic) to people with HIV to help prevent their getting TB •Enhancing infection control in healthcare settings so that TB does not spread
The Costs and Consequences of TB
•TB patients lose about 60% of their individual annual income and 40% of household income due to falling ill with TB •Could be financially catastrophic to many families •Stigmatized condition •Economic growth of a country inversely correlated with the rate of TB
Tuberculosis (Tb): Burden (2017)
•Tb is caused by the bacteria Myobacterium tuberculosis and is spread through aerosol droplets •Must be exposed to someone with active Tb •Thought to be a "disease of poverty" • •Number of new cases of active Tb in 2017: 10 million •5.8 million were men •3.2 million were women •1 million were children •About 900,000 (9%) of new cases of Tb were in people co-infected with HIV •Proportion of new cases with drug-resistant TB: 560,000 (of which 82% were multi-drug resistant)
Challenges in TB Control
•The WHO End TB Strategy seeks to end the global epidemic by 2035, with a 95% reduction in deaths and reduce incidence to 10 per 100,000 people •Focuses on expanding TB prevention and care •Putting the new strategy in place requires additional financial and technical resources
The Consequences of Emerging and Reemerging Infectious Diseases
•The cost varies, but can be very large •Table 13-10 page 362 •Must consider the direct cost of caring for sick person as well as the indirect costs •Must consider the costs of drug resistance too •Treating drug-susceptible TB is $100-500 whereas treating drug resistant TB is $9,000-49,000
HIV Treatment
•The global community has made a commitment to trying to ensure that all people with HIV are placed on ART treatment when clinically eligible •Clinically eligible: CD4 cell count below 500 •UNAIDS estimated that in 2017, 75 % of HIV-positive people knew their status and 79% of them were on anti-retroviral therapy
Seven Most Common NTD's
•These tend to infect a large number of people and the manner in which they are addressed: •Roundworm (affects up to 1 million people) •Whipworm (affects over 7 million people) •Hookworm (affects over 7 million people) •Schistosomiasis (snail fever) affects over 200 million people •Elephantiasis (lymphatic filariasis) affects 120 million people •Blinding trachoma (affects 40 million) •Onchocerciasis (river blindness) affects 26 million people
Mortality and the Burden of Disease: Malaria
•Transmitted through bites from mosquitos • •Cause of almost 600,000 child deaths per year •Leading cause of death in children under-5 in sub-Saharan Africa • •Extremely high morbidity; estimate some people in sub-Saharan Africa have about five episodes per year
The Burden of Emerging and Reemerging Infectious Diseases
•Truly global threats and "a perpetual challenge" • •Zoonoses (infection spread from animals to humans) cause of about 60% • •578 outbreaks in 132 countries from 1998-2001
Mortality and the Burden of Disease: Pneumonia
•Upper respiratory tract infections include the common cold and ear infections, and lower respiratory infections include bronchiolitis and pneumonia •Pneumonia can be caused by bacteria, viruses and fungi • •Children under-5 in low- and middle-income countries average 3-6 acute respiratory infections per year •These infections tend to be more severe and cause higher rates of death in low- and middle-income countries • •Pneumonia is the leading infectious cause of death globally in children under-5 •
The Burden of HIV/AIDS
•When HIV first appeared in a population, it was generally concentrated in sex workers, men who have sex with men, or injection drug users •Highest prevalence rate of HIV/AIDS is sub-Saharan Africa: 4.7% of the adults aged 15-49 •New HIV infections predominantly in people aged 15-24, or infants from mother-to-child transmission
Risk Factors for Neonatal, Infant, and Child Deaths
•Why do so many children get sick and die? •Social determinants of health and poverty •Mother's nutritional and health status, and education •Access to trained healthcare provider to attend birth and provide counseling •Water quality and sanitation •War and conflicts