Global Health Final Exam

Diarrheal Disease Prevention

1. Access to clean water and sanitation - piped water, disinfection and storage 2. Rotavirus Immunization 3. Exclusive Breastfeeding for the first 6 months

Congenital Abnormalities

1. Birth Defects 2. Heart Defects, neural tube defects, Down's Syndrome, congenital rubella, syphilis

Main Difference Between Wasting and Stunting

1. Stunting - the child is undernourished, therefore they don't grow to their potential. Results from chronic/long-term undernutrition 2. Wasting - can be the result of acute undernutrition. It's usually caused by something like a famine or a drought.

Needs for Zinc Deficiency

1. Supplementation - decreases the length and severity of some illnesses (DD helps the fighting ability of the immune system)

Needs for Vitamin A Deficiency

1. Supplements - take these 2 times a year. This intervention is cost-effective and can reverse the standards. Give women and children a capsule and consequences from deficiency immediately go away. Can potentially knock mortality down 20-30% 2. Improved Diets

Neonatal

First month of life

Milk

Fortified with Vitamin A, Vitamin D, and DHA (type of fatty acid important with brain functions and development)

Vaccine Preventable Disease Rate in the US

Rates are rising in the US, despite near elimination in 1990. Change in vaccination from Dtap to Ttap

Measles in the US

These are back in the US after they were eradicated in the country in 2000. There were zero cases for three consecutive years In 2010, it comes back and begins to grow from there. So, we starting putting great effort into it again.

Height-For-Age Stunting

We're looking at the height for certain ages. People who are much shorter may be a result of undernutrition stunting.

Countries With Active Polio

1. Afghanistan 2. Pakistan 3. Nigeria All three of these countries still have active Islamic insurgency (Muslims reject vaccination) They cannot participate in National Immunization Days

UNICEF Guatemala Video

1. Child is slowly getting sicker and sicker 2. ARI - Effects the passageway where air moves into the human body 3. ARI is caused by viruses or bacteria 4. ARI - Main cause of death/visits to a health clinic 5. Most of the time, when the child is brought to the hospital, they're already seriously ill 6. 12 out of 100 boys/girls die each year from the illnesses. 7. Symptoms include: coughing, stuffy nose, sore throat, earaches, raspy breathing/wheezing when the child is sleeping, and fever

Undernutrition Deficiencies

1. Energy - Not enough calories 2. Protein - Environmental constraint because they can live in an area with heavy vegetation or lack of access to protein 3. Micronutrients - Vitamins, minerals, etc.

Hunger Map 2013

1. Food is the most basic of human needs required for survival, but 1/8 people in the world go to bed hungry. 2. Possible to achieve zero hunger in our lifetimes but we need to start by cutting hunger in half by 2015, as pledged in the Millennium Development Goals. 3. Costs, on average, only 25 cents a day to feed a hungry child.

Child Survival

1. There's been a 70% decline in this over the last 50 years. 2. About 7 million children under the age of 5 die each year 3. This is closely linked with poverty - 99% of the deaths are in low/middle-income countries.

Challenges in Using the Vaccines for Hib and Pneumococcus

1. They're very expensive - because the drugs are relatively new. 2. Difficulty in delivering the drugs. 3. It's difficult to target the areas with the most disease; therefore, we don't know where to send the vaccines.

The 4 Micronutrient Deficiencies

1. Vitamin A 2. Iron 3. Zinc 4. Iodine

Under-5

Birth to the 5th birthday for a child.

Neonatal Tetanus

Clostridium tetani spores in the dirt. This is a powerful spasmodic toxin that causes lockjaw Introduced to the umbilicus during the delivery and it's often fatal. Common in rural areas where the delivery occurs in the home.

"Stupid Deaths"

Deaths that are completely preventable. They have no business occurring because we know how to deal with the issue at hand in the modern world. Simple, low-cost interventions are the answer.

Weight-For-Height Stunting

How much a child at a certain height should weigh

Vaccine Preventable Diseases

Humans have created an effective vaccine for the disease. These are improving because of improving health and science Vaccination helps the body create the attack Almost all of these diseases are viruses - these are for the most part very simple. Much simpler than bacteria.

Global Alliance for Improved Nutrition (GAIN)

In 2002, this organization works with many different countries to invest in food fortification.

Congenital Abnormality Risk Factors

Maternal malnutrition Maternal Infection Maternal exposure to toxins

Kangaroo Care

Method for extra support of preterm and low-weight babies The infant is held skin-to-skin with their mother or another adult. This helps with temperature control, breathing support, access to breastfeeding, and bonding.

Nutrition Nerd Micronutrient Deficiency Video

Micronutrients are vitamins and minerals that are essential in small quantities. Most important are Vit. A, Iron, Zinc, and Iodine. Vit A - 1/3 children under age 5 experience this deficiency. It weakens their immune system. Iodine - main cause of mental impairment in developing countries. Zinc - up to 25% of the world's population is deficient. Effects the organ system, leading to increased rates of pneumonia, diarrhea, and malaria.

Hidden Hunger (from nutrition nerd video)

The absence of the most important micronutrients. Very rarely can you see the effects of the absence of the micronutrients.

Uneven Progress in Child Mortality

We are seeing progress in deaths that occur in the ages from 1-5. But we aren't improving earlier deaths. High rates occurring in Sub-Saharan Africa and South Asia Need to address the very first moments of the child when they enter the world.

Assessing Stunting

We can assess this by looking at the standard deviation from a reference population. We are looking for how many z-scores the population being studied is from the mean. If a country is 2 z-scores below the average than they are assumed to be experiencing stunting (more prevalent in low/middle-income countries). Huge stunting implies that there's been long-term undernutrition.

Under-5 Child Mortality Globally

We can see a significant decline in this from 1980 to 2015. We didn't quite meet the the MDG's for child mortality, though. Having said that, we can conclude that we did very well. We are, however, still at a rate that's much higher than we'd like it to be.

Needs for Iron Deficiency

1. Fortification - putting iron in things that don't normally contain iron 2. Supplementation - supplements similar to Vit. A. 3. Dietary Change - Need access to healthier diets (need access to things like protein) 4. Infection Control - This nutrient can help fight infections

Anthropometric Indicators of Protein Energy Undernutrition (PEM)

1. Height-for-age Stunting 2. Weight-for-height Stunting 3. Weight-for-age Stunting

Hans Rosling on Child Survival

1. If we want to improve child survival, we need to identify where the investments are needed 2. There are 7 billion people in the world: 2B in deep poverty, 3B a little better off, 1B saving to buy cars, and 1B in the richest countries where most of their needs are satisfied 3. Child mortality is in the 2B (deep poverty) and this is where we need to invest 4. This is within human reach, but we need to combine the heart, the money, and the brain

Response from WHO to Polio Outbreak

1. Information Gathering - Who is at risk, what needs to be done, etc. Answering key questions. 2. Transporting vaccine vials carefully - Must remain at a certain temperature, if it's not then the vaccine becomes deactivated. 3. Vaccinators reach every single child 4. To stop the virus, they must complete 3 rounds of vaccinations 5. Reliance on a network of people

Needs of Preterm Babies

1. Kept Warm - risk of hypothermia 2. Help with feeding 3. Help with breathing 4. Help avoiding infections If they survive, they will be at a high risk for disabilities

ALRI

1. Leading Cause - S. Pneumonia (Pneumococcus) 2. Major Cause - H. Influenza (Hib)

Hans - Child Survival Video

1. MDG's suggest a 4% decline per year. 2. Congo, Ghana, and Kenya have experienced improvements in child mortality. 3. It takes a very long time for countries to see vast improvements (it doesn't happen over night) 4. We're starting late on African countries, but they're still experiencing improvements. It's a long-term investment. 5. Hans arguing that we shouldn't conclude that we aren't progressing just because some countries aren't improving at a fast rate. 6. If families have access to family planning and women are empowered enough then the fertility rate can successfully decline. As fertility declines, so too does child mortality.

Prevention of Neonatal Tetanus

1. Maternal Vaccination 2. Clean Delivery 3. Clean chord care

What do Polio and Small Pox have in Common?

1. Neither of them effects any other species 2. It's possible to vaccinate everyone on the planet and there would be no human that could affect another human

Causes (and %) of Child Mortality

1. Neonatal Causes - 37% 2. Pneumonia - 19% 3. Diarrhea - 17% 4. "Other" - 10% 5. Malaria - 8% 6. Measles - 4% 7. Injuries - 3% 8. AIDs - 3%

Roles Involved With ALRI

1. Nutrition Role 2. PE and Micronutrient Role - i.e., breastfeeding 3. Environmental Role - Housing, health facilities, etc.

Diarrheal Disease Treatment

1. Oral Rehydration - reestablish the balance of electrolytes in the body. Do this with water, sugar, salts (our version of Pedialyte) 2. Zinc Supplementation - Cases won't last as long and won't be as severe 3. Antibiotics - rarely used, depends on the type of bacteria.

Infections/Sepsis During Neonatal Period

1. Pneumonia 2. Diarrhea 3. Sepsis - blood infections that are mainly bacterial. Many times these are transplacental or from the birth environment.

Consequences of Undernutrition

1. Poor Health 2. Low Energy Levels 3. Mental and Cognitive Impairment 4. Poverty This is a viscous cycle. None of these things can experience progress unless we address the central problem.

Consequences of Iron Deficiency

1. Poor pregnancy outcomes 2. Impaired physical and cognitive development - need in iron in the brain 3. Reduced productivity - can't go to school and learn

Needs for Iodine Deficiency

1. Prevent this in mountainous regions where seafood isn't consumed often (if at all). 2. Fortification of Salt- putting salt in things that don't normally contain salt.

Cost-Effective Short Term Interventions

1. Promotion of exclusive breastfeeding for the first 6 months of life in resource-poor settings. 2. Vitamin A, Iron, and Zinc Supplementation - Especially for children and pregnant women 3. Iodization of Salt 4. Other Food Fortification - Taking the nutrient and putting it in some staple food source that the population is already consuming.

Severity and Mortality From Acute Respiratory Infections (ARI)

1. Quality of Housing 2. Indoor Smoke 3. HIV

Insufficient Nutrition in Undernutrition

1. Quantity 2. Quality - They may be getting enough food, but they're not receiving the essential things 3. Poor nutrient uptake because of illnesses.

3 Essential Steps for Childhood Pneumonia

1. Recognize that the child is sick - This involves discovering that there's something severe going on with a child and taking action by getting them to a clinic as quickly as possible. 2. Seek Appropriate Care 3. Treat Appropriately with antibiotics

ALRI Transmission

1. Respiratory Droplet 2. Aerosol 3. Normal Floral in the lungs

Mortality Caused by Diarrheal Disease

1. Rotavirus - 860,000 2. Typhoid - 600,000 3. Shigella - 600,000 4. ETEC - 380,000

Why Measles Come Back to the US

1. There was a huge antivaccination movement in California and the West Coast. 2. This leads to low vaccination rates in the west 3. In order for eradication to remain, at least 80% of the population needs to be vaccinated. 4. Most of the cases in 2010 occur on the West Coast 5. In 2014 it reaches Disney Land and many children are effected. Since this, it begins to decrease again.

Video - Pneumococcal Vaccine Introduced in Yemen

1. Very difficult for a family to raise a child 2. Pneumonia is the leading cause of death 3. It leads to infant mortality 4. More than 42% of people are under the poverty line - so, when they get sick they can't pay for medicine 5. Yemen introduces the vaccine into the country 6. This was an activity that GAVI was involved with - they were getting vaccines to poor countries that otherwise wouldn't be able to afford them.

Prevalence of Vitamin A, Iron, and Zinc Deficiencies

1. We see variability from region to region 2. The occurrence of them is still way too high, globally. 3. It's rare for a child to one have 1/3 of these deficiencies; rather, they're deficient in all 3 of them.

ALRI Diagnosis

1. X-Ray or Lab Tests 2. Clinical Symptoms - This occurs in resource-poor settings where there is no access to lab tests nor x-ray systems.

Iron Deficiency

30% of the world's population is anemic (50% are pregnant women and 40% are preschool children) Aggravated by helminths, malaria, HIV/AIDs because red blood cells need iron to fight diseases.

National Immunization Days

All children in a country are vaccinated. Usually takes place for about 5-7 days. Every single house that includes a child is vaccinated.

Old People (65+) Susceptible to Vaccine Preventable Diseases

As they age, their immune system weakens and their ability to fight disease decreases substantially.

US Vaccination Schedule vs. Nigeria Vaccination Schedule

Both are very complicated because of increasing knowledge. Each country has a vaccine schedule that's very specific to their country. First Polio Dose - 1. US: at 2 months 2. Nigeria: at birth Both countries give booster shots along the way. The vaccination is given orally and it only requires one drop

Diarrheal Disease in Children

Children tend to get this disease multiple times a year. The difference lies in the context in which the cases occur - environment and how healthy the body is at the time of infection.

Global Eradication of Vaccine Preventable Diseases

Countries that eradicate a vaccine preventable disease must continue to vaccinate until their are no cases globally. (This is how small pox was eradicated) Rejection leads to countries having to continue to vaccinate

Pneumonia Cartoon from Slides

Depicts a cautionary tale for getting proper treatment and recognizing any issues. Serves as a means of education for parents. Emphasizes that we need to have proper medicine ready to go at health clinics.

Vaccination Occurring in Nature

Example of small pox - They noticed that women who milked cows and had lesions on their hands did not get small pox. Almost all traditions used to inoculate people from lesions of people getting sick with small pox. People who had small pox, but survived, were used to treat the people who came down with small pox.

Birth Asyphyxia

Failure to establish breathing at birth Involves resuscitation: 1. Drying, stimulating, and warming babies in distress 2. Clearing their airways 3. Ventilation with the use of bag-and-mask or equivalent device. *This is a critical step for asphyxiated babies* Many babies can improve rapidly

Major Cause of Vaccination Rejection During an Outbreak

Fatigue - children have other diseases and are worn down by the number of vaccinations they are receiving.

Perinatal

First week of life

Infancy

First year of life

Prevention for Congenital Abnormalities

Folic Acid Iodine Vaccination Adequate Antenatal Care

Golden Rice

Form of selective breeding where we grow foods based on the nutrients we need.

Zinc Deficiency

Growth retardation, impaired immune functions, skin disorders, cognitive dysfunction Major risk factor for morbidity and mortality from diarrhea, pneumonia, and malaria

Present-Day Progress of Stunting

Height is getting better due to better nutrition and stunting is occurring less frequently. This is why people today are much taller than people used to be because people are actually growing to their potential.

Effect of Quality of Housing on Severity of ARI

In America, we live in houses that are climate controlled. We are protected from rain, snow, freezing temperatures, etc. In low/middle-income countries, however, they may not have access to this.

Where do approximately half of Under-5 deaths occur globally?

India, China, Nigeria, DRC, and Pakistan

Ready-To-Use-Therapeutic-Foods (RUTF)

Intervention strategy for an acute situation. An example is Plumpy Nut - a heavily fortified form of peanut butter. Planes drop huge quantities of this to populations in dire need.

Neonatal Mortality

Involves the first 30 days of life. Newborns aren't doing many independent things at this stage of their life. We are seeing an increasing proportion of deaths in this period. Estimated that there are 4 million deaths per year. Many are unrecorded because the births aren't taking place in a hospital or medical center. 3/4 occur in the first week of life (majority of them occur on the first day of life) NOTE: Low birth weight is a factor in 60-80% of these deaths

Major Cause of Hidden Hunger

Lack of dietary diversity. This can stem from multiple things like the lack of economic means or the lack of physical access.

Undernutrition Globally

More than 1/3 of deaths are attributable to this and there are many different causes. This is not a matter of starvation, it's how inadequate nutrition partners with diseases.

Iodine Deficiency

Most common form of preventable mental illnesses in the world. Goiler - helps give this nutrient to the thyroid gland Impaired intellectual development - Cretinism, stillbirth and fetal loss

Pneumonia/ALRI

Occurs in the lower respiratory - symptoms descend into the bronchi and lungs. Leading cause of death in low/middle-income countries. On average we see 3-6 cases a year for every child. This may be due to the fact that they're exposed to more serious things.

Cereal

Organic whole grain types don't have that many vitamins and minerals; however, most has percentages of the micronutrients we need.

Food Fortification Video

Over 2 billion suffer from micronutrient deficiency Iron - People are tired and can't work/learn Vitamin A - Weakened immune system. Children experience lowering IQ's. Hinders development in countries - World Bank estimates a country can lose 2-3% of GDP from micronutrient deficiency Fortification has been practiced for nearly a century and is a top global priority for development. In 2002 the Global Alliance for Improved Nutrition (GAIN) is working with countries to invest in food fortification

Long-Term Solutions for Micronutrient Deficiency

Policies addressing poverty, trade, and agriculture. Improvements in the status of women and their access to education. This is associated with reduced child mortality and undernutrition. Access and consumption of affordable food that meets nutrition needs.

Preterm Birth Complications

Poor women are at higher risk because of nutrition, infection, toxin exposure, and lack of antenatal care. Can care for these women with: 1. ANC - Antenatal Care, identifying nutrition issues or infections that are present 2. Steroid injections - Can speed up the development of the babies' lungs, helping them adapt to being born early, more quickly. 3. Attending to the health of the mother from birth - focus on promoting healthier lives for mothers to prevent any of this from happening

Stunting in places like Asia

Populations that are known to be shorter have the same growth potential as other countries, however, they're still experiencing stunting.

Prevention/Treatment of Infections/Sepsis During Neonatal Period

Prevention - through hygienic delivery and newborn care vaccines. Treatment with antibiotics and/or other supportive care.

Vaccination Rejection

Refusing to be vaccinated. There are 2 active rejections: 1. Some Muslim communities rejecting polio vaccination 2. MMR rejection by western elite - this has been fueled by celebrities.

Effects of Indoor Smoke on Severity of ARI

Someone may be smoking in the houses; however, what we're really looking at is smoke stemming from cooking fires. This is bad ventilation from biomass (wood, charcoal, etc - anything resulting from cooking or warmth). When the smoke hangs in the air, it can have serious effects on children.

Lufwanyama Neonatal Survival Project (LUNESP)

Study that aims to reduce Zambia's high infant mortality rate and increase the chances that Zambian children will live past their first birthday The study trains attendants to intervene in four of the most common, preventable contributors to neonatal mortality: birth asphyxia, neonatal hypothermia, sepsis, and perinatal transmission of HIV

Weight-For-Age Stunting

The average weight for a certain age (we don't use this method very often)

Children (0-5) Susceptible to Vaccine Preventable Diseases

Their immune systems have not developed enough. They inherit antibodies from their mother (called active immunity), however, they have to build their own immune system as they age. When their immunity levels decline, they need to be vaccinated.

Vaccines for Hib and Pneumococcus

These are known as conjugate vaccines. They're very effective. Hib - Can be combined with DPT, polio, and hep B Pneumococcus - Covers multiple strains of the illness

Nutrition Gaps During the First 1000 Days

This can cause irreversible mental, physical, metabolic, and immune system problems.

Conception to 2nd Birthday

This is the key period of 1000 days where nutrition is essential. This key period involves the "building and wiring" of children. The roots for growth and health, as well as brain development and physical development begin here.

Fecal-Oral Transmission

This results in dehydration if the case gets severe enough. This is the most direct transmission. Progression that is usually going on for so long that the body is losing fluids and other things necessary for functioning. Occurs through: 1. Water Supply 2. Food Preparation 3. Flies

Effects of HIV on Severity of ARI

This weakens the immune system of children, thus making them more susceptible to the illness.

How to Create Vaccines

Use something from the virus that simulates the attack

Diarrheal Disease

Used to be one of the top killers, globally (now 2nd to respiratory diseases). Cause by a variety of pathogens - rotavirus, ETEC, vibrio, Shigella, Salmonella, Campylobacter, Giardia, Clostiridium This can be mild to life threatening and there are multiple episodes per year in children. We've made significant strides in addressing this disease.

Where We're Really Struggling With Child Mortality

We're having great success in preventing child mortality for children in years 2-5; however, we're struggling with child mortality for children who are newly born. Most dangerous times - perinatal and neonatal stages of life for newborns.

Vitamin A Deficiency

Xeropthalmia (night blindness) and blindness - pregnant women at greater risk because their baby is taking their nutrients. Growth and Immune system functions - Need vitamin A to fight off infections. Without it, you chances of fighting infection are decreased. All-Cause Mortality - 6.5% of all children under the age of 5 in low/middle-income countries are dying because of vitamin A deficiencies.