Public Health Midterm 3

What are some ways in which social norms can be changed to promote HWWS?

"comfort" emerged as motivation for handwashing in all the studies. people value having skin that is free not just of disgusting substances, but also of matter such as earth, charcoal, wetness, stains, or oily residues. comfort resided both in being able to sense cleanliness directly, but also as a state of mind: being clean implied inner comfort, freshness, readiness for anything, confidence, and purity

What is the process of demand shaping and how can this be applied to community sanitation efforts?

-"demand shaping" is a demand-driven, supply-constraining customer-centric approach to planning and execution. -it aligns processes with customer demand at strategic and tactical levels and with an organization's capabilities, resulting in improved revenue, profitability and market share. optimizes use of resources, reducing excess inventory and improving inventory turns -aligning customers' long-term demand patterns to long-term resource and capacity constraints -understanding demand patterns and then influencing customers' demand toward available supply, using the levers of price, promotion, and products/services bundling

Appreciate the severity of the clean water access issue, especially in developing countries.

-2.2 billion (35%) lack access to safely managed drinking water -2.6 billion lack access to safely managed sanitation services

Appreciate the different biologic bases for malabsorption and secretory diarrhea.

-acute watery diarrhea: too much secretion (V. cholera, E. Coli), or lack of absorption (rotaviruses) -acute bloody diarrhea (dysentery): intestinal damage (Shigella) -persistent diarrhea (>14 days duration): severe undernourishment, AIDS -diarrhea with severe malnutrition: marasmus or kwashiorkor

Recognize differences in cholera and rotavirus infection.

-cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. it has a short incubation period and produces an enterotoxin that causes a copious, painless, watery diarrhea that can quickly lead to severe dehydration and death if treatment is not promptly given. vomiting also occurs in most patients -rotavirus is a virus that causes diarrhea and other intestinal symptoms. rotavirus causes inflammation in the stomach and intestines. It can cause severe diarrhea, vomiting, fever, belly pain, and dehydration in infants, young children, and some adults

Consider how Freire's 3 Levels of Conscientization can be applied to health behavior change.

-conscientization: 3 levels -least aware level: magic, fatalistic consciousness -external forces are in charge: nothing can be done to change things as they are -middle level: emerging sense of control, begin to question things as they are -critical consciousness: in-depth understanding of the forces that changes one's life space, become an active agent in constructing a different, more just reality

Discuss the key health promotion motivations necessary to address to promote hand washing with soap (HWWS)?

-disgust: strong universal emotion especially with fecal smell -affiliation: "everyone is doing it", social norm

What are the clinical manifestations of childhood diarrhea?

-fever: > 37.9o C (100.2o F) -vomiting 1-2 days -diarrhea: average 4 days (1-16) days > 5 ml to > 200 ml/kg body weight/day, dehydration, malnutrition

Differentiate between motivations and capacities to perform health behaviors.

-motivation: short-term cognitive or emotional process -capacities: a central concept that is used to describe the abilities of individuals, organizations, and communities to promote health

Describe the key features of the behaviorist and empowerment/adult learning theories. How does this theory differ from other theories discussed earlier in the semester?

-planning: long-term cognitive process -motivation: short-term cognitive or emotional process -habit: without thinking

What are people's key water-related needs? What are some interventions available to address water quality? What interventions could reduce diarrhea-related mortality among children? Discuss overlapping characteristics of these strategies.

-water-related needs: our individual health, our collective agricultural needs, and the needs of our environment -interventions: boiling, chlorination, flocculation, filtration, or solar disinfection -reduce diarrhea-related mortality: clean water treatment, food safety measures, and sanitation

Recognize the key prevention and treatment strategies identified in the UNICEF/ WHO 7-Point plan. Discuss how these are related through similar public health efforts.

1. fluid replacement to prevent dehydration 2. zinc treatment 3. rotavirus and measles vaccinations 4. promotion of early and exclusive breastfeeding and vitamin A supplementation 5. promotion of handwashing with soap 6. improved water supply quantity and quality, including treatment and safe storage of household water 7. community-wide sanitation promotion

Appreciate the general global distribution of deaths related to diarrhea disease. How have diarrheal-related deaths changed over the past 30 years?

1.7 billion episodes annually; 400,000 deaths per year (3rd leading cause)

What proportion of worldwide child mortality is attributable to childhood diarrhea?

20-25% of all deaths among children < 5 years

What is Oral rehydration therapy? How and why are glucose and salt useful in promoting rehydration during a diarrheal infection? What is the unique historic feature of ORT (i.e. where did it originate?)

ORT is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. glucose increases the uptake of sodium and thus water by the intestines, and the potassium chloride and sodium citrate help prevent hypokalemia and acidosis. it was first used on cholera patients by the US Army in 1964

What major types of pathogens are responsible for diarrheal infections?

Rotavirus, enterotoxic e. Coli, Shigella species, Campylobacter jejuni, and Cryptosporidium parvum

What are the new SDGs and how do they relate to WASH?

action-oriented, concise, easy to communicate, limited in number, aspirational, global in nature. universally applicable to all countries, while taking into account different national realities, capacities, and levels of development and respecting national policies and priorities

How can the diarrheal-malnutrition cycle be broken?

by continuing to give nutrient-rich foods - including breast milk - during an episode, and by giving a nutritious diet - including exclusive breastfeeding for the first 6 months of life - to children when they are well

How can improvements in empowerment connect with development outcomes? Be able to draw some practical connections using the World Bank empowerment framework.

by creating an enabling atmosphere, strengthening community knowledge and abilities, and ensuring replicable and sustainable results

Why is childhood diarrhea considered such a major public health problem?

children (< 5 years) in LMICs experience 2-3 episodes of diarrhea per year; the burden of disease among children is enormous

Which age range is most at risk for diarrheal infection?

children 6-11 months of age

Review the readings on empowerment. Be able to define empowerment and apply the concept to key problems in public health.

empowerment: the process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights

What is exclusive breastfeeding? Optimal breastfeeding? What features of breastfeeding make this such an important health behavior?

feeding breastmilk only, without any food, water, juice, or other liquids; EBF lowers risk of infections (sepsis, diarrhea, and respiratory)

Critically assess the essential caregiver behaviors necessary to accomplish 4 key diarrheal-related interventions.

give extra fluid, give zinc supplements, continue feeding, when to return

What public health interventions could reduce diarrhea incidence among children?

improve access to safe drinking water, improve availability and use of improved sanitation facilities

What are key general improvements that are pursued in the sanitation and drinking water sectors?

increased schooling, earning, especially from fewer missed days of school, foregone medical costs, time savings, greater productivity for caregivers if distance to safe water source is decreased

Describe why breastfeeding helps to lower diarrhea-related morbidity, as well as other common childhood illnesses?

ingested sIgA from breast milk colostrum and milk coat the intestinal tract providing passive protection against intestinal microbes

Critique the concept of health education in relation to key health behaviors necessary for diarrhea prevention.

large-scale handwashing promotion programs are needed that move away from the simplistic assumption that imparting knowledge about germs and disease will change behavior. hand washing needs to be integrated into the habitual, motivated, and planned activities to the everyday lives of child caretakers in their own domestic environments

Discuss the infectious nature of rotavirus and why it is so commonly spread between children.

mainly transmitted through fecal-oral route. some indications of a probable respiratory route infection. common in children and adults, but more children since they don't wash their hands properly

Describe the relationship between malnutrition and diarrhea. Appreciate the specific nutrient deficiencies that increase diarrhea-related morbidity and mortality

malnutrition increases the likelihood that a child with diarrhea will die or develop persistent diarrhea. diarrhea, in turn, has a negative impact on growth. deficiencies in Vitamin A and zinc are associated with increased morbidity and mortality from diarrheal disease

Do cause-specific characteristics of diarrheal pathogens influence the approach to case management and prevention of diarrhea? Why or why not?

no

What is MDG Target 7?

reducing by half the proportion of people without sustainable access to safe drinking water and basic sanitation

Develop an idea to alter the social environment, including environmental cues, as it relates to key-diarrhea preventing behaviors.

reducing stigma, increasing sanitation

How does rotavirus attack enterocytes, and thereby promote malabsorption diarrhea?

rotavirus targets the mature enterocyte cells located in the upper areas of the intestinal villi. rotavirus infection of enterocytes results in cell death and villous atrophy

Discuss the issue of sanitation from the perspective of gender equity.

sanitation provides opportunities to reduce discrimination against women and girls by placing their needs at the forefront of best practices

Utilitarianism

the consequences of the action determine its rightness, do the most good for the greatest number

What specific features of secretory IgA antibodies enable them to avoid digestion/denaturation in the GI tract?

the secretory component of sIgA protects the immunoglobulin from digestions by proteolytic enzymes, thus sIgA can survive in the gastrointestinal tract environment providing protection against intestinal microbes

What are some key ethical issues that relate to the public health problem of childhood diarrhea, including the underlying issues of water and sanitation?

these issues are a bigger problem in LMICs, which increases ethical disparities

Discuss how the simple provision of latrines and toilets stops short of promoting community-level change in sanitation practices.

traditionally, providing safe, effective sanitation services to the poor has focused on the construction of latrines through government-sponsored programs, with little input from the community and scant regard for what users really want and need. so once latrines are installed, they are often not used or maintained

What is the water Insecurity Index and how is it measured?

water insecurity is the inability to reliably access and benefit from safe and adequate water for well-being and a healthy life. typically measure what can be directly observed