global health exam 2

waterborne

(carried in water) germ in water is ingested (ex; cholera)

water-washed

(or water scarce) lack of water for hygene (ex: trachoma, yaws)

" What are some challenges for health systems?

-Demographic and epidemiological changes (improve this by reducing tobacco use, which lowers risk of cancer and cardiovascular disease) -Stewardship (improve this by reducing corruption) -Human Resources ("brain drain") (improve this by training and rewarding worker performance) -Quality of Care (use standard guidelines) -Financing health systems (use low cost, effective interventions) -Financial protection& universal coverage (strive for universal coverage) -Access & equity of care (Focus on main diseases in primary health care and the district hospital levels.)

" What are 3 limitations of existing health systems in developing countries?

-Gaps are widening in health outcomes -Some health systems lack capacity to care to those in most need -Yet interventions and technologies to cure and extend life are available from slide- examples of existing limitations: Essential Medicines may be unavailable. 100 Million are impoverished by health expenditures 57 countries have extreme shortages of _health_workers 50% of medical equipment is unused in developing countries

Selected measures to reduce intimate partner violence:

-Prevention and education campaigns to increase awareness of intimate partner violence and change -cultural norms about violence against women -Treatment for those who engage in intimate partner violence -Programs to strengthen ties to family and jobs -Couples counseling -Shelters and crisis centers for battered women -Mandatory arrest for offenders

" Name 3-4 traditional practices the UN considers as harmful to girls and women.

1. Female genital cutting, 2. early/child marriage & motherhood, 3. forced feeding of girls, 4. son preference, 5. female infanticide

" What the 2 main cause of indoor air pollution; what are solutions?

1. Fossil and biomass fuels for cooking and heating, 2. Poor people tend to use open unvented stoves Solutions: vented stoves, kerosene and gas stoves

" What are two global agencies/organizations that focus on child health?

1. UNICEF (The United Nations Children's Fund (UNICEF), originally known as the United Nations International Children's Emergency Fund) 2. Save The Children

" What 3 measures may prevent early child undernutrition?

1.Breastfeeding 2. Appropriate complementary foods 3. Feeding foods rich in micronutrients e.g., Vitamin A

" What percentages of children are underweight, stunted, or died of causes related to poor nutrition?

16% are underweight 26% are stunted IMPORTANT: 45% of deaths of young children related to poor nutrition

-What percentage of young children die due to poor nutrition?

45%

" What benefits of breastfeeding are especially important in global health?

Achieve optimal growth, development and health, and thereafter, to meet their evolving nutritional requirements Also, exclusive breastfeeding for 6 months gives passive immunity (the short-term immunity which results from the introduction of antibodies from another person, so mother passes certain immunities to child) and reduced exposure to unclean water.

" To which environmental factors (indoor air pollution; outdoor air pollution; unsafe water, sanitation, hygiene) are each of the these most at risk: women, children, poor people, and older people most at risk?

Air pollution: (outdoor) those with certain conditions, younger and older people (indoor) poor Unsafe sanitation and water: Children, poor and less educated in south Asia and sub-Saharan Africa, rural areas of developing countries

IMPORTANT: Vitamin B-1 deficiency causes-

Beriberi is a disease caused by a vitamin B-1 deficiency, also known as thiamine deficiency. There are two types of the disease: wet beriberi and dry beriberi. Wet beriberi affects the heart and circulatory system. In extreme cases, wet beriberi can cause heart failure.

" What are causes/determinants of child malnutrition? What is a new product to treat it?

Causes: inadequate education, resources and control, political/economic factors/structures Determinants: risks for malnutrition are multi-factorial (environmental, political factors, family feeding & care practices, economic), risks are circular (malnutrition>weakened immune system>poor appetite even if food is available>more sickness>more malnutrition) Plumpy nut

" What areas of life does nutrition affect?

Child survival, growth & development Health and illness: childbirth infections, chronic diseases, life expectancies School performance & completion Work productivity, income

" Which populations are at greater risk for health problems caused by poor environments?

Children, poor and less educated in south Asia and sub-Saharan Africa

" How is environmental health defined?

Concerned with preventing disease, death, and disability by reducing exposure to adverse environmental conditions and promoting behavioral change

" Why is cooperation & partnering important in solving global health problems?

Consensus more effective than working alone, share knowledge to set global standards, global efforts for global problems, disease surveillance across nations, share costs of global threats

" Explain what the "three delays" are that lead to maternal mortality?

Delay in recognizing complications and seeking care Delay in transport of mother to hospital Delay in providing needed emergency obstetric care

Process of productive land turning into a desert

Desertification

Doctors without Borders (MSF)

Doctors Without Borders, is an international humanitarian medical non-governmental organisation (NGO) of French origin best known for its projects in conflict zones and in countries affected by endemic diseases. In 2015, over 30,000 personnel—mostly local doctors, nurses and other medical professionals, logistical experts, water and sanitation engineers and administrators—provided medical aid in over 70 countries.[1] The vast majority of staff are volunteers. Private donors provide about 90% of the organisation's funding, while corporate donations provide the rest, giving MSF an annual budget of approximately US$1.63 billion.[2] -Their mission? deal with endemic diseases -What services they provide? medical aid -How are they financed? Private donors and coporate donations -What is done for quality/efficiency? -How are they organized? -Values that guide their work? -Who their workers are? -Criticism?

intervention aimed at meeting the immediate needs of the victims of a disastrous event

Emergency relief

" What are emergency relief, desertification, hidden hunger and food insecurity?

Emergency relief - intervention aimed at meeting the immediate needs of the victims of a disastrous event, also emergency relief from undernutrition Desertification- Process of productive land turning into a desert Hidden hunger- when an individual suffers from subclinical nutrient deficiencies but does not have overt clinical signs of undernutrition Food insecurity- when people do not have adequate physical, social, or economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life

when people do not have adequate physical, social, or economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life

Food insecurity-

" What are examples of the type of contributions key foundations make to global health?

Form public-private partnership, finance global initiatives, fund biomedical research

" What are TRIPS and GATS, and what are 1 or 2 health issues associated with them?

GATS (General Agreement on Trade in Services); corporate control of national health services, exporting health workers (from wiki: While the overall goal of GATS is to remove barriers to trade, members are free to choose which sectors are to be progressively "liberalised" (i.e. marketised and privatised); which mode of supply would apply to a particular sector; and to what extent that "liberalisation" will occur over a given period of time) TRIPS (The Agreement on Trade-Related Aspects of Intellectual Property Rights): affects low-income countries ability to buy expensive drugs covered by patents (wiki: The Doha declaration is a WTO statement that clarifies the scope of TRIPS, stating for example that TRIPS can and should be interpreted in light of the goal "to promote access to medicines for all." Specifically, TRIPS requires WTO members to provide copyright rights, covering authors and other copyright holders, as well as holders of related rights, namely performers, sound recording producers and broadcasting organisations; geographical indications; industrial designs; integrated circuit layout-designs; patents; new plant varieties; trademarks; trade names and undisclosed or confidential information.) TRIPS issues: (plumpy nut patent held by Nutriset, controversy with doctors without borders)

" Give examples of MDGs that relate to improving health of children.

Goal 1 eradicate extreme hunger and poverty Goal 4 reduce child mortality Goal 5 improve maternal health Goal 6 combat HIV/AIDS malaria and other diseases

" Give examples of MDGs that relate to nutrition in global health.

Goal 1 eradicate poverty and hunger (poor nutritional status is a cause and consequence of poverty) Goal 2 achieve universal primary education (malnourished children miss school and perform worse) Goal 3 promote gender equality and empower women (women with nutritional deficiencies are not as productive. Obesity/overweight from stuff like force-feeding limits productivity of females and constrains earning potential) Goal 4 reduce child mortality (45% of child deaths worldwide are associated with malnutrition) Goal 5 improve women's health (over/undernutrition affect preganant women and their children) Goal 6 combat HIV/AIDS , malaria and other diseases (poor nutrition weakens immune system, which limits body's ability to fight off HIV/AIDS/diseases)

" What are examples of sexually transmitted infections affecting women globally?

HIV, hepatitis B

" What are six building blocks of health systems? What does each do to ensure quality?

Health services: safe, effective care given Health workforce: trained, capable staff Health information system: reliable& accurate Medical products: essential medicine available: equipment in working order Health financing: public financing may be very low in LMIC (some less than $3-10 per person in very poor countries) Leadership/governance: accountable management and spending from slide: "As health systems are highly context-specific, there is no single set of best practices... But health systems that function well have certain shared characteristics. They have procurement and distribution systems that actually deliver interventions to those in need. They are staffed with sufficient health workers having the right skills and motivation. And they operate with financing systems that are sustainable, inclusive, and fair. The costs of health care should not force impoverished households even deeper into poverty." -WHO

Which of these 6 building blocks of health systems were used by Sri Lanka in efforts to reduce maternal motality?

Health services: safe, effective care given---Sri Lanka established health facilities throughout the country Health workforce: trained, capable staff-----Sri Lanka staffed health facilities with medical officers. Promoted midwife training in giving birth, expanded the number of midwives who deal with childbirth/pregnant women. Health information system: reliable& accurate-----Sri Lanka made use of civil registration data to identify what areas of country had most significant problems with maternal mortality. Medical products: essential medicine available: equipment in working order----Sri Lanka established a working ambulance service and introduced antibiotics for malaria to help lower maternal moratlity

" What the top causes of maternal mortality?

Hemorrhage, hypertensive disorders, sepsis, indirect causes sepsis: Sepsis occurs when chemicals released in the bloodstream to fight an infection trigger inflammation throughout the body. This can cause a cascade of changes that damage multiple organ systems, leading them to fail, sometimes even resulting in death. hemorrhage: The release of blood from a broken blood vessel, either inside or outside the body. especially related to profuse bleeding.

when an individual suffers from subclinical nutrient deficiencies but does not have overt clinical signs of undernutrition

Hidden hunger

Which environmental factor has the highest priority in terms of solutions?

Hygiene: important for its own sake and to maximize effect of other investments

Which of these building blocks were shown in Aravind Eye Hospital System?

I think all of them. Service Delivery Health Workforce____ Information Medical Products, vaccines, & technologies financing ___Leadership_/governance Summary of video: Aravind started in 1976 as an 11-bed eye clinic in an old temple-city. Today it is the largest and most productive eye care facility in the world. Taking its compassionate services to the doorstep of rural India, Aravind's stunningly effective strategies vaulted barriers of distance, poverty and ignorance to create a self-sustaining system that now treats over 1.7 million patients each year, two-thirds of them, for free.

IMPORTANT: which country had the heaviest burden for iodine deficiency? What was the intervention used to reduce this deficiency?

In 1993, China launched the National Iodine Deficiency Disorders Elimination Program, with technical and financial assistance. from the donor-funded Iodine Deficiency Disorders Control Project. The public needed to be made aware of the risk of iodine deficiency, especially in regions where goiter was so common that it was regarded as normal. A nationwide public education campaign was launched, using posters on buses, newspaper editorials, and television documentaries to inform consumers and persuade them to switch to iodized salt. Provincial governors ensured that government education efforts reached even the most remote villages. The supply of iodized salt was increased by building 112 new salt iodination factories and enhancing capacity at 55 existing ones. Bulk packaging systems were installed to complement 147 new retail packaging centers, with packaging designed to help con¬sumers easily recognize iodized salt. The sale of noniodized salt was banned, and technological assistance was provided to salt producers to adopt iodination. Salt quality was monitored, both at production, where the amount of iodine added needs to be just right, and in distribution and sales, because iodine in salt dissipates easily, reducing the shelf life of iodized salt. China's nationally controlled network of production and dis¬tribution made licensing and enforcement of legislation easier. The Impact By 1999, iodized salt was reaching 94 percent of the country, compared to 80 percent in 1995. The quality of iodized salt also improved markedly. As a result, iodine deficiency was reduced dramatically, and goiter rates for children ages 8 to 10 fell from 20.4 percent in 1995 to 8.8 percent in 1999.

Why are women more biologically at risk for STIs than men?

Increased mucosal surface Less likely to show symptoms Barriers to obtaining health care

" Where is Tamil Nadu? What was the intervention, and its impact, and lessons learned?

India, feeding practices education with group growth-monitoring, sustained reductions in child malnutrition, growth-monitoring with sup. Feeding of roth-faltering children was cost effective from slide: Where is Tamil Nadu? South India What was the intervention? feeding practices education with group growth-monitoring What was the impact? sustained reductions in child malnutrition What were the lessons learned? Growth monitoring with supplementation. Feeding of growth-faltering children was cost effective

Which environmental factor is the third most important risk factor behind malnutrition an unsafe sex?

Indoor air pollution

IMPORTANT: Vitamin B-3 aka niacin deficiency causes:

Know 4 D's (symptoms of pellagra, caused by lack of vitaimin B3 aka niacin): diarrhea, dermatitis (aka eczema), dementia, and death

What is the largest international NGO (non-governmental aid groups)?

Largest NGO is BRAC (Building Resources Across Communities), founded in Bangladesh. BRAC is a development organisation dedicated to alleviating poverty by empowering the poor to bring about change in their own lives.

" What are the following: low birth weight, underweight, stunting and wasting and what types of undernutrition (acute, chronic) are associated with the latter?

Low birthweight: birth weight < 2500 grams or 5lbs, 8oz Underweight: low weight for their age Stunting: height-for-age z score -2 below reference (sensitive to CHRONIC undernutrition) Wasting: weight-for-height z score -2 below reference (sensitive to ACUTE undernutrition)

" What are key environmental factors (main focuses) that impact the global burden of disease? Which of these is the leading environment-linked cause of death in low & middle income countries?

Main focuses: air pollution, safe water & sanitation Indoor air pollution is the leading cause of death

-What can you do to improve indoor air quality in a small village in India?

Make sure people are using kerosene as cooking fuel.

What are the water-'' " classifications for these diseases? A. Cholera B. Malaria C. Schistosomiasis

Malaria is spread by mosquitoes that lay eggs in still water, so they are water-related diseases, cholera is carried in water, aka water-borne schistosomiasisis a disease in which worms live in snails for part their life cycle (aquatic intermediate host), so water-based

what is a toxin ?

NATURALLY occurring substance harmful to health

-Three prototypes of health systems are:

Nat'l Health Insurance, Nat'l Health service, and Pluralistic

" What are 3 "prototypes" of health systems and what is a country with each type?

National Health Insurance; Germany, Canada, japan, France National Health Service; UK, Cuba Plurastic; India, Nigeria, USA

" What time periods do "neonatal" and "infant" cover in global health?

Neonatal: birth to one month (28 days) Infant: birth to first year of life Under 5: birth to 4 years old perinatal: 20 weeks gestation (in womb) to 1 week old

" What are the top two causes of neonatal and post-neonatal-to under 5 deaths? In which period has the most progress been made?

Neonatal: preterm birth, asphyxia at birth (suffocation), sepsis Post-neonatal: respiratory infection, diarrhea, malaria, other Group 1 (communicable) diseases Progress has been made in reducing post-neonatal to <5 years. However, little progress has been made in reducing neonatal (<28 days) sepsis: Sepsis is a potentially life-threatening condition caused by the body's response to an infection. The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body's response to these chemicals is out of balance, triggering changes that can damage multiple organ systems

" What are key MCH (Maternal and Child Health) interventions (such as ORT aka Oral Rehydration Therapy) that can reduce child mortality?

Nutrition for pregnant women, breastfeeding, immunizations, vitamin a , prevention and treatment of malaria, growth monitoring

" What are key nutritional issues at the various life cycle stages?

Pregnancy: maternal & fetal health First 2 years: CRITICAL window for growth and brain development Adolescence; calcium, iron, & energy for growth Adults: avoid diet-related chronic diseases Older adults: money for food

" What are the 3 levels in the hierarchy of health systems and what is the focus of each?

Primary care: first point of contact Secondary care: general hospital, some specialists Tertiary care: array of specialist, specialized hospitals

Which macronutrient is key in undernutrition?

Protein

" What are the functions of a health system?

Provide health services Generate money for health services Pay for health services Govern and regulate the health system

" What are the three types of actors in health systems?

Public; (gov at any level: hospitals, county hospitals) Private: (usually for profit: insurance companies, some hospitals, cancer treatment centers) NGO: ( non-gov organizations: non-profit filling gaps)

" What are the fundamental choices that shape how a health care system is organized?

Right to healthcare, owners of health facilities, who employs health providers, what type of insurance, how is insurance paid for from slide: Is health a right for all? Who owns health facilities? Who employs health providers? Is insurance public, private, for-profit? How is insurance paid for: taxes, employer premiums, etc?

" Describe biological risks & social determinants of women's health and maternal mortality.

Risks: anemia, pregnancy related conditions, STI's, cancer, obstetric fistulas (injury during birth, causes incontinence. ) , malaria Social determinants: abortion of female fetus, early marriage, less legal rights& life control, poverty& less education opportunity, sexual abuse& rape, dowry deaths obstetric fistula: An obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labor, leaving a woman incontinent of urine or feces or both. For women with obstructed labor, labor that goes unattended, the labor can last up to six or seven days.

" What are reasons women's and maternal health are an important focus in global health?

Some health problems are unique to women, maternal mortality Is preventable, womens health affects family health, relatively low costs solutions, DALYs high

" Which region of the world does not have much access to safe drinking water and proper sanitation?

South Asia and sub-Saharan Africa

" In what regions of the world is child undernutrition the highest?

Sub-Saharan Africa & south Asia

" What two regions of the world have the highest rates of maternal deaths?

Sub-Saharan Africa and south Asia

How did Tamil Nadu address these "three delays"?

The strategy of the Tamil Nadu state government has included three components and seeks to combat the three delays. First, the policies aim to prevent and terminate unwanted pregnancies. A second objective is to provide greater access to obstetric care at the primary level, which would improve access to high-quality antenatal care, routine obstetric care, facility deliveries, and stabilization of emergencies before referral. Third, the policies seek to provide access to emergency obstetric care at the first referral level. To prevent unwanted pregnancies, the government increased accessibility and demand for family planning. In addition, the government increased the availability of safe abortion facilities in government-sponsored clinics. In conjunction with increased education, more economic development, and changing social norms, the total fertility rate in Tamil Nadu decreased to 1.7 in 2011. -The state government addressed the delay in seeking appropriate care by improving the quality and accessibility of obstetric care at the primary level. Three staff nurses, who are also trained birth attendants, each work one 8-hour shift a day to ensure that care is available 24 hours a day. The nurses conduct antenatal checkups, attend deliveries, care for sick newborns, and arrange timely referrals if further care is necessary. Over 96 percent of mothers completed at least three antenatal visits during their last pregnancies in 2005-2006. Accessible obstetric care led to greater early registration of pregnancies and follow-up visits, causing earlier detection of pregnancy complications and the arrangement of life-saving referrals. -The delay in transport to receive care has been significantly reduced through the introduction of an ambulance service. The government provides vehicles, and the service is managed by a local NGO. Poor pregnant women ride the ambulance free of charge, and wealthier patients are required to pay. Ninety-eight percent of deliveries took place in institutions in 2007-2008, compared to 67 percent in 1993-1994. -Availability and access to emergency obstetric care were improved through the creation by 2008 of 62 Comprehensive Emergency Obstetric (CEmOC) and Newborn Care Centres. With an obstetrician and pediatrician on staff at all times and an anesthetist on call, these facilities provide all essential emergency obstetric and newborn care services 24 hours a day.

" What are concerns about the role and effectiveness of NGOs in Haiti one year after the Earthquake?

There is no action being done, the is investment but no result, people say they are supportive but will only stand by. more can be done. The case study of Haiti is one that shows an example of poor collaboration between NGOs and government "A report by the international aid group Oxfam on the one-year anniversary of the earthquake stressed that Haitian authorities need to show greater strategic leadership but that the international community should do much more to support the capacity of Haitian institutions rather than sidelining them."Sylvain Groulx, head of the mission for the group Doctors without Borders, said that "it is true that a major, major challenge for the NGO community in Haiti has been coordination. We all need to ask ourselves, honestly, how have we done." I see a very weak government...unable to deliver appropriate services to the population," said Eustache. "And on the other side I see very very strong NGO's with a lot of money, sometimes sounding pretty arrogantly and trying to do whatever they want, whatever they want, without any control, because of the weakness of the state."Gabriel Thimote, the Director General of the Haitian Health Ministry, says.... "We are interested in the outcome, in the result," ..."But sometimes there is no result, there is investment but no result."Government ministers like Thimote have to walk a fine line when it comes to controlling the thousands NGO's operating in the country. That's because, in many communities, NGO's exercise more political clout than the government.Joia Mukherjee says with the money controlled by so many different non-governmental organizations, it's difficult to see how Haiti will emerge as a functioning state.

Case study: family planning in Bangladesh: what are the 4 approaches used in Bangladesh's successful program to promote family planning?

Theses goals were part of a program implemented by Bangladesh to reduce national birth rate: 1. Commitment to goal by Government & NGO 2. Home visits by "family welfare assistants" (visit women at home and offer information and contraceptive services) 3. Mass media(target husbands; soap opera heroine in story becomes a family welfare assistant, this soap opera helped FWAs gain cultural acceptance) 4. Evaluate programs by collecting data (Matlab) (Within villages in the Matlab area, researchers have tested various approaches to the delivery of health services. Matlab evaluations have shaped maternal and child health programs in Bangladesh and in many other countries.)

Tamil Nadu nutritional improvements intervention:

This project began in 1980 in the South Indian state of Tamil Nadu. It aimed at improving the nutritional status of poor women and children in the rural areas of the state through a set of well-focused interventions. Intervention: The project included a package of services that were delivered by health and nutrition workers that consisted of nutrition education, primary health care, supplementary on-site feeding for children who were not growing properly, vitamin A supplementation, periodic deworming, education of mothers for managing childhood diarrhea, and the supplementary feeding of a small number of women. Impact: The nutrition interventions of the project were largely implemented as planned, but the health efforts were not fully implemented. Nonetheless, through careful evaluation the project was shown to have significantly reduced the levels of malnutrition of the targeted children. These improvements also continued over a substantial time, suggesting that the gains of the project were sustainable. The project was also more cost-effective than other investments that had tried to achieve similar aims in India. Lessons Learned: This project was pioneering and revealed some very important lessons, including: ••Growth monitoring, coupled with short-term supplementary feeding of children who are faltering, can be a cost-effective way of improving nutritional status. ••More universal and longer term feeding of children is not necessary to achieve improvements in nutrition. ••Women can be organized to participate actively in growth monitoring efforts. ••Nutrition education can have a permanent and sustainable impact on child care and child feeding practices, even in the absence of other interventions.

Which macronutrient [sic] is key in overnutrition?

Total Energy

" What are the nutrition transition and the fetal-origins hypothesis?

Transition: change in intake from unprocessed to higher calorie processed foods: go from under-to over-nutrition Fetal-origins hypothesis: gene-environmental interactions shift pathways, increases incidence of obesity, heart disease, diabetes in offspring, preventing chronic disease begins before or during pregnancy Background on fetal-origins hypothesis: The fetus was once believed to be a "perfect parasite",[3] immune to harmful environmental toxins passed from the mother via the placenta. Stemming from this belief, pregnant women of the early to mid 20th century freely drank alcohol, ingested medications, smoked cigarettes, and were largely ignorant of any nutritional needs for a developing fetus. This easy going attitude about pregnancy was challenged, however, by findings relating substances ingested by a mother to tragic outcomes for a fetus. The birth defects crisis due to the medication thalidomide in the 1960s, where thousands of children were born with defects ranging from brain damage to truncated and missing arms and legs is an example of how a seemingly miracle medication supposed to prevent morning sickness instead had disastrous consequences

" Where are the rates of cesarean births the highest?

Turkey is the highest. next, Mexico, Italy. from slide: •WHO: recommended level: 15% •High rates in "high-income countries (eg., Australia, France, Italy, US [30%] •High rates in middle-income countries (China, Brazil [45%], especially in private hospitals) •Low rates in low-income African & Asian countries (eg. 1.6% in Mali, 1.4% in Yemen)

" Which environmental factor has the highest priority in terms of solutions?

Unsafe water, hygene, and sanitation

" What are examples of outdoor air pollutants, and where in the world is outdoor air pollution the greatest?

Use of gasoline, diesel, coal& wood fuels; chemical releases Types of outdoor pollutants: carbon monoxide, lead, nitrogen gases, ozone Ukraine is bad, Mexico, Turkey, Delhi Most polluted of all is Zabol, city in Iran

What intervention in Nepal (p. 279) reduced child mortality? __________; who delivered the intervention? _______________

Vitamin A supplementation; Nepalese Ministry of Health initiated a plan of action on vitamin A in 1992. The ministry worked closely with other government agencies and NGOs to develop a pilot program to deliver vitamin A capsules throughout Nepal. A technical assistance group was created to assist the health ministry in running the program. His Majesty, the King of Nepal, also demonstrated long-term commitment to this effort by incorporating Nepal's National Vitamin A Program into the Ten Year National Program of Action. This program aimed to reduce child morbidity and mortality by prophylactic supplementation of high-dose vitamin A capsules to children 6 to 60 months of age, twice each year

" What are important effects of deficiencies in the following on the health of mothers and children: vitamin A, vitamin D, iodine, and iron?

Vitamin A; eye infections & blindness, impaired immune responses & contributes to child mortality (IMPORTANT: Vitamin A supplementation has greatly reduced illness in children) Vitamin D; skeletal disorders (rickets) Iodine; mental impairment if a child (IMPORTANT causes mental disability in children), hypothyroidism & goiters, stillbirth, birth disorders/defects Iron; can cause anemia; places women at risk in childbirth (IMPORTANT: can contribute to maternal mortality)

" What are the key UN (United Nations) agencies that focus on health or health-related problems?

WHO, UNICEF, WFP, UNAIDS • World Health Organization--WHO: "providing leadership on global health matters" (e.g., small pox) • United Nations Children's Fund--UNICEF__: "overcome poverty, violence, disease...in a child's path" • World Food Programme—WFP: "world's largest...agency fighting hunger" • Program on HIV/AIDS—UNAIDS: Global monitor/advocate concerning HIV/AIDS

" What are the 4 types of water-related infections and give examples?

Waterborne: (carried in water) germ in water is ingested (ex; cholera) Water-washed: (or water scarce) lack of water for hygene (ex: trachoma, yaws) Water-based: aquatic intermediate host, like a snail or copepod (ex: guinea worm, schistosomiasis, drancunculiasis) Water-related insect vector: from insects that breed in water like mosquitos (ex; malaria, yellow fever, zika, dengue)

" How is weight measured in adults and how are overweight and obesity defined?

Weight in kg divided by height in meters squared Overweight: BMI> 25.0 Obese: BMI> 30.0

" What are the key focuses of the following: World Bank, WTO (World Trade Organization), USAID (US Agency for International Development)?

World bank: focuses on links between health and poverty, health systems WTO: promotes trade and treaties to open global trade USAID: supports long-term and equitable economic growth and advances US foreign policy

Is access to health care considered a determinant of health?

Yes, it's on the key determinants of health figure

" Is there an MDG on access to health care?

Yes, mostly all apply. especially: 5. Improve maternal health • Reduce maternal mortality by three quarters • Achieve universal access to reproductive health 6. Combat HIV/AIDS, malaria and other diseases • Halt and reverse the spread of HIV/AIDS • Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it • Halt and reverse the incidence of malaria and other major diseases 8. Develop a global partnership for development • Develop further an open, rule-based, predictable, non-discriminatory trading and financial system • Address special needs of the least developed countries, landlocked countries and small island developing States • Deal comprehensively with developing countries' debt • In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries • In cooperation with the private sector, make available the benefits of new technologies, especially information and communications technologies

water-based

aquatic intermediate host, like a snail or copepod (ex: guinea worm, schistosomiasis, drancunculiasis)

-Water-washed connected infections:

are caused by a lack of water and poor hygiene

Low birthweight

birth weight < 2500 grams or 5lbs, 8oz

Vitamin A deficiency leads to:

blindness

IMPORTANT risks of Vitamin A deficiency

blindness; compromises immune system which increases risk of death from diseases like malaria

What is one solution to desertification?

conservation agriculture, no-tilling: is a farming system that promotes maintenance of a permanent soil cover, minimum soil disturbance (i.e. no tillage), and diversification of plant species. It enhances biodiversity and natural biological processes above and below the ground surface, which contribute to increased water and nutrient use efficiency and to improved and sustained crop production. Minimum mechanical soil disturbance (i.e. no tillage) through direct seed and/or fertilizer placement. Permanent soil organic cover (at least 30 percent) with crop residues and/or cover crops. Species diversification through varied crop sequences and associations involving at least three different crops.

IMPORTANT: Role of calcium in adolescence

establishes BONE BANK

-Pneumonia is the #1 cause of neonatal mortality:

false; pneumonia is a top cause for POST neo-natal to under 5 deaths

what time period is considered perinatal?

first week of life

water-related insect vector

from insects that breed in water like mosquitos (ex; malaria, yellow fever, zika, dengue)

stunting

height-for-age z score -2 below reference (sensitive to CHRONIC undernutrition)

WHO leaders view proper nutrition as a fundamental __ __

human right

which country has the highest out of country expenditure?

pakistan

what is the #1 cause of neonatal mortality ?

pre-maturity & asphyxia

(choose 1) YOUNG UNDERNOURISHED CHILDREN ARE MORE LIKE TO DIE BECAUSE?? •___ effects of unclean water •___ effects of maternal care practices •___ undernutrition lowering immune function

undernutrition lowering immune function

what are the three categories of undernutrition assessed by children in WHO growth chart?

underweight, wasting, stunting

-Perinatal refers to the first:

week of life

Wasting

weight-for-height z score -2 below reference (sensitive to ACUTE undernutrition)