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Global Health Elective The World As We Know It
Topics/Objectives
Introduce Common Health Problems In Various Countries Emphasis on prevalence and incidence
of infectious disease, mechanisms and treatment
Introduce Aid Organizations Addressing Specific Issues
Before We Begin…
Shock Value vs Immediacy
Top 10 Causes of Death
Low Income Countries:
1. Lower Respiratory Infection
2. Coronary Heart Disease
3. Diarrheal Disease4. HIV/AIDS5. Stroke/CVD6. COPD7. TB8. Neonatal Infection9. Malaria10. Prematurity/Low Birth
Weight
Worldwide:1. Coronary Heart
Disease2. Stroke/CVD3. Lower Respiratory
Infection4. COPD5. Diarrheal Disease6. HIV/AIDS7. TB8. Trachea/Bronchus/
Lung Cancer9. Road Traffic Accidents10. Prematurity/Low Birth
Weight
Global Health
Issues to be discussed Tuberculosis HIV/AIDS Cholera Malaria Diarrheal Disease- eg Cryptosporidosis,
Rotavirus Parasitic infection- eg Leischmaniasis
Life Expectancy
Tuberculosis
1/3rd of the world’s population is infected with TB
Each year, over 9 million people are newly infected with TB and there are almost 2 million TB-related
deaths.
Tuberculosis
The vast majority of TB deaths are in the developing world, with more than half occurring in Asia. Affects impoverished young adults in
their most productive years.According to the CDC, over 11
thousand cases of TB were reported in 2009 in the United States. Importantly, Multi Drug Resistant-TB
(MDR-TB) prevalence is increasing and is present in all countries.
Tuberculosis
Cause: air-born bacteria Mycobacterium tuberculosis Latent (non-infectious,
no symptoms) and ActiveTB attacks the lungs,
kidney, spine and brainPatients with compromised immune
systems (e.g. HIV infected) are at greater risk for development of active TB infection
Active Tuberculosis InfectionSymptoms:
Bad cough lasting 3 weeks or longer Pain in the chest Coughing up blood/sputum Weakness/fatigue No appetite, significant weight loss Chills/fever/night sweats
Transmission: Active TB is highly contagious. Spread via coughing, sneezing,
speaking, etc
TB
Treatment: Short course of chemotherapy: Isoniazid, Rifampicin, Streptomyocin,
Ethambutol▪ Isoniazid and Rifampicin are the most effective▪ Streptomyocin are also used for certain TB
bacterial populations. ▪ Ethambutol (or thiocetazine) are for preventing
the emergence of resistant TB bacteria WHO recommends receiving these
chemotherapeutic agents 3x/week for 6 months to a year to fully treat the patient
TB
Directly Observed Treatment- Short Course (DOTs) DOTs relies on :
▪ continuous political commitment▪ access to quality TB sputum microscopic
analysis▪ standardized short course of chemotherapy ▪ uninterrupted access to quality medications▪ accurate recording and reporting of patient
treatment and outcome What does this mean? A constant
supply of drugs ($$$) and health care workers that ensure patients receive their drugs 3x/week.
Organizations
Governmental agencies High level political commitment – e.g.
Peru British Thoracic Society, TBAlert India,
etcPartners In Health
MDR-TB in Russia and PeruStop TB Partnership
WHO, BBC, AstraZeneca, American Lung Assoc, American Red Cross… 1644 partners total
Tuberculosis
The ICRC and many other organizations have been fighting the spread of MDR-TB in Central Asia, Africa, and Latin America for more than a decade, focusing on prisons.
Prison systems serve as uncontrollable breeding grounds for the spread of TB – overcrowding, poor health care, malnutrition, co-morbidity, and
inadequate ventilation all contribute.
TB: Incidence
TB: Prevalence
TB: Prevalence
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200
400
600
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TB prevalence, all forms (per 100 000 population per year)
TB and HIV
TB and HIV
HIV/AIDS
In 2009, an estimated 33.3 million people were living with HIV, of whom more than 30 million
were living in low- and middle-income countries.
HIV/AIDS
More than 33 million people worldwide are infected with HIV
In 2009, 2.8 million people died from AIDS, 1.3 million of which originate from sub-Saharan Africa
UNAIDS estimates that in 2009, 7000 people a day became newly infected with HIV Of those 7000, 1000 are children under
15 and 97% are in low to middle income countries.
HIV/AIDS
HIV is a retrovirus It incorporates itself into the host’s DNA and uses host machinery to replicate and infect.
This infection leads to progressive failure of the immune system, leading to increased cancer rates and infections.
Three Targets: TreatmentAntiretroviral Treatment (ART)
http://www.youtube.com/watch?v=rqDkYJn7w9Y
Drug treatments target various phases of the virus lifecycle Fusion Inhibitors Reverse Transcriptase Inhibitors
(nucleoside and non-nucleoside) Protease Inhibitors
Problems: non-adherence, side effects of the drugs, resistance
Three Targets: Prevention
Behavioral ModificationRX for survival clip Thailand’s
government sponsored initiative
Three Targets: Vaccination
National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Health (NIH), and Department of Health and Human Services (DHHS)
No known functional vaccine
Living With AIDS
Deaths in 2009
Estimated adult and child deaths from AIDS 2009
Western &
Central Europe
8500 [6800 – 19 000]
Middle East & North Africa
24 000 [20 000 – 27 000]
Sub-Saharan Africa
1.3 million [1.1 million – 1.5
million]
Eastern Europe
& Central Asia
76 000 [60 000 – 95 000]
South & South-East Asia
260 000 [230 000 – 300 000]
Oceania 1400
[<1000 – 2400]
North America 26 000
[22 000 – 44 000]
Central & South
America 58 000
[43 000 – 70 000]
East Asia 36 000
[25 000 – 50 000] Caribbean 12 000
[8500 – 15 000]
Total: 1.8 million [1.6 million – 2.1 million]
Organizations
UNAIDS (includes UNICEF, WHO, and World Bank) UNAIDS vision: “Zero new HIV
infections. Zero discrimination. Zero AIDS-related deaths.”
Partners In Health: HIV Equity Initiative Four Pillars of the HIV Equity Initiative
Doctors Without Borders HIV/AIDS adult and pediatric pandemics,
Campaign For Access To Essential Medications
Malaria
Every year, malaria causes nearly one million deaths. In Africa, one in every 5 childhood deaths is due to the
effects of the disease.
Malaria Risk
Malaria
Due of 1 of 4 species of Plasmodium, a parasite transmitted via mosquito bites.
Symptoms can be non-specific and therefore difficult do diagnose.
Most common symptoms include:-Fever and chills-Vomiting and diarrhea-Headache, myalgias, and
weakness Most important diagnostic tool: history of travel/residence in disease-endemic area.
Malarial Episodes
Depending on the infecting species, malarial paroxysms occur in three stages; cold, hot, and sweating stages. Cold – shaking chills that last less than
an hour Hot – high grade fever (106°F), 2-6 hours Sweating – profuse sweating as fever
subsides, 2-4 hours P. vivax cycles every 48 hours, while P.
malariae cycles every 72. P. falciparum does not show this cycling and episodes occur more frequently.
Three Targets: Prevention
Quinine and Quinine-derivatives are given prophylactically The US Army prescribes Mefloquine and
Hydrochloride as a prophylaxis for soldiers
The US Army considers Falciparum Malaria to be one of the deadliest infectious threats to soldiers worldwide.
Three Targets: Treatment
Quinine and Quinine-derivatives Chloroquinine, Artesunate (in trials) Artemisinin-based combination therapies
(Get on Medical Letter) P. falciparum is now resistant to
chloroquinine
Three Targets: Vector Control
This includes indoor residual spraying, insecticide treated bed nets, and larviciding in areas with great amounts of stagnant water.
Vector control is the primary means of prevention for the spread of malaria
Organizations
Malaria No More Malaria In California 2010
WHO Global Malaria ProgrammeRoll Back Malaria Partnership
WHO, UNICEF, UNDP, the World Bank- a total of 500 different organizations working towards a global eradication of malaria
The Red Cross: Malaria Prevention Plan
Partners In Health: Malaria Net Challenge
Etc, etc, etc …
Cholera
There are an estimated 3 to 5 million cholera cases and 100,000 – 120,000 deaths due to cholera every year.
For 2008 alone, a total of 190,130 cases were notified from 56 countries, including 5,143 deaths.
Cholera
Gram negative bacteria with singleflagellum which infectthe small intestines
Symptoms: profuse, watery diarrhea (“rice water”)vomitingsevere dehydrationelectrolyte imbalance
Cholera
Treatment
Oral Rehydration Therapy- a combination of Na+, glucose, KCl, and citrate in water to allow for rehydration and balancing of electrolytes
Research shows that antibiotic treatment has no effect on transmission rates and contributes to increasing antimicrobial resistance – therefore only given to severe patients who also require IV fluids.
Outbreaks
Outbreaks
Recent outbreaks- Zimbabwe in 2009, Haiti in 2010
Haiti article from Wall Street Journal – need to scan
Diarrheal Disease
Diarrheal diseases are the #3 killer of people in low
income countries and #5 worldwide.
Disease
Bacterial Cholera Escherichia coli
Parasitic Cryptosporidiosis
Virus Rotavirus
Threats
Dehydration By far the most important issue. Lack of
access to water or inability to keep up with course of the disease leads to extreme dehydration, shock, loss of consciousness, and death. ▪ Cholera can kill in less than a day.
Need Oral Rehydration Salts for all forms of severe diarrhea
Transmission and Prevention
Generally feces-contaminated water Children who are malnourished are most
susceptible and are, in turn, made more malnourished by diarrhea
Prevention: Rotavirus vaccination Improved sanitation and personal & food
hygiene Increased health education, focused on
spread of disease
Parasitic Disease
Parasitic Diseases
Amoebiasis Entemoeba histolytica
HookwormLeishmaniasisSchistosomiasisChagasDracunculiasis
Location is Key
Location is Key
Location is Key
Location is Key
Location is Key
Effects: from disfiguring to deadly
Top 10 Causes of Death
Low Income Countries:
1. Lower Respiratory Infection
2. Coronary Heart Disease
3. Diarrheal Disease4. HIV/AIDS5. Stroke/CVD6. COPD7. TB8. Neonatal Infection9. Malaria10. Prematurity/Low Birth
Weight
Worldwide:1. Coronary Heart
Disease2. Stroke/CVD3. Lower Respiratory
Infection4. COPD5. Diarrheal Disease6. HIV/AIDS7. TB8. Trachea/Bronchus/
Lung Cancer9. Road Traffic Accidents10. Prematurity/Low Birth
Weight
But Have Hope…
Due to developments in medications and vaccinations, NGO support, increased education, etc… things are looking up. World Bank and Stop TB Partnership
report higher rates of treatment, of drug development and decreases in price▪ “Globally, the percentage of people
successfully treated for TB has reached its highest level, at 86%.”
WHO: In Africa, a total of 11 countries showed a greater than 50% reduction in either confirmed malaria cases or malaria admissions and deaths over the past decade
But Have Hope…
AIDS/HIV: had the highest increase in treatment rates ever from 2009-2010
Declines in global child mortality – from 192 to 79 deaths per 1000 live births (1959 to 2004).
Immunization coverage – 75-80% of the world
Looking Forward
Concerns for the future: Increased antimicrobial resistance (XDR-
TB) Decreases in life expectancy in
Africa/Russia since 1990 Continued supply of medications to
those in need Increasing maternal mortality rates Continuing and sustaining current efforts
that have proved effective
The Vision
