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HEAL 230 Global Cattano Final Exam

Terms in this set (226)

Malnutrition
lack of proper nutrition (too little, too much, wrong kind)
Undernourished
lack of sufficient energy/nutrients
Underweight
low weight for age
Overweight/obese
too heavy for height or age
Wasted
weakened; feeble; worn away
Stunted
slowed or stopped abnormally in growth or development
Micronutrients
vitamins and minerals that are essential to the body in small amounts for enzyme and hormone production
Most vulnerable groups to micronutrient deficiency
1. Pregnant women
2. Lactating women
3. Children
The most common micronutrient deficiencies worldwide are
1. Vitamin A
2. Iodine
3. Iron-deficient anemia
4. Zinc
5. Folic acid
Effects of Vitamin A deficiency
blindness, low immunity, death
Effects of iodine deficiency
Goiter, spontaneous abortion, congenital abnormalities, brain damage
Effects of iron deficiency anemia
preterm delivery, low birth weight, fetal death
Effects of zinc deficiency
growth retardation, impaired immune response, damage to central nervous system
Effects of folic acid deficiency
neural tube defects
Solutions to Vitamin A deficiency
breastfeeding, supplements, fortification
Solutions to iodine deficiency
iodized salt
Solutions to iron deficiency
increased iron intake, infection control, improved nutrition
Solutions to zinc deficiency
eating foods high in zinc ie: dairy and nuts
Solutions to folic acid deficiency
eat foods high in folic acid ie: leafy greens, enriched breads and cereals
Common locations of vitamin A deficiency
Africa
SE Asia
Common locations of iodine deficiency
Africa
Asia
The #1 most common micronutrient deficiency is
Iron deficient anemia
4 primary ways people can get micronutrients
1. balanced diet
2. supplements
3. food fortification
4. biofortification
Food fortification
adding vitamins and minerals to food staples
Biofortification
plant breeding for the specific purpose of enhancing the nutrition properties of crop varieties
Specific solutions to micronutrient deficiencies
1. Ready to use therapeutic food (RUTF)
2. Nutritional education
3. School feeding programs
4. Food subsidies
ready-to-use therapeutic food (RUTF)
highly caloric food products offering carbohydrate, lipid, protein, and micronutrients in a soft-textured paste used to promote rapid weight gain in malnourished people, particularly children

used by UNICEF for severe acute malnutrition

no need to mix with potentially contaminated water
severe acute malnutrition
malnutrition caused by recent severe food restriction; characterized in children by underweight for height (wasting)
Nutritional education
-school programs
-dietary guidelines
Growth Monitoring
Use of weight-for-age and weight-for-height charts in infant and early child care to identify children who are malnourished, and thus, susceptible to disease.
Functions of School Feeding Programs
1. Promote education
2. Breaks cross-generational cycle of poverty
3. Provide structured market for local agriculture
School Feeding Programs have...
Take-home incentives so that families will receive food if their child regularly attends school
Food subsidies
-food stamps
-conditional cash transfers
conditional cash transfer (CCT)
programs that provide cash grants to the poor and in exchange require particular beneficial behavior from the poor, such as children's attendance at school and visits to health clinics
communicable disease
a disease that is spread from one host to another
acute communicable diseases
Common cold, pneumonia, mumps, measles, pertussis, typhoid fever, cholera
define acute communicable disease
-severe
-sudden onset
-short duration
Chronic communicable diseases
AIDS, Syphilis
define chronic communicable diseases
-less severe
-continuous duration
-symptoms severe if left untreated
Virulence
the severity or harmfulness of a disease
The more virulent (severe) the pathogen
the LESS chance for transmission

because person is so sick that they can't even leave their house
The less virulent (severe) the pathogen
the MORE chance for transmission

person is able to be out in public spreading it
Virulence of TB over time
The actual TB pathogen has evolved to ensure that its host lives longer so it can still be spread to others. Its in their advantage to keep their host alive longer.
Types of transmission
1). Person-to-person
2). Common vehicle
3). Zoonotic
4). Vector
Types of person-to-person transmission
1. direct
2. indirect
direct person-to-person transmission
1. vertical transmission
2. horizontal transmission
vertical transmission of disease
Transfer of a pathogen from a pregnant women to the fetus, or from a mother to her infant during child birth or breast feeding.
horizontal transmission
person to person
examples of vertical transmission
-gonorrhea
-herpes
-congenital syphilis
-HIV
-staph
examples of horizontal transmission
-syphilis (sexual)
-skin-to-skin contact
-AIDS (sharing needles)
indirect person-to-person transmission
1. fomites
2. droplets
fomites
contaminated inanimate objects
droplets
particles of liquids that are sprayed from the nose or mouth when a person sneezes, coughs, sings, talks, or laughs
common vehicle transmission
transmission by means of contaminated items such as food, water, medications, devices, and equipment

potential for widespread transmission
zoonosis transmission
vertebrate animals to humans
examples of zoonotic transmission
-CJD (mad cow)
-leprosy
-lyme disease
vector transmission
transmission of an infectious agent by a nonvertebral animal (insect, arthropod)
examples of vector transmission
-malaria
-yellow fevor
Types of pathogens
viruses, bacteria, parasites, fungi
Examples of viruses
Ebola, HIV (AIDS), Herpes Simplex I & II, Rabies, Cold, Influenza
Examples of bacterial diseases
Strep throat, pneumonia, leprosy, tuberculosis, Lyme disease
Examples of parasitic disease
Amoebic dysentery, malaria, African sleeping sickness
types of fungal diseases
1. Systemic - through inhalation 2. Subcutanous - through wound, localized 3. Cutaneous - invade keratinized and cutaneous tissue, inflammatory response 4. Superficial - infections of skin and hair, innocuous, reappear, no inflammation 5. Opportunistic infections - look for vulnerable patients 6. Mycotoxins
Emerging communicable diseases
new diseases caused by exposure to a new agent
examples of emerging communicable diseases
-lyme disease (suburbinization)
-HIV
-Ebola
Re-emerging communicable disease
existing diseases that have increased in incidence or taken on new forms
Examples of re-emerging communicable disease
-malaria
-TB
-cholera
-syphilis
Cause of re-emerging diseases
Antimicrobial resistance
antimicrobial resistance
bacteria evolve to be resistant to antibiotics
Cause of antimicrobial resistance
1. Overuse and overprescription of antibiotics
2. Patients not finishing treatment
3. Lack of hygiene and poor sanitation
4. Lack of new antibiotics being developed
Consequences of emerging and re-emerging diseases
1. Direct costs of treating disease increase when the case is drug-resistant
2. Indirect costs due to tourism and trade
tropical diseases
a group of diseases that mainly occur in tropical and subtropical environments and are most common in countries where people lack access to safe water and sanitation
examples of tropical diseases
-parasitic worms
-Leprosy
Leprosy
A chronic, curable infectious disease mainly causing skin lesions and nerve damage.
Risk factors of tropical disease
1. Poverty
2. Lack of sanitation (many are waterborne and connected to vectors or have zoonotic origin)
Solutions to tropical diseases
1. SAFE Strategy (WHO)
2. Innovative and Intensified Disease Management
3. Vector control

Not many solutions exist because many either don't have a cure OR we just don't know the biology behind them. This is due to underfunding, researchers not living in the area, and pharmacies seeing no profit.
SAFE Strategy (WHO)
Combined drug, hygiene, and environmental management. Gives people access to medication, sanitation, and helminth control
helminth
A parasitic roundworm or flatworm
The SAFE strategy has greatly reduced the global burden of what disease...
Trachoma
Innovative and Intensified Disease Management
encourages the development of better tools
Vector control
reducing contact of vectors with susceptible populations
What does SAFE stand for?
1. Surgery - treat blinding stage of disease
2. Antibiotics - clear infection
3. Facial cleanliness - reduce transmission
4. Environmental improvement - access to clean water and sanitation
The Global Fund to Fight AIDS, Malaria, and Tuberculosis
WHO agency that funds programs to address AIDS, TB, and Malaria
Function of Global Fund to Fight AIDS, TB, and Malaria
-fundraising
-working with NGOs
HIV/AIDS
Virus that destroys the immune system
HIV/AIDS transmission
1.Blood transfusion
2.Sharing injecting devices
3.Vaginal intercourse
4.Receptive anal intercourse (more risk for tearing causes exposure to blood)
cause of AIDS
human immunodeficiency virus (HIV)
AIDS/HIV Symptoms
1. primary infection (flu-like)
2. Asymptomatic stage
3. Symptomatic (breakdown of immune system)
4. Full-blown (CD4 count below 200(
HIV/AIDS treatment
1. Antiretroviral therapy (ART)
2. "3 by 5 initiative" by WHO and UNAIDS
Antiretroviral therapy (ART)
The use of several different antiviral medications to treat HIV infection; it does not cure HIV, but it can block HIV replications.
3 by 5 initiative
extended treatment to 3 million LMICs in two years
HIV/AIDS Prevention and Control
-Education
-Safer sex practices
-Condom use
-Partner restrictions, notifications
-Abstinence
Controversial prevention of HIV/AIDS
Targets sexual behavior of females:
1. Abstinence-only programs
2. Virginity-testing before marriage
3. Virgin clubs
HIV/AIDS diagnosis
blood and saliva
What country is HIV/AIDS most prevalent in?
Sub Saharan Africa
Intellectual property rights of ART drugs...
create barriers to accessing low-cost ARTs due to the exclusive right creators have over their product for a certain amount of time
1997 South Africa Medicines Act
Reduced cost and increased availability of drugs

Pharmaceutical companies fought to overturn it, causing there to now be regulations prohibiting them from fighting back
Tuberculosis (TB)
Airborne contagious disease caused by a bacterial infection
Causes of TB
1. Antimicrobial resistance
2. Malnutrition
3. HIV coinfection (weakens immunity)
TB symptoms
fever, night sweats, weight loss, hemoptysis
TB transmission
airborne
TB treatment
1. Directly observed treatment (DOTS)
2. Vaccine for children
Directly observed treatment (DOTS)
patients must be watched when taking medicine, which lasts for 6 months
What is necessary for a successful DOTS program?
1. appropriate diagnostic technology
2. regular supply of TB drugs
3. program evaluation
TB prevention
1.screening
2.quarantine
3.vaccination
TB diagnostic tests
1.Sputum smear microscopy
2.Arm injection
3.Rapid test
95% of deaths caused by _____ occur in LMICs
TB
TB challenges
-Sputum smear can give false negatives
-Sputum smear won't show different strains
-Multi-drug resistant TB
-HIV coinfection
What does multi-drug resistant TB entail?
You don't want to give someone with drug-resistant TB the first line of treatment because the strain will become even more resistant
Malaria
protozoan infection
Malaria risk factors
-malnutrition
-geography
Malaria signs and symptoms
Recurrent cycles of intense chills and fever alternating with feeling healthy
Malaria transmission
Vector: Anopheles mosquito
Malaria treatment
Early 1800s used Quinine

Today we use Artemisinin-based combination therapies (ACTs)
Artemisinin-based combination therapies (ACTs)
medications that combine two or more drugs with different mode of action, currently the most effective drugs to treat malaria
Malaria prevention
-insecticide treated bed nets
-indoor residual spraying
-vector control
-parasite control (taking ACTs before infection - received by all pregnant women)
Malaria diagnostic tests
Blood test
70% of people infected with _____ are children under the age of 5
malaria
Malaria challenges
1. Difficult to diagnose "great imitator"
2. Growing resistance to ACTs
3. Problems with insecticide treated bed nets
Nigeria case study
Discovered problems with insecticide treated bed nets:

1. low usage rates
2. ineffective
3. needed to be retreated often
4. Organizations will give them out for free which causes people to not use them the way they're supposed to
Latent TB
non-infectious, does not cause disease, occurs in 90% of infected people

25% of population
Active TB
will lay dormant in the lungs unless the immune system is compromised (can be due to HIV, tobacco, malnutrition)
Global Outbreak Alert and Response Network (WHO)
provide a rapid identification and response to outbreaks and alert the international community
proximal causes
causes that have direct and immediate relations with their effects
distal causes
increase the probability of getting a disease
What are proximal causes of women's health issues?
1. Reproductive biology (breast cancer, STIs, maternal mortality)
2. Malnutrition + pregnancy
What are distal causes of women's health issues? (increase the probability of women getting diseases)
1. Poverty
2. Less education
3. Low social status
4. Sexual division of labor
5. Early marriage
Why is poverty a distal cause of health issues among women?
Women are more likely to direct their money towards their children
What is the sexual division of labor?
Women spend less time working for pay and make up for this time by doing unpaid labor within the home
Kinship patterns
The study of the patterns of social relationships in one or more human cultures, or it can refer to the patterns of social relationships themselves
partilineal descent
A system found in societies with fixed resources so that the eldest son will receive all of the family's belongings and the daughter will receive nothing since they do not carry on the family name.
Where does patrilineal descent occur?
cultures where women have the lowest status
Patrilineal descent occurs in ___% of the world's cultures
45%
Patrilocal residence
system under which a bride lives with her husband's family after marriage
Dowry
money or property brought by a woman to her husband at marriage
Why are sons preferred to daughters in India?
-A son can continue the family name.
-The family receives the dowry
Dowry deaths are a major problem facing women in
India
Pakistan
dowry death
the bride is brutally beat or killed for her fathers failure to fulfill the marriage agreement
____________ and __________ increase risk of dowry deaths.
Patrilocality, dowry
child marriage
a formal marriage or informal union before age 18, is a reality for both boys and girls, although girls are disproportionately the most affected.
arranged marriage
the process by which senior family members exercise a great degree of control over the choice of their children's spouses
Consequences of early/child marriage
1. Maternal mortality
2. Domestic violence
3. Reduced education
Highest rates of child/early marriage by country
Niger and Chad in Africa
Highest rates of child/early marriage by income
poor homes where people can't afford to take care of their own child
maternal mortality
death of a mother during pregnancy, childbirth or within six weeks (42 days) of delivery
Maternal Mortality Rate
Number of deaths per thousand of women giving birth.
In 2015, ____ women died for every 100,000 live births.
216
Causes of maternal mortality
hemorrhage, followed by infection, eclampsia and obstructed labor
#1 global cause of maternal mortality
hemorrhage
#1 cause of maternal mortality in developing countries
hypertension
Solution to maternal mortality
Misoprostol to stop hemorrhage
Misoprostol complications
Must be administered when 0.5 L of blood has been lost
absorbent delivery mat
determines amount of blood loss during birth
Maternal morbidity
illness or injury from the time of conception until the end of the puerperium and attributed to childbirth.
obstetric fistula
medical condition in which a hole develops between either rectum & vagina or between bladder & vagina following prolonged or obstructed labor
Highest prevalence of obstetric fistulas are in _______ and _______.
Asia, Sub Saharan Africa
Consequences of obstetric fistulas
-urinary/fecal incontinence
-stigma or isolation
Solutions to obstetric fistulas
1. Safe abortion services
2. Family planning
3. Prenatal care (at least 8 visits)
4. Emergency transportation
5. Drugs and supplies
6. Skilled birth attendants
What are safe abortion services?
Sterile environments with trained professionals
Family planning
Providing information, clinical services, and contraceptives to help people choose the number and spacing of children they want to have.
Female genital cutting
traditional practices that are all related to the cutting of the female genital organs
Types of female genital cutting
-Clitoridectomy
-Excision
-Infibulation
-Any type of manipulation of genitalia
Highest prevalence of female genital cutting is in _________ and _________.
SE Asia, Sub Saharan Africa
Purpose of female genital cutting
-Feminine symbol and ethnic identity marker for different tribes
-Religious beliefs
Highest prevalence of HIV/AIDS is in _________ and _________.
Africa, SE Asia, America
Highest prevalence of Malaria is in _________.
Africa
Highest prevalence of TB is in ....
India
Health risks of female genital cutting
-hemorrhage
-infection
-ulceration
-blood poisoning
Issues with the PROCESS of female genital cutting
-performed on girls aged 4-14
-performed by traditional practitioners
-no consent
Solutions to female genital cutting
1.Consciousness raising -- talk about health issues and statistics
2.Create alternative rites of passage -- point out that there are other ways of marking womanhood
3.Work with healthcare providers
4.Legislation -- pass laws that ban the practice
skilled birth attendant
trained professional for managing pregnancies, childbirth, complications, etc
traditional birth attendant
may not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensure
Why do majority of women in LMICs still turn to traditional birth attendants?
1. Transportation issues
2. Sociocultural reasons
3. Lack of preparation
Neonatal
newborn, first 27 days
Postneonatal
28 days to 1 year
Leading causes of neonatal death
1. Low birth weight
2. Prematurity
3. Maternal complications
4. Spina bifida
5. Bacterial sepsis (blood infection)
Solutions to neonatal death
1. Prevent low birth weight
2. Low-cost, low-tech interventions
3. Skilled birth attendant
Kangaroo mother care
The term used to describe a method of human infant care which involves extended skin-to-skin contact and breastfeeding on demand.
Leading causes of postneonatal death
1. Pneumonia
2. Diarrheal disease
pneumonia
respiratory infection caused by a virus or bacteria. Symptoms include cough, fever, difficulty breathing. Risk factors include second-hand smoke, indoor air pollution, pre existing conditions, malnutrition.
diarrheal disease
second leading cause of death globally

Common in developing countries and a result of:
Inadequate sanitation
Water filtration
Food safety

Deaths due to diarrheal disease 2.6 million & two thirds in children under 5

Result of bacterial, viral & parasitic infections

Deaths can be prevented with access to simple toilets & clean water
Pneumonia prevention
1. Treatment
2. Environmental factors (indoor air pollution)
3. Vaccines
Diarrheal Disease Treatment
-oral rehydration therapy
-zinc supplementation
-antibiotics (rarely)
oral rehydration therapy (ORT)
a treatment involving the administration of a salt and sugar solution to a child who is dehydrated from diarrhea
Top 4 causes of preterm birth and low birth weight:
1. Malnutrition
2. Mother's age
3. Smoking
4. Stress
exclusive breastfeeding
Feeding with only breastmilk, no supplements of water, glucose water, artificial breastmilk, or foods for 6 months
cultural factors of exclusive breastfeeding
-When weaning should occur
-When complementary foods should be introduced
-Type of complementary food introduced
-Who can breastfeed and where
-Breastfeeding schedule
cultural practice of giving newborns sugar water
leads to diarrhea, practiced due to belief that water is necessary for life and treats many things
Barriers to exclusive breastfeeding
1. early marriage
2. less educated parents
3. male child
4. working mother
5. late initiation of breastfeeding
Unsafe Abortion
termination of an unintended pregnancy by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both.
noncommunicable disease
a disease that is not transmitted from one host to another
examples of noncommunicable diseases
cancer, cardiovascular disease, chronic respiratory disease, diabetes
risk factors for noncommunicable disease
1. Tobacco
2. High BP
3. Diet
4. Alcohol
5. Physical activity
#1 cause of preventable death
tobacco
WHO Framework Convention on Tobacco Control (FCTC)
taxes, public smoking bans, large health warning labels, ban on terms such as light, low tar, or mild, strong public education, restriction on youth market
diabetes
A condition in which the body is unable to produce enough insulin, the hormone required for the metabolism of sugar
type 1 diabetes mellitus
diabetes caused by a total lack of insulin production; usually develops in childhood, and patients require insulin replacement therapy to control the disorder
type 2 diabetes
progressive disorder in which body cells become less responsive to insulin
Diabetes damages what parts of the body?
kidneys and nerves in the hands and feet
complication of diabetes
organ failure
Kidney failure causes and treatment
caused by type II diabetes and hypertension

treated with dialysis
Liver failure causes
caused by hepatitis B & C and alcoholism
Heart failure causes
congenital heart failure
Challenges of organ shortage in LMICs
1. Sociocultural - People believe that belief that donating organs disrupts bodily integrity. After death if your bodily integrity has been disrupted, that disrupts your afterlife.

2. Legal - purchase or sale of organs is prohibited

3. Economic - cost of health care
Consequences of organ transplants/shortage
1. International organ trade
2. Transplant tourism
3. Recipients have medical complications
4. Donors experience depression and lack follow-up care
5. People must take immunosuppressants forever after transplant
Top organ EXPORTING countries
India, Pakistan, China
Top organ IMPORTING countries
Australia, Canada, Israel, USA
What is the most widely transplanted organ?
kidney due to diabetes
transplant tourism
Affluent patients visiting a country to search for "fresh" organs harvested from poor people
Solutions to international organ trade
1. treating diseases that lead to organ failure
2. implementing laws
3. upgrade facilities and standardize medical care
What are the main mental health disorders?
Depression
Schizophrenia and other psychoses
Associated with hallucinations
Bipolar affective disorder
Dementia
Challenges to treating mental disorders
1. Pay out of pocket
2. Under-diagnosis
3. Hard to estimate prevalence
4. Symptoms may vary cross-culturally
Why are there so many under diagnosed mental disorders in LMICs?
People don't have access to care to be diagnosed.
Those exhibiting behaviors associated with _____ ______ are more likely to be seen by providers.
psychotic disorders
Solutions to treating mental disorders
1. Diagnosis and intervention
2. Continuity of care
3. Wider range of services
4. Strengthened information systems
#1 cause of death globally
CVD
Risk factors of CVD
1.Hypertension
2.High blood glucose
3.overweight/obesity
CVD challenges in LMICs
-Lack of access to integrated primary health programs for early detection and treatment
-CVD places a heavy burden on the economies of LMICs
-Poorest people are affected the most due to out-of-pocket expenditure
What is the #2 cause of death globally?
Cancer
Major cause of death from cancer?
metastasis (spreading to other parts of the body)
Cancer risk factors
-Tobacco use!!!!
-Alcohol use
-HPV
-Hepatitis B and C
-Lack of physical activity
-Aging
-High BMI
-Unhealthy diet
Causes of cancer
carcinogens
Most common cancers:
Lung
Breast
Colorectal
Prostate
Skin cancer (non-melanoma)
Stomach
Country with highest rate of cancer
Australia
70% of deaths from _______ occur in LMICs
cancer
Cancer: Challenges in LMICs
-Lack of organized screening programs
-Lack of treatment facilities
-Lack of palliative care
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