Shared Flashcard Set

Details

Final Exam
Cumulative material
191
Sociology
Undergraduate 3
12/18/2011

Additional Sociology Flashcards

 


 

Cards

Term
TB
Definition
airborne infectious disease transmitted by inhaling TB bacteria put into the air by a person with active TB. Overcrowding and poor ventilation and poor sanitation facilitates disease spread
Term
Latent TB
Definition
no symptoms, not infectious, small risk of developing active TB and the transition is very dependent of the strength of the immune system. Malnutrition, HIV/AIDS and other co-morbidities encourage it.
Term
Active TB
Definition
Symptomatic and infectious. Each active TB patient will infect 10-15 people per year and if it is not treated there is a 2/3 mortality rate. Treatment takes 6-8 months
Term

 

Global Burden of TB

Definition

It is the leading infectious cause of adult mortality in the world, with up to 1/3 of the global population infected (half of which will not be diagnosed. 6% growth rate in new infections annually -- disease is spreading

 

  • most cases occur in the developing world as do most of the deaths
  • disease and death hits 14-54 year olds (very broad range)
  • TB kills more women than all other of the maternal deaths combined
  • costs 12 billion dollars a year
Term
4 causes for TB resurgence
Definition
  1. HIV/AIDS
  2. Multi drug resistant strains of TB
  3. Lapse of TB control programs
  4. Structural factors (especially poverty)
Term
TB and HIV/AIDS
Definition
  • HIV/AIDS leads to more vulnerability: 1/3 of people globally with HIV/AIDS are infected with TB and in Sub-Saharan Africa, up to 70% of HIV/AIDS patients have TB
  • TB accelerates the replication of HIV and leads to the replication of HIV and the onset of AIDS : it is a major cause of death for HIV/AIDS patients
  • HIV positive patients need to be tested and treated for TB
Term

TB and Poverty

 

Poverty causes and is therefore linked to TB:

 

(9)

Definition
  1. Malnutrition
  2. overcrowding
  3. poor sanitation
  4. inadequate health care
  5. low education
  6. unstable housing
  7. unstable employment
  8. social marginalization
  9. co-morbidity with other disease
Term
Prevention and Treatment
Definition

Vaccination for children

Treatment is done by taking two or three different types of antibiotics

Term

DOTS (Direct Observed Therapy Shortcourse)

 

5 steps

Definition

 

  1. governement support
  2. case detection by sputum smear when symptomatic patient enters health clinic
  3. standardized treatments lasting 6-8 months for those testing postive on the sputum smear. They must be directly observed for the first two months
  4. regular and unterupted supply of the anti-TB drugs
  5. standardizing and reporting system that allows for assement and outreach for the patient and the TB control program
Term
DOTS results in China
Definition
TB is the leading cause of adult mortality in China from infectious disease but when a DOTS program was implemented (with monetary benifits given to doctors who ensured the proper implementation of DOTS) there was a decline of almost 40% of TB prevelance in DOTS areas compared to non-DOTS areas which only experienced a 3 % decrease. In addtion, there was strong government support and the treatment was provided for free. There was an extensive support network implemented through local doctors and village networks and infrastructure was provided in the form of clinics, training staff and local and national recording of cases.
Term
Challenges of TB treatment in India and DOTS implementation there
Definition

First established a National Tuberculosis Program (NTP) in the 1960's with very poor results. Very few patients finished their treatment as there was a short supply of drugs, support, staff, diagnosis tools and patient follow up. In 1993 RNTCP was established to implemented the WHO DOTS program. The goal was to cure 85% and reach 70%.

 

They evaluated the intergration of DOTS into different clinics (with controls).

Those with RNTCP were often stuck waiting on lines and just handed drugs to take elsewhere in the clinic. The cure rate was around 70% with a drop out rate between 6-11%

Term
Difficulty of DOTS in India
Definition

More than half of the patients opted out or were excluded from the DOTS program:

the patients either found the logistics too complicated or the provider refused because they did not want those who were less able to comply to their treatment method to spoil their results.

Social marginalization and poverty were key factors in exclusion

Term

Multi-Drug Resistant TB CAUSED BY

 

(5)

Definition
  1. Erratic drug ingestion
  2. Omission of one or more of the perscribed agents
  3. Suboptimal dosage
  4. poor drug absorption
  5. Insufficient number of active agents in a regimen
Term

Treatment of Mutli-Drug resistant TB

 

 

(4)

Definition
  1. 18-24 months of treatment
  2. second line drugs which are much harsher than the first course
  3. $200,000 dollars per person
  4. efficacy of treatment is only slightly more than 50% of patients HIV NEGATIVE
Term
MDR TB IN HAITI
Definition
Paul Farmer writes that it is not the individual's fault but rather the structural violence in Haiti that causes their sickness. Structural violence is visited upon ll those whose social status denies them access to the fruits of scientific and social progress. 
Term

What predicts compliance to TB treatment? 

 

3 factors

Definition
  1. Free and convinient treatment 
  2. access to supplemental food and income 
  3. those least likely to comply are those least able to 
Term

Lecture 8B - Health and Development 

 

Definition
Term
Definitions of Orphanhood
Definition
Children under the age of 15 who have lost one or both their parents due to any cause 
Term
4 types of orphanhood
Definition
  1. Single
  2. Double 
  3. Maternal (includes double)
  4. Paternal (includes double) 
Term
Why is the definition of orphanhood important?
Definition

It determines how you give out resources and services 

 

NOTE: Human rights groups push for childhood being determined as U 18

Term
What is the conflict between different groups providing different services to the population and how do they differ in how they want to define orphanhood?
Definition
Advocacy groups want big numbers to garner more support but NGO groups providing phsyical services don't or can't necessarily provide for as many numbers. 
Term
Social Fostering in Africa
Definition
This was not paid attention to until the AIDS epidemic. 
Term
Reality of Social Fostering 
Definition
  • 75% not actually orphans
    • High fertility
    • high migration 
    • provide labor to families without children 
    • This works as long as money is flowing from children to adults
  • Caldwell's Theory of Wealth flows 
  • Farming out of kids for labor
  • Purposive vs. crisis fostering
  • Crisis fostering is part of Social Immunity 
Term
Social Immunity 
Definition
Social immunity is the social understanding that, given a crisis, you will take in someone elses children and vice versa. As a result, orphanhood during crisis is much less dire. 
Term
What happens to Social Immunity as the AIDS epidemic continues?
Definition
There is a strain on the system. Though the social immunity process absorbed the initial shock from the epidemic, people can no longer take in as many children. There are less adults to take children in since they are dying of AIDS related causes. 
Term
AIDS orphans as a percentage of the overall orphan population
Definition
In some places such as Zimbabwe and Zambia and Uganda the percentage of the orphan population representd by HIV /AIDS orphans is as high as 17 and 15 % which means that more of these orphans need to be taken in if the number of orphans is higher. 
Term
Epidemic Curves of HIV and AIDS and how this affects orphanhood
Definition

Because there is a delay between initial infection and death from AIDS there is a lag in orphanhood. As a result we can expect a huge jump in AIDS orphans after this delay is caught up. 

 

PREDICT: 25 million orphans 

 

At this time, fostering is no longer as benificial or feasible. 

 

Already there is a jump in the rise of orphanages

Term
Trend in AIDS orphans
Definition
There is an increase in AIDS orphans
Term
Paternal vs. Maternal vs Total orphanhood
Definition
Paternal orphans are plateauing but maternal orphans are rising. Mothernal orphans are the driving force
Term
Double Orphans: AIDS related causes is? 
Definition
The number of double orphans is increasing and there is a huge increase of this being attributed to AIDS. Parents are giving each other HIV.
Term
Chances of getting HIV
Definition

1/500 is you have sex once with an infected person

 

transmission occurrs within 4 months of infection. 

Term

Changes in orphanhood:

 

Used to be because of 

________ but now it is because of ______

 

Definition
Used to be from conflict but now because of AIDS
Term

Number of Orphans in sub-Saharan Africa:

 

  1. Total 
  2. Due to AIDS
  3. Expected to rise to 
  4. Double orphans
Definition
  1. There are 48.3 million orphans in Sub-Saharan Africa
    • 12% of children 
       
  2. 12 million are from AIDS 
     
  3. Expcted to rise to 25 million to due AIDS when the delay in death occurrs 
     
  4. About 8 millionare double orphans  -- a large proportion of this is due to AIDS
Term

Impacts of Orphanhood on Children

 

(5)

Definition
  1. Parental illness and death
  2. changes in caregiver -- Health: who cares for you matters
  3. changes in caregiver -- Education: impacts your edu
  4. psycho-social impact: don't get enough attention
  5. vulnerability over the lifecourse: impacts you negatively 
Term

Parental Illness and death

What is the Double Jeopardy?

 

Definition
As seen in "HIV and Mortality of Mothers and Children" the double jeopardy is that children whose mother is HIV positive have almost 3 times the risk of death AND  children whose mother dies are more than 3 times as likely to die within the next two years of life for both HIV positive and negative mothers. However, since mothers who are HIV positive run a higher risk of death, children of HIV positive mothers run the double risk of having their mother die and that she is HIV positive. 
Term

Why is paternal illness and death so bad? 

 

(3)

Definition
  1. Double jeopardy
  2. Parental illness is very harmful and many children die before their parents due to lack of care 
  3. Maternal Death increases child mortality threefold
    • lack of breastfeeding has a huge impact 
Term
Changes in Caregivers 
Definition
As the AIDS epidemic grows, more and more children are being cared for by their grand-parents because their aunts or uncles cannot take their charge. 
Term
Changes in Caregivers: Health
Definition
You are more likely to get your kids vaccinated then foster kids. HOWEVER in 1992, a study shows that foster kids are more likely to be vaccinated. This shows what the impact the HIV/AIDS epidemic has had on foster children in recent years. When the AIDS epidemic first started, it had effected much less people. Children were placed in homes that were better off and often their parents were not dead and still cared for them. In a lot of ways, foster kids were doing a lot better. 
Term
Deiniger Study
Definition

Shows the relationship between education and health in foster vs. own children.

 

Compared in 1992 and 1999

 

Foster children were pretty much equal if not better than own children in 1992 but there is a drastic shift and in 1999 for health especially foster children are now at a disadvantage when they used to have the advantage

Term
Parental Death and Education
Definition

Low enrollement and investment in educaton is not related to poverty but rather to closeness to the caregiver. The more distantly related to the caregiver, the less likely to be in school. 

 

HAMILTON'S RULE: Closeness of biological ties governs altruism. 

Term
Psycho-socio impact 
Definition

Children that were orphans demonstrated twice as much anxiety and 2 times as much depression, anger and disruptive behavior. 

 

In addition, children that were orphans were almost 6 times as likely to answer yes to the question: "Do you wish to die?"

 

Almost 6 times as likely to think that their lives would be bad. 

Term
Vulnerability over the life course 
Definition

Children who lose their parents do tend to "lose their childhoods" and engage in "risky" adult behavior.


When comparing vulnerable children, the orphans were more likely to experience teen pregnancies, STIs and contract HIV. 

Term

Policy Interventions for Children 

 

Conflicts,issues and problems

Definition
  1. 40% of countries with HIV epidemics lack policies for orphans
  2. Disagreement on whether or not to target poverty of orphans -- contentious issue. But then also, where do you cut the povert line off? 
  3. Household vs institutional care
  4. Emphasize Mother to Child tranmission or Protect Whole Families? 
    • need to protect the whole family because even if the child is not affected with HIV, their health suffers if their parent is sick 
Term
Lecture 9A: Women's Education and Child Survival 
Definition
Term
Infant Mortality Rate Formula
Definition

# of deaths under 1 year during a specified period 

------------------------------------------------------------ x 1000

# of live births occuring during the same time period

Term
Child Mortality Rate Formula (under 5)
Definition

# of deaths  U5 years old during a specified time

------------------------------------------------------------ x 1000

# of live births occuring during the same time 

Term

Number of Child deaths under 5 

 

in 1999


in 2008

 

 

Where do they occur? 

 

Definition

1999: 10.4 million

 

2008 : 8.8 million

 

 

98% occur in developing countries 

 

Solutions are cheap and could be made widely available! 

Term
Mortality by age group and development level : What do you see? 
Definition
See that in the developing world, there is a very steap and extreme number of deaths in the 0-4 years of age range, on top of the gradual increase in deaths as you move up the age grade. However, there are more deaths than in the developing world. 
Term
Distribution of Child Deaths 
Definition

Africa contains 10 % of the population but account for 1/2 the child deaths 

Asia is 40% of the population and represents another large portion of child deaths

 

.1% of child deaths from the developed countries 

 

West and Central Africa and South Asia are the areas with the highest proportion of child deaths (UNICEF)

Term
Why is there a shift in the rate of decline in child mortality?
Definition
  1. End of the Cold War
  2. SAPs -- the article blames most of it on this
  3. AIDS
  4. Plateauing  
There is a steap decline in child mortality until about 1990 after which the decline is much less steep. 
Term

MDG 4: Reduce the number of childhood deaths under 5 by 2/3 by 2015

 

What does it look like? 

Definition

Sub-Saharan Africa does not look like it will at all despite the fact that it would be very cheap to make drastic changes to the mortality rate there. It woud also be a lot easier. 

Term
Progress towards MDG 4
Definition
South Asia and Africa no progress or not on track 
Term

Major causes of infant mortality 

 

(6)

Definition
  1. Acute respiratory infection (ARI) (Pneumonia) 
  2. Diarrhea 
  3. Measles
  4. Malaria
  5. Perinatal (usually kills wihtin the first month)
  6. Other (accidents, congenital disorders etc...)
 
YET
 
Pneumonia would be easy to treat with antibiotics
 
Diarrhea is really easy to treat with clean water and salts and fluids -- misconception that you should stop giving children fluids so they die of dehydration. 
Term

Malnutrition plays a MAJOR role in 50% of these deaths

 

Make these diseases deathly when the child is malnourished 

Definition
Term

Women's Education and Mortality


What does one year of education for the mother correspond to in terms of decline in under 5's mortality

Definition
7-9% decline in U5 mortality with every year of additional maternal education 
Term
Education between men and women
Definition
EDU for men and women has increased and evened out. The number of years between men and women is about the same. In many places women are getting MORE education then men. 
Term
Impact of maternal education between 1970 and 2009 
Definition
More than half of the reduced number of deaths attributed to maternal education in a study that compared all the factors leading to the decrease. 
Term
GDP versus Maternal Education 
Definition

Can see that if GDP had remained at the 1970 levels, child mortality would only be very slghtly higher whereas if the maternal EDU levels were where they were in the 1970's, the child mortality rate would have been very much higher. 

 

With both GDP and maternal EDU at levels from the 1970, mortality would have been at its highest. 

Term
Relationship between Poverty and mother's edu and CHild mortality
Definition

See that child mortality decreases steadily along the wealth gradient. Being in the richest versus the poorest gradient cuts mortality in half

 

Yet, the difference between women that had recieved only primary edu or none at all and women who had recieved secondary or higher education had also halved the number of child mortality rates. 

 

Wealth and education are obviously correlated -- wealthy tend to have more education. 

Term
Effect of maternal education between the years of 3-5
Definition

Cuts the chance of death by half

 

** neonatal issues are beyond a mother's control but later on in life, a mother can impact her children's health**

Term

Correlates and Predictors of Infant and Child Mortality

 

(10)

Definition
  1. Low birth weight
  2. maternal age (over 40 and under 20 is more dangerous)
  3. birth interval 
  4. Birth order and plurality (twins or triplets less healthy)
  5. sex
  6. breastfeeding
  7. maternal education
  8. Ethnicity and culture 
  9. Economic and environmental conditions including health care
  10. maternal health including HIV 
Term

Need conceptual framework to understand all the factors 

 

MOSELY - CHEN  ANALYTIC FRAMEWORK 

 

Aims: 

 

(3)

Definition
  1. What predicts when a child gets sick?
  2. Combines both mortality and growth faltering/stunting
  3. Uses a gradient of malnutrition with death being the highest grade 
Term

Proximate determinants of the Mosely - Chen analytic framework

 

(5)

Definition
  1. Maternal Factors
  2. Environmental Contaminents
  3. Injury
  4. Nutrient Deficiency
  5. Personal Illness control (treatment and prevention)

 

Term

The five proximate determinants of the Mosely - Chan analytic framework are determined by socio-economic factors. These socio-economic factors are broken into 3 different parts:

 

 

Definition
  1. Individual variables (edu, productivity, norms, beliefs, traditions)
  2. household variables (income/wealth)
  3. community variables (ecological, political, econ, health system)
Term
Two most important socioeconomic determinants that effect all the proximate determinants 
Definition
  1. Mother's education
  2. Income / Wealth 
Operates through each of the proximate determinants
Term
Frost, Forste and Haas (from Mosely-Chen reading) Main Hypothesized Pathways
Definition
  1. Improved socioeconomic status (Mosely-Chen socioeconomic determinants)
  2. Health KNowledged (M-C Personal Illness control)
  3. Modern attitudes towards health care (Person lllness control)
  4. Female autonomy (M-C Personal Illness control)
  5. Reproductive behaviors (Maternal factors) 
Term

1) Improved Socio-economic status 

 

(3)

Definition
  1. Women with more education are likely to have better paying jobs 
  2. Women with more edu are more likely to have husbands with more education and better paying jobs 
High household income means better environmental conditions, and better nutrition 
 
Health = wealth
Term

2) Health Knowledge

 

(4)

Definition
  1. Improved understanding about causation of disease
  2. Improved prevention
  3. Improve timely treatment 
  4. Better understanding of healthmessages 
Term

3) Health Attitudes

 

(3)

Definition
  1. Shift towards modern medicine and away from traditional practices
  2. Less fatalistic about disease and death
  3. More likely to adopt innovative remedies
Term

4) Greater Autonomy 

 

(4)

Definition
  1. Women generally are the primary care givers -- earlier recognition of illness
  2. Have greater decision making power on health matters 
  3. they have more confidence in handling medical officials
  4. more willing to travel alone 
Term
5) Reproductive Behavior
Definition

Found that when birth interval was spaced by 2 or more years survival was greater 

 

Still found that educaton was the most influential factor changing women's perception of health and their ability to intervene. 

Term

Policy Interventions to Improve Child Survival 

 

(5)

Definition
  1. Reduction of high risk births
  2. expanded program on immunization (EPI)
  3. Oral rehydration therapy
  4. Breastfeeding 
  5. Health and nutritional statu of mothers
Term

Anthropometric Measures

 

Definition and 3 requirements

Definition

These are tools used to measure nutritional status of children. They quantify growth deficits that are presumed to be associated with inadequate food consumption or infection/disease 

 

  1. International or standard reference 
  2. Simple indices 
  3. Identification of poor status 
Term
1) INternational Reference
Definition

Need an international measure for what height should be at a given age. 

Use National Health Survey as a standard

International comparison shows little variation among different ethnic or racial groups among well nourished children

Term

2) Simple Indices

 

(2)

Definition
  1. wastng: deficit in tissue and fat mass for height (from lack of recent adequate food or infection)

    - look at : weight for height and current health status
     
  2. Stunting: slowing of the skeletal growth due to poor environment, reoccuring infection, poor nutrient intake
    • look at height for age
    • longer term growth
Term
BMI (Body Mass Index) Formula
Definition

Weight

--------------------

(height)squared

Term

3) Cut-off points for poor status

 

(3)

Definition
  1. Calculate Z-scores
  2. Kids below 2 standard deviations from norm suffer from wasting or stunting
  3. Kids below 3 standard deviations from norm suffer from severe wasting or stunting 
Term
9B: Nutrition and Development 
Definition
Term
What are the two big components for a healthy diet?
Definition
  1. Macronutrients: carbs, proteins, fats and oils
  2. Micronutrients : vitamines and minerals
Term
Causes of Malnutrition in Children
Definition

Overarching factor: Poverty/Low Socioeconomic Status 

causes:

1. Limited access to food ----> Inadequate dietary intake

2. Limited access to improved water and sanitation ----> Infectious disease AND Inadequate Dietary intake

3.Limited access to health services ----> Infectious disease

 

Culminates in: Undernutrition, death and disability

Term
Two reasons why maternal health matters
Definition
  1. Short stature leads to higher rates of obstructed labor which requires caesarean delivery
  2. Low BMI in pregnancy leads to intrauterine growth restriction and low birth weight infants 
Term
Two regions most at risk for Low Birth Weight
Definition
South Asia and Southeast Asia
Term
Preterm Birth
Definition

less than 37 weeks

 

(difficult to document)

Term
Small for gestational age (SGA) or Intra-uterine growth restricton 
Definition
less than the 10th percentile, sex specific references
Term
Low Birth weight 
Definition

less than 2500 grams

 

this number is easy to collect since it only depends on weight but it tells you less because low birth weight could be due to either small for gestational age or preterm birth

Term
Breastfeeding exclusively should happen
Definition
first 6 months 
Term
Breastfeeding with complementary and safe fods for
Definition
up to two years or beyond 
Term

Infant and yound child feeding recommendations 

 

(7)

Definition
  1. early initiation of breastfeeding (within one hour of birth)
  2. Exclusive breastfeeding birth to 6th month
  3. continued breastfeeding two 2 years or more
  4. Introduction of solid, semi-solid foods or soft foods from 6 months
  5. minimum of four food groups for dietary diversity
  6. meal frequency according to age (2-3 for 6-8 months, 3-4 from 9 months with 1-2 nutritious snacks as needed)
  7. consumption of iron rich (flesh) or iron fortified foods
Term
Adherence to breast feeding Guidelines across AFrica, Asia and Latin America/ Carribbean 
Definition
For under two months they do better but then they all three do significantly less well. 
Term

Complementary feeding is challenging 

 

2 major reasons 

Definition

1. Local foods pose a problem: 

      - low energy dense

      - low micronutrient dense

      -high phylate bings minerals 

      - little variety

      - seasonal hardship 

      - little no animal products

 

2. Feeding style

    - passive

    - not frequent enough

    - household distribution

    - poor hygiene 

Term
Traditional Food systems are benificial because 
Definition
Provide diverse source of nutrients that are rich in protein sources. They also place a cultural value on food and are available and affordable. 
Term

Health Implications of malnutrition

 

(7)

Definition
  1. Stunting
  2. Wasting 
  3. Anemia
  4. Blindness (lack of Vitamin A)
  5. Brain damage (iodine deficiency)
  6. Vulnerability to infection
  7. Death 
Term
Wasting 
Definition

27% of all U5 children in developing countries are underweight

 

Including half of the children in South Asia

Term
Iodine deficiency (causes brain damage) 
Definition
40 million newborns are not protected against iodine deficiency disorder 
Term

Child Health and Mortality: 

 

# of deaths and % of DALYs

 

(3)

Definition
  1. 2.2 million deaths and 21% of DALYs due to stunting wasting and intrauterine growth restrictions
  2. 1.4 million deaths and 10% of DALYs due to suboptimal breastfeeding 
  3. 3.5 million deaths and 35% of DALYs due to maternal and child malnutrition
Term
Overnutrition and Obesity
Definition

Is a type of malnutrition

effects about 20 million children worldwide 

associated with type 2 diabetes, hypertension, gallstones, asthma, back pain, arthritis, heart disease, stroke and some types of cancer

Term
10A: Family Structures and Child Survival 
Definition
Term
Defining families 
Definition

a family is a group of individuals affiliated by consanguinity, affinity or co-residents. 

 

Rely most on co-habitation definition

 

 

Extended vs nuclear

household vs family

matrilineal vs patrilineal 

opposite sex vs same sex 

cohabitation vs married 

intact vs blended 

monogomous vs polygamous

singly vs dual

Term

Implications of family on child well-being -- NORTH AMERICAN EVIDENCE 

 

4 facts

Definition

- children of single parents :

poorer outcomes in edu, behavior and general health

 

- fewer investments made on children in blended families vs intact families 

 

- married men and women tend to be healthier and live longer than unmarried 

 

- lower levels of wealth among unmarried account for about 1/2 of these effects but still controling for wealth the effects of family structure remain

Term

Polygamy vs monogamy and dual vs single parenthood in Sub-Saharan Africa 


Definition
Term
Polygyny is sustained by
Definition

High fertility

 

25-50% of unions in SSA

Term

Benificial Effects of Polygamy on Children

 

(4)

Definition

Wealthier households

longer breastfeeding 

longer birth intervals and postpartum abstinence 

social and economic suport from co-wives

Term

Harmful effects of Polygamy on Children 

 

(7)

Definition
  1. Poorer per-capita
  2. lower parental investment by fathers
  3. selectivity of mothers (rural, less educated women tend to be in polygamous relationships)
  4. Over crowding
  5. Rivalry among co-wives
  6. In polygamous societies, there are lower HIV rates but having concurrent partnership raises the risks of infection
  7. Problem when there are urban and rural wives and they don't get the benifits of polygamy
Term
Overall effect of Polygamy on children
Definition

Negative 

 

Children have higher risks of dying when born into a polygamous family 

Term
GRAPH: Effects of Polygyny over Child's age
Definition

First year of life there is no difference between monogomous and polygamous

 

Between 2 and 5 the risks are higher for polygynous kids because the social factors start to take effect 

Term
two ways for women to become single mothers
Definition

pre-marital birth

divorce/widowhood before child turns 15

Term
What are the effects of single motherhod on child mortality? 
Definition

dying before the age of 5 with a single mother increases between 33-66 %

 

 

YET EDUCATION: no edu increases the probability of childmortality between 0 and 84%

Term
Possibility of becoming a single mother 
Definition
betwen 30-70% of women can expect to become single moms before their 45th birthday if current trends continue 
Term
10B: Maternal Mortality
Definition
Term
Maternal death
Definition
The death of a woman when she is pregnant or within 42 days of the end of the pregnancy, irrespective of the duration and site of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes 
Term
Late Maternal Death 
Definition

 

Death of a womanfrom direct and indirect obstetric causes more than 42 days after but less than one year after the termination of a pregnancy 

Term
Pregnancy related death
Definition
Death of a women while pregnant or within 42 days of the termination of pregnancy, irrespective of the cause of death 
Term
Direct obstetric deaths 
Definition
death relating to obstetric complcations of the pregnant state (pregnancy, labor and postpartum) resulting from either of the three
Term
Indirect Obstetric deaths 
Definition

 

Deaths resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes but was aggravatd b physiologic effects of pregnancy 

Term
maternal mortality ratio
Definition

 # of deaths to women from pregnancy-related cases

----------------------------------------------------------------

# of live births 

 

expressed as a number over 100,000 live births

Term
maternal mortality rate 
Definition

# of deaths to women from pregnancy during a specific period 

-----------------------------------------------------------------

# of women of reproductive age during specific time

Term
Indirect Sisterhood Method
Definition

Ask people about their adult sisters 

 

- can use small sample size

- ask four questions

- good for high fertility settings 

- long term retrospective period 

 

ask :

how many total numer of sisters did you have who reached the age of 15?

How many are still alive?

How many dead?

How many of these sisters died during childbirth, right after childbirth or while pregnant?


Term
Direct Sisterhod method
Definition

Shorter reference period, larger sample size and more detailed questions asked. 

 

For sisters that are dead: 

 

- was she pregnant?

- did she die in childbirth ?

-did she die within 2 months of childbirth?

Term
The Global Burden of Maternal death
Definition

Occurs disproportionately in developing countries (99%)

 

90% occur in asia and africa 

 

child mortality U5 doubled if mother dies 

 

1 in 7,300 chance of death in the developed world

1 in 73 chance in developing world 

Term
Controversy in data of Morther mortality rate in Hill and Hogan studies. What do they both show? 
Definition
Hill used less data and Hogan more (and he found lower mortality numbers) but both show that there is a slow steady decline in MM but that it is not fast enough to meet the MDG 5 
Term

Why do women die? 

 

(7)

Definition

 

 

Unsafe abortions

severe bleeding 

infection

obstructed labor 

other direct causes 

indirect causes 

eclampsia

 

Term
Three delays for seeing care 
Definition
  1. deciding to seek care
  2. reaching and finding a medical facility 
  3. receiving adequate and appropriate treatment 
Term
1) delay in seeking care 
Definition

- decision making power

-status of women

-perceptions of the illness

-physical distance from the facility

-previous experience at the facility and percieved quality of care

-socio-cultural barriers

Term
2) Delay in reaching the health care facility
Definition

 - distribution of health facilities

- travel time from home to the facility

- availability and cost of transport

- conditions of roads and geographical obstacles 

Term
3) Delay in recieving care at the facility 
Definition

adequacy of referral system

lack of supplies and equipment

lack of trained health professionals

availability of trained personnel 

Term
prevention of maternal death
Definition
family planning safe abortion antenatal care traditional and skilled birth attendants improving overall population health
Term
management 
Definition
management of stage thre labor, recognition and referral of complications, availability of transport to referrals, availability of emergency obstetric care
Term

Emergency Obstetric Care (EOC)

 

Basic

Definition

- give meds

- remval of the placenta 

removal of retained tissue

- assistance with vaginal delivery

-provision of newborn care

Term

EOC 

 

Comprehensive

Definition

- all basic services 

- c-section

- safe blood transfusion

- emergency care for sick newborns

Term

EOC 

 

International guidelines

Definition
for every 500,000 people there should be 4 basic EOC centers and 1 comprehensive one 
Term
Case Study Egypt
Definition

National Mother mortality Study done because recognized high maternal mortality --- 1992

 

 

Many interventions

 

NMMS redid study found a drop of 50% of maternal deaths 

 

 

 

Term

What Egypt case study maternal death reduction attributed to

 

 

(5)

Definition

increased hospital births 

skilled attendants at birth

antenatal care coverage

contraceptive use

decrease in fertility 

Term
Where do the majority of the deaths in Egypt occur?
Definition
Pregnancy or right after within 24 hours 
Term
Egypt 2006
Definition

increased to 80% of births attended by skilled person

higher contraceptive use

higher literacy for women -- lessening of gap between men and women 

antenatal care increased

 

Term
11A : The Epidemiological Paradox
Definition
Term

If lower socio-economic status have:

 

Definition

lower edu

lower earnings 

poorer housing conditions

lower health insurance

less access to health services

discrimination

less political protection

Term

Would assume Mexican immigrants to be between US and Mexican mortality rate 

 

What is it?

Definition
LOWER -- EPIDEMIOLOGICAL PARADOX
Term

Mexican Immigrants are found to have: 

 

4

Definition

- higher birthweight babies 

- less obeisity, better adult health status 

-lower infant and child mortality 

- lower adult mortality 

Term
Study populations 
Definition

- found AFrican Americans did worst 

almost as bad as those in developing countries 

 

- foreign born hispanic population is best `

Term
Accross all populations studied, if mother is US born
Definition

higher chance of infant mortality 

 

- some stats were not significant 

Term
Obeisity and length of time in US
Definition

longer in the US, the more chances of being obesese.

 

By 15 years only a slightly less chance of being overweight in ill health 

Term
Diabetes and cardiovascular health in texas -- who is most affected?
Definition
3r generation 
Term
Two explanations of the Epidemiological Paradox
Definition

1- selection bias : paradox doesn't exist because we selectively chose healthy immigrants 

healthy people are more likely to immigrate, if you are sick you go home, there is no point to immigrate if you are sick 

2- The Acculturation Hypothesis 

Term

The Acculturation Hypothesis 

 

Recent immigrants are :

 

(5)

Definition
  1. less likely to smoke
  2. drink less alcohol
  3. lower rates of teenage pregnancy (better maternal risk profiles)
  4. Live with extended families and therefore have better social networks 
  5. eat more nutritious foods 
Term
Smoking during pregnancy : who is more likely to smoke? 
Definition
US born women 
Term

Selection Bias 

 

3

Definition

Salmon Hypothesis (you go home if you are sick) 

poorer registration or under registration of infant or adult immigrant deaths 

Healthy immigrant Theory

Term

Testing the Salmon Hypothesis 

 

What do you compare?

 

3

Definition

those that cannot return (Cuba)

Those whose deaths even if they return home will be recording in US stats (Puerto Rico)

Compare US born Latinos 

Term
Findings of Salmon Hypothesis 
Definition

Still found that immigrants have better rates of mortality

 

there is still no argument against healthy immigrant effect 

Term

The Epidemiological Paradox in Canada 

 

Objectives of Canada's Immigration Policy

 

4

 

enacted in 1978

Definition

- promotion of Canada's demographic, economic, social and cultural goals

 

- family reunion

- nondiscrimination

- refugee obligation

 

Term
The epidemiological paradox in Canada
Definition

Less severe than in the US

 

Immigrants tend to live in poverty but suffer less emotional problems and retain cultural heritage 

Term
11B: Urbanization, Environment and Health 
Definition
Term
Definition of urban
Definition

x number of people per square kilometer

number of residents

precentage of population not reliant on agriculture 

provision of public services and utlities available

 

 

There is no universal definition as it differs from country to country 

Term
UN definition of Urban
Definition
community or settlement with a population of over 20,000 
Term

Urbanization

 

3

Definition

growth in the proportion of a population living in urban areas 

 

level of urbanization is reported as the percentage of the total population living inurban areas 

 

the rate of urbanization is the rate at which it grows

Term

Trends in Urbanization: Global urbanization

 

number of people urban

 

 

mega cities def

Definition

half world population

 

mega cities = 10 million residents or more 

there are 26 mega cities globally 

 

rise in urban poor 

 

asia has the highest urbanization levels 

 

steady decrease in smaller settlements (but they are still high) and rise in urban settlements 

Term

What impacts Urbanization?

 

2

Definition

- increase in Births -- more births than deaths (HIgher in latin america) 60%

 

- internal migration (highest in Africa) 40% responsible

Term

Factors pulling people to cities from rural areas

 

4

Definition

employment

 

edu opportunities

 

higher standard of living and amenities

 

stimulation and excitement 

Term
factors pushing people out of rural areas 
Definition

 - high unemployment 

 

natural disasters

 

political upheaval

 

food insecurity 

Term
Four typical patterns of rural to urban migration 
Definition

circular migration of men -- temporarily leave village for work in urban area

 

long term migration of men

 

circular family migration

 

permanent urban settlement 

Term
Feminzation of migration 
Definition
half of international migrants are women and there is poor data on internal women migrations but anecdotal data suggests that more women and girls are migrating to urban areas
Term

Impacts of rapid urbanization 

 

4

Definition

- strain on infrastructure (drainage, clean water, sewage, waste removal, transportation, electricity)

 

- inadequate housing 

 

- food supply

 

- development of squatter settlements and urban slums 

Term

Slum -- UN def

 

plus 5 shelter deprivations 

Definition

heavily populated urban area characterized by substandard housing and squalor and lacking in tenure security

 

one or more of the sheleter deprivations: 

 

- Lack of durable housing

- insufficient living area

- lack of access to clean water

inadequate sanitation

insecure tenure 

 

Term
Population living in slums global 
Definition
percentage of urban population living in slums decreased everywhere except western asia 
Term
Slum vs. urban growth rate in the developing world
Definition
Slum growth rate is almost the same as the urban growth rate in developing countries 
Term
# of slum dwellers and the percentage of the pop of urban dwellers
Definition

1 billion slum dwellers

 

1/3 of urban population globally 

Term
Slum land
Definition

- permanent or temporary housing

 

- usually on unwanted, dangerous land (flood plains, garbage dumps, close proximity to train tracks or industrial sites)

 

- lack of accessible roads 

unregulated and illegal 

 

Term

Conditions in Urban slums 

 

6

Definition

extreme poverty

overcrowding

indoor and outdoor polution

substandard housing 

food insecurity

little or no public infrastructure 

Term

Health Consequences of Urban Slums 

 

 

Definition

1) Infectious diseases  (measles , TB, Cholera, Dengue Fever)

 

2) Environmental Diseases (Respiratory health and diarrhea) 

 

3) Infant and child health (high infant mortality, respiratory disease stunting and wasting) 

 

4) Maternal Health (higher STDs, lower age of marriage and first birth, higher MM)

 

5) Mental Health 

- poverty and high rates of violence and murder and rape

- breakdown of tradition support networks

- depression, alchohol use drug use

- increased rates of suicide

 

Term
The Urban Advantage 
Definition

Overall urba dwellers are better off because have better mortality and morbidity rates BUT this is NOT  true of the urban poor 

 

- comparable to rural and slightly worse of child indicators 

Term

Urbanization and Health Factors

 

8

Definition
  1. Double health burden (both communicable and lifestyle disease -- caught between the worst of both rural and urban environments)
  2. Pollution
  3. Lack of Sanitation
  4. poor diet
  5. increased smocking
  6. urban violence
  7. industrial and traffic incidents
  8. lack of health care
Term

Case study of Nairobi Slums 

 

Korogocho Slum

Definition

4thlargest Nairobi slum

 

30-35,000 people 

 

next to the largest dump

 

high dependency -- 1/3 pop under 15

Term
Viwandani Slum
Definition

40,000 

 

bordered by heavy industrial river that is very polluted, a train track and a busy highway

 

higher men to women 

 

lower dependency ratio

Term
Definition

korogocho is more settled but still high circular migration, don't stay more than 3 years 

 

high migration of women in and out of the slum, net migration of women 

 

interviewed women: 3/4 had migrated from somewhere else in Kenya or east Africa married with kids 

 

complained of slum conditions 

Term
Slum Upgrading 
Definition

process through which slum areas are formalized and incorporated into city by extending services and citizenship to slum dwellers. 

 

provide economic social institutional and community services available to other citizens:

 

legal land tenure physical infrastructure 

Term
13B: International Trade and Health
Definition
Term
Why international trade may be good to those living in developing areas ?
Definition

Increase GDP

Source of revenue 

source of foreign investment 

greater employment 

better access to more nutritious and diverse foods

increase tech transfer , including medical 

Term
Why might it be bad? 
Definition

exposure to new disease

increased inequality

two tiered system of health

brain drain

infringe on public health provision

Term
Indirect relationship between trade and health
Definition

economic growth

inequality

Term
direct relationship between trade and health
Definition
food supply medical knowledge and tech disease 
Term

General Agreement on Trade in Services (GATS)

 

4 modes of international trading in services

Definition

Mode 1: cross border supply: non-resident suppliers supply services across a border into the country

 

Mode 2 Consumption abroad: consumers or firms make use of a service in another country

 

Mode 3: commercial presence: a foreign company sets up subsidies or branches to provide service in another countr

 

Mode 4: Presence of natural persons: individuals travel from their home country to supply services in another country

Term
Brain drain and global migration
Definition

175 million people living abroad 

 

88% of migrants to OECD have at least secondary edu 

 

60% have tertiary edu

 

1 in 10 teriary educated ppl from developing world now live in a high income country

Term
Positive 
Definition

Improved opportunities for edu ppl and their fams

 

knowledge transfer 

 

remittances 

Term
Negative impact of brain drain 
Definition

loss of human capital 

 

loss of education investment 

 

shrinking of the middle class and potential political instability 

 

deficits in health and educational sectors 

Term
14A: Profits, Drugs and Neglected Diseases
Definition
Term
Neglected Diseases
Definition

Soil transmitted helminthiasis

schistosomiasis

lymphatic filariasis

blndind trachoma

onchoceriasis

changas disease

leishmaniasis

Term
Big three
Definition

AIDS

 

TB 

 

Malaria 

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