Term
| List the main beneficial effects of zinc treatment for diarrhea as observed in efficacy and effectivness trials? |
|
Definition
Zinc decreases the severity of diarrhea, the duration of diarrhea, and has s protective effect against future diarrhea and pneumonia for the next 3 months months.
Decreases hospitalization due to diarrhea and pneumonia.
Decreases all causes of child mortality.
Other benefits that have been obsrved with Zn: increase use of ORS, decrease use of Antibiotics. |
|
|
Term
| What is the zinc supplement dose for diarrhea? What are the reported adverse events? |
|
Definition
| Zn must be provided for 10-14 days. AR reported are vomiting. |
|
|
Term
| What is the purpose of the Global Zinc Task Force? |
|
Definition
Goal: Accelerate adoption of Zn for the management of diarrhea in LIC by helping countries to integrate Zn in their national strategies, outlining partners activities and other needs to secure 100% adoption. Support advocacy, manufacturing and field planning activities NOT CURRENTLY FUNDED BY PARTNER ORGANIZATIONS.
formed by UNICEF, SHO, JHSPH and USAID.
Policy currently exists in only 46 countries |
|
|
Term
| What are the challenges that countries face when trying to implement this policy?What is the catch-22? |
|
Definition
| Price is a big issue. Diarrhea not commonly perceived as an important problem. Countries don't have local Zn manufacturers. For a market to be stimulated, the country needs to integrate Zn to their policy, but for gov to include Zn, they need for a local manufacturer to be at hand. |
|
|
Term
| What are the challenges for developing countries in increasing Zn utilization and coverage? |
|
Definition
| Advocacy to see the magnitude of the problem. Manage to get Zn into govnt policies and achieve local production. Formative research might be needed to understand local health seeking behavior. |
|
|
Term
| With what disease is Zn deficiency associated? |
|
Definition
| LRI, diarrhea and malaria |
|
|
Term
| Where were RCT conducted to gather evidence regind zinc benefits ? |
|
Definition
| Indonseia, Bangladesh, India, Brazil and Nepal. |
|
|
Term
| What is the Zn Procurement Fund? |
|
Definition
| The Zn procurement fund was created to feel in the funding gaps in countries where scaling up is needed until they are able to incorporate Zn in to their national policy. |
|
|
Term
| What are the Zn program components? |
|
Definition
1. Provide Zn
2. Educated
3. Train |
|
|
Term
| What indicators have been proposed to estimate risk of Zn deficiency in a population? |
|
Definition
1. The prevalence of stunting.
2. The level of absorbable Zn available in the food supply chain |
|
|
Term
| What is the global burden of Tuberculosis? Where are Tb prevalence and incidence highest? |
|
Definition
| It is estimated that 1/3 of the pop is infected with TB. 2 million deaths/yr. 9.3 mill cases. 400K cases of MDR and 40K cases of XDR. Prevalence is highest in India and China. Incidence is highest in SSA. |
|
|
Term
| What have been the traditional strategies for controlling TB? |
|
Definition
1. Prevent TB: BCG and IPT
2. Dx: SS
3: Tx: TB |
|
|
Term
| What went wrong in TB control? |
|
Definition
1.HIV
2.MDR and XDR
3. DOTS is incomplete strategy.
4. Lack of an effective vaccine.
5. Need for long term treatment.
6. Lack of tool for rapid dx. |
|
|
Term
5 components of DOTS?
And additional components of DOTS-plus? |
|
Definition
1. Political commitment
2. Registration system for px.
3. Secure drug supply.
4. Microbiological dx.
5. Assure at least 2 months of observed treament.
6. Address TB/HIV
7. Procure tx for MDR.
8. Empower communities
8. Research
9. Engage care providers
10. CONTRIBUTE TO STRENGTHEN HEALTH SYSTEMS. |
|
|
Term
| What are some of the strengths and weakness of the global plan? |
|
Definition
Strengths: Epi based. Funding addressed. Key partners involved.
Weakness: Unrealistic targets. Increasing HIV/TB and MDR/TB epidemic. Lack of adequate funding. |
|
|
Term
| What are the three major accomplishments of the OCP? |
|
Definition
1. First major investment of WB in PH prgram.
2. First major public private (Merck) partnership applied to public health.
3. Innovative control strategy (e.g. community directed distribution program) |
|
|
Term
| Factors that influence the epidemiology of onchocerciasis? |
|
Definition
1. Type of vector
2. Vector feeding preference.
3. Prevalence of infection of black fly.
4. Prevalence of infection in the community.
5. Environment.
6. Parasite strains (forest vs savanna) |
|
|
Term
| Mention some performance indicators used in the OCP? |
|
Definition
1. % Children infected.
2. % of Blind children in the community.
3. % of vectors infected with L3.
4. Biting rates in areas under larvicide activity. |
|
|
Term
| What were challenges face in implementing the community based approach? |
|
Definition
1. Mapping and cening villages.
2. Convincing people to participate.
3. Training people in management of mild side effects. |
|
|
Term
| What are S and S of onchocerciasis? |
|
Definition
| Leonine Facies, Sclerosing keratitits, Necrotizing retintis, snoflake corneal opacities. |
|
|
Term
| What are some of the characteristics of the black fly that transmits O. volvulus? |
|
Definition
| It breeds in fast moving water and transmit L3 larvae. |
|
|
Term
| Name some fundamental characteristics of o.volvulus that are target of the intervention? |
|
Definition
| The lifespan of the filaria is of 13 to 14 yrs, and the reproductive life is 11-12 yrs. So treatment with ivermectin needs to be given throughout the rep lifespan. Ivermectin only kills microfilariae. |
|
|
Term
| What are the basis for OCP and APOC? |
|
Definition
Larvicide+ivermectinx12 yrs= decrease in transmission.
Ivermectin will not eliminate transmission. |
|
|
Term
| Where do most neonatal deaths take place? |
|
Definition
| 90% of neonatal deaths occur in L and MIC. The highest prevalence is observed in SEA and SSA. 66% in INDIA, BNGLDSH, PAKSITAN and NEPAL. |
|
|
Term
| When are neonatal deaths occurring? |
|
Definition
| Over 75% of deaths occur in the 1 week. 50% in the firs 24 hrs. |
|
|
Term
|
Definition
1. Asphyxia (23%)
2. Infection (36%)
3. LBW (underlying cause)
1.7 deaths occur q yr due to vaccine preventable diseases.
4. Preterm (27%) |
|
|
Term
| Service delivery modes to prevent neonatal mortality and morbidity |
|
Definition
1. Clinical care: skilled obstetric care,Ab for premature rupture of membranes, corticosteroids for premature labor,emergency care for newborn.
Out-patient: Antenatal visits, ID signs and symptoms of complications, dx bacteriruria.
Familiy/community: prepare for delivery, clean delivery, BF, tx of pneumonia, extrafeeding for LBW. |
|
|
Term
| Comment about the SEARCH project in India that reported a 70% reduction in neonatal mortality rate |
|
Definition
| Clean delivery by literate female TBA, clean cord, extra warmth for preterm baby, treatment of pneumonia, AN visits and 8 post natal visits. |
|
|
Term
|
Definition
| Reported redution in neonatla mortality of 50%. Based on HB care by TBA. Similar intervention to SEARCH in India. |
|
|
Term
| Comment on PROJANMHO in Bangladesh? |
|
Definition
| Base in Silhet. This project reported a reduction in neonatal mortality of 34%. Only 3 post natal visits. HB by CHW. EW for LBW. Management of infection. |
|
|
Term
| What are the challenges for community based newborn health in developing countries? |
|
Definition
Have access to health service with capacity to solve emergencies. Train CHW. Educate on proper care of newborn and referal signs. Home management of infections. Improve maternal health.
coordinatino with national stakeholders, adequate funding, leadership, advocacy. strength of referral systems |
|
|
Term
| Discuss the MINI project of Nepal |
|
Definition
Most births attended by friend/family. Problem: Most take place at home.
Intervention: educate for care of LBW, home management of pneumonia, promotion of institutional delivery, recognize and tx asphyxia.
innovation: neonatal care can be provided at home at low cost (clean delivery BF).
Barriers: low coverage, social cultural bleiefs, low training. |
|
|
Term
| Describe the measles vaccination strategy |
|
Definition
it is a 4 prong strategy:
1. Catch-up: stop transmission. All children 9 to 14 yrs of age.
2. Keep-up: Coverage of vaccination >90%. Use of vaccination days. Children 1-4 yrs.
3. Follow-up: Give second opportunity. Target children 1-4 yrs. Every 3-5 yrs to avoid concentration of susceptibles.
4. Mop-up: vaccination in hard to reach areas. or areas where cass have been reported. Areas with high migration. |
|
|
Term
| What are some of the opportunities and challenges of integrating Rubella to measles eliminations strategy? |
|
Definition
-Same vaccine.
-Same surveillance system.
-Same age group.
Challenge: adult vaccination. |
|
|
Term
| name 4 components of effective surveillance? |
|
Definition
| Simple, Timely, Sensitive and Acceptable |
|
|
Term
| Where were the last cases of measles identified in the americas? |
|
Definition
|
|
Term
| What constituencies make up the Roll Back Malaria Partnership? |
|
Definition
| NGO's, Governments, Academia, Civil Society, Bilateral Organizations, WHO, Foundations, GFMTA |
|
|
Term
| What is Global Malaria Action Plan? |
|
Definition
| Global plan to control and eliminate Malaria. Set goals to scale up interventions, control the epidemic and bring down the disease. It describes the epidemiology of disease and the interventions that are needed as well as the funding required to achieve the goals. Research is fundamental throughout the plan. |
|
|
Term
| What are the targets of the Global malaria Action Plan? |
|
Definition
Decrease incidence/deaths by 50% of 2000 levels by 2010 and 75% by 2015.
Give access to needed intervention to people at risk.
Eliminate malaria in 8-10 endemic countries by 2015.
Eradication is the long term goal.
Challenge: death is complicated given that in endemic areas, malaria is commonly misdiagnosed. Many infants die at home, and are not counted. |
|
|
Term
| What are know effective strategies for malaria control? |
|
Definition
1. ITBN.
2. Combination therapy
3. Indoor Residual Spraying.
4. Presumptive treatment for pregnant women. |
|
|
Term
|
Definition
| 300-500 cases/yr 1 million deaths especially. 3.3 billion people at risk in 109 countries. 80% of cases in SSA and 75% of deaths in U5 |
|
|
Term
| Describe the 3 phases of international engagement in PH? |
|
Definition
1. XIX-mid XX. Safety. Commerce. Self-interest. Cholera, YF and plague. Prevent disease for getting in countires.
2. Mid XX to 90's: WHO. Control diseases globally. Safety. Commerce. Self-Interest.
3. 90's - today. Commerce. Safety. Self-interest. Security. Humanitarian reasons. Contol disease globally. enter Private and Foundations. |
|
|
Term
| Example of successful eradication effort? |
|
Definition
| Small-pox. Erdicated in 1980 |
|
|
Term
| What makes the Global Fund a unique approach to global disease control? |
|
Definition
| It is a mechanism that is completely open about the procedures and financing. It is independent. Includes civils society. Targets 3 diseases. |
|
|
Term
| Name 3 factors that make international engagement for non-communicable diseases difficult |
|
Definition
1. There is no short term effect.
2. Difficult to transmit urgency.
3. Competing health priorities.
4. Needed long term comitmment. |
|
|
Term
| What is the difference between a maternal death and a pregnancy related death? |
|
Definition
A meternal death is death of a pregnant women that occurs during pregnancy and 42 days after delivery, regardless of the duration or site of pregnancy, and death not due to accident.
A pregnancy related death is irrespective of cause. |
|
|
Term
| what are the common types op population based data sources for measures for this outcomes? |
|
Definition
RAMOS:Reproductive Age Mortality Studies
Hospital
Census
Vital Registration |
|
|
Term
| Which developing countries have greatly reduced their maternal mortality rates in the recent years and how have the ben successful? |
|
Definition
| Bangladesh, Sri Lanka, Thailand, Indonesia and Honduras. Having data available, providing evidence based services adapted to local needs. The most important factor has been an increase in infrastructure. Midwifery training and referral hospitals. A decrease in MM of more then 50% has been observed in the past 25 yrs. |
|
|
Term
| 5 main causes of maternal mortality? |
|
Definition
1. PPM
2. Infection
3. Obstructed labor
4. Pre-eclampsia and eclampsia
5. Abortion |
|
|
Term
| How have recommendation of the safe motherhood initiative have evolved in regards to reducing maternal mortality? |
|
Definition
Shift from antenatal to intrapartum care. Failure to id high risk women.
1. In 1987 in Nariobi: focus on training of SBA. Id risk factors.
2. 1997: High risk approach does not work. Move to increase access to medical assistance. Need of health infrastructure.
3. 2007: Skilled attendant as a continum of care for mother newoborn and infant. |
|
|
Term
| How have recommendation of the safe motherhood initiative have evolved in regards to reducing maternal mortality? |
|
Definition
Shift from antenatal to intrapartum care. Failure to id high risk women.
1. In 1987 in Nariobi: focus on training of SBA. Id risk factors.
2. 1997: High risk approach does not work. Move to increase access to medical assistance. Need of health infrastructure.
3. 2007: Skilled attendant as a continum of care for mother newoborn and infant. |
|
|
Term
| What are the 4 models of service delivery and which one is recommended in the Lancet paper? |
|
Definition
1. Home delivery + non-professional
2. TBA + Home Delivery. Referral to EOC.
3. Basic EOC + TBA and referral (recommended)
4. EOC in hospital. |
|
|
Term
| What is the purpose of misoprostol and what are concerns that governments have regarding its widespread use? |
|
Definition
| Misoprostol is used to prevent hemorrhage and is part of the active management of the thirds stage of labor. It can also be used as an abortificant. |
|
|
Term
| What are some barriers for progress in decreasing maternal mortality? |
|
Definition
1. Lack of accurate data.
2. Lack of visibility
3. Many Maternal deaths go unreported.
4. Many deaths linked to abortion. Delicate issue to address. |
|
|
Term
| What are some common wrong assumptions regarding MM? |
|
Definition
1. Taking care of pregnant women will result in healthy deliveries.
2. Pre-natal screening id high risk women.
3. Community activities are less expensive than EOC.
4. Hospitals will provide adequate care. |
|
|
Term
| What is maternal mortality rate? |
|
Definition
| It is e frequently used indicator that reflects the risk of death for a women throughout its reproductive lifetime |
|
|
Term
| What is maternal mortality ratio? |
|
Definition
| It is the # of maternal death/100K live births. Indicate risk of dying/pregnancy. Has wide in country variability. DOES NOT CAPTURE DECREASE RISK DUE TO DECREASE FERTILITY. Sweden: 1/30K in Afghanistan: 1/6 |
|
|
Term
|
Definition
| To decrease MM ratio by 75% from 1990 levels. |
|
|
Term
| When are most maternal deaths taking place? |
|
Definition
|
|
Term
|
Definition
| 400/100 K live birhts. In SSA 905/100K LB. 99% of MM occurs in L-MIC. |
|
|
Term
|
Definition
1.2 mill/yr. By 2030 RTI will be the 2nd killer of men and are predicted to double by 2020.
90% death occur in L-MIC.
Pedestrians are most at risk.
1000 people die/day.
Young adults are most at risk.
8th cause of DALY's
Highest burden in SEA. |
|
|
Term
| Why is there increased fatality due to RTI in DC? |
|
Definition
1. Unsafe roads.
2. Unsafe cars.
3. Unsafe and overcrowded public transport.
4. Vulnerable pedestrians |
|
|
Term
| WHO recommendations for RTI reduction? |
|
Definition
0. Lead agency
1. Identify local institutions
Have an nat'l plan
2. Allocate human and financial resources.
3. Identify problems.
4. Enforce regulations and specidic actions (seatbelt, helmet, impaired driving, safe roads, speed.
5. Int'l cooperation.
5. |
|
|
Term
| What should be included in an intervention package to reduce RTI? |
|
Definition
1. Roadaway design
2. Helmets
3. Seatbelts.
4. Speed.
5. No imparied driving |
|
|
Term
| Why don't people acknowledge RTI as a public health problem? |
|
Definition
1. It is not seen as a PH problem.
2. Deaths occur in L-MIC countries.
3. No quick fix.
4. No good metric system. |
|
|
Term
| Describe two of the problems associated with official development assistance as a funding mechanism for global health initiatives? |
|
Definition
1. Not constant flow.
2. Won't help for salaries or recurrent costs
3. Might not be in line with a countries priorities.
4. Short term
5. Does not strengthen systems sufficiently. |
|
|
Term
| How has financing health care has changed form pre 2000 to post 2000? |
|
Definition
Pre 2000: Low cost evidence based interventions. Cost-benfit. How much do we have to address a problem. Focus on low cost interventions (family planning, child health and primary care). Off-patent drugs.
Pst-2000: 2 billion /yr in ODA. How much money will we need to solve the problem? On patent drugs. Private organizations. More investment into research Vaccines, dx, tx). 12 billion/yr in ODA. disease specific programs. |
|
|
Term
| Name some innovative financing mechanisms |
|
Definition
Advanced Market Commitment
Unitaid
Project REd
IFFIm
These mechanisms address the problem of volatile funding and unpredictability. |
|
|
Term
| What are the rationale for donors to spend on health programs? |
|
Definition
Self interest
Security
Values
Leadership
Responsability |
|
|
Term
| What is the International Finance Facility for Immunization? |
|
Definition
| It is a form of funding that through borrowing money and selling bonds, will get a total of 4 bill for the purchase of vaccines form 2005 -2015 |
|
|
Term
| What is and Advanced Market Commitment? |
|
Definition
| It is a funding mechanism in which countries commit to buy a specific product before it is developed, so a market is secured for the developer of such product. It has been tried with vaccines. |
|
|
Term
| What is the rationale for developing an integrated approach for child health, in regards to the cause of death among children? |
|
Definition
| The great majority of children die of a few treatable diseases (LRI, Diarrhea, Malaria, measles). 50% of this deaths have underlying malnutrition. Some of them die due to lack of access health service and some to bad management of the disease. IMCI groups evidence based interventions that prevent and treat this common causes of children's death. |
|
|
Term
| What are the three components of IMCI as defined by WHO? |
|
Definition
1. Community/Family practies
2. HW performance improved by use of guidelines.
3. Health systems. |
|
|
Term
| What is the rationale behind IMCI? |
|
Definition
| By improving Health systems, HW performance and communities and families, an improvement of govn't health facilities will be achieved that will result in an increase in the use of this services and will have a potential impact in preventing 70% of deaths in U5 |
|
|
Term
| What are the 4 steps of the Mutli-country evaluation? |
|
Definition
1. Service provision
2. Service utilization
3. Coverage
4. Impact |
|
|
Term
| What are some of the problems that have been observed in implementing IMCI? |
|
Definition
1. Not full intervention is implemented.
2. high cost of training HW.
3. High HW turnover.
4. It takes a long time for a HW to be fully trained, living a health post short of HR.
5. Private sector is the primary source of care in some settings.
6. Scale-up versus quality |
|
|
Term
| What are the positive outcomes and the measurable impact of IMCI? |
|
Definition
Outcomes: increase HW performance and improved quality no extra cost.
Impact: Decrease in stunting in some countries (Tanzaia and Brazil). No impact in mortality. |
|
|
Term
| What are some of the barriers for IMCI implementation? |
|
Definition
1. Staff turnover
2. Supply chain
3. Bad management.
4. Money |
|
|
