In this blog post, I will be discussing some key determinants of malaria in Nigeria.
Malaria in Nigeria. as in many other countries, cannot be attributed to a single cause. Numerous determinants, including biological, socio-cultural, economic, and environmental, cause and contribute to this deadly infectious disease in Nigeria. The gender inequality in Nigeria is a social determinant of malaria. Nigerian women are more likely to be poor, uneducated, and without political power compared to Nigerian men due to gender discrimination in the country. Therefore, there is a neglect of women's health and this leads to potential problems in the infant developmental process. Thus, Nigerian women, especially pregnant mothers, are at an increased risk of having untreated malaria due to this gender discrimination. Another social determinant of malaria in Nigeria is the barriers to health care access. This may include lack of money, transportation, and conflicting cultural and religious beliefs. Education is another social determinant of malaria in Nigeria. Only 68% of all Nigerians are educated, implying that many Nigerians are not aware of the implications of malaria and the preventive measures available. Biological determinants of malaria in Nigeria include genetic susceptibility. Many Sub-Saharan Africans lack what is called a Duffy blood factor, which is an important mechanism that can limit parasite growth in the red blood cells. Without this protective mechanism, many Nigerians are not protected against severe diseases such as malaria. Also, the parasites that cause malaria are especially resistant to antibiotics, making treatment very difficult with drugs. An environmental determinant of malaria in Nigeria is warm temperature and high rainfall in the country. Mosquitos tend the thrive in sub-tropical/tropical areas, which makes Nigeria a very good mosquito breeding area. Also, human engineering projects destroys the natural terrain, and this favors increased mosquito breeding by creating new breeding sites. Poverty is an economic determinant of malaria. A striking 70% of Nigerians fall below the poverty line. Therefore, many Nigerians cannot afford the preventive measures such as bednets and insecticide sprays. Malaria is also a cause of economic burden because when a family member catches the disease and falls ill, he or she cannot go to work and make money for the family.
1.http://www.who.int/social_determinants/country_action/NIGERIA%20Dr%20ADETUNJI%20Labiran.pdf
2.http://origem.info/FIC/pdf/Breman%20et%20al%20Ears%20Hippopotamus_AJTMH%2001.pdf
3.http://www.rbm.who.int/cmc_upload/0/000/015/330/415680a_r.pdf
4.http://www.nationsencyclopedia.com/economies/Africa/Nigeria-POVERTY-AND-WEALTH.html
Sunday, November 28, 2010
Friday, November 19, 2010
The Magnitude of Malaria in Nigeria
In this post, I will be addressing the magnitude of the problem my final paper will be on.
Problem Statement (not final): Malaria in Nigeria has caused millions of deaths in the country and has had a enormous toll on the economic and social structures of the country.
Malaria causes around 250,000 deaths in children under five every year in Nigeria. An enormous proportion of the country's hospital resources are devoted to treating malaria and the medical staff work overtime all the time. Among the 151 million people in Nigeria, 110 million are clinically diagnosed with malaria. In Nigeria, malaria causes 11% of maternal deaths, and 60% of out-patient visits and 30% of hospitalizations are malaria related. Around $870 million are used every year for prevention and treatment of malaria in Nigeria and the toll on the country's economy is significant. Therefore, malaria has a great burden on society because it not only affects people physically, it affects people mentally, psychologically, and financially. As a result, the economic and social development of the country will be hindered.
Surveillance is rigorously implemented in assessing malaria in Nigeria. Records from all health facilities in the country are reported to the organizations responsible for data collection. Data is collected using standardized tools and there is a monthly reporting system for malaria in Nigeria. The organizations then analyze the data and decide what types of programs should be implemented in preventing and treating malaria and how the limited resources can be most effectively used.
There are several indicators of malaria in Nigeria. Direct indicators include the fact that Nigeria's under 5 mortality rank is number nine in the world, as described by UNICEF. Also, only 8% of Nigerian households own at least one insecticide treated bednet (ITN), 6% of Nigerian children under age 5 sleep under ITNs and 33% of Nigerian children under age 5 receive anti-malarial drugs, documented by the Department of Health Services. Indirect indicators include a high prevalence rate (3.1) of HIV in Nigerians aged 15-49, documented by the Joint United Nations Program on HIV/AIDS. Other indirect indicators include the fact that only 47% of Nigerians use improved drinking water sources and only 30% use improved sanitation facilities, as studied by a combination of organizations including UNICEF and The World Health Organization.
There are several strengths and weaknesses of the above indicators. Bednets are very effective and cost-effective in preventing malaria so the use of bednets and the prevalence of malaria are directly but not exclusively related. Malaria has an enormous toll on children and the high ranking Nigeria received in its under 5 mortality rate means that malaria is widespread in this country. The high prevalence rate of HIV resembles a link to a high prevalence rate of malaria because the two diseases are mutually cohesive. Also, improved sanitation and a cleaner water source decreases the spread of malaria, as studies have shown. The weakness of the above indicators is that most of them were all conducted as surveys of Nigerians. Surveys bring up all kinds of voluntary response bias and are not the best type of data collection.
sources:
1. http://www.unicef.org/infobycountry/nigeria_49472.html
2. http://mobileactive.org/malaria-kills-getting-63-million-bednets-nigerians-rapidsms
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1890276/
4. http://nmcpnigeria.org/?p=m-and-e
5. http://www.unicef.org/infobycountry/nigeria_statistics.html
Problem Statement (not final): Malaria in Nigeria has caused millions of deaths in the country and has had a enormous toll on the economic and social structures of the country.
Malaria causes around 250,000 deaths in children under five every year in Nigeria. An enormous proportion of the country's hospital resources are devoted to treating malaria and the medical staff work overtime all the time. Among the 151 million people in Nigeria, 110 million are clinically diagnosed with malaria. In Nigeria, malaria causes 11% of maternal deaths, and 60% of out-patient visits and 30% of hospitalizations are malaria related. Around $870 million are used every year for prevention and treatment of malaria in Nigeria and the toll on the country's economy is significant. Therefore, malaria has a great burden on society because it not only affects people physically, it affects people mentally, psychologically, and financially. As a result, the economic and social development of the country will be hindered.
Surveillance is rigorously implemented in assessing malaria in Nigeria. Records from all health facilities in the country are reported to the organizations responsible for data collection. Data is collected using standardized tools and there is a monthly reporting system for malaria in Nigeria. The organizations then analyze the data and decide what types of programs should be implemented in preventing and treating malaria and how the limited resources can be most effectively used.
There are several indicators of malaria in Nigeria. Direct indicators include the fact that Nigeria's under 5 mortality rank is number nine in the world, as described by UNICEF. Also, only 8% of Nigerian households own at least one insecticide treated bednet (ITN), 6% of Nigerian children under age 5 sleep under ITNs and 33% of Nigerian children under age 5 receive anti-malarial drugs, documented by the Department of Health Services. Indirect indicators include a high prevalence rate (3.1) of HIV in Nigerians aged 15-49, documented by the Joint United Nations Program on HIV/AIDS. Other indirect indicators include the fact that only 47% of Nigerians use improved drinking water sources and only 30% use improved sanitation facilities, as studied by a combination of organizations including UNICEF and The World Health Organization.
There are several strengths and weaknesses of the above indicators. Bednets are very effective and cost-effective in preventing malaria so the use of bednets and the prevalence of malaria are directly but not exclusively related. Malaria has an enormous toll on children and the high ranking Nigeria received in its under 5 mortality rate means that malaria is widespread in this country. The high prevalence rate of HIV resembles a link to a high prevalence rate of malaria because the two diseases are mutually cohesive. Also, improved sanitation and a cleaner water source decreases the spread of malaria, as studies have shown. The weakness of the above indicators is that most of them were all conducted as surveys of Nigerians. Surveys bring up all kinds of voluntary response bias and are not the best type of data collection.
sources:
1. http://www.unicef.org/infobycountry/nigeria_49472.html
2. http://mobileactive.org/malaria-kills-getting-63-million-bednets-nigerians-rapidsms
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1890276/
4. http://nmcpnigeria.org/?p=m-and-e
5. http://www.unicef.org/infobycountry/nigeria_statistics.html
Friday, November 12, 2010
Malaria in Sub-Saharan Africa
In this blog post, I will address what my final paper topic is on and give background information on it and why I am interested in the topic.
For my final paper, I plan on addressing malaria in Sub-Saharan Africa. Malaria is a disease that is caused by a parasite that uses mosquitos as its vector to humans. Victims of malaria experience flu-like symptoms and if left untreated, they will die. Malaria is especially prevalent in temperate areas such as Sub-Saharan Africa. According to the CDC, in 2008, there were 190-311 million cases of malaria worldwide and 700 thousand to one million deaths, most occurring in Sub-Saharan Africa (http://www.cdc.gov/MALARIA/). Malaria can also be spread from a pregnant mother to her infant child. There are many reasons why malaria is especially prevalent in Sub-Saharan Africa. Sub-Saharan Africa is home to the deadly species of mosquitos that transmit malaria and since this place is very temperate, these mosquitos thrive in this region. Also, many Sub-Saharan Africa countries lack the medical and public health infrastructure and resources to deal with malaria prevention. Furthermore, the disease has shown increasing drug resistance to past antibiotics and has mutated in even dangerous forms. The problem is complicated by the fact that money donated to malaria prevention campaigns by the World Health Organization (WHO) usually ends up in the hands of African military and political groups seeking for personal benefit due to the lack of infrastructure and the confusion when it comes to distribution of resources. Malaria is such a big problem in Sub-Saharan Africa because it causes the economic system to be unstable. When people are infected, they are unable to go to work and thus, become poor because they are receiving no wages, which is bad for both the person and the company/place he or she works for.
Malaria prevention includes bed nets, indoor insecticide sprayings, vaccines, and DDT. Bed nets are the most probable and cost efficient among these. However, it is difficult to ensure that all Africans are properly using bed nets. Indoor insecticide sprayings are very effective but they cause toxic and smelly odors. Vaccines are obviously the most effective prevention measure and in recent years, there has been a lot of research done on developing a malaria curing vaccine. However, all the vaccines that have been introduced so far have not had great success and the anti-drug resistant nature of the malaria causing parasite makes it difficult for researchers to develop such a vaccine. Also, vaccines are expensive, so it will not be available to the general Sub-Saharan Africa public. DDT is another very effective prevention measure but it has caused a lot of controversy over the use of it when dealing with malaria. DDT itself introduces many other dangerous side effects and depending on the individual, it can cause many unpleasant reactions.
I am interested in malaria because I am surprised by its pervasiveness and its effect on the economies of Sub-Saharan African countries. I am amazed by how such a disease can make the economies of 20 or so countries suffer so much. Also, the nature of the disease is very interesting to research on because of its uniqueness. Furthermore, the issue of malaria not only involves public health preventions and medicinal cures, but also involves governments of other countries seeking power in the region by getting involved, numerous global organizations trying to provide help, and military regimes within the Sub-Saharan African countries trying to seek personal empowerment. The issue covers public health, medicine, politics, warfare, and international relations, and that is what interests me the most.
For my final paper, I plan on addressing malaria in Sub-Saharan Africa. Malaria is a disease that is caused by a parasite that uses mosquitos as its vector to humans. Victims of malaria experience flu-like symptoms and if left untreated, they will die. Malaria is especially prevalent in temperate areas such as Sub-Saharan Africa. According to the CDC, in 2008, there were 190-311 million cases of malaria worldwide and 700 thousand to one million deaths, most occurring in Sub-Saharan Africa (http://www.cdc.gov/MALARIA/). Malaria can also be spread from a pregnant mother to her infant child. There are many reasons why malaria is especially prevalent in Sub-Saharan Africa. Sub-Saharan Africa is home to the deadly species of mosquitos that transmit malaria and since this place is very temperate, these mosquitos thrive in this region. Also, many Sub-Saharan Africa countries lack the medical and public health infrastructure and resources to deal with malaria prevention. Furthermore, the disease has shown increasing drug resistance to past antibiotics and has mutated in even dangerous forms. The problem is complicated by the fact that money donated to malaria prevention campaigns by the World Health Organization (WHO) usually ends up in the hands of African military and political groups seeking for personal benefit due to the lack of infrastructure and the confusion when it comes to distribution of resources. Malaria is such a big problem in Sub-Saharan Africa because it causes the economic system to be unstable. When people are infected, they are unable to go to work and thus, become poor because they are receiving no wages, which is bad for both the person and the company/place he or she works for.
Malaria prevention includes bed nets, indoor insecticide sprayings, vaccines, and DDT. Bed nets are the most probable and cost efficient among these. However, it is difficult to ensure that all Africans are properly using bed nets. Indoor insecticide sprayings are very effective but they cause toxic and smelly odors. Vaccines are obviously the most effective prevention measure and in recent years, there has been a lot of research done on developing a malaria curing vaccine. However, all the vaccines that have been introduced so far have not had great success and the anti-drug resistant nature of the malaria causing parasite makes it difficult for researchers to develop such a vaccine. Also, vaccines are expensive, so it will not be available to the general Sub-Saharan Africa public. DDT is another very effective prevention measure but it has caused a lot of controversy over the use of it when dealing with malaria. DDT itself introduces many other dangerous side effects and depending on the individual, it can cause many unpleasant reactions.
I am interested in malaria because I am surprised by its pervasiveness and its effect on the economies of Sub-Saharan African countries. I am amazed by how such a disease can make the economies of 20 or so countries suffer so much. Also, the nature of the disease is very interesting to research on because of its uniqueness. Furthermore, the issue of malaria not only involves public health preventions and medicinal cures, but also involves governments of other countries seeking power in the region by getting involved, numerous global organizations trying to provide help, and military regimes within the Sub-Saharan African countries trying to seek personal empowerment. The issue covers public health, medicine, politics, warfare, and international relations, and that is what interests me the most.
Sunday, November 7, 2010
Reflection on first half of course
In this blog post, I will be reflecting on the first half of the Intro to Public Health class and my thoughts and impressions so far.
I believe this class has been very interesting so far. The lectures are enjoyable because they are all taught by various faculty selected from the Bloomberg School of Public Health and they all are very knowledgable about their respective topics. The online course readings have been entertaining to read and although the textbook may be boring to read sometimes, it still presents some interesting things such as giving case studies and historic examples of public health problems and their respective solutions. I feel like my knowledge of public health has vastly expanded and I would like to continue to learn more about this broad area of study.
Personally, I found that the area of infectious diseases and bioterrorism were interesting to me. I feel like these two areas relate to my interest in biology and are topics that combine public health and biology. I also like history, so learning about the history of infectious diseases and their various historic examples are of particular interest to me. Bioterrorism is a interesting topic because of the psychological impact it has. Even though anthrax and other bioterrorism mechanisms have not killed many people, the psychological impact that it penetrates into society is huge. I would like to take further courses related to infectious diseases and/or bioterrorism later on in my college experience.
To me, the most surprising thing is that chronic diseases are now more pervasive than infectious diseases. I had no prior knowledge of public health so as a child, I thought that infectious diseases are the most dangerous and probably the most widespread types of diseases in the world in part due to the inherent "danger" in its name. However, I found out in this course that chronic diseases are actually the most pervasive type of disease and it is also becoming the most widespread disease in developing countries. It makes sense because as countries develop and industrialize, the risk factors for chronic diseases will increase and risk factors for infectious diseases can be prevented through advanced research on the causes of the infectious diseases.
Initially, I took this class because I wanted to know what public health does and how it relates to medicine. Throughout my childhood, I witnessed many public health disasters and I wanted to know what public health does in these types of situations and their powers and limitations. Many things have certainly changed since my first blog post. Now, I have a general understanding of all the areas of public health. I know that it covers many more areas of study than I initially thought it did and I now know that public health is intertwined with medicine, law, and politics. After taking more than two months of this class, I feel like I definitely have more respect for public health because it deals with saving the maximum number of lives as possible and the issues and problems that public health officials face are almost always as difficult if not more difficult than those that doctors face in the field of medicine. My public health interest has definitely increased as a result of taking this course because I am now aware to the numerous aspects of public health that are available for study. I definitely plan to take more upper level public health classes and pursue a major in this area of study.
I believe this class has been very interesting so far. The lectures are enjoyable because they are all taught by various faculty selected from the Bloomberg School of Public Health and they all are very knowledgable about their respective topics. The online course readings have been entertaining to read and although the textbook may be boring to read sometimes, it still presents some interesting things such as giving case studies and historic examples of public health problems and their respective solutions. I feel like my knowledge of public health has vastly expanded and I would like to continue to learn more about this broad area of study.
Personally, I found that the area of infectious diseases and bioterrorism were interesting to me. I feel like these two areas relate to my interest in biology and are topics that combine public health and biology. I also like history, so learning about the history of infectious diseases and their various historic examples are of particular interest to me. Bioterrorism is a interesting topic because of the psychological impact it has. Even though anthrax and other bioterrorism mechanisms have not killed many people, the psychological impact that it penetrates into society is huge. I would like to take further courses related to infectious diseases and/or bioterrorism later on in my college experience.
To me, the most surprising thing is that chronic diseases are now more pervasive than infectious diseases. I had no prior knowledge of public health so as a child, I thought that infectious diseases are the most dangerous and probably the most widespread types of diseases in the world in part due to the inherent "danger" in its name. However, I found out in this course that chronic diseases are actually the most pervasive type of disease and it is also becoming the most widespread disease in developing countries. It makes sense because as countries develop and industrialize, the risk factors for chronic diseases will increase and risk factors for infectious diseases can be prevented through advanced research on the causes of the infectious diseases.
Initially, I took this class because I wanted to know what public health does and how it relates to medicine. Throughout my childhood, I witnessed many public health disasters and I wanted to know what public health does in these types of situations and their powers and limitations. Many things have certainly changed since my first blog post. Now, I have a general understanding of all the areas of public health. I know that it covers many more areas of study than I initially thought it did and I now know that public health is intertwined with medicine, law, and politics. After taking more than two months of this class, I feel like I definitely have more respect for public health because it deals with saving the maximum number of lives as possible and the issues and problems that public health officials face are almost always as difficult if not more difficult than those that doctors face in the field of medicine. My public health interest has definitely increased as a result of taking this course because I am now aware to the numerous aspects of public health that are available for study. I definitely plan to take more upper level public health classes and pursue a major in this area of study.
Friday, October 29, 2010
Public Health and Law
In this blog post, I will be summarizing a court case regarding public health and its complications and addressing some public health legal issues.
The specific court case in the article regarded whether or not a woman called Miss Mary Kink, who had gotten anesthetic leprosy, should be sent to the city pesthouse. Miss Kink got affected by this contagious disease while working on missionary efforts in Brazil but she had developed anesthetic kind of leprosy, which is not dangerous to the community. Furthermore, she is an elderly woman who has lived and been part of the community of Aiken for a long time and has not spread this disease to anyone else. The city board of health stated that Miss Kink be placed in the city pesthouse or she move out of the city. Miss Kink and her doctor complained and stated their reasons for complaint to the city court judge, Judge Aldrich. Miss Kink is a woman of culture and comfort, so moving her to the city pesthouse would make living very difficult for her. Also, the city pesthouse was usually a place to keep African Americans who had developed smallpox. Furthermore, the city pesthouse was located very close to a city waste dumping site where waste was incinerated and the foul odors were present in the pesthouse. After reviewing and prolonging the case for months, the court ruled that Miss Kink could stay in the city and does not have to be sent to the city pesthouse or move out of the city.
The difference between quarantine and isolation is quite clear. A person is sent to isolation when he or she is known to become ill from a contagious disease. The person is isolated from the general population and can make no contact with other people to prevent people from catching the contagious disease. A person is quarantined when he or she is only known to be exposed to a contagious disease. It is unknown whether the person has actually developed the contagious disease. The person is told to remain in specific locations (such as his or her house) to prevent the person from spreading the disease to others. In most cases, state and local public health authorities decide whether or not a person should be quarantined. Their power comes from the US Constitution. According to the article, the principles of constitutional law governing health regulations provides the legislation of the rights of the individual vs. the rights of the community. In specific cases, it is up to the courts to interpret this law and decide how to balance these rights. Personally, I believe that it is more appropriate to err on the side of protecting the rights of the community because the ultimate goal is to protect as many people as possible. However, there has to be an empirical statistical analysis of each option and decide whether quarantining the individual will actually provide better prevention to those who are not yet affected by the disease.
-YP
The specific court case in the article regarded whether or not a woman called Miss Mary Kink, who had gotten anesthetic leprosy, should be sent to the city pesthouse. Miss Kink got affected by this contagious disease while working on missionary efforts in Brazil but she had developed anesthetic kind of leprosy, which is not dangerous to the community. Furthermore, she is an elderly woman who has lived and been part of the community of Aiken for a long time and has not spread this disease to anyone else. The city board of health stated that Miss Kink be placed in the city pesthouse or she move out of the city. Miss Kink and her doctor complained and stated their reasons for complaint to the city court judge, Judge Aldrich. Miss Kink is a woman of culture and comfort, so moving her to the city pesthouse would make living very difficult for her. Also, the city pesthouse was usually a place to keep African Americans who had developed smallpox. Furthermore, the city pesthouse was located very close to a city waste dumping site where waste was incinerated and the foul odors were present in the pesthouse. After reviewing and prolonging the case for months, the court ruled that Miss Kink could stay in the city and does not have to be sent to the city pesthouse or move out of the city.
The difference between quarantine and isolation is quite clear. A person is sent to isolation when he or she is known to become ill from a contagious disease. The person is isolated from the general population and can make no contact with other people to prevent people from catching the contagious disease. A person is quarantined when he or she is only known to be exposed to a contagious disease. It is unknown whether the person has actually developed the contagious disease. The person is told to remain in specific locations (such as his or her house) to prevent the person from spreading the disease to others. In most cases, state and local public health authorities decide whether or not a person should be quarantined. Their power comes from the US Constitution. According to the article, the principles of constitutional law governing health regulations provides the legislation of the rights of the individual vs. the rights of the community. In specific cases, it is up to the courts to interpret this law and decide how to balance these rights. Personally, I believe that it is more appropriate to err on the side of protecting the rights of the community because the ultimate goal is to protect as many people as possible. However, there has to be an empirical statistical analysis of each option and decide whether quarantining the individual will actually provide better prevention to those who are not yet affected by the disease.
-YP
Saturday, October 23, 2010
Global Health Problems and Concerns
In this blog post, I will be summarizing the article "The Challenge of Global Health" by Laurie Garrett. Then, I will be discussing some of my thoughts and opinions on the article.
This article basically addresses the issues regarding global health and the effectiveness of the measures taken to deal with them. Nowadays, a lot of money from various organizations (WHO, NGOs, private donors) have generously been donating money to deal with the health problems in developing countries. However, due to the lack of organization and that most of the money is directed towards specific diseases rather than public health in general, it is likely that we will not reach our global health expectations. One major reason is that most of the proposed public health projects are created by wealthy nations, experimented on under a limited scope, and don't allow the developing communities being served say what they need. The author then starts giving a history of global health and the role that organizations play. The author claims that the surge in funding and donations to global health is a direct result of the HIV/AIDS pandemic. It all started towards the turn of the 21st century and has since involved numerous nations. Nations opt to take part in contributing to global health for various reasons such as moral duty, public diplomacy, and self-protection against the disease itself. Finally, the author talks about why global health problems are still a high priority despite the increasing amount of funds provided. Problems include the money not being used efficiently and effectively, lack of coordination amongst public health organizations, ignorance of the true needs of developing communities, and others.
In my opinion, the biggest reason why the surge in public health funds is still not enough to counter the issue of global health problems is that the money is not being utilized and distributed effectively. There are many reasons for this. Developing countries receiving the aid such as areas in Sub-Saharan Africa do not have the public health infrastructure (hospitals, clinics) to distribute these resources. Also, money leaks out to transportation costs, random employees, the black market, and other underground business since corruption is prevalent in these areas. Furthermore, the lack of a stable government in these countries means that there are flaws in the coordination of distributing the resources.
According to the article, the two markers for public health success in developing countries are increased maternal survival and increased overall life expectancy. Maternal survival is a key indicator of public health success because in order for a pregnant woman to survive, the environment, personnel, and equipment involved in the delivery needs to be as best as possible to ensure a high success rate. Therefore, if the country has these resources and personnel available, it means that the country has a good overall health care system. Overall life expectancy is an indicator of public health success because the average person in a country lives, the better the quality of health in that country. It means that the water is cleaner leading to less contamination, the mosquito population is low leading to low rates of malaria, and immunizations are available for prevalent infectious diseases.
The author indicates that some public health measures have caused more harm than good. For example, many of the hospitals and clinics in developing countries reuse syringes for vaccinations, inadequately sterilize surgical instruments, and lack testing for blood-bank systems, all of which could increase the spread of HIV to the patients that are vaccinated (for preventable diseases) and the general population. Another example of how public health measures may have caused more harm than good is the concern about influenza spreading across the world. Public health measures dealing with this issue include donating money and inventing methods to prevent the spread of influenza. However, the developing nations lack hospital personnel, public health experts, and research scientists to perform the preventive methods. Also, coordination requires the presence of public health infrastructure, which these countries also lack.
This article basically addresses the issues regarding global health and the effectiveness of the measures taken to deal with them. Nowadays, a lot of money from various organizations (WHO, NGOs, private donors) have generously been donating money to deal with the health problems in developing countries. However, due to the lack of organization and that most of the money is directed towards specific diseases rather than public health in general, it is likely that we will not reach our global health expectations. One major reason is that most of the proposed public health projects are created by wealthy nations, experimented on under a limited scope, and don't allow the developing communities being served say what they need. The author then starts giving a history of global health and the role that organizations play. The author claims that the surge in funding and donations to global health is a direct result of the HIV/AIDS pandemic. It all started towards the turn of the 21st century and has since involved numerous nations. Nations opt to take part in contributing to global health for various reasons such as moral duty, public diplomacy, and self-protection against the disease itself. Finally, the author talks about why global health problems are still a high priority despite the increasing amount of funds provided. Problems include the money not being used efficiently and effectively, lack of coordination amongst public health organizations, ignorance of the true needs of developing communities, and others.
In my opinion, the biggest reason why the surge in public health funds is still not enough to counter the issue of global health problems is that the money is not being utilized and distributed effectively. There are many reasons for this. Developing countries receiving the aid such as areas in Sub-Saharan Africa do not have the public health infrastructure (hospitals, clinics) to distribute these resources. Also, money leaks out to transportation costs, random employees, the black market, and other underground business since corruption is prevalent in these areas. Furthermore, the lack of a stable government in these countries means that there are flaws in the coordination of distributing the resources.
According to the article, the two markers for public health success in developing countries are increased maternal survival and increased overall life expectancy. Maternal survival is a key indicator of public health success because in order for a pregnant woman to survive, the environment, personnel, and equipment involved in the delivery needs to be as best as possible to ensure a high success rate. Therefore, if the country has these resources and personnel available, it means that the country has a good overall health care system. Overall life expectancy is an indicator of public health success because the average person in a country lives, the better the quality of health in that country. It means that the water is cleaner leading to less contamination, the mosquito population is low leading to low rates of malaria, and immunizations are available for prevalent infectious diseases.
The author indicates that some public health measures have caused more harm than good. For example, many of the hospitals and clinics in developing countries reuse syringes for vaccinations, inadequately sterilize surgical instruments, and lack testing for blood-bank systems, all of which could increase the spread of HIV to the patients that are vaccinated (for preventable diseases) and the general population. Another example of how public health measures may have caused more harm than good is the concern about influenza spreading across the world. Public health measures dealing with this issue include donating money and inventing methods to prevent the spread of influenza. However, the developing nations lack hospital personnel, public health experts, and research scientists to perform the preventive methods. Also, coordination requires the presence of public health infrastructure, which these countries also lack.
Friday, October 15, 2010
Whooping Cough is on the rise again!
In this blog post, I will be summarizing the Washington Post article, "Whooping cough makes a comeback." Then I will be talking about herd immunity and vaccinations in public health.
This article basically states that whooping cough, considered a disease of the past, is starting to rise again starting in California. If the right preventive measures are not taken, this disease could spread nationally and with an infection rate greater than smallpox, has potential to be a very serious public health issue. Whooping cough is also a cyclical disease, meaning that it has its highs and lows in terms of infection rates. It is a very dangerous disease because of its high infection rate and various characteristics that differ from most other diseases. The bacteria that causes whooping cough, Bordetella pertussis, initially only causes minor symptoms in its host and once it is detected, the disease is usually too late to treat. The article gives an example of a woman's child who died because he was detected with this disease too late.
Herd immunity is a theory that states that if a portion of the population is vaccinated against a particular disease, this will provide protection for the unvaccinated portion of the population from that disease. The logic behind this is that if a large portion of the population is vaccinated and since infectious diseases are passed from person to person, this chain of infection is going to be less significant. Normally, those who do not receive vaccinations will experience some sort of negative side effect upon vaccination. Therefore, the public health importance here is that if most of the population who can be vaccinated are vaccinated, the rest of the population who, for whatever reason, cannot take the vaccination will be protected because it is harder for the infectious disease to get to them since the majority of the population will be immune to the disease.
This article basically states that whooping cough, considered a disease of the past, is starting to rise again starting in California. If the right preventive measures are not taken, this disease could spread nationally and with an infection rate greater than smallpox, has potential to be a very serious public health issue. Whooping cough is also a cyclical disease, meaning that it has its highs and lows in terms of infection rates. It is a very dangerous disease because of its high infection rate and various characteristics that differ from most other diseases. The bacteria that causes whooping cough, Bordetella pertussis, initially only causes minor symptoms in its host and once it is detected, the disease is usually too late to treat. The article gives an example of a woman's child who died because he was detected with this disease too late.
Herd immunity is a theory that states that if a portion of the population is vaccinated against a particular disease, this will provide protection for the unvaccinated portion of the population from that disease. The logic behind this is that if a large portion of the population is vaccinated and since infectious diseases are passed from person to person, this chain of infection is going to be less significant. Normally, those who do not receive vaccinations will experience some sort of negative side effect upon vaccination. Therefore, the public health importance here is that if most of the population who can be vaccinated are vaccinated, the rest of the population who, for whatever reason, cannot take the vaccination will be protected because it is harder for the infectious disease to get to them since the majority of the population will be immune to the disease.
The revival of whooping cough especially in California is due to numerous reasons. First, it is legal and easy for parents in California to refuse vaccinations for their children. Vaccination laws differ among different states and California is lenient in terms of an individual choosing whether or not to get vaccinated. The reason they opt to not be vaccinated is that there was a rumor that vaccinations cause autism, brain damage, and other negative side effects. Parents also believe in herd immunity, thinking that if their children's peers all get vaccinated, their children will be protected against the disease as well. Also, these days, physicians give children acellular vaccines instead of whole-cell vaccines because acellular vaccines are considered safer. However, they are not as effective in curing whooping cough than whole-cell vaccines are. Also, the Pertussis bacteria (the bacteria that causes whooping cough) has evolved and mutated and is more resistant to vaccines nowadays. Therefore, the vaccines used earlier up to the mid 1990s are not as effective as the newly developed vaccines. Furthermore, this bacteria is very good at hiding and is hard to detect even with advanced biological tools used by researchers. The whooping cough vaccination, unlike other vaccinations, does not 100% prevent someone from getting the disease, so one can get infected even after being vaccinated.
Public Health policymakers should educate the general population about whooping cough and inform them of its various unique characteristics. Therefore, people will be more cautious and parents will be more willing to let their children get vaccinated. Policymakers should provide evidence that states that there are no negative side effects in getting vaccinated for this disease. Also, parents should be informed that herd immunity will only work up to a certain point (herd immunity threshold). That is, a certain level of the community needs to be vaccinated in order for herd immunity to operate. Therefore, all children who don't experience negative side effects should be vaccinated. Also, biomedical researchers should continue doing ongoing research on this disease and not just reject it as a "disease of the past." This bacteria has shown that it can mutate and evolve various mechanisms to continue to infect even those who are vaccinated. Also, researchers should be informed that this bacteria is very hard to detect even with the most advanced scientific tools so they should perform numerous trials and scrutinize their results carefully.
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