16 International Health Flashcards
Q: Explain what “Neglected Tropical Diseases” are. Current use?
A: Name given to a number of infectious and parasitic diseases that affect many millions of people and cause much disability and suffering without causing enough deaths to be considered as acute diseases like malaria and HIV/AIDS.
Because they affect the poorest of the poor they tend to be neglected and left untreated.
This name was coined in 2005, but after almost 10 years activity the word “neglected” does not fit the description any more.
Q: Provide examples of NTD under 4 subheadings. (3,3,5,2)
A: protozoan infections: -Human African Trypanosamiasis (HAT) -chagas disease -leishmaniasis Bacterial infections: -buruli ulcer -leprosy -trachoma Helmith infections: -intestinal worms (hookworm and ascaris) -trichuriasis -schistosomiasis, -lymphatic filariasis -onchocerciasis Viral: -Dengue -rabies
Q: What are the 2 strategies used to deal with NTD?
A: diagnosis and treatment (eg leprosy and sleeping sickness).
OR
4 drugs (Mectizan, Albendazole, Zithromax and Praziquantel), which between them are used widely to provide an annual mass treatment – usually given in pairs six months apart. Over time – say 8 years - this regime should eliminate the morbidity due to these diseases but not eliminate the infections.
Q: Where do the drugs used to treat NTD come from? Conditions? Problem?
A: most part donated as part of the pharmaceutical industries humanitarian donation programme
condition of the donation is that countries need to identify a source of the funds required for mapping, health education, training, distribution, monitoring and evaluation
usually amounts to less than 50 pence per person per year, because the treatment target numbers are so great (say 500 million in Africa) up to £250 million pounds per year is needed to complete the job. Not huge in terms of total health spending, but for the poorest countries it is enough to stretch resources.
Q: Define DALY.
A: The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed as a way of comparing the overall health and life expectancy of different countries.
Q: Which region has the Highest Prevalence of # Neglected tropical diseases?
A: Sub-Saharan Africa
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Q: What is Schistosomiasis (AKA Bilharzia)? Who does it affect? Life cycle? Chronic health problems? Life threatening consequences? Treatment?
A: Blood-borne fluke of Schistosoma that is chronic and debilitating
It affects the poorest of the poor // Wherever there are fresh water people are largely infected.
Life cycle:
Worms lay eggs in blood vessels-> eggs travels round the body to intestines/ bladder-> hatch to produce Larvae-> go on to reproduce
Chronic health problems: inflammation and fibrosis of the bladder wall, colon, liver, spleen, lungs
Life threatening consequences:
Bladder cancer, portal hypertension, hematemesis
Treatment= miracle drug Praziquantel- kills adult schistosomes
Q: What do female genital schistosomiasis cause? Linked to?
A: Urinary schistosomiasis in females causes genital lesions as eggs are trapped in the cervix
These lesions have been linked to increased HIV risk
Q: What do Soil-Transmitted Helminth Infections “worms” lead to? Drugs?
A: STHs lead to stunting and decreased school performance in children
2 miracle drugs- Albendazole and Mebendazole
Q: How does Onchocerciasis (AKA River Blindness) pass from individual to individual? Can cause? Treatment?
A: Uses vector blackfly
Causes blindness and severe skin disease
Treatment with Mactizan
Q: How is Lymphatic Filariasis transmitted? Treatment? (2) Elimination when?
A: by mosquitoes
Annual treatment prevent transmission Albendazole with Mectizan in Africa Albendazole with DEC in Asia and Far East Prevents new infections
After 6 years could lead to elimination
Q: What’s the world’s leading cause of preventable blindness? Treatment?
A: Blinding Trachoma
Miracle drug 4= Zithromax
Q: What are the NTD treatments available?- inc what for (7)
A: Albendazole – helminths and LF Mebendazole - helminths Mectizan (Ivermectin) oncho and LF Praziquantel - schistosomiasis Mixed treatments against trypanosomiasis Combined therapy against leprosy Zithromax – trachomalec
Q: When is the strategy of Mass Drug Administration (MDA) recommended? By who? What is an inappropriate treatment in these cases? Example figures.
A: For the intestinal helminths, LF schistosomiasis, onchocerciasis and trachoma, the WHO recommended strategy is MDA in areas where prevalence rates are above certain thresholds.
Diagnosis and treatment is impossible because of diagnostic costs
E.g. For Schisto 10% - target school aged children, For Schisto >50% treat everyone (MDA), For STH >50% MDA, For trachoma >10% MDA, For LF >1% MDA
Q: What is done to control NTDs? (9)
A: Mapping Advocacy using evidence Stakeholders meet Strategic plans – National Master Plan developed drugs ordered Health education material Training at all levels Clear drugs and distribute them Treatment (schools of community) Coverage surveys
Q: What is the pharmaceutical industry contribution to treatment? But…
A: is drugs but they will not do it alone
The pharmaceutical industry is providing the tools – the drugs – but are expecting partners to fund the delivery.
Q: How is it ensured that the donated drugs get delivered to those who need them? (6)
A: We now need: Political will Advocacy tools Training Transport Community Drug Volunteers Collaboration
Q: Describe Dengue in the context of a success story or NTD control. What is it? Control strategy? (5)
A: A mosquito borne (Aedes aegypti) viral disease with a global tropical distribution.
Today over 125 countries have Dengue There are 4 known viral serotypes
Control strategy
- Diagnosis and case management
- Integrated surveillance and outbreak response
- Sustainable vector control
- Possible vaccine in the future
- Operational research
Q: Describe Rabies in the context of a success story or NTD control. When is the death rate 100%? How do humans get infected most commonly? Control successes? (3)
A: Once symptoms develop death rate is 100%
There are several animal reservoirs (bats) but dog bites are by far the most common way humans get infected
Control successes
- Canine vaccination
- Humane management of dogs
- Vaccination of people immediately after exposure
Q: Describe Buruli Ulcer in the context of a success story or NTD control. What is it? Highest incidence in? What may hide the true prevalence? Control strategy? (4)
A: A chronic skin disease caused by Mycobacterium ulcerans endemic in 33 countries but highest in Ghana, Gabon and Australia
Poor knowledge and reporting may hide the true prevalence
Control strategy
- Training of health workers
- early case detection
- treatment with antibiotics
- Case management – surgery if necessary
Q: What is Leprosy? Incubation period? Over 95% of population have? Strategy for prevention and control targets? (5)
A: Leprosy is a chronic disease caused by Mycobacterium leprae
incubation period= 5 years.
Over 95% of the population have natural immunity
Leprosy strategy for prevention and control
Target 1 implementation of strategy of early detection and MDT
Target 2 reduce new cases by 50% by 2015
Target 3 Capacity building to sustain control
Target 4 Reduce stigma and discrimination
Target 5 Intensify research
Q: What is the incubation period?
A: the period between exposure to an infection and the appearance of the first symptoms
Q: How does Podocniosis (non-LF elephantiasis) present? Treatment?
A: horrible swelling of the feet and lower legs
no treatment
Q: How is Trypanosomiasis sleeping sickness transmitted? Status of sleeping sickness control? (4)
A: by the Tsetse fly which has a sharp bite but fortunately a very limited distribution
Early diagnosis
Therapy to infected persons (Sanofi and Bayer donate the drugs)
Tsetse control (baited traps)
New tsetse control
Q: Describe tsetse control?
A: using systemic insecticides in cattle in Uganda to prevent the two forms mixing geographically
Q: How do you get ‘rapid impact’? Which NTD? (5)
A: Control of co-endemic neglected diseases should be integrated “Rapid Impact” Soil-transmitted Helminth Infections Ascaris/Trichuris/Hookworm Schistosomiasis Lymphatic Filariasis Onchocerciasis Trachoma
