16 International Health

Question 1

Q: Explain what “Neglected Tropical Diseases” are. Current use?

Answer 1

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.

Question 2

Q: Provide examples of NTD under 4 subheadings. (3,3,5,2)

Answer 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

Question 3

Q: What are the 2 strategies used to deal with NTD?

Answer 3

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.

Question 4

Q: Where do the drugs used to treat NTD come from? Conditions? Problem?

Answer 4

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.

Question 5

Q: Define DALY.

Answer 5

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.

Question 6

Q: Which region has the Highest Prevalence of # Neglected tropical diseases?

Answer 6

A: Sub-Saharan Africa

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Question 7

Q: What is Schistosomiasis (AKA Bilharzia)? Who does it affect? Life cycle? Chronic health problems? Life threatening consequences? Treatment?

Answer 7

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

Question 8

Q: What do female genital schistosomiasis cause? Linked to?

Answer 8

A:  Urinary schistosomiasis in females causes genital lesions as eggs are trapped in the cervix
 These lesions have been linked to increased HIV risk

Question 9

Q: What do Soil-Transmitted Helminth Infections “worms” lead to? Drugs?

Answer 9

A:  STHs lead to stunting and decreased school performance in children
 2 miracle drugs- Albendazole and Mebendazole

Question 10

Q: How does Onchocerciasis (AKA River Blindness) pass from individual to individual? Can cause? Treatment?

Answer 10

A:  Uses vector blackfly
 Causes blindness and severe skin disease
 Treatment with Mactizan

Question 11

Q: How is Lymphatic Filariasis transmitted? Treatment? (2) Elimination when?

Answer 11

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

Question 12

Q: What’s the world’s leading cause of preventable blindness? Treatment?

Answer 12

A: Blinding Trachoma

Miracle drug 4= Zithromax

Question 13

Q: What are the NTD treatments available?- inc what for (7)

Answer 13

A: 	Albendazole – helminths and LF 
	Mebendazole - helminths
	Mectizan (Ivermectin) oncho and LF 
	Praziquantel - schistosomiasis
	Mixed treatments against trypanosomiasis 
	Combined therapy against leprosy 
	Zithromax – trachomalec

Question 14

Q: When is the strategy of Mass Drug Administration (MDA) recommended? By who? What is an inappropriate treatment in these cases? Example figures.

Answer 14

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

Question 15

Q: What is done to control NTDs? (9)

Answer 15

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

Question 16

Q: What is the pharmaceutical industry contribution to treatment? But…

Answer 16

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.

Question 17

Q: How is it ensured that the donated drugs get delivered to those who need them? (6)

Answer 17

A: We now need:
	Political will
	Advocacy tools
	Training
	Transport
	Community Drug Volunteers
	Collaboration

Question 18

Q: Describe Dengue in the context of a success story or NTD control. What is it? Control strategy? (5)

Answer 18

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

1. Diagnosis and case management
2. Integrated surveillance and outbreak response
3. Sustainable vector control
4. Possible vaccine in the future
5. Operational research

Question 19

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)

Answer 19

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

1. Canine vaccination
2. Humane management of dogs
3. Vaccination of people immediately after exposure

Question 20

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)

Answer 20

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

1. Training of health workers
2. early case detection
3. treatment with antibiotics
4. Case management – surgery if necessary

Question 21

Q: What is Leprosy? Incubation period? Over 95% of population have? Strategy for prevention and control targets? (5)

Answer 21

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

Question 22

Q: What is the incubation period?

Answer 22

A: the period between exposure to an infection and the appearance of the first symptoms

Question 23

Q: How does Podocniosis (non-LF elephantiasis) present? Treatment?

Answer 23

A: horrible swelling of the feet and lower legs

no treatment

Question 24

Q: How is Trypanosomiasis sleeping sickness transmitted? Status of sleeping sickness control? (4)

Answer 24

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

Question 25

Q: Describe tsetse control?

Answer 25

A: using systemic insecticides in cattle in Uganda to prevent the two forms mixing geographically

Question 26

Q: How do you get ‘rapid impact’? Which NTD? (5)

Answer 26

A: Control of co-endemic neglected diseases
should be integrated “Rapid Impact”
	Soil-transmitted Helminth Infections 
	Ascaris/Trichuris/Hookworm 
	Schistosomiasis
	Lymphatic Filariasis Onchocerciasis
	Trachoma