9. GLOBAL V LOCAL STRATEGIES FOR DISEASE RISK& ERADICATION POLIO & GUINEA WORM

Question 1

POLIO

Example of good Top Down strategies

Answer 1

https://www.youtube.com/watch?v=4NyRolNlNsw&list=PLdgqkwfRbp5zfSqb5l81IulmlJsfQKZV4&index=23

• Infectious, communicable & highly contagious
• Severe effects – death & paralysis
• 1952 - 600,000 deaths per year
• UK – has 93% of one-year olds vaccinated vs Pakistan 75%

TOP DOWN STRATEGY
* The Global Polio Eradication Inititiave (GPEI) supported by multiple agencies eg WHO, UNICEF, the CDC , Gates Foundation and others concentrating on:
Planning
Expertise
Surveillance

Challenges
* However difficult to reach remote places – physical relief difficult
* Conflict affected areas male it difficult to deliver vaccine and porous borders.
* Social and cultural barriers eg not ‘haram’ so vaccine forbidden
* Funding gaps and political stability a challenge.
* Fake vaccination centres

Effectiveness
* Significantly reduced cases world-wide 125 countries in 1988 to 2 places
* But Pockets exist eg Pakistan & Afghanistan

Question 2

GUINEA WORM - ERADICATION STRATEGY

VALUE OF BOTTOM UP STRATEGIES!!

Answer 2

https://www.youtube.com/watch?v=zKadL4a5Djw&list=PLdgqkwfRbp5zfSqb5l81IulmlJsfQKZV4&index=26

SUITABLE TO ERADICATE
Diagnosis easy
Host parasite in stagnant water only
Small geographic distribution - GHANA
Intervention & treatment cheap and easy (water filters)
Seasonal transmission

CHALLENGES
Ethnic Conflict
Damaged water infrastructure

TOP DOWN STRATEGIES
Mapping of disease prevalence
Database to monitor prevalence
Strategy development
Resources (expertise, leadership)

BOTTOM UP - VERY SUCCESSFUL
Trained local women about prevention & monnitoring
Education education eduction !

EFFECTIVENESS
Highly effective - 190,000 cases in 1989
last case in 2010