A global perspective on ENT, Opthalmic and Neurological Conditions Flashcards
According to the GMC, why should medical students be interested in global health?
“Medical students should be able to discuss from a global perspective, the determinant of health and disease and variations in healthcare delivery and medical practice”
WHO definition of health.
Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.
What are the top 10 causes of death in low income countries?
- Lower respiratory infections
- HIV/AIDS
- Diarrhoeal diseases
- Stroke
- Ischaemic heart disease
- Malaria
- Preterm birth complications
- Tuberculosis
- Birth asphyxia
- Protein energy malnourishment
What are the top 10 causes of death in high income countries?
-Ischaemic heart disease
-Stroke
Trachea, bronchus and lung conditions
-Alzheimer’s disease and dementia
-COPD
-Lower respiratory infections
-Colon rectum cancers
-Diabetes mellitus
-Hypertensive heart disease
-Breast cancer
What is the current global state of health?
Enormous progress made to improve health status globally but enormous disparities in health status and access to health services within and between countries
What are the 5 determinants of health?
- Genes and biology
- Physical environment
- Clinical care
- Health behaviours
- Social and economic factors
Give examples of social and economic factors affecting health?
- Social class
- Gender
- Ethnicity
- Education
- Health policy
- Governance
- Culture
What gradient do health and illness follow?
A social gradient, worsening with decreasing socio-economic position
What are the 8 millennium development goals?
- Eradicate extreme poverty and hunger
- Achieve universal primary education
- Promote gender equality and empower women
- Reduce child mortality
- Improve maternal health
- Combat HIV/AIDS , malaria and other diseases
- Ensure environmental sustainability
- Global partnership for development
What are the 17 sustainable development goals?
- No poverty
- No hunger
- Good health
- Quality education
- Gender equality
- Clean water and sanitation
- Clean energy
- Good jobs and economic growth
- Innovation and infrastructure
- Reduced inequalities
- Sustainable cities and communities
- Responsible consumptions
- Protect the planet
- Life below the water
- Life on land
- Peace and justice
- Partnerships for the goals
What are the statistics on global visual impairment?
- 285 million people are visually impaired
- 39 million are blind
- 19 million children are affected
- 90% in low income setting
- 80% can be prevented or cured
What are the causes of global visual impairment?
- Cataract
- Refractive error
- Glaucoma
- AMD
- Corneal scar
- Diabetic retinopathy
- Childhood
- Trachoma
- Oncho.
- Other
What global causes of visual impairment are curable?
- Cataract
- Refractive error
What global causes of visual impairment are treatable?
- Glaucoma
- AMD
- Diabetic retinopathy
What global causes of visual impairment are preventable?
- Corneal scar
- Diabetic retinopathy
- Trachoma
- Oncho.
What are cataracts a leading cause of?
Blindness
What increases the risk of cataracts?
UV exposure
What is required for successful cataract treatment?
- Access to surgery
- Follow up
- After care
Why is there often a loss of confidence in treating cataracts in the developing world?
- Many receive treatment at cataract camps
- Lack of follow up and complications including infection leads to loss of confidence
How can refractive errors be corrected?
Glasses
How can glaucoma be treated?
Lifelong eye drops
Why is glaucoma a leading cause of blindness in developing countries?
- Requires lifelong supply of eye drops
- Access to medications
- Supply of medications
- Storage of medications
- Poor hygiene with drop insertion leads to loss of confidence in treatment
What is corneal scarring usually secondary to?
Trachoma
Trachoma
Bacterial infection due to face washing with dirty water, sharing linen and lies
What bacterium causes trachoma?
Chlamydia trachomatis
What predisposes you to trachoma?
Malnutrition in particular vitamin A deficiency
What pathophysiology occurs with trachoma?
- Granulation of inner eyelid
- Eyelids turn inwards causing scratching of cornea
What is the treatment for trachoma?
SAFE
- Surgery
- Antibiotics
- Face washing
- Environmental
What is the prevalence of trachoma?
- 50 million people affected
- 4.9 million blind
How many people in the world do not have access to safe drinking water?
780 million
How many people in the world do not have access to safe sanitation?
2.5 billion
What is the medical name for river blindness?
Onchocerciasis
How is river blindness transmitted?
By blackfly
What does infection by blackfly larvae cause?
Eye lesions, inflammation and scarring
How is river blindness prevented?
Annual dose of Ivermectine
How many people are affected by childhood blindness?
- 1.4 million blind children
- 3/4 in Africa/Asia
What does childhood blindness cause in industrialised nations?
Lesions
What does childhood blindness cause in LMIC?
- Vitamin A deficiency
- Corneal scars
What are the common causes of corneal scars in LMIC in childhood blindness?
- Measles
- Traditional eye remedies
- Infections
- Rubella cataracts
How many people are affected by eye trauma each year?
55 million
How many people are blinded by trauma each year?
1.6 million plus 21 million with visual impairment
How can avoidable blindness be avoided?
- Hygiene, sanitation, clean water
- Improved access to eye care
- Improved nutrition
What approaches can be take towards avoidable blindness?
- Awareness and education
- Target nutrition and hygiene
- Community education for earlier referral
- Eye surgery camps and mobile cataract team
- Improved facilities and access
- Vaccination programmes
- VISION 2020
Disabling hearing loss
Hearing loss greater than 40dB in adults
How many people are affected by disabling hearing loss?
5% world population (360 million people)
What would many with disabling hearing loss benefit from?
- Aids
- Implants
- Sign language
- Social support
What are the congenital causes of disabling hearing loss?
- Maternal infections including rubella and syphilis
- Birth asphyxia
What are the acquired causes of disabling hearing loss?
- Infections
- Trauma
- Excess noise
How does disabling hearing loss differ by region?
Prevalence of disabling hearing loss in some regions is nearly double that of the high income countries
What are the consequences of hearing loss?
- Inability to communicate leading to social isolation
- Affect on academic performance and prospects
What are the strategies to combat hearing loss?
- Immunisations (measles, mumps, rubella and meningitis)
- Antenatal care and rubella immunisations
- Education
- Hygiene and clean water
- Health and safety legislation regarding PPE/noise
- Early detection and intervention
- Social support
- Simple aids
Why are non-communicable diseases increasing globally?
Changing lifestyles
What percentage of global mortality does neurological disease account for?
-12%
-16% in LMIC
13% in HIC
What is the 2nd leading cause of death globally?
Stroke
Why are mortality rates for stroke 2-4x higher in LMIC?
Limited resources for acute treatment and 1st and 2nd degree prevention
Why is the burden of epilepsy 14 x higher in LMIC?
Lack of access to medication
Give examples of neurological disease with high prevalence globally?
- Haemorrhagic stroke
- Ischaemic stroke
- Migraine
- Epilepsy
- Dementia
- Parkinson’s
- Tension headaches
- Multiple sclerosis
- Other
What is the 9th leading cause of death globally?
Trauma but is set to rise to 3rd by 2020
Why do more than 90% of deaths due to trauma occur in LMIC?
- Limited health and safety legislation
- Road traffic accidents
- Conflict
- Access to healthcare
What is the leading cause of trauma death?
Head injury
Why are surgical interventions for head and neck disease difficult in LMIC?
Limited ENT and anaesthesia services and equipment
Why are head and neck cancers more common in the developing world?
- Infections
- Poor oral hygiene
- Chewing tobacco
- Certain nuts (areca)
- Smoking
- Alcohol
- Late detection
What are craniofacial abnormalities secondary to?
Maternal infections
Give an example of a fairly common facial deformity?
Cleft lip and palate
Why is the incidence of cleft lip/palate higher in LMIC?
- No additional folic acid in pregnancy
- Vitamin deficiencies
What can cleft lip/palate lead to?
- Feeding difficulties and malnutrition
- Ear infections
- Speech problems
- Breathing difficulties
