Didesses Of Public Health Concern

Question 1

What is public health
What is a public health problem

Despite the rapid advancement of medical treatments and technologies, there are still many public health problems plaguing industrialized nations around the world. The leading causes of death, which accounted for 74% of all mortalities, included:

•Heart disease
•Cancer
•Chronic lower respiratory diseases
•Stroke
•Alzheimer’s disease
•Diabetes
•Influenza and pneumonia
•Kidney disease

Answer 1

Public health is the science of improving the well-being of communities through research, health programs, policies, and education. Unlike the health care field, public health is more about protecting entire populations.

This could be something as small as a rural neighbourhood, or as large as an entire country. Rather than treating existing medical issues, public health professionals try to prevent problems by promoting healthy lifestyles, designing outreach campaigns, and advising policymakers.
They also work to eliminate health disparities by advocating for health care equity and accessibility.
A public health problem, therefore, is a medical issue that affects a significant portion of a specific population. Some examples include chronic illnesses like Type 2 diabetes, infectious diseases such as HIV and tuberculosis, mental health challenges, and even motor vehicle accidents.

Question 2

What is heart diseases
What are some of the behaviours that contribute to heart diseases
What are the five non modifiable risk factors for stroke

Answer 2

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Heart disease
•This is currently the leading cause of death worldwide. On average, someone dies from cardiovascular disease every 38 seconds, which is around 2,303 deaths per day.

term “heart disease” is actually used to describe several different conditions, many of which relate to the buildup of plaque in a person’s arteries or irregular heart rhythms. Unlike infectious diseases, this public health problem is highly preventable and the risk factors are well understood by medical professionals.

•Some of the health behaviors that contribute to heart disease include:
•Tobacco use
•Physical inactivity
•Poor nutrition
•Obesity

There are five non-modifiable risk factors for stroke. Having one or more uncontrollable risk factors for stroke does not make a person fated to have a stroke. With proper attention to controllable stroke risk factors, the risk for stroke can be reduced.

•Gender: Men are 30 percent more likely than women to have a stroke, yet more women die from their strokes than men. In fact, strokes kill more women each year than breast cancer.
•Age: Age is one of the single most important risk factor of stroke worldwide. The incidence of stroke increases with age. It is important to note, however, that one-quarter of all stroke survivors are younger than 65. It is not strictly a disease of the elderly.

Race: African Americans have more than twice the risk for stroke than Caucasians. This is due to the greater number of other risk factors present in the African American population.

•History of prior stroke or Transient Ischemic Attack (TIA): A previous history of stroke or TIA significantly increases the risk for recurrent stroke. The risk is highest within the first 30 days after a stroke. TIAs are called mini-strokes and are stroke warning signs that should be treated as a medical emergency. A person experiencing a TIA is at the greatest risk for stroke during the first days and weeks following the TIA episode.

•Heredity: Having a family member who has previously experienced a stroke or TIA younger than 60 can increase the risk for stroke among other family members.

Question 3

What causes malaria?
What are the common clinical features of malaria?
Name the parasites that cause malaria ,where they’re usually to found and how they manifest
Which people are particularly vulnerable to malaria and why?

Answer 3

Malaria in humans is caused by four different species of the protozoan parasite Plasmodium: Plasmodium falciparum, P. vivax, P. ovale and P. malariae.

Common clinical features
Malaria typically produces a string of recurrent attacks, each of which has 3 stages - chills, followed by fever and then sweating.

Plasmodium. falciparum is responsible for most malaria deaths worldwide. It is most prevalent in sub-Saharan Africa and in certain areas of South East Asia and the Western Pacific.

P. falciparum may present with a varied clinical picture, including one or more of the following, fever, chills, sweats, anorexia, nausea, lassitude, headache, muscle and joint pain, cough and diarrhoea. If treated inadequately the disease may progress to severe malaria, of which the most important manifestations are; acute encephalopathy (cerebral malaria), severe anemia, icterus, renal failure, hypoglycaemia and respiratory distress.

Plasmodium vivax, is the most geographically widespread of the species. Once found in temperate climates, P. vivax is now found mostly in the tropics, especially throughout Asia.
P. vivax produces less severe symptoms including, a slowly rising fever of several days duration followed by a shaking chill and rapidly rising temperature, commonly accompanied by headache, nausea and profuse sweating. Following a fever free period this cycle of symptoms may recur daily, every other day or every third day. An untreated primary attack may last from a week to a month. Relapses can occur at irregular intervals for up to 5 years.
Plasmodium malariae, infections produce typical malaria symptoms and can persist in the blood for very long periods (possibly for life) without producing symptoms.
Plasmodium ovale, is less common and generally occurs in West Africa. It can cause relapses.
•Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity to malaria, making her more susceptible to malaria infection
and increasing the risk of illness, severe anaemia and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight - a leading cause of child mortality.
Persons who are partially immune or who have been taking prophylactic drugs may show an atypical clinical picture and a prolonged incubation period

Question 4

Epidemiology
Malaria is one of the most important public health problems worldwide. It is the leading cause of morbidity and mortality in many developing countries, where young children and pregnant women are most affected.
As of 2004, 107 countries and territories have reported malaria transmission. It is estimated that worldwide approximately 3.2 billion people are at risk of malaria infection
WHO estimate that 350-500 million clinical cases and more than 1 million deaths from malaria occur worldwide each year

Africa - has the greatest burden of malaria cases and deaths worldwide. An estimated 60% of all cases and over 80% of malaria deaths occur in sub Saharan Africa.
In sub-Saharan Africa, malaria is responsible for 1 in 5 of all childhood deaths.
Most malaria infections in sub-Saharan Africa are caused by P. falciparum (93% ) of which the principal vectors are Anopheles gambiae and Anopheles funestus. Both efficient vectors.

True or false
What is the mode of transmission for malaria

Answer 4

Mode of transmission
•Transmitted by various species of infective female Anopheles mosquitoes. Most species feed and night; some important vectors have biting peaks at dusk or in the early morning.
•Injection or transfusion of contaminated blood may also transmit malaria.
•Congenital transmission is rare.
•The mosquitoes that can transmit malaria are found not only in malaria endemic areas, but are also found in areas where malaria has been eliminated. The latter areas are thus constantly at risk of re-introduction of the disease.

Question 5

How can malaria be prevented and controlled (name six)
Malaria is endemic where?
Which specific part?

The length of malaria transmission varies by what? Depending on what?
What are the two major transmission patterns

Answer 5

Prevention and control
•Awareness
•Know about the risk of malaria infection
•Bites
•Prevent or avoid
•Compliance
•With appropriate malaria chemoprophylaxis
•Diagnose
•Breakthrough malaria swiftly and obtain treatment promptly

malaria is endemic and perennial in Ghana, with pronounced seasonal variations in the northern part of the country. The length of malaria transmission varies by geographic region, depending on the length of the dry season (December–March), during which there is little transmission.

There are two major transmission patterns
A 6–7-month transmission season in a larger part of the north of the country and a shorter 3–4-month transmission in the upper part of the north, with the highest number of cases occurring between July and November.

In the southern part of the country, the transmission season is 9 months or more, with a small peak from May to June and a larger peak from October to November.

Question 6

2% of global malaria cases and 3% of deaths, Ghana is among the 15 highest burden malaria countries in the world. Between 2016–2019, however, Ghana made significant progress in malaria control – cases decreased by 32% (from 237 cases per 1000 of the population at risk to 161 cases), and deaths decreased 7% (from 0.4 per 1000 of the population at risk to 0.37
True or false
How can the burden of malaria be reduced in Ghana?

result of improved access to testing, the reported rates of malaria cases in children under five has gradually risen from 12% in 2016 to 33% in 2017.

Although 73% of households owned at least one insecticide-treated net (ITN) in 2016, usage rates were noted to be lower. For instance, net use among pregnant women and children under five was 52% and 50%, respectively, in the same year.

Following the positive impact of Seasonal Malaria Chemoprevention (SMC) on severe malaria (protective efficacy of 48% in the Upper West Region), the program was expanded to the Upper East region and was extended to a further 23 districts in the Northern region in 2019.

In 2021, the National Malaria Control Programme (NMCP) will expand SMC to Oti region to achieve coverage of all SMC-eligible regions in Ghana

Answer 6

).

•To reduce the burden of malaria in the country, the high burden, high impact approach was introduced in Ghana in November 2019.

•Ghana has achieved the highest rate of two doses of intermittent preventive treatment in pregnancy (IPTp2) for pregnant women in sub-Saharan Africa – 78% in 2016 and 80.2% in 2019 [2,6]. The percentage of pregnant women receiving the third dose of IPTp (IPTp3) also increased from 39% to 60% between 2014 and 2016, and to 61% in 2019

Question 7

Explain how facility based management ,ICCM and CHPS helps in reducing malaria burden

Answer 7

Facility-based case management
In 2019, Ghana’s National Malaria Control Program (NMCP) updated malaria treatment guidelines to better align with WHO malaria treatment recommendations. Severe malaria cases are referred from the community level to health centers and hospitals where patients receive injectable artesunate and supportive therapy

Integrated Community Case Management (iCCM) and Community Health Planning and Services (CHPS)
The iCCM strategy corresponds to the lowest level of health care delivery in the country and is implemented via community-based agents (CBAs) selected by the community.
iCCM has been integrated into the Community Health Planning and Services (CHPS) strategy. The government plans to expand coverage from 4,400 functional CHPS zones to 6,548 by 2020 (DHIMS Analysis).
A major component of the CHPS strategy is that traditional community leaders must accept the concept and commit to supporting it. Malaria treatment is included in the Community Health Planning Services. Services provided by accredited CHPS are free for those having an active national insurance card

Question 8

How will the plan to reduce malaria be funded in Ghana
Under severe malaria policy and practice,what is the national treatment guidelines for this severe malaria? State the strong drug for it and the two alternative drugs,what drugs are given to pregnant women w malaria (state the trimesters and drugs given and which is strong and which are the alternatives

Answer 8

Health funding
As of 2017, less than 25% of the country’s spending on health was from national resources.
In accordance with its vision of “Ghana Beyond Aid”, the government aims to procure all malaria commodities with local funding.
It also plans to procure all its ACTs without international funding (donor support), beginning in 2020.
The government also made a commitment to universal health coverage when it passed the law to establish the National Health Insurance Scheme (NHIS) at the end of 2003.

As of 2017, the NHIS covered 45% of Ghana’s population. All necessary malaria services and medicines are covered at no cost to NHIS members.

Recommendation
Treatment
Strong. IV artesunate
Alternative. IM artemether
Alternative. IV quinine

Malaria in pregnancy:
Trimester. Treatment
First. B IV or slow IM quinine

First trimester alternative. IV or IM artesunate

Second/third. IV or IM artesunate

Recommendation. Pre-referral
Strong. Rectal artesunate
Alternative. IM artesunate
Alternative. IM quinine
Alternative. IM artemether

Question 9

HIV/AIDS
Like other countries worldwide, HIV/AIDS is present in Ghana. As of 2014, an estimated 150,000 people infected with the virus.
HIV prevalence is at 1.37 percent in 2014 and is highest in the Eastern Region of Ghana and lowest in the northern regions of the country.
In response to this,what has Ghana done?
What is the coordinating body for all HIVAIDS related activities in the country?
What does it do?
What framework is it reviewing?
What targets does this framework set?
In Ghana,when is an individual said to have developed AIDS?
State five major signs of AIDS
State five minor signs of AIDS

Answer 9

In response to the epidemic, the government has established the Ghana AIDS Commission which coordinates efforts amongst NGO’s, international organizations and other parties to support the education about and treatment of aids throughout Ghana and alleviating HIV/AIDS issues in Ghana.

The Ghana AIDS Commission is the coordinating body for all HIV/AIDS-related activities in the country; it oversees an expanded response to the epidemic and is responsible for carrying out the National Strategic Framework on HIV/AIDS for the 2001–2005 period.

The Ghana AIDS Commission is currently reviewing the National Strategic Framework II, covering 2006–2010, with stakeholders, and bilateral and multilateral partners.

The frameworks set targets for reducing new HIV infections, address service delivery issues and individual and societal vulnerability, and promote the establishment of a multisectoral, multidisciplinary approach to HIV/AIDS programs

•In Ghana, an individual is said to have developed AIDS when he or she presents with
a combination of signs and symptoms and has a positive HIV antibody test. These are
grouped into major and minor signs and symptoms.

A. The major signs and symptoms include:
• Prolonged fever (more than one month)
• Prolonged and chronic diarrhoea (usually over a month)
• Significant weight loss (over a period of time and more than 10 percent of body
weight)

B. The minor signs and symptoms include:
• Persistent cough for more than one month
• Persistent skin infection
• Aggressive skin cancer (Kaposi Sarcoma)
• Oral thrush (C andidiasis)
• Recurrent Shingles (“Ananse”)
• Enlargement of the lymph glands

Question 10

How do public health officials follow trends in HIVAIDS

Until the sharp rise in HIV/AIDS national median prevalence rate from 2015 onwards, the infection was on a steady decline in Ghana (National AIDS Control Programme [NACP], 2017).
Although the national median HIV prevalence rate declined from 2.4 in 2016 to 2.1% in 2017, it reverted to 2.4 in 2018. This constitutes a 14.29% increase from 2017 to 2018, and a 50.0%
increase from 1.6 in 2014 to 2.4 in 2018.
The national incidence rate has, however, remained the same at 0.11% since 2015 to 2019, and is projected to decline to 0.09% in 2020 (Ghana AIDS Commission [GAC],
2019). True or false?
Several factors have accounted for the increase in the national median prevalence rate. Name them

Answer 10

Se ntinel Surveillance System
If most people do not know they are infected, how do public health officials monitor
trends?
In Ghana, the Ministry of Health operates a sentinel surveillance system that
provides data for estimating the extent of HIV infection.
Each of the ten regions has designated two hospitals or health centres to be sentinel surveillance sites.
In addition, to two additional sites are included from the Greater Accra Region. At these selected sites, health workers take blood samples from pregnant women as part of their standard antenatal care.
These blood samples are then tested anonymously for HIV infection. That is, the blood is tested for HIV after the routine laboratory tests, for which the blood was originally drawn, have been done and personal identifiers removed.
This is the procedure that is recommended by the World Health Organization and that is used in almost all countries

Factors:

These include complacency resulting from reduction in HIV infection rates from past years, the notion that HIV is no longer a threat, and the societal belief that the virus is non-existent.

The low patronage of condoms and the habit of resorting to herbalists and prayer camps rather than hospitals for HIV treatment have also been blamed for the rise in HIV infection rates.

Question 11

What is Ghanas goal for HIVAIDS
The first national strategic plan focused on five themes,name them.
What does the second national state fix plan focus on?(name six)

Answer 11

Ghana’s goal is to prevent new HIV infections as well as to mitigate the socioeconomic and psychological effects of HIV/AIDS on individuals, communities, and the nation.

The first national strategic plan focused on five themes: prevention of new infections; care and support for people living with HIV/AIDS; creation of an enabling environment for a national response; decentralization of implementation of HIV/AIDS activities through institutional arrangements; research; and monitoring and evaluation of programs.

The second national strategic plan, currently in process, focuses on: policy, advocacy, and enabling environment; coordination and management of the decentralized response; mitigating the economic, sociocultural, and legal impacts; prevention and Behaviour Change Communication; treatment, care, and support; research and surveillance; and monitoring and evaluation

Question 12

Which people actively participate in the national response to HIVAIDS
Substantial funding for HIVAIDS activities is received from where?
Name some HIVAIDS activities that receive funding

Answer 12

Multilateral and bilateral partners, nongovernmental organizations (NGOs), and civil society organizations actively participate in the national response, with more than 2,500 community-based organizations and NGOs reportedly implementing HIV/AIDS activities in Ghana.

•Substantial funding for HIV/AIDS activities is received from the Ghana AID Commission.

•Activities include the five-country, World-Bank-led HIV/AIDS Abidjan-Lagos Transport Corridor project; the World Bank-funded Treatment Acceleration Program for public-private partnership in HIV/AIDS management; the World Health Organization (WHO) 3X5 initiative; the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)

Question 13

hana conducted the second national TB prevalence survey in 2013, 57 years after the first survey. The estimated national TB prevalence, 290 per 100,000 population, shows that the disease burden is four times higher than WHO estimates for the same year (71 per 100,000 population). The national TB case detection rate, calculated using these new figures, is 20.7% (2013).
•Tuberculosis occurs in all age groups, but that older males (above 45 years) bear the biggest brunt of the TB burden. Ghanaian men are particularly affected, with a male to female ratio of about 2:1.
•The TB epidemic is generalized with geographic variation in relation to case notification linked to better access to health facilities. Case notification rates are particularly high among people living with HIV (PLHIV), prisoners, miners, pregnant women and people with diabetes. Cases among children constitute approximately 5% of all notified TB cases.
•A baseline study of HIV among TB patients revealed a co-infection prevalence of 14.7%. HIV prevalence among TB patients varied in the different regions ranging from 33.4% in the Eastern Region to 9.4% in the Upper East. The proportion of TB patients tested for HIV rose from 17% during the first year of the introduction of TB/HIV activities to 77.8% in 2012. ART coverage among HIV-positive TB patients increased from 13.9% in 2008 to 42.6% in 2013.

exact burden of MDR-TB (multi drug resistant tuberculosis) is unknown, as a formal drug resistant survey has not yet been done. MDR-TB prevalence is estimated to have increased by 50% between 2008 and 2013. There is an obvious gap between expected MDR-TB cases and the number detected and enrolled on treatment.
•The death rate among smear positive cases has been stable over the last 15 years varying between 6 and 9%. Brong-Ahafo, Northern and Upper West Regions had higher death rates while lower death rates were reported in Greater Accra, Ashanti and Western Regions. Death rates are particularly high among prisoners (32.6%) and PLHIV (20%).

Greater Accra region consistently has the highest mean TB cases is a general increase in the mean TB cases in this region with a very slight reduction in 2018.
Although the mean TB cases for Ashanti region is the lowest when compared with Brong-Ahafo and Eastern regions in (2015), Ashanti region is the second region after (Greater Accra region) with the highest mean TB cases in Ghana.
Also, Greater Accra region is the region with the highest population density in Ghana followed by the Ashanti region, which probably accounts for the larger numbers of TB cases in the Greater Accra and Ashanti regions.
Upper West region has the lowest TB cases relative to all the regions in Ghana, probably due to low population density in this region.

True or false

Answer 13

True

Question 14

What is cholera and what causes?
Cholera is an indicator for ?
What is the causative agent of cholera?
Which serotype of the agent colonizes the small infestine of humans?
What are the two. Biotypes of this agent?

Answer 14

CHOLERA

Cholera is an acute diarrheal illness, caused by the toxigenic strains of the bacterium Vibrio cholerae serogroups O1 or O139 .
It is one of the important public health problems in Asia and Africa and causes substantial morbidity and mortality.
Since centuries, cholera has been a subject of interest for epidemiologists.
Cholera is an indicator of a lack of social development and is a global threat to public health.

With rapidly increasing population in developing world, the populations living in unsanitary conditions are increasing and the re-emergence of cholera is of public health concern.

Causative agent
The causative agent of cholera, V. cholerae, is a waterborne and foodborne gram-negative bacterium. Vibrio cholerae can cause global pandemics which makes it unique among the diarrheal pathogens .

The serotype O1 or O139 colonizes and multiplies within the human small intestine . There are two biotypes of V. cholerae O1: Classical and El Tor. Each of these biotypes has two serotypes: Inaba and Ogawa.

Question 15

How is cholera transmitted
What is the incubation period

Answer 15

•Mode of transmission

Cholera is transmitted by drinking water or eating food contaminated with the V. cholerae. Fecal contamination of water or foods may result in large epidemics. The disease may also be transmitted through eating contaminated raw or undercooked shellfish . Before the late 1970s, it was believed that person-to-person transmission of cholera is the main mode of transmission. Now, V. cholerae is found in riverine, estuarine, and coastal waters throughout both temperate and tropical regions of the world. It is recognized as a component of coastal and estuarine microbial ecosystems

Incubation period
The disease has a short incubation period of 18 hours to 5 days, and it can spread rapidly through a population

Question 16

How is cholera diagnosed and treated
How is it prevented

Answer 16

Diagnosis
The confirmatory test for cholera is done by culture of a stool specimen or rectal swab. For transport of specimen, Cary Blair media is the most appropriate, and for isolation and identification of the organism, the selective thiosulfate–citrate–bile salts agar (TCBS) is the medium of choice. Commercially available rapid test kits should not be used for routine diagnosis as they cannot determine the subtypes and are not able to isolate the antimicrobial susceptibility. However, they are useful during epidemics .

•Treatment
Rehydration by oral rehydration salts and, if required, intravenous fluids and electrolytes, is the cornerstone of cholera treatment. In addition, antibiotics may be needed for severe cases. Commonly used antibiotics include tetracycline, doxycycline, furazolidone, erythromycin, or ciprofloxacin

Cholera prevention
It is important to understand the factors that are responsible for initiating and sustaining cholera infection in a community . Measures for the prevention of cholera include provision of clean water and proper sanitation to the cholera-endemic communities.

Health education
Health education regarding personal hygiene and food hygiene should be provided to these communities. Media, community leaders, and religious leaders should participate in health education and social mobilization campaigns
Centers for disease control and prevention has listed five basic cholera prevention messages. These include drinking and using safe water; washing hands with soap and water; using latrines or proper sanitation methods; proper cooking of food, covering it, and eating it hot; proper cleaning up of places used for bathing and washing clothes

Question 17

State 10 clinical features of cholera

Answer 17

Clinical features of cholera
•The infection may be mild or asymptomatic in most of the cases, but sometimes it can be severe. Approximately 5–10% of persons suffer from severe cholera. In severe cases, the clinical features include profuse watery diarrhea, vomiting, increased heart rate, loss of skin elasticity, dry mucous membranes, low blood pressure, feeling of thirst, muscle cramps, metabolic acidosis, and restlessness or irritability. These patients can develop acute renal failure, severe electrolyte imbalances, and coma, leading to hypovolemic shock and death [3, 15]. If untreated, 50% of severe cases are fatal, while proper treatment and fluid replacement reduce mortality to less than 1%
•Clinical features of cholera
The infection may be mild or asymptomatic in most of the cases, but sometimes it can be severe.
Approximately 5–10% of persons suffer from severe cholera.

In severe cases, the clinical features include profuse watery diarrhea, vomiting, increased heart rate, loss of skin elasticity, dry mucous membranes, low blood pressure, feeling of thirst, muscle cramps, metabolic acidosis, and restlessness or irritability.

These patients can develop acute renal failure, severe electrolyte imbalances, and coma, leading to hypovolemic shock and death. If untreated, 50% of severe cases are fatal, while proper treatment and fluid replacement reduce mortality.

Question 18

Epidemiology of cholera
Cholera is said to be a ‘forgotten disease’ which mainly affects ‘forgotten people’ of the world. It comes into limelight when an extensive cholera outbreak occurs, although some neglected populations continually suffer from the recurrent episodes of cholera
True or false
What is the main cause of epidemic diarrhea in developing countries?
What is the social and behavioural epidemiology of cholera?

Answer 18

.
Cholera is the main cause of epidemic diarrhea in the developing countries. For the last four decades, there is an ongoing global pandemic in Asia, Africa, and Latin America
Epidemiology of cholera
Cholera is said to be a ‘forgotten disease’ which mainly affects ‘forgotten people’ of the world. It comes into limelight when an extensive cholera outbreak occurs, although some neglected populations continually suffer from the recurrent episodes of cholera .
Cholera is the main cause of epidemic diarrhea in the developing countries. For the last four decades, there is an ongoing global pandemic in Asia, Africa, and Latin America

•Social and behavioral epidemiology of cholera
•Cholera transmission is closely associated with the social and behavioral aspects of individuals as well as communities. There are many demographic factors which predispose an individual or community to cholera infection. An increase in population density can result in overburdening existing water supply and sanitation systems. Thus, population density, urbanization, and overcrowding influence intensity of the cholera outbreak

With increasing world population, urbanization is expected to increase. Most of this urban growth will occur in the developing countries. Because of economic issues, most of urban growth in the developing countries is the expansion of squatter settlements. These settlements comprise of households that lack access to safe drinking water and sanitation facilities.
These conditions are of particular concern in the spread of infectious diseases which have been associated with conditions prevalent in urban squatter settlements There are obvious socioeconomic disparities in the occurrence of cholera. Even in the developing countries, the incidence of cholera is higher in socially deprived communities as compared to economically privileged class .
Among vulnerable groups living in areas at high risk for cholera, the case fatality rate is high. The secondary cases of cholera occur through fecal–oral transmission, and are related to poor hygiene, poor water, and sanitation environment .
The water and sanitation environment as well as proper hygiene and educational level are associated with socioeconomic status of individuals as well as communities.
Individuals with low socioeconomic status lack financial resources to install an appropriate sanitary system or obtain cleaner water sources.
It is reported that cholera is more common in poorer households without safe water and proper sanitation system as compared to those having appropriate water and sanitation systems

Question 19

How many oral cholera vaccines are available?
Dukoral can be given to which group of people?
How many doses are given to children 2-5 years ,1-6 weeks ?
Booster is given when to this group?
How many doses are given to kids more than six years? When is booster given to this group?

The earliest onset of protection is given when?
When can Shanchol be given?
What is the earliest onset of protection for this vaccine?

How can cholera be controlled?

Answer 19

Vaccination
Vaccines
Currently, there are two oral cholera vaccines available: Dukoral and Shanchol.
Dukoral is a killed whole cell vaccine including V. cholerae O1 serogroup and recombinant B subunit of cholera toxin. It can be given to children ≥2 years and to adults. For children 2–5 years of age, three doses, 1–6 weeks apart, are given orally, and booster dose is given after 6 months..

For adults and children ≥6 years, 2 doses, 1–6 weeks apart, are given orally while booster dose is given after 2 years. The earliest onset of protection is 7 days after the second dose, and the protection at 6 months is 85–90%

. Shanchol is a killed bivalent (O1 and O139 serogroups) whole‐cell vaccine suspension. It can be given to ≥1 year of age; 2 doses, 2 weeks apart, are given orally. The earliest onset of protection is 7–10 days after the second dose, and there is 65% protection for at least 5 years

Cholera control
•Cholera-endemic areas should prioritize cholera control measures . Countries facing complex emergencies and displacement of internally displaced people (IDP) on a large scale or refugees to places where the provision of safe water and proper sanitation is compromised, and they are vulnerable to cholera outbreaks. In such situations, it is critical to depend on surveillance data to watch for an outbreak and to implement appropriate intervention measures . Thus, strengthening of surveillance system and early warning system is vital in places at high risk of cholera outbreak .

Question 20

What are coronaviruses
How many species of coronavirus cause disease?
Which of them are zoonotic origin?
The outbreak of the zoonotic species of this virus was reported where?
The causative pathogen of the outbreak was identified as what?

Answer 20

COVID 19
Coronaviruses are RNA viruses that cause respiratory, hepatic and neurological diseases in domestic and wild animals, and humans. Among humans, six species of coronavirus have been identified to cause disease.
Among these, Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV) are of zoonotic origin and have been known to cause severe acute respiratory syndrome outbreaks among humans.

With increasing human to animal contact and interfaces in recent times, an outbreak of novel zoonotic species of Coronavirus was reported in late 2019 in Wuhan, China.

The causative pathogen for the outbreak was identified as SARS - Coronavirus - 2 which rapidly spread through China and other parts of the world. The disease was thereafter named COVID-19.

Question 21

COVID 10 Has disrupted what services?
Name six symptoms of COVID
When did Ghana record its first two cases? Where did they come from?
How did the country respond to these first two cases?

Answer 21

data from the World Health Organization reveal that the COVID-19 pandemic has disrupted malaria services, leading to a marked increase in cases and deaths.
According to WHO’s latest World malaria report, there were an estimated 241 million malaria cases and 627 000 malaria deaths worldwide in 2020.
This represents about 14 million more cases in 2020 compared to 2019, and 69 000 more deaths.

Approximately two-thirds of these additional deaths (47 000) were linked to disruptions in the provision of malaria prevention, diagnosis and treatment during the pandemic.

Symptoms of COVID 19
Symptoms of COVID-19 include fever, dry cough, headache, sore throat, cold, difficulty in breathing, muscle pain and malaise. From large cohorts of patients, it was found that the disease presents as self-limiting in approximately 80% of infected individuals with 15% developing severe pneumonia and mortality estimated at 3.5%.

Ghana recorded its first two cases on March 12, 2020. These were imported from Norway and Turkey.

The country began its response with heightened surveillance for identification of cases and subsequent tracing of their contacts. Mandatory quarantine of travelers entering the country was imposed on March 17, 2020.

The borders were subsequently closed on March 22, 2020. As the number of cases continued to increase to a little above 60, restrictions were placed on movement in the Greater Accra and Ashanti Regions on March 30, 2020 as response continued.

Voluntary testing of people within 1–2 km radius of identified cases was also instituted. With these response strategies, the country was able to detect about 1000 additional cases of which about 90% were asymptomatic. As at June 30, 2020, over 300,000 tests have been conducted with over 17,000 confirmed cases, 117 deaths and 13,000 recoveries.

Question 22

What were the two main epicenters of the country during the first four months of COVID outbreak?

Having a large proportion of cases showing no symptoms has implications for control of the disease as cases who are unaware of their status will continue interacting with people thereby propagating the outbreak.

• Research has shown that large proportions of cases exhibit no symptoms especially in countries where screening is done amongst populations without symptoms.

•Mandatory wearing of masks regardless of COVID-19 status is being implemented heavily in Ghana with support from the Government and all other institutions together with other preventive measures including regular hand washing.

Answer 22

The two main epicenters of the country during the first four months of the COVID outbreak were Greater Accra and Ashanti Regions.

Ashanti region is the third largest of the 16 administrative regions covering 10.2% of the total land area of Ghana.

The region is the most densely populated in Ghana with an estimated 5,924,478 inhabitants according to the Ghana Statistical Service projected population for May 2020.

Greater Accra region occupies 1.4% of the total land area of the country. The region is the second most densely populated in the country and contains 15.4% of Ghana’s population with 5,055,883 inhabitants.

n the first four months of the COVID-19 pandemic in Ghana, approximately 75% of recorded cases were asymptomatic.

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Question 23

What do vaccines do to the immune system?
How do the vaccines work?
How does the ASTRAZENECA vaccine work?
How does MODERNA work?
How does inactivated vaccines work?
How do attenuated vaccines work?
How do protein vaccines work?

Answer 23

Vaccines train your immune system using a harmless form of the virus, SARS-CoV-2, which causes COVID-19.
Vaccines stimulate an immune response without causing illness. Each type of vaccine for COVID-19 works differently to introduce antigens, which are unique features of the SARS-CoV-2 virus, to your body.
The antigen triggers a specific immune response and this response builds immune memory, so your body can fight off SARS-CoV-2 in future.

Viral vector vaccines for COVID-19
AstraZeneca vaccine
This type of vaccine uses an unrelated harmless virus (the viral vector) to deliver SARS-CoV-2 genetic material.
When administered, our cells use the genetic material to produce a specific viral protein, which is recognised by our immune system and triggers a response.

This response builds immune memory, so your body can fight off the virus in future.

Genetic vaccines for COVID-19
The Moderna and Pfizer/BioNTech COVID-19 vaccines use this type of technology to train the immune system.
The vaccines contains a segment of genetic mat of the SARS-CoV-2 virus, which causes COVID-19.
The genetic material, RNA in the case of Moderna and Pfizer/BioNTech vaccine, codes for a specific viral protein.
When administered, your cells use the genetic material from the vaccines to make the protein, which is recognised by your immune system and triggers a specific response. This response builds immune memory, so your body can fight off SARS-CoV-2 in future.

Inactivated vaccines for COVID-19
This type of vaccine contains the killed SARS-CoV-2 virus, which is recognised by the immune system to trigger a response without causing COVID-19 illness. This response builds immune memory, so your body can fight off SARS-CoV-2 in future.

Attenuated vaccines for COVID-19
This type of vaccine contains the weakened SARS-CoV-2 virus, which is recognised by the immune system to trigger a response without causing COVID-19 illness. This response builds immune memory, so your body can fight off SARS-CoV-2 in future.

Protein vaccines for COVID-19
This type of vaccine contains proteins from the SARS-CoV-2 virus, which are recognised by the immune system to trigger a response. This response builds immune memory, so your body can fight off SARS-CoV-2 in future.

Question 24

What causes TB?
Which particular organs does TB affect?
Risk of reactivation of TB bacilli increases w what?

Answer 24

Epidemiology of Infectious Diseases: Tuberculosis
Causal agent
An infection caused by the bacterium Mycobacterium tuberculosis complex. This includes M. tuberculosis (most cases), M. africanum, M. canettii, and M. bovis (primarily from cattle).
TB primarily affects the lungs (pulmonary TB). However, tuberculosis can affect any organ or tissue, in the body including; the lymph nodes, pleura, pericardium, kidneys, bones and joints, larynx, middle ear, skin, intestines, peritoneum, and eyes.
About 10% of those initially infected will eventually develop active TB disease (50% within the first 2 years following infection). 90% of untreated infected individuals will never develop active TB (latent TB infection).
Bacilli survive in latent form which may reactivate in later life. The risk of reactivation increases with age, chronic disease and immunosuppression (e.g. HIV/AIDS).
Reactivated TB is often pulmonary and without treatment carries a high mortality.

Question 25

State five common clinical features of TB

Epidemiology
In 1993 the World Health Organization declared TB a ‘global emergency’.
TB remains one of the world’s leading infectious causes of death among adults.
According to the WHO, one-third of the world’s population is infected with the TB bacillus.
There were 9 million new TB cases and approximately 2 million TB deaths in 2004.
More than 80% of all TB patients live in sub-Saharan Africa and Asia.
Increases in TB have been reported worldwide since the 1980s, notably in Southeast Asia and sub-Saharan Africa. Important factors in the resurgence of TB include the HIV/AIDS pandemic, neglect of TB control programs, poverty and immigration.
TB is the leading cause of death among people who are HIV-positive. In Africa, HIV is the single most important factor determining the increased incidence of TB in the past 10 years.

Answer 25

Common clinical features
TB disease develops slowly in the body, and it may take several months for symptoms to develop (HPA).
•Infection with TB is commonly characterized by:
•Fever and night sweats
•Persistent cough lasting 3 weeks or more that may produce discoloured or bloody sputum.
•Pain with breathing or coughing (pleurisy)
•Weight loss
•Symptoms of TB disease in other parts of the body depend on the area affected.

Question 26

How can TB be transmitted
What is the incubation period of TB

Answer 26

Person to person via inhalation of M. tuberculosis bacilli in droplet nuclei from coughing, sneezing and talking.
However, the risk of transmission depends upon the amount of bacilli in the sputum, the nature of the cough, the closeness and duration of the interaction, the virulence of the organism and the susceptibility of the contact.
Bovine TB is spread primarily through the ingestion of unpasteurised milk or milk products and in some cases through airborne transmission.
Risk groups for TB infection include the immunosuppressed (including, AIDS, cancer, lymphoma), alcohol and drug users, diabetics and severe malnutrition and recent arrivals to the UK from high prevalence countries.

Incubation period
3-8 weeks, range 3-12 weeks (from infection to reaction to tuberculin test).
Latent infection may be many decades.

Question 27

How is TB prevented or controlled

Answer 27

Prevention and control
Tuberculosis is a statutorily notifiable disease.
In September 2005, changes in national BCG vaccination policy came into effect, aimed at providing an improved targeted BCG vaccination programme for;
All infants living in areas where the incidence of TB is 40/100,000 population or >.
All infants with a parent or grandparent who was born in a country where the incidence of TB is >40/100,000 population.
In addition older unvaccinated children with specific risk factors for TB to be identified and tested and vaccinated if appropriate

Question 28

What causes AIDS
What types of this causative agent are there?
Which is responsible for majority of AIDS cases?
State some clinical manifestations of HIV
WHAT is ARS? What is it characterized by?

Answer 28

Human immunodeficiency virus (HIV), a retrovirus is the causative agent for Acquired Immunodeficiency syndrome (AIDS).
•Two serologically and geographically distinct types, HIV-1 and HIV-2 have been identified.
•Both HIV-1 and HIV-2 have the same modes of transmission and are associated with similar opportunistic infections and AIDS.
•HIV-1, which is responsible for the majority of AIDS cases worldwide, is divided into three groups - the ‘major’ group M, the rarer ‘outlier’ group O and ‘new’ group N. Within the M group (which accounts for up to 90% of HIV infections worldwide), at least 9 strains (clades) of HIV-1 have been identified

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•HIV-2 infections are less common and are predominantly found in West Africa. HIV-2 infection has a longer latent period before the appearance of AIDS, a less aggressive course of AIDS and a lower viral load with higher CD4 lymphocyte counts thanHIV-1 infection until late in the course of the disease when clinical AIDS is apparent.

Common clinical features
The clinical manifestations of HIV infection range from the initial acute retroviral syndrome to full blown AIDS.

Acute retroviral syndrome (ARS) is the first stage of infection with the human immunodeficiency virus (commonly occurring between 1-6 weeks following infection) and is characterized by an acute self-limited mononucleosis-like illness lasting for a week or two. However, primary infection may go unnoticed in up to 50% of cases.

Following exposure there is a period of viraemia during which the individual is highly infectious. Generally, within 3 weeks to 3 months following infection the immune response is accompanied by a simultaneous decline in HIV viraemia.

The stage of clinical AIDS is reached years following infection and is marked by the appearance of one or more of the typical opportunistic infections or neoplasms diagnostic of AIDS by definitional criteria.
Untreated, half of those with HIV infection will develop AIDS within 7-10 years and of these 80-90% will die within 3-5 years

Question 29

How is HIV transmitted?
What is the incubation period of HIV
How canHIV BE PREVENTED AND CO TROLLED

Answer 29

Mode of transmission
•Person to person transmission through exposure to infected blood and tissues.
•Unprotected sexual intercourse (anal or vaginal) with an infected partner.
•The presence of a concurrent sexually transmitted infection (STI), especially an ulcerative one increases the risk of HIV transmission.
•Transmission is especially efficient between male homosexuals in whom receptive anal intercourse and multiple sexual partners are particular risk factors.
•Sharing of contaminated needles or syringes (intravenous drug users).
•Transfusion of infected blood or blood products.
•Mother to child transmission (MTCT) - An estimated 15-35% of infants born to HIV positive mothers are infected through placental processes at birth.
•MTCT through breast milk.
•Transmission via needle stick injury.
•The transmission of HIV-2 is similar to that for HIV-1, though perinatal transmission is much less frequent.

Incubation period
Following exposure HIV nucleic acid sequences may be detected in the blood within 1-4 weeks following infection and HIV antibodies can be detected within 4-12 weeks.

The time from HIV infect infection to diagnosis of AIDS has an observed range of less than 1 year to 15 years or longer. The increasing availability of anti-HIV treatment has reduced the development of clinical AIDS in most industrialized countries.
For perinatally acquired HIV infection, the time to development of clinical AIDS may be shorter than in adults. Signs associated with HIV infection appear in over 80% of seropostive infants by the age of 5 months. Approximately 50% of children with perinatally acquired HIV infection are alive at 9 years.
Prevention and control
•Public health education to reduce high risk behaviours associated with the transmission of HIV.
•No vaccine is currently available.
•Highly active antiretroviral therapy (HAART) reduces disease progression.

Question 30

What are neglected tropical diseases
What causes them?
Why are NTDS called neglected?
State ten types of NTDS and their causes and some signs and symptoms

Answer 30

NEGLECTED TROPICAL DISEASES

Neglected tropical diseases (NTDs) are a diverse group of tropical infections which are common in low-income populations in developing regions of Africa, Asia, and the Americas.
They are caused by a variety of pathogens such as viruses, bacteria, protozoa and parasitic worms
Neglected tropical diseases (NTDs) are widespread in the world’s poorest regions, where water safety, sanitation, and access to health care are substandard.
An estimated 1 billion people—approximately one-sixth of the world’s population—suffer from at least one NTD.
NTDs are called “neglected” because they generally are not considered public health problems in wealthier nations and historically have not received as much attention as other diseases.
Some NTDs are found in parts of the United States, particularly among impoverished minorities.

Types of Neglected Tropical Diseases

•Ascariasis
Caused by a parasitic roundworm called A​scaris lumbricoides, ascariasis is common in areas where sanitation and hygiene are poor. The disease often causes only mild symptoms (or no symptoms at all), but in cases of high worm infestation, ascariasis can lead to severe abdominal pain, vomiting, restlessness, and sometimes death.

•Buruli ulcer
Caused by Mycobacterium ulcerans, an organism from the same family of bacteria that causes tuberculosis and leprosy, Buruli ulcer can lead to massive skin ulceration, usually on the legs or arms. If untreated, the disease can spread to the bones and cause long-term disability.

•Chagas’ disease (American trypanosomiasis)
Caused by a parasite transmitted by blood-sucking “assassin bugs,” Chagas’ disease can lead to swollen lymph nodes and organ damage.

•Human African trypanosomiasis (sleeping sickness)
Caused by a parasite transmitted from tsetse flies, human African trypanosomiasis can lead to headaches, fever, weakness, and stiffness. If untreated, the parasite migrates to the central nervous system, causing seizures, psychiatric disorders, and ultimately death.

•Leishmaniasis
A parasitic disease transmitted by infected sand flies, leishmaniasis can cause skin ulcers or lesions and swelling of the spleen and liver.

•Leprosy (Hansen’s Disease)
A chronic infectious disease caused by mycobacteria, leprosy can lead to permanent damage to the skin, nerves, limbs, and eyes.

•Lymphatic filariasis (elephantiasis)
A parasitic worm disease spread from human to human by mosquitoes, lymphatic filariasis can lead to disfiguring swelling of the legs, scrotum, and breast.

•Onchocerciasis (river blindness)
A parasitic worm disease spread by infected black flies, onchocerciasis can cause extreme itching, blindness, and skin lesions.

•Schistosomiasis
A parasitic worm disease transmitted by fresh water snails, schistosomiasis can lead to blood in the urine, impaired growth, and malfunctioning of the kidney, liver, and spleen.

•Trachoma
Caused by the bacterium Chlamydia trachomatis, trachoma can lead to scarring of the inside of the eyelid. If untreated, the disease can lead to irreversible blindness.

Question 31

How can NTD or Neglected tropical diseases be prevented?(state five)
How can vector borne NTDS be prevented
How can NTD be diagnosed?
Why is it that NTDS can be hard to diagnose?

Answer 31

Prevention of Neglected Tropical Diseases
•Neglected tropical diseases (NTDs) are largely preventable, even without vaccines. Clean water, sanitary food handling, and good hygiene hygiene can prevent diseases such as guinea-worm disease, schistosomiasis, soil-transmitted helminthiasis, and trachoma.
•Vector-borne NTDs—those that are spread by worms, flies, mosquitoes, or other hosts—can be prevented through control of the vectors themselves. This can include mass spraying of insecticides in areas where the vectors breed or gather, killing them before they become parasite carriers. Scientists are also exploring ways to genetically alter the vectors so that they cannot carry the parasite. The genetically altered vectors would then be released into the population to breed and spread their genetic abnormalities to future generations.

•Educating the at-risk population is also an important aspect of NTD prevention. By controlling environmental factors that invite NTDs, people can reduce their risk. For instance, eliminating areas of standing water, where mosquitoes like to breed, will reduce the risk of mosquito-borne diseases, or sleeping under a treated bed net will reduce the risk of diseases carried by flies that circulate at night. Travelers to areas where insect-borne NTDs are widespread should take care to wear protective clothing, use bug repellant, and sleep under a treated bed net.

•Neglected Tropical Diseases Diagnosis
•Many neglected tropical diseases (NTDs) can be diagnosed in the laboratory using simple and inexpensive microscopy, serology, and culture techniques. Some diseases, particularly those caused by parasites, can be detected in stool samples.

•While most NTDs can be recognized and diagnosed in a clinical setting by trained health professionals, many are not because those infected are typically poor and do not have access to quality health care and lab facilities.
•In these cases, creating easier access to better facilities would allow affected people to receive treatment for NTDs more quickly—thus avoiding many complications of advanced disease.

Question 32

How are NTDS transmitted?
What are the symptoms of NTDS

Answer 32

Neglected Tropical Diseases Transmission
•Several neglected tropical diseases (NTDs) are transmitted by infected insects. For example, Chagas disease is transmitted by the kissing can lead to life-long cardiac problems; leishmaniasis is transmitted by infected sand flies and can lead to sores that cause permanent scarring; onchocerciasis is transmitted by infected black flies and can lead to blindness; and dengue fever, which can lead to circulatory failure, and lymphatic filariasis, which can lead to extreme swelling of the genitalia or limbs, are both transmitted by infected mosquitoes.
•Other NTDs are transmitted through consumption of water or food that harbors parasites. Guinea-worm disease, fascioliasis, and schistosomiasis are examples of NTDs that infect people through contaminated water or food.
•Most NTDs are not transmitted from person to person, although there are exceptions. Leprosy—although not highly contagious—can be transmitted through respiratory droplets in coughs and sneezes and can lead to thick skin lesions and nerve damage. Trachoma, which can lead to blindness, can be transmitted through personal contact and the sharing of personal items that harbor the bacteria.

•Neglected Tropical Diseases Symptoms
•Symptoms of neglected tropical diseases (NTDs) vary dramatically from disease to disease. Some immediately present symptoms such as fever, aches, rash, sores, or swelling of the lymph nodes or at the site of infection.
•Some NTDs, such as sleeping sickness, leprosy, and guinea-worm disease, may not present symptoms for one or several years.
•If treated, most NTDs are not fatal. But if left untreated, NTDs can lead to serious and chronic conditions and can even cause death. Because NTDs generally occur in regions with poor access to health care, many infected people likely die from their infections before the infections are ever reported.

Question 33

How can NTDS be treated

Answer 33

Neglected Tropical Diseases Treatment
•The good news about neglected tropical diseases (NTDs) is that many are treatable with existing drugs. Certain treatments are easy to administer and do not require health professionals. The bad news is that, while drug treatments are available for many NTDs, they don’t often reach the people most in need.
•Several governmental and non-governmental organizations work to help strengthen health infrastructure and deliver drugs in regions afflicted by NTDs. For example, the World Health Organization Division of Control of Neglected Tropical Disease helps organize funding and relief efforts in these areas. Some drug companies also donate medications to help treat NTDs.
•As with tuberculosis and malaria, drug resistance is becoming an issue with NTDs. For example, praziquantel has been used since the 1980s to treat the neglected parasitic worm disease schistosomiasis. Public health officials fear that the worms are evolving resistance to the drug and have underscored the need for further research and development of new and improved treatments for the disease.

•Intestinal parasitic nematode (roundworm) diseases infect well over 1 billion people worldwide and cause significant illness, especially in children and pregnant women. To date, there is only one drug, albendazole, which is widely used in administering single-dose treatments to large populations as an antihelminthic (a substance to destroy or eliminate parasitic worms, especially intestinal helminths).
•Given the large numbers of people to be treated, and the threat of parasites developing resistance to the current drug, another drug called tribendimidine has been developed, and appears to be as good as albendazole in clinical trials. Scientists are also studying new treatment options.
•Lymphatic filariasis, commonly known as elephantiasis, affects more than 120 million people in 80 countries. It is caused by Wuchereria bancrofti, a filarial worm, which is transmitted to humans through the bite of an infected mosquito. Disease control efforts through drug therapy and the use of insecticides has had limited success. Scientists are now looking to the use of novel vector control strategies to provide an additional tool to break the cycle of disease transmission.