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Conflict And Catastrophe Medicine > Disease And Disasters (PART 2) > Flashcards

Disease And Disasters (PART 2) Flashcards

1
Q

How do we monitor the effectiveness of control programmes?

A
  • Estimate disease burden
  • Identify risk groups
  • Determine incidence trends over time
  • Measure outcomes & impacts of preventive, treatment & public health interventions
    • Evaluate the overall control interventions
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2
Q

What do you need to know when undertaking health programmes and disease control activities?

A
  • Population makeup: Numbers, Ages! Sex ratios
  • The health status of the population
  • What diseases affect the population?
  • Who might be affected?
  • Any information about transmission (e.g. seasonal factors,
    vectors)
  • What is the makeup, skills etc. of the health services?
  • What health care facilities are available?
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3
Q

Define Epidemiology

A

The study of diseases in human populations in order to promote, protect & restore health

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4
Q

Define Disaster Epidemiology

A

The use of epidemiological methods to study and manage the public health aspects of disasters

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5
Q

Describe one epidemiological method to study and manage public health aspects of disasters

A

Time, Person & place

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6
Q

How can Time be used as an epidemiological method to study and manage public health aspects of disasters?

A
  • When did the problem start?
  • Is it still happening?
  • If it has finished – when?
  • What might have been happening at those times?
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7
Q

How can a person be used as an epidemiological method to study and manage public health aspects of disasters?

A
  • Old?
  • Young?
  • Female?
  • Male?
  • Defined group?
  • Characteristics?
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8
Q

How can a Place be used as an epidemiological method to study and manage public health aspects of disasters?

A
  • By Finding out:
  • Where is it happening?
  • What are the characteristics of that place?
  • How is the population distributed in that place?
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9
Q

How can numbers and rates be used as epidemiological methods?

A
  • Number of cases: Assess needs for resources (Human & material). Can be misleading regarding disease situation
  • Rates (Numbers per unit of population): Assess changes of disease levels in the population. Compare different locations. Used to calculate key indicators
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10
Q

List some small elements you need to be careful about with epidemiological methods

A
    1. Small datasets: Small changes can have big results
    1. Statistical significance: Is it statistically significant? If no then even if one dataset appears to differ from the other it does not mean that it is actually different
  • See above #1 – you need a certain minimum size of sample for valid statistical analysis
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11
Q

List the key indicators of mortality #1

A
  • Changes in mortality rates are often the first indicator of
    health problems.
  • Crude Mortality Rate (CMR)
  • The most important - indicates the severity of the problem: Changes in CMR show how a medical emergency is developing. Usually number of deaths / 10,000 persons / day
  • CMR >1/10,000/day = acute emergency is developing
  • The emergency phase lasts until the daily CMR falls to 1/10,000/day or below
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12
Q

List the key indicators of mortality #2

A
  • Age-specific mortality rate - mortality rate for a specified age group.
  • In children usually given as: No. deaths in <5y & >5y / 1,000 children of each age / day
  • Cause specific death rates (case fatality rates)
  • % of cases of a specified condition fatal within a specified time.
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13
Q

List the key indicators of mortality #3

A
  • Maternal mortality rate: No. of mothers dying from puerperal causes within x days of giving birth / y births / z time
  • Maternal death: the death of a woman whilst pregnant
    or within 42 days* of the termination of the pregnancy,
    from any cause related to the pregnancy or its
    management. (* Can be 1 year)
  • A sensitive indicator of the effectiveness of health care
    systems.
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14
Q

What is the incidence rate and Prevalence rate of Morbidity?

A
  • Incidence Rate: The number of new cases during defined period of time
  • Prevalence rate: The total number of cases in a population at a given time
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15
Q

List other indicators

A
  • Nutritional situation: Prevalence of: Global acute malnutrition, Severe acute malnutrition, Micronutrient deficiencies. Number of children needing selective feeding programmes (SFP)
  • Immunisation: Need for programme, Effectiveness of programme
  • Vital needs: Water, Sanitation, Food & Shelter
  • Health service activities: Consultations, hospital admissions, laboratories, cold chain
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16
Q

Provide an example of an Outbreak investigation

A
  • Angola: October - November 2007
  • Investigation of outbreak of neurological illness undertaken by Angolan Ministry of Health (MINSA)
  • Supported by WHO (Angola, AFRO region & Geneva offices)
17
Q

What happened in Angola in 2007

A

On 24th October 2007, the Direction Provinciale de la Santé (DPS) in Angola reported that 42 cases of a “neurological illness” with 3 fatalities had occurred in the municipality of Cacuaco to the north-east of the capital Luanda since the beginning of October.

18
Q

What were the symptoms presented by people in this case?

A
  • General symptoms:
  • Affected patients normally & previously healthy
  • fever, headache, diarrhoea, abdominal pain, vomiting
  • Neurological symptoms: Dizziness, Weakness, Muscular spasms, Ataxia, Somnolence or semi-coma
19
Q

Provide a case definition for Angola 2007

A

Any person who presents with sleepiness, deep asthenia, blurred vision, dizziness, difficulties in speaking and difficulties in walking

20
Q

Describe the epidemiology for Cacuaco Municipality

A
  • 461 cases in Cacuaco Municipality
  • Mainly children, majority female
  • No exclusively breastfed infants
  • Households of 8/19 bairros (neighbourhoods) affected
  • Additional 17 cases in Caxito, Bengo Province (north of
    Cacuaco)
21
Q

What was the hypothesis for Cacuaco Municipality?

A
  • Cases due to a toxin rather than an infectious agent.
  • Samples of food & blood sera tested at labs in UK &
    Germany for over 8000 possible toxins: all negative
22
Q

What was the cause of the Cacuaco Municipality?

A
  • Bromide poisoning suggested as cause.
  • Blood sera from cases +ve
  • High concentrations of sodium bromide (>80%) found in table salt
  • None in other foods
  • Cause was probably ingestion of table salt contaminated with sodium bromide
23
Q

Describe Sodium Bromide

A
  • White crystalline compound
  • Looks like sodium chloride
  • Tastes weakly “salty”
  • Widely used as an anticonvulsant & a sedative in the late 19th & early 20th centuries
  • In Angola, used extensively in the oil industry
  • Very large amounts transported in 25kg bags on trucks
24
Q

What was the significance of sex and age in this case?

A
  • Females more affected than males because at home more, cooking & tasting food.
  • Children are at home & (especially female) taste food when helping mothers cook. (Also lighter & toxic dose smaller).
25
Q

What were the public health measures carried out for this case?

A
  • Remove contaminated salt from the community: Identification of safe salt supply, Recall and replacement process
  • Develop public health messages
  • Source investigation: Investigation of other food sources
  • Prevention of similar incidents: Improved security of chemicals, Education
26
Q

Summary

A

Conflict And Catastrophe Medicine (34 decks)

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