Social and Economic Determinants of Health: Infectious Respiratory Disease

Question 1

What percent of incident TB cases worldwide affect children?

Answer 1

60%

Question 2

What is the increased risk of contracting TB in HIV-infected persons?

Answer 2

20-27x increased risk

~13% of cases are co-morbid with HIV

Question 3

What is the current incidence of TB in Australia?

Answer 3

4/100 000

Question 4

What percentage of TB deaths occur in lower-income countries?

Answer 4

>95%

Question 5

How many new cases of TB emerged in 2011? How many died?

Answer 5

8.7m new cases; 1.4m died

Question 6

What percentage of death in HIV patients is due to TB?

Answer 6

25%

Question 7

What is the TB millenium development goal?

Answer 7

• # 6
• halve TB prevalence and death rates, and decline in incidence by 2015 (compared to 1990 levels)
• eliminate TB by 2050
• epidemic has globally been reversed, number of cases has declined ~40% since 1990

Question 8

What year was TB declared a major public health problem by the world health assembly?

Answer 8

1991

Question 9

What is the DOTS initiative?

Answer 9

• TB drugs must be taken for extended periods (previously, 12-18mo)
• can be effective in as little as 6mo if taken daily
• tf program to have family members, community workers, or healthcare professionals observe pt take drugs daily (directly observed treatment shortcourse)

Question 10

What is the Stop TB strategy?

Answer 10

• 2006
• identify and treat MDR TB with second line treatment
• address issues of comorbidities of TB and HIV, and also with weak health systems in certain countries

Question 11

What is the issue with the WHO TB strategies?

Answer 11

they are largely biomedical and do not target reducing the underlying vulnerability of those contracting TB in the first place

Question 12

What are the proximate risk factors for TB?

Answer 12

• exposure to infectious droplets
• compromised host defence (HIV)
• malnutrition (undernutrition and obesity)
• indoor air pollution
• alcohol abuse
• other disease
• depression and stress

Question 13

How many countries contribute to the large part of the remaining global burden of TB?

Answer 13

80% accounted for by 22 countries

Question 14

What are the population attributable fractions for selected TB risk factors in the 22 countries comprising 80% of the current global burden of TB?

Answer 14

• malnutrition (27%)
• smoking (23%)
• HIV (19%)
• diabetes (6%)
• harmful alcohol use (13%)
• indoor air pollution (26%)

Question 15

What is the poverty-ill health cycle?

Answer 15

there is a cyclical relationship between the determinants of poverty and the determinants of disease status (ill-health)

Question 16

What are the 6 points of the WHO Stop TB strategy?

Answer 16

• pursue high-quality DOTS expansion and enhancement
• address TB-HIV, MDR-HIV< and the needs of poor and vulnerable populations
• contribute to health system strenthening based on pimary health care
• engage all care providers
• empower people with TB and communities through partnership
• enable and promote research