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BIOE 301 Lecture Two: Health Problems in the Developed and Developing World: Ages 0-4

BIOE 301 Lecture Two: Health Problems in the Developed and Developing World: Ages 0-4. Louise Organ 1.11.07. Review of Lecture One. Course goals Four main questions we aim to address Technology assessment Introduction to world health Health data and uses. World Health Organization: WHO.

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BIOE 301 Lecture Two: Health Problems in the Developed and Developing World: Ages 0-4

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  1. BIOE 301 Lecture Two:Health Problems in the Developed and Developing World: Ages 0-4 Louise Organ 1.11.07

  2. Review of Lecture One • Course goals • Four main questions we aim to address • Technology assessment • Introduction to world health • Health data and uses

  3. World Health Organization: WHO • Established by charter of the UN after World War II • Headquartered in Geneva • Mission: • “Attainment by all peoples of the highest possible level of health” • Website: • http://www.who.int/en/

  4. Functions of the WHO • Services to governments: • Epidemiologic intelligence • International standardization of vaccines • Reports of expert committees • Data on world health problems • Member countries must provide certain info in regular reports • Disease outbreaks • Health of population • Steps to improve health

  5. Lecture Two • Health problems in developed and developing world: ages 0-4 • Unit 1-What are the major health problems worldwide? • Differences between developed and developing word • Understand disease/condition causes, treatments, and prevention

  6. Developed Countries Developing Countries Group 1 = communicable diseases, maternal/perinatal conditions, malnutrition Group 2 = Non-communicable diseases (cardiovascular, cancer, mental disorders) Group 3 = Injuries World Mortality Rates (2002)

  7. Infant and Child Mortality • 8 UN Millennium Development Goals (MGDs) • Goal 4: Reduce Child Mortality • Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate • WHO World Health Report 2005: Make Every Mother and Child Count • Almost 11 million children under five will die in 2005 from causes that are largely preventable • 4 million babies who will not survive the first month of life

  8. WHO 2005 World Health Report Causes of Child Mortality

  9. Causes of Child Mortality by Region WHO 2005 World Health Report

  10. Leading causes of mortality: ages 0-4 • Developing world • Perinatal conditions • Lower respiratory infections • Diarrheal diseases • Malaria • Developed world • Perinatal conditions • Congenital anomalies • Lower respiratory infections • Unintentional injuries

  11. Perinatal Conditions • Period from 22 weeks of pregnancy through the first week of life • 2.5 million children die from perinatal conditions • > 500,000 women die as a consequence of pregnancy and childbirth • Leading cause of death for women of childbearing age in developing countries

  12. Perinatal Conditions • 3.3 million stillborn infants per year • Likely underestimates as vital registration rates and practices vary • Countries with the highest mortality rates tend to also have the lowest rates of vital registration

  13. Common Perinatal Conditions • Premature delivery • Low birth weight • Birth asphyxia • Entangled umbilical cord • Breech birth

  14. Common Perinatal Conditions • Birth trauma • Mechanical forces encountered during decent through the pelvic region • DALY • Infections • Umbilical cord • Non-sterile instruments • Organisms in the maternal genital tract • PATH kit • http://www.path.org/

  15. World Health Report: 1995 vs. 2005

  16. 37% Mortality Due to Neonatal Causes

  17. Challenges to Reducing Perinatal Conditions • Lack of skilled birth attendants

  18. Challenges to Reducing Perinatal Conditions • No adequate way to predetermine difficult births • Cultural isolation • “Birth” may not be celebrated until after perinatal period is over • Vital registration rates • Isolation may be positive • Delaying medical care can be negative

  19. Lower Respiratory Infections • #2 in developing world & #3 in developed • 1 million children per year • Pneumonia • Lung infections • Fever, cough, chest pain, weakness • Until 1936 pneumonia was the leading cause of death in the US

  20. Causes of Pneumonia • A group of infections • Viruses, bacteria, and fungi • 50% bacterial • Streptococcus pneumoniae, Haemophilus influenzae, Staphlococcus aureus, and pertussis (whooping cough) • 50% viral • SARS • Influenza • Measles • Coinfection is an increasing concern

  21. Pneumonia: Physiopathology • Bacteria or virus invades lungs • Immune response causes fluid and pus • Filled alveoli have limited gas exchange

  22. Etiology affects treatment Chest X-rays Blood tests Examine sputum/secretions Direct Fluorescence Assay (DFA) Collect sample and separate cells Fix cells onto slide and immerse in alcohol Apply solution containing antibodies Apply second antibody coupled to fluorescent dye View with fluorescent microscope Identifying Pneumonia

  23. Pneumonia: Treatment • Viral • Usually resolves on its own • Severe cases: oxygen and antiviral drugs • Bacterial • Treat with antibiotics • Because the etiologies are hard to detect WHO recommends antibiotics for all children with pneumonia • Proven to reduce mortality in developing world • May also foster the development of resistant strains

  24. Diarrheal Disease • #3 in developing world • Gastrointestinal disorders characterized by frequent, watery stools • Bacterial infection • Escherichia coli • Vibrio cholerae • Viral infection • Rotavirus

  25. Spread by water or food contaminated with bacteria Often a result of inadequate sewage and water treatment Outbreaks were common, historically, and remain a concern Rwandan refugees Diarrheal Disease: Cholera

  26. Diarrheal Disease is often a result of unsafe water sources Access to Safe Water (2000)

  27. Diarrheal Disease • Normally, 98% of the water intake from food or liquid is reabsorbed by epithelial cells in the lower digestive tract • Diarrheal disease rapidly leads to extreme dehydration and death • The loss of body fluid leads to dangerously low blood pressure • 10% loss of volume is sufficient to cause death • Treatment must effectively and efficiently replace fluids

  28. Diarrheal Disease: Physiopathology • Epithelial cells line the entire GI tract • Different regions have varying specific mechanisms but all work to reabsorb osmotically active nutrients and salts • To maintain osmotic balance, water follows and is eventually reabsorbed into the blood vessels • Toxins produced by bacteria inhibit sodium uptake from the lumen and cause epithelial cells to secret chloride into the lumen • Double whammy!

  29. Oral Rehydration Therapy (ORT) • A simple, inexpensive mixture of water, salt, and sugar • 1 liter boiled water, 1 tsp. salt, 8 tsps. sugar • Developed in 1960s and responsible for a dramatic decrease in the mortality rates of diarrheal diseases

  30. Why Does ORT Work? • Giving sterile water or salt water alone is not sufficient • Discovery of a sodium reabsorption mechanism that is coupled to glucose transport • 1950s • Unaffected by cholera toxin • In 1960s shown to result in a net reabsorption of water into the bloodstream

  31. Oral Rehydration Therapy • 1975 WHO and UNICEF standard • 90 mM sodium • 20 mM potassium • 80 mM chloride • 30 mM bicarbonate • 111 mM glucose • Packet of ORT costs ~10 cents • ORT treats a symptom (dehydration) not the disease (or organism) • The volume of diarrhea usually remains unchanged

  32. Rarely used More expensive and painful IV therapy is far more common Even when ORT is sufficient and acceptable treatment Likely due to initial troubles with original formulations (50’s-60’s) Elevated sodium levels Inaccurate mixing ORT use in the US

  33. Diarrheal Disease in the US • Second leading cause of US pediatric emergency room visits • E. coli • Spinach outbreak in Sept.-Oct. 2006 • Taco Bell outbreak in Nov.-Dec. 2006 • Rotavirus • Causes ~30% of diarrheal disease deaths • Ubiquitous and highly contagious

  34. Rotavirus Vaccine • Almost every child will be infected with a rotavirus • 50,000 child hospitalizations annually • Vomiting also occurs, so ORT can be difficult although still effective • RotaShield was FDA approved in 1998 • 80-100% effective • 1 in 12,000 have severe complication • Vaccine was voluntarily withdrawn in 1999 • Ethical concerns • Complications vs. potential lives saved • Mortality disparity in developed vs. developing world

  35. #4 mortality rate of children under 5 in developing world Spread by Anopheles mosquitoes which carry a parasite that infects humans 300 million cases annually African children: 1.6-5.4 episodes/year 1 million under the age of 5 die each year Malaria CDC/ James Gathany

  36. Mosquito transfers sporozoites which infect and rupture liver cells releasing merozoites Invade RBCs and either repeat a similar cycle or form gametocytes Gametocytes are free in blood Ingested during bite Reproduce in mosquito to form new sporozoites Malaria: Physiopathology http://www.cdc.gov/malaria/biology/life_cycle.htm

  37. Infected RBC Ruptured RBC Gametocyte Malaria: Physiopathology • Blood stage is time of clinical manifestation and diagnosis • Burst RBCs result in anemia • Is particularly dangerous for mother and child • Malaria can be transmitted across the placenta US Public Health Image Library

  38. Malaria: Drug Treatments • Chloroquine, sulfadoxine-pyrimethamine, quinine • Relatively inexpensive • Cents/course • Malaria parasites now show resistance • Chloroquine resistance in Africa • New therapy development is slow • Non-synthetic • Expensive

  39. Malaria: Prevention • Insecticide treated nets • Cheap ~ $2 • Must be retreated, ~ 5 cents • Shown to reduce low birth weights by 25% • Proven to reduce mortality rate in young children by 20% • April 25, 2007 is Malaria Awareness Day

  40. Leading causes of mortality: ages 0-4 • Developing world • Perinatal conditions • Lower respiratory infections • Diarrheal diseases • Malaria • Developed world • Perinatal conditions • Congenital anomalies • Lower respiratory infections • Unintentional injuries

  41. Congenital Abnormalities • 2-3% of all children have birth defect • 400,000 deaths annually • As general health increases, congenital abnormalities rise as a cause of mortality • #2 in developed world

  42. Congenital Abnormalities: Causes • Can be roughly grouped into 3 categories • Maternal age is a risk-factor • Over 35 • More common in developed world

  43. Unintentional Injuries • Similarly, increased general health results in a higher percentage of injury fatalities • 15,000/year in developed and 273,000/year in developing (#9) • Drownings • Road traffic accidents

  44. MDG #4: Making progress? WHO World Health Report 2005: Make every mother and child count

  45. Reducing child mortality depends largely on every mother and every child having the right to access health care from pregnancy through childbirth, the neonatal period, and childhood MDG #4 : Making progress?

  46. How to Foster the Decline in Child Mortality? • Complicated with multiple factors involved • Nutrition • Maternal health • Both viral and bacterial causes for respiratory and diarrheal disease • Encourage medical care while discouraging overmedicating • Antibiotic resistance

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