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Global Health Challenges Social Analysis 76: Lecture 20. Attributable Disease Burden of 20 Risk Factors. Iron Deficiency Anaemia Vitamin A Deficiency Zinc Deficiency Review of Diseases, Injuries and Risk Factors. Perinatal mortality: OR’s for each 1 g/dL Hb increase. Summary OR: 0.72.
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Global Health ChallengesSocial Analysis 76: Lecture 20 Harvard University Initiative for Global Health
Attributable Disease Burden of 20 Risk Factors Harvard University Initiative for Global Health
Iron Deficiency Anaemia Vitamin A Deficiency Zinc Deficiency Review of Diseases, Injuries and Risk Factors Harvard University Initiative for Global Health
Perinatal mortality: OR’s for each 1 g/dL Hb increase Summary OR: 0.72 From Stoltzfus et al, 2005 Harvard University Initiative for Global Health
Prevalence of anaemia among children 0 – 4 years old by CRA region Prevalence (%) 5 - 16 16 - 28 28 - 39 39 - 51 51 - 63 From Stoltzfus et al, 2005 Harvard University Initiative for Global Health
Effect of Iron/Folic Acid (IFA) Supplementation on Adverse Events in Children 1-48 Months Old • Nepal (19,299 child-years IFA, 9,799 placebo) – no effect on deaths1 • Zanzibar (16,950 child-years IFA, 8,574 placebo) – 12% increase in all hospitalizations/deaths, 16% in malaria, 33% in pneumonia2 1Tielsch et al, submitted 2Sazawal et al, submitted Harvard University Initiative for Global Health
Effect of Iron/Folic Acid Supplementation on Adverse Events (Hospitalization and Death) in Children in Zanzibar (following 16,950 child-years in supplemented and 8,574 in placebo groups) From Sazawal et al, submitted Harvard University Initiative for Global Health
Iron Deficiency Anaemia Vitamin A Deficiency Zinc Deficiency Review of Diseases, Injuries and Risk Factors Harvard University Initiative for Global Health
Effects of Vitamin A on Infectious Disease Morbidity • Possible effect on diarrhea severity, but not all morbidity • No effect on pneumonia morbidity • Effect on measles complications Harvard University Initiative for Global Health
Prevalence of vitamin A deficiency among children 0-4 years old by CRA regions Prevalence (%) 0 - 1 0 1 0 - 1 9 1 9 - 2 9 2 9 - 3 8 3 8 - 4 8 From West et al., 2002 Harvard University Initiative for Global Health
Major Trials of Vitamin A to Prevent Mortality Over 165,000 children participated in these 8 trials Harvard University Initiative for Global Health
Vitamin A Implementation • Widespread implementation of Vitamin A supplementation often linked to immunization programs. • Is coverage sustainable outside of immunization campaigns? Harvard University Initiative for Global Health
Iron Deficiency Anaemia Vitamin A Deficiency Zinc Deficiency Review of Diseases, Injuries and Risk Factors Harvard University Initiative for Global Health
Global Zinc Deficiency 0 – 14.9 % Deficient 15 – 24.9 % Deficient > 25 % Deficient From Brown et al, 2004 Harvard University Initiative for Global Health
Preventive Effect of Zinc Supplementation on Diarrheal Prevalence in Continuous Supplementation Trials Harvard University Initiative for Global Health
India(S) Peru Vietnam Jamaica India(B) Pooled 0 0.5 1 1.5 2 2.5 3 Relative Risk and 95% CI Preventive Effect of Zinc Supplementation on Pneumonia Incidence in Continuous Supplementation Trials Harvard University Initiative for Global Health
Effect of Zinc Supplementation on Malaria in Children 1Bates et al, Brit J Nutr, 1993 2Shankar et al, Am J Trop Med Hyg, 2000 Harvard University Initiative for Global Health
Trial in Bangladesh Evaluating the Preventive Effect of Weekly Zinc Supplementation • 1-23 mo. old children, weekly zinc (70 mg) • 6% less diarrhea, 17% less pneumonia, 49% less severe pneumonia and 42% less otitis media, • 85% less mortality From Brooks et al, Lancet 2005 Harvard University Initiative for Global Health
Efficacy Trials of Zinc Supplementation on Child Mortality • Zanzibar and Nepal • Children 1-35 mo. old (>60,000 child-years) • Randomized, controlled trials • Daily 10 mg zinc (5 mg if <12 mo old) • All children receive vitamin A • Trial to be completed in Zanzibar in September 2005 and Nepal in January 2006 Harvard University Initiative for Global Health
Iron Deficiency Anaemia Vitamin A Deficiency Zinc Deficiency Review of Diseases, Injuries and Risk Factors Harvard University Initiative for Global Health
Leading Causes of the Global Burden of Disease 2002 DALYs % • Perinatal conditions 6.5 • Lower respiratory infections 6.1 • HIV/AIDS 5.7 • Depression 4.5 • Diarrhoeal diseases 4.2 • Ischaemic heart disease 3.9 • Cerebrovascular disease 3.3 • Malaria 3.1 • Road traffic accidents 2.6 • Tuberculosis 2.3 Source: World Health Report, 2004 Harvard University Initiative for Global Health
Attributable Disease Burden of 20 Risk Factors Harvard University Initiative for Global Health
What is Missing? What diseases, injuries or risk factors are missing from these lists? Harvard University Initiative for Global Health