Activity 3: Research Article

Global health

Reducing child mortality

Respiratory infections

Kills 2 million infants and children each

year, usually from dehydration
Pneumonia kills ~2 million children each
year

Malaria
AIDS

GOAL 4: Reduce child mortality

Good

Average

Poor

Drop in the number of children dying of

preventable causes
BUT child mortality has increased in subSaharan Africa

In 1990 12.6 million children

died from preventable
causes
This number has been cut to
9 million
Interventions:

Status report: MDG 4

AIDS and malaria

American Journal of Clinical Nutrition,

2005

Posted on my website as Activity 3

article 2005
Activity 3: read the article and answer
the questions

MDG 4:
Reduce child mortality

Big 4 infectious diseases that

kill children <5 yrs old worldwide
Diarrhea

Title: Comparison of home-based

therapy with ready-to-use therapeutic
food with standard therapy in the
treatment of malnourished Malawian
children: a controlled, clinical
effectiveness trial.

Learn how to read research

articles critically

Vaccination campaigns
(measles, etc)
Expanding basic health
services

The 3 most important things

to protect childrens health:
1. Good nutrition
2. Good hygiene
3. Immunizations

When the mom is malnourished, her fetus doesnt

grow normally
Low birth weight
If the child is chronically underfed, s/he doesnt grow
normally
Stunting
A transient lack of food leads to extreme thinness but
relatively normal height for age
Wasting
Micronutrient deficiencies
Iron, iodine, vitamin A

Undernourished children

Reduced learning
capacity
Behavioral problems

Decreased resistance to
infection

Diarrhea and respiratory

infections (pneumonia)

Diarrhea and dehydration

d
ze
ali
tri
us
d
In

Increased risk dying in

infancy
Those who survive often
suffer lifelong physical and
mental disabilities

Poor nutrition Infection

Weakened immune
system
Increased
susceptibility to
infection

Loss of appetite
Vomiting
Diarrhea
Weight loss

What causes diarrhea?

Bacteria

Found in contaminated water

60-70% of child deaths due to diarrhea

Often caused by contact with food/water

contaminated with feces
Leads to dehydration
Death can occur within 24 hr

Every year, >20 million lowbirth weight babies are born

in developing countries

Vicious cycle of malnutrition

and illness

Diarrhea is common in developing

countries

Stunted growth, wasting

Poor motor development
Impaired mental
development

De
ve
lo
pi
ng

Maternal malnutrition
increases infant mortality
Infant mortality
(deaths/1000 births)

What happens when a child

doesnt get enough food?

An ameba

Ameba - cause amebic dysentery

cause typhoid, cholera, etc.

Found in contaminated milk and dairy

products, salads and poultry (Shigella
bacteria)
Found in food or water contaminated by
feces

Rotavirus family of viruses

Commonly infect children

Simple Rx:
Oral Rehydration Therapy

Cholera
Caused by a toxin secreted into the
intestine by the bacterium Vibrio
cholerae
Bacteria is transmitted by
contaminated water or food
Sx: Massive watery diarrhea

Loaded with bacteria

Spreads the infection

One of the most rapidly fatal illnesses

known

Dehydration

Rx: oral rehydration therapy

Cholera hospital in Dhaka

Preventing Diarrhea

ORT prevents 1 million deaths per year

Replace the fluid and salt lost through
diarrhea
Rehydration solution contains water,
salt and sugar
Add sugar - enhances transport of
salts across intestinal wall
Caveat: best to use clean (boiled) water
so dont re-infect the child

Waterborne diseases

Clean water
Good hygiene

One of greatest public health

breakthroughs of 20th century

Safe drinking water and

sanitation are key to public
health, yet

Wash your hands! After pooping, diaper

changes, before preparing meals and
feeding kids

Contaminated water

Preventing waterborne
diseases

Build basic infrastructure: Water

treatment and sanitation systems

Treat sewage before it enters the

waterways

Water purification

Sterilize all water used for drinking,

washing, or cooking by boiling or
chlorination

1/3 of worlds population lacks

modern sanitation
1/6 of population lacks access to
safe drinking water
Leading cause of disease and
death
Single largest killer of infants
Principal cause of illness in adults

Not a small problem

Over 2 billion people (1/3 of the worlds

population) still lack modern sanitation
and hygiene needed to protect their
environment from human fecal
contamination

Complex challenges for

developing nations

Contaminated water
Uncollected garbage
Untreated sewage
Other disease vectors

Respiratory infections/
pneumonia

rodents (plague), mosquitoes (malaria, dengue

fever), flies, cockroaches,
Parasites: tapeworms, hookworms, etc.

mosquito nets and mosquito repellant

mosquito control (pesticides)

Caused by a virus

Young, malnourished children esp

vulnerable
In developing nations, a child has a
5-15% chance of dying from measles
Many survivors suffer serious
complications

Blindness, loss of hearing, nerve damage

No vaccine is availableyet

Vaccination

The worlds most contagious disease

Preventing Measles

an infectious disease caused by variety

of pathogens: bacteria, viruses,
parasites or fungi
Causes severe inflammation of lungs,
difficulty in breathing

Infectious disease: Measles

Malaria kills more than 3000

children under the age of 5 each
year
The majority of the cases occur in
Africa, where poverty is the
biggest problem facing this
epidemic
Prevention

Two billion people use open

fires as their primary
cooking method.

Contaminated food due to no refrigeration

Half the worlds people use dung, wood,

or coal for cooking and heating
Poor ventilation of smoke (no chimney)

Pneumonia

Infectious disease: Malaria

Indoor air pollution is a major

contributing factor

Vaccine costs 26 cents per dose but has yet to

reach many of the worlds poorest countries.
Vaccine has not reached everyone in Africa, South
Asia

Vaccination: if >90% coverage, the population

will achieve herd immunity

Immunization levels high enough so that minority

not immunized will still be protected.

Importance of immunizations

Measles vaccination program in Latin

American and Caribbean
Strategy of catch up, keep up and follow up

Catch up campaign to achieve 90% vaccination

coverage
Maintenance to keep up to 80% coverage
Regular follow up campaigns every 3-4 yrs

Dramatic drop in measles cases

250,000 in 1990
537 in 2001

What is a vaccine?

Strategies for improving

child survival

Purpose: get the immune system

ready to fight without exposing
anyone to active germs
Whats in that syringe?
Dead or weakened viruses
Inactivated toxins
Part of a virus

Boost the immune system so

that it produces antibodies to the
pathogen

Interventions that improve

health and nutrition

Promoting breast feeding

Educating moms about feeding at weaning
Micronutrient supplements

Vitamin A and zinc supplements for kids

Could reduce deaths by about 10%

Calcium, iron & folate supplements during pregnancy

Breastfeeding
Global recommendations

prevent 1/4 of all maternal deaths

Reduce the burden of disease

Promote hand washing

Reduce malaria (bed nets)

Breast feeding - advantages

Optimal nutrients for

healthy growth
Contains antibodies that
protect against disease
Sanitary
Always ready
Inexpensive
May delay subsequent
pregnancies

Educate new moms about

the benefits of breast milk
Encourage mothers to
breastfeed exclusively for
first 6 months
Continue breastfeeding
with complementary food
until the child is at least 2

Breastfeeding Setbacks

The number of infants exclusively breastfed

to 4 months has dropped to ~50%
Aggressive promotion of infant formula to
new mothers
More women working outside the home

What if the mother is HIVpositive?

A complicated decision

Challenges

The HIV virus is transmitted through breast milk

Need to educate HIV-positive moms

Shortened duration of breast feeding is an option
esp. in areas that lack clean water

Implementing successful
programs

Study: Infants of HIV+ moms breast fed for the first 3mo have same risk of contacting HIV as infants fed
formula

Reaching those in need

HIV/AIDS
TB
Malaria

Women
Young children (esp under 2 yrs)
The poor

Top 6 killer infectious

diseases worldwide

Deadliest diseases for adults

Promoting exclusive breast feeding

for the 1st 6 months
Micronutrient supplementation

Disease
Estimated # of deaths
1. Respiratory infections
3.9 million
2. HIV/AIDS

2.9 million

3. Diarrhea

2.0 million

4. Tuberculosis

1.6 million

5. Malaria

1.1 million

6. Measles

0.7 million
WHO 2002

Tuberculosis (TB)

Caused by the bacterium Mtb

A contagious, airborne disease

Sx: severe cough, chest pain,

coughing up blood

Latent

Transmitted thru coughing,

sneezing, talking
A person with active TB infects 1020 others, often family members and
caretakers

TB usually attacks the lungs and

destroys lung tissue

Infection with Mtb

The immune system sequesters the bacteria and

prevents them from multiplying
May persist for years without making its host ill
90% of people infected with Mtb never develop
active TB disease

Active TB

Develops in people with weak immune systems

Bacteria multiply rapidly and attack the organs,
esp the lungs

TB

Treating TB

98% of new infections occur in the developing

world
Rising number of people in industrialized
nations are contracting TB

their immune systems are compromised by AIDS,

immunosuppressive drugs, substance abuse
Global transmission by jet travel

Leading cause of death among people with

HIV/AIDS

Antibiotic resistance is a
growing problem

Multidrug resistant TB
(MDR-TB)

Many patients stop taking meds when they begin to feel well
Inconsistent use of antibiotics give the bacteria time to evolve
into a drug-resistant form

Challenges in TB treatment

20% of TB cases are resistant to standard treatments

Multidrug-resistant TB (MDR-TB)
Extensively drug-resistant TB (XDR-TB)

Drugs that are easier to administer and cheaper

Vaccine to prevent TB infection in the 1st place
Mtb genome was sequenced in 1998

new insights into how the bacterium infects humans

Gates Foundation: $$ to develop new drugs and vaccines

MDR TB occurs when the Mtb

strain is resistant to the most
powerful first-line drugs.
To cure MDR TB, a combination of
second-line drugs is used
These drugs have more side
effects, the treatment lasts much
longer, and the cost may be up to
100 times more than first-line
therapy

Malaria

Desperate need for better drugs and vaccines

Difficult, expensive,
requires long courses of
multiple antibiotics
Drug-sensitive TB is
usually cured with a
combination of first-line
drugs taken for 6 to 9
months.
These drugs were
developed more than
40 years ago.

Caused by a tiny parasitic

protozoa, Plasmodium
Vector: female Anopheles
mosquito
Parasites transmitted from
one human to another by the
bite of this mosquito

Malaria

World Malaria report 2010

populations that face the greatest risk

Endemic to tropical
areas in Africa, Asia
and South America
Each year 250-500
million people are
infected
Vast majority of
victims are children
under 5

Malaria

Starts in the salivary glands of

mosquitoes
Moves to the human
bloodstream
Migrates to the liver where it
reproduces, forming thousands
of merozoites.
These invade RBCs and
multiply, causing the cells to
rupture and infect more RBCs.
Finally moves back into the
body of a new mosquito

The parasite enters the

human body in one of
three ways

The bite of infected

Anopheles mosquitoes
Congenitally (from a
mother to her fetus)
Transfusions with
infected blood

Sx: severe fever and flu-like

illness, chills, anemia
Sx caused by

RBC bursting after

malaria infection

Malariatransmission

Bed nets in sub-Saharan Africa

Spray houses with insecticide
Rapid diagnostic tests
Combination therapy

Malaria symptoms

the parasite has a complex life cycle

Deaths from malaria dropped 21% over past

9 yrs
Vast majority of victims: children under 5
strategies to fight malaria

the massive release of

merozoites into the
bloodstream
Anemia results from the
destruction of RBCs
Jaundice (yellow-colored skin
and eyes) caused by large
amounts of hemoglobin
released into the blood after
RBCs rupture

Malaria - interventions

Insecticides to kill mosquitoes

DDT used indoors to kill mosquitoes w/o harming environment

Mosquito nets for beds (Anopheles is a night feeder),

insect repellants
Anti-malarial drugs
must be taken continuously to reduce infection
Too expensive for people living in endemic areas

Plasmodium parasite is becoming resistant to older

medications
No vaccine for malaria - yet

Why isnt there a vaccine for

malaria?
Developing a malaria vaccine is one of the most
important research projects in public health, but ...
The malaria parasite is a complex organism with a
complicated life cycle.

It is constantly changing so developing a vaccine is

difficult.

Scientists dont understand the immune responses

that protect humans against malaria.

Promising new vaccine

strategies

A stronger traditional vaccine

A vaccine from weakened parasites

Chemicals added to boost the immune response

In late stage clinical trials, but only 50% effective
Irradiate parasites in the mosquitos gut, then inject pieces of
weakened parasite into humans to trigger immune response

Develop a vaccine for mosquitoes

To break the cycle of transmission

Malaria vaccine 3:22

http://www.pbs.org/newshour/video/module_byid.html?s=news01pb88

Genetic disorders:

Socio-economic effects

Malaria is associated with poverty

Malaria hinders economic development

but is also a cause of poverty

impact includes costs of health care
working days lost due to sickness
days lost in education
decreased productivity

PBS - Malaria in Tanzania 3:55

Sickle-cell Anemia

A recessive genetic disorder

Caused by a mutated gene that
produces a defective version of
hemoglobin
The hemoglobin sticks together
and produces a stiff red blood
cell with a sickle-shape
Sickled RBCs are destroyed
rapidly, leading to anemia

http://www.pbs.org/newshour/video/search_results.html?q=malaria&submit=Search

Sickle cell trait and malaria

People (and particularly

children) infected with
malaria parasite are more
likely to survive the acute
illness if they have sickle cell
trait.
The sickling of the cells halts
infestation of the malaria
plasmodium

Neglected Tropical Diseases

Neglected Tropical Diseases

Neglected Tropical Diseases

About 1 billion people

are affected by one or
more neglected tropical
diseases (NTDs)
Diseases of poverty

Most are parasitic or bacterial

infections

These diseases are

named "neglected"
because they persist in
the poorest and the most
marginalized populations.

Parasitic worms that live in the intestine

Rob children of nutrients, stunting their
growth

Dont often kill, but they debilitate by

causing severe anemia,
malnutrition, delays in cognitive
development
They help perpetuate poverty

Filtering water

Children have trouble learning in school

Adults workers are less productive
NTDs 3:21
http://www.pbs.org/newshour/video/module_byid.html?s=news01pb88

Neglected Tropical Diseases

The 3 most common NTDs

are caused by parasitic
worms that live in the
intestines

Ascaris roundworm

Large common roundworm,

Ascaris

Treating NTDs

Afflicts 800 million people

Whipworm 600 million

Hookworms 600 million

The good news: NTDs can

be treated simply and
cheaply
However WHO estimates that
treatment programs reach
less than 10% of people
suffering from NTDs
Strategies: fold in with other
interventions

Bed nets
Immunizations
Nutritional supplements such as
vitamin A