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Control of diseases and economic development 2
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Control of diseases and economic development 2

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  • 1. STRATEGIES FOR CONTROL OF DISEASES PRESENTATION BY DR F D E MTANGO
  • 2. WHAT DO WE MEAN BY CONTROL OF A DISEASE?
    • CONTROL MEANS REDUCING THE DISEASE OR PROBLEM TO A LEVEL WHERE IT IS NO LONGER A PUBLIC HEALTH PROBLEM
    • CONTROL MUST MEET THE DEMANDS OF THE POPULATION, BE NATIONWIDE , PERMANENT , AFFORDABLE AND ACCEPTIBLE. IT IS SERIOUS, OR AS SERIOUS AS A MILITARY OPERATION
  • 3. MEANING OF CONTROL OF A DISEASE, CONT…
    • CONTROL IS NOT ONLY CONCERNED WITH ELIMINATION OF THE AGENT BUT ALSO MODIFICATION OF ENVIRONMENMENT , WHICH CONSTITUTE THE ROOT CAUSES OF DISEASE
    • CONTROL OF DISEASES SHOULD GENERATE WEALTH AND ABATE HUMAN MISERY AND POVERTY AND NOT JUST DO AWAY WITH ILLNESS
  • 4. MEANING OF CONTROL OF A DISEASE CONT….
    • DISEASE CONTROL IS AN ACTIVITY BASED ON SCIENTIFIC EVIDENCE, OBTAINED FROM SCIENTIFIC RESEARCH, AND CARRIED OUT BOTH AS A SCIENTIFIC AND MILITARY PROJECT
    • SCIENTIFIC EVIDENCE MEANS STATISTICAL OR MATHEMATICAL PROOF. A MILITARY PROJECTS HAS A VICTORY TARGET IN A GIVEN TIME AND RESOURCES
  • 5. WHAT IS A PUBLIC HEALTH PROBLEM?
    • A PUBLIC HEALTH PROBLEM IS A POLITICAL DECISION AND INTERPRETATION. THUS DIFFERENT COUNTRIES MAY HAVE DIFFERENT PUBLIC HEALTH PROBLEMS OR DIFFERENT PRIORITY DISEASES FOR CONTROL .
    • THE WHO , HOWEVER, DETERMINES PRIORITY DISEASES FOR GLOBAL CONTROL PROGRAMMES
  • 6. STAGES OR PHASES OF A CONTROL PROGRAMME:
    • PREPARATORY PHASE
    • ATTACK PHASE
    • CONSOLIDATION PHASE
    • MAINTANANCE PHASE
    • SURVEILANCE PHASE
    • NB: MONITORING AND EVALUATION IS AN ONGOING ACTIVITY THROUGHOUT THE CONTROL PROGRAMME
  • 7. ATTACK PHASE vs CONSOLIDATION PHASE
    • ATTACK PHASE IS THE BREAKING GROUND PERIOD UNTIL THE ENEMY STARTS TO RETREAT OR THE PROBLEM BEGIN TO DEMINISH
    • CONSOLIDATION PHASE IS THE PHASE OF FULL SCALE OPERATION , EXPANSION TO COVER THE WHOLE AREA AND INCREASING EFFICIENCE, SO THAT THE DISEASE INCIDENCE DROPS DOWN FASTER AND FASTER WITH TIME
  • 8. IMPORTANCE OF THE MAINTANANCE PHASE
    • India had serious malaria control program since independence
    • Indian control program was initially designated as National Malaria eradication program and this was as follows:
    • Attack phase 1958 to 1961
    • Consolidation phase 1961 TO 1964 (malaria incidence had dropped down to nearly zero by 1964
    • Maintenance phase 1965 to 1967
  • 9. Resurgence of malaria after eradication in India
    • From 1965 malaria began to rise again and by 1976 malaria incidence had come to 6,500,000 cases in India. The Indian Government was made to decide that malaria eradication was not feasible in the near future and instead a modifiable plan of operations was devised (MPO), which was in essence a malaria control programme. This led to reduction of cases from 6,500,000 to 2,000,000 per year, and has remained so until today.
  • 10. SOME REASONS FOR RESURGENCE:
    • Short supply of and late arrival of DDT
    • Low quality of health services
    • Lack of adequate maintenance phase- this phase was handed over to state governments with less resources
    • Inadequate transport
    • Inadequate laboratory services
    • Low morale of staff and drastic retrenchment of staff on entrance into maintenance phase.
    • The fact that India realized these short comings and corrected them they are an ideal for us to copy regarding control programmes
  • 11. ELIMINATION
    • ELIMINATION MEANS ERADICATION OF DISEASE FROM A LARGE GEOGRAPHICAL AREA, E.G MEASLES IS CURRENTLY IN THE PROCESS OF BEING ELIMINATED IN THE AMERICAS .
  • 12. ERADICATION
    • ERADICATION MEANS COMPLETE OR PERMANENT EXTERMINATION OF AN INFECTIOUS AGENT SO THAT THE DISEASE WILL NEVER OCCUR AGAIN IN THE WORLD. ONLY ONE DISEASE HAS BEEN ERADICATED SO FAR AND IT IS SMALLPOX. HOWEVER, DISEASES WHICH ARE POSSIBLE AND IN THE PROCESS FOR ERADICATION INCLUDE MEASLES, POLIO, DIPHTERIA, AND GUINEA WORM
  • 13. DIFFERENCE BETWEEN GENERAL AND SPECIFIC CONTROL STRATEGIES
    • GENERAL CONTROL STRATEGIES ARE THOSE APPLICABLE TO SEVERAL DISEASES, EG. BREAKING THE WEAKEST POINT IN THE CHAIN OF CAUSATION. ANOTHER EXAMPLE IS MOBILIZATION OF COMMUNITY FOR COMMUNITY PARTICIPATION
    • SPECIFIC CONTROL STRATEGIES ARE MEASURES APPLICABLE TO A SPECIFIC DISEASE, EG. CONTROLING OR ELIMINATING THE RESERVOIR FOR RABIES, ISOLATION OR QUARANTINE FOR CHOLERA
  • 14. Types of epidemicity
    • EXOTIC DISEASE
    • SPORADIC DISEASE
    • EPIDEMIC DISEASE
    • ENDEMIC DISEASE
    • HYPERENDEMIC DISEASE
    • HOLOENDEMIC DISEASE
  • 15. EXOTIC DISEASE
    • OCCURRENCE OF A DISEASE IN A COUNTRY WHERE IT HAS BEEN ELIMINATED, AND THUS ONLY ONE CASE OCCUR AND NO MORE
  • 16. SPORADIC DISEASE
    • ONLY A FEW CASES OF DISEASE OCCUR SCARTERED IN TIME AND SPACE
  • 17. EPIDEMIC DISEASE
    • OCCURRENCE OF A DISEASE IN A FREQUENCY WELL AND ABOVE THE EXPECTED
  • 18. ENDEMIC DISEASE
  • 19. HYPERENDEMIC DISEASE
  • 20. HOLOENDEMIC DISEASE
  • 21. CONTROL STRATEGIES
    • GENERAL CONTROL MEASURES :
    • IMMUNIZATION
    • HEALTH EDUCATION,
    • HEALTH PROMOTIVE MEASURES, E.G. IMPROVING THE ENVIRONMENT, THE ECONOMY,
    • GOOD HOUSING,
    • SANITATION, WATER, SEWAGE DISPOSAL FACILITIES, REFUSE DISPOSAL,
    • DRAINAGE, AND VECTOR CONTROL
  • 22. CONTROL STRATEGIES CONT…
    • SPECIAL FACILITIES, E.G. OFFICERS, ISOLATION HOSPITALS , FOR TACKLING EPIDEMICS SHOULD BE DESIGNATED
    • PROPER HEALTH ADMINISTRATION OF WELL DEFINED AREAS TO ALLOW A MORE ACCURATE MONITORING OF THE HEALTH STATUS
    • SETTING UP OR IMPROVING PUBLIC HEALTH LABORATORIES FOR CORRECT AND PROMPT DIAGNOSIS OF DISEASES OR TRACING UP CONTACTS AND CARRIERS
  • 23. CONTROL STRATEGIES CONT…
    • DISASTER PREPAREDNESS , E.G. FOR TACKLING EPIDEMICS OF DANGEROUS DISEASES , SUCH AS EBOLA AND LASSA FEVERS
    • INTERNATIONAL HEALTH OR AWARENESS OF POSSIBLE IMPORTATION OF DISEASES THROUGH LARGE INTERNATIONAL FARES, SPORTS MEETINGS AND HAJJ
  • 24. CONTROL STRATEGIES CONT..
    • CASE MANAGEMENT:
    • FOR CASES : ISOLATION, DISINFECTION, QUARANTINE, CONTACT TRACING AND TREATMENT
    • FOR CONTACTS: SCREEN AND DIAGNOSE AS FOR CASES, OBTAIN INFORMATION ABOUT MOVEMENTS, IMMUNIZE IF FREE FROM INCUBATION PERIOD, INVESTIGATE SOURCE OF INFECTION, IDENTIFY AND TREAT SECONDARY CASES, INVESTIGATE SECONDARY CONTACT
    • FOR CARRIERS : INCLUDE LAB DIAGNOSIS, EXCLUDE CARIERS FROM CERTAIN JOBS,EG FOOD HANDLING, TEACHERS, REGISTER CARRIERS WITH LOCAL AND STATE AUTHORITIES
  • 25. Economic development and health
    • ECONOMIC DEVELOPMENT IS MEANT BY WEALTH IN ALL ITS FORMS. HOWEVER WEALTH IS EASILY MEASURED BY AVAILABILITY AND USED OF MONEY AND SELLABLE POSSESSIONS, SUCH AS LAND , LIVESTOCK AND HOUSING. INCOME PER CAPITA IS A GOOD MEASURE OF WEALTH OF COUNTRIES AND DEVELOPMENT IN GENERAL
    • TANZANIA IS ONE OF THE POOREST COUNTRIES AS MEASURED BY INCOME PER CAPITA, HAVING AN ANNUAL INCOME PER CAPITA OF LESS THAN 500 USD
  • 26. DISEASES OF POVERTY LET US BRAIN STORM
    • DIARRHEAL DISEASES, DUE TO POOR ENV. SANIT.
    • TRACHOMA
    • TUBERCULOSIS
    • SCABIES
    • INTESTINAL HELMINTHS
  • 27. DISEASES OF AFLUENCE, LET US BRAIN STORM
    • OBESITY, WHY? HEART DISEASES (ATHEROSCLOEROTIC VASCULAR DISEASES). BUT RHEUMATIC HEART DISEASE- THIS IS A DISEASE OF POVERTY.
  • 28. HEALTH BY CHOICE OR BY CHANCE’’,
    • HEART DISEASE BEFORE 80 IS OUR FAULT NOT GOD’S FAULT OR NATURE’S WILL ” -Paul Dudley White, M.D.
    • HEALTH BY CHOICE NOT BY CHANCE’’, Ludington and Diehl, 2002
    • “ MUST I IMPRISON ALL TANZANIANS’’, Julius Kambarage Nyerere, Former President of Tanzania
  • 29. AGE STANDARDIZED DEATH RATE DUE TO CORONARY HEART DISEASE PER 100,000 IN VARIOUS INDUSTRILIZED COUNTRIES IN MALES AND FEMALES
  • 30. MUST I IMPRISON ALL TANZANIANS?
    • Despite sub-human diets and torture, survivors of the holocaust (the killing of the Jews by Adolf Hitler, during World War II) were surprisingly free of atherosclerosis. It was the first indication – later conformed by angiographic examinations of American prisoners of war in Vietnam, that the process of atherosclerosis is reversible. Those held longest in captivity had the cleanest arteries. Ludington & Diehl, 2002
  • 31. AGE STANDARDIZED DEATH RATE DUE TO CORONARY HEART DISEASE PER 100,000 IN VARIOUS INDUSTRILIZED COUNTRIES IN MALES AND FEMALES COUNTRY YEAR TOTAL MALE FEMALE SCOTLAND 1983 192 284 124 FINLAND 1980 177 284 102 SWEDEN 1982 158 232 98 AUSTRALIA 1981 156 224 100 ENGWALES 1982 155 231 95 USA 1980 155 220 104 DENMARK 1982 153 221 97 CANADA 1982 145 205 95 ITALY 1980 80 114 52 FRANCE 1981 47 72 28 JAPAN 1982 30 39 22
  • 32. AGE STANDARDIZED DEATH RATE DUE TO CORONARY HEART DISEASE PER 100,000 IN VARIOUS INDUSTRILIZED COUNTRIES IN MALES AND FEMALES COUNTRY YEAR TOTAL MALE FEMALE SCOTLAND 1983 192 284 124 FINLAND 1980 177 284 102 SWEDEN 1982 158 232 98 AUSTRALIA 1981 156 224 100 ENGWALES 1982 155 231 95 USA 1980 155 220 104 DENMARK 1982 153 221 97 CANADA 1982 145 205 95 ITALY 1980 80 114 52 FRANCE 1981 47 72 28 JAPAN 1982 30 39 22
  • 33.