A presentation on tuberculosis control efforts in Cuba vs. Haiti. Presented for my class Intensive Study of Public Health Services in Cuba, June 25, 2015.
The epidemiology of tuberculosis in Kenya, a high TB/HIV burden country (2000...Premier Publishers
Interest in the epidemiology of TB was triggered by the re-emergence of tuberculosis in the early 1990’s with the advent of HIV and falling economic status of many people which subjected them to poverty. The dual lethal combination of HIV and poverty triggered an unprecedented TB epidemic. In this study, we focused on the period 2000-2013 and all the notified data in Kenya was included. Data on estimates of TB incidence, prevalence and mortality was extracted from the WHO global Tuberculosis database. Data was analysed to produce trends for each of the years and descriptive statistics were calculated. The results showed that there was an average decline of 5% over the last 8 years with the highest decline being reported in the year 2012/13. TB continues to disproportionately affect the male gender with 58% being male and 42% being female. Kenya has made significant efforts to address the burden of HIV among TB patients with cotrimoxazole preventive therapy (CPT) uptake reaching 98% AND ART at 74% by the end of 2013. Kenya’s TB epidemic has evolved over time and it has been characterised by a period where there was increase in the TB cases reaching a peak in the year 2007 after which there was a decline which began to accelerate in the year 2011. The gains in the decline of TB could be attributed in part to the outcomes of integrating TB and HIV services and these gains should be sustained. What is equally notable is the clear epidemiologic shift in age indicating reduced transmission in the younger age groups.
Emerging and reemerging infectious diseasesarijitkundu88
Various emerging and reemerging diseases. Factors contributing to the emergence of infectious diseases. Antibiotic resistance. The global response to control them. Laboratories network in surveillance.
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
All you need to know about Tuberculosis (TB)GLRA India
The core activity of GLRA is to cure people affected by leprosy, tuberculosis and to address physical disabilities.
In this presentation, GLRA describes
WHAT WE NEED TO KNOW ABOUT TUBERCULOSIS?
Consider this scenario A cyber-attack occurred in a healthcare orAlleneMcclendon878
Consider this scenario: A cyber-attack occurred in a healthcare organization, resulting in significant data loss. You have been called as an information security management consultant to recommend an incident response plan for this incident and will need to present it to the executive board of the healthcare organization.
Develop a 10- to 12-slide multimedia-rich presentation of your recommended incident response plan to mitigate or reduce impact to the organization, and do the following:
· Define the incident response plan goal and scope for this cyber-attack.
· Analyze the impact and severity of the cyber-attack by applying a business impact analysis (BIA) to the organization, including mission performance, regulatory requirements, and compliance.
· Identify the communication requirements, including criteria for escalation and organization reporting and regulatory requirements.
· Explain the process for responding to this incident.
· Describe the relationship with other organization processes and methods, such as BCP/DR.
· Recommend prioritization, resource requirements, and any opportunity created by the event.
Use appropriate images and charts where applicable.
Include a slide with APA-formatted references.
Infectious disease in a highly connected world: Nurses’ role to prevent, detect, respond
Catherine M. Dentinger, Amy R. Kolwaite
“With Ebola back in the Democratic Republic of the Congo, this year’s World Health Assembly sees the threat of pandemic diseases and the fragility of global health security once again at the forefront of the global health leaders’ minds.”
71st World Health Assembly, May 21, 2018 (retrieved from www.devex.com/news/what-to-watch-at-this-year-s-world-health-assembly-92787)
Not long ago, infectious diseases were thought to be well controlled through hygiene measures, vaccines, and antimicrobial medications, but that perspective has shifted. In the past 35 years, we have experienced infectious disease outbreaks in which global spread of severe infections has occurred due to an increasingly interconnected world. Timely detection of and efficient response to these events is key to limiting their magnitude and duration; this requires sustained attention, international engagement and coordination, and reliable resources. Nurses, the largest sector of the global health care workforce, are integral to preventing, detecting, and responding to these infectious disease threats.
Context
“Vaccines and antibiotics have made many infectious diseases a thing of the past; we’ve come to expect that public health and modern science can conquer all microbes. But nature is a formidable adversary.”
Dr. Tom Frieden, Centers for Disease Control and Prevention (CDC), February 2016
By the 1960s, advances in public sanitation, immunizations, and antimicrobials led to large declines in morbidity and mortality from infectious diseases in some countries and toward what was thought to be their eventual elimination as a human health c ...
The epidemiology of tuberculosis in Kenya, a high TB/HIV burden country (2000...Premier Publishers
Interest in the epidemiology of TB was triggered by the re-emergence of tuberculosis in the early 1990’s with the advent of HIV and falling economic status of many people which subjected them to poverty. The dual lethal combination of HIV and poverty triggered an unprecedented TB epidemic. In this study, we focused on the period 2000-2013 and all the notified data in Kenya was included. Data on estimates of TB incidence, prevalence and mortality was extracted from the WHO global Tuberculosis database. Data was analysed to produce trends for each of the years and descriptive statistics were calculated. The results showed that there was an average decline of 5% over the last 8 years with the highest decline being reported in the year 2012/13. TB continues to disproportionately affect the male gender with 58% being male and 42% being female. Kenya has made significant efforts to address the burden of HIV among TB patients with cotrimoxazole preventive therapy (CPT) uptake reaching 98% AND ART at 74% by the end of 2013. Kenya’s TB epidemic has evolved over time and it has been characterised by a period where there was increase in the TB cases reaching a peak in the year 2007 after which there was a decline which began to accelerate in the year 2011. The gains in the decline of TB could be attributed in part to the outcomes of integrating TB and HIV services and these gains should be sustained. What is equally notable is the clear epidemiologic shift in age indicating reduced transmission in the younger age groups.
Emerging and reemerging infectious diseasesarijitkundu88
Various emerging and reemerging diseases. Factors contributing to the emergence of infectious diseases. Antibiotic resistance. The global response to control them. Laboratories network in surveillance.
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
All you need to know about Tuberculosis (TB)GLRA India
The core activity of GLRA is to cure people affected by leprosy, tuberculosis and to address physical disabilities.
In this presentation, GLRA describes
WHAT WE NEED TO KNOW ABOUT TUBERCULOSIS?
Consider this scenario A cyber-attack occurred in a healthcare orAlleneMcclendon878
Consider this scenario: A cyber-attack occurred in a healthcare organization, resulting in significant data loss. You have been called as an information security management consultant to recommend an incident response plan for this incident and will need to present it to the executive board of the healthcare organization.
Develop a 10- to 12-slide multimedia-rich presentation of your recommended incident response plan to mitigate or reduce impact to the organization, and do the following:
· Define the incident response plan goal and scope for this cyber-attack.
· Analyze the impact and severity of the cyber-attack by applying a business impact analysis (BIA) to the organization, including mission performance, regulatory requirements, and compliance.
· Identify the communication requirements, including criteria for escalation and organization reporting and regulatory requirements.
· Explain the process for responding to this incident.
· Describe the relationship with other organization processes and methods, such as BCP/DR.
· Recommend prioritization, resource requirements, and any opportunity created by the event.
Use appropriate images and charts where applicable.
Include a slide with APA-formatted references.
Infectious disease in a highly connected world: Nurses’ role to prevent, detect, respond
Catherine M. Dentinger, Amy R. Kolwaite
“With Ebola back in the Democratic Republic of the Congo, this year’s World Health Assembly sees the threat of pandemic diseases and the fragility of global health security once again at the forefront of the global health leaders’ minds.”
71st World Health Assembly, May 21, 2018 (retrieved from www.devex.com/news/what-to-watch-at-this-year-s-world-health-assembly-92787)
Not long ago, infectious diseases were thought to be well controlled through hygiene measures, vaccines, and antimicrobial medications, but that perspective has shifted. In the past 35 years, we have experienced infectious disease outbreaks in which global spread of severe infections has occurred due to an increasingly interconnected world. Timely detection of and efficient response to these events is key to limiting their magnitude and duration; this requires sustained attention, international engagement and coordination, and reliable resources. Nurses, the largest sector of the global health care workforce, are integral to preventing, detecting, and responding to these infectious disease threats.
Context
“Vaccines and antibiotics have made many infectious diseases a thing of the past; we’ve come to expect that public health and modern science can conquer all microbes. But nature is a formidable adversary.”
Dr. Tom Frieden, Centers for Disease Control and Prevention (CDC), February 2016
By the 1960s, advances in public sanitation, immunizations, and antimicrobials led to large declines in morbidity and mortality from infectious diseases in some countries and toward what was thought to be their eventual elimination as a human health c ...
Author: Dr Christa Maria Joel
Module: Principles of Infection and Disease Control
Supervisor: Dr William Mackay Gordie and Ms Fiona Hernandez
University of the West of Scotland
It is very important to pay attention to the double burden of the communicable and noncommunicable diseases in the Low and Middle Income Countries (LMIC). In this presentation we discuss the association between HIV and its treatment and Diabetes mellitus.
Today we stand at a vital threshold. Within our grasp is the opportunity to end 30 years of suffering and death due to HIV/AIDS. Individuals and communities around the world have been mobilized toward prevention, and existing treatment can prolong life for many years. While we celebrate these successes, we reject any modicum of complacency. Now is the time to double down and finish the job. The world is fighting AIDS today just as it had previously fought to eliminate smallpox. For centuries, smallpox was a feared scourge that killed nearly half of those infected and maimed those that survived. A worldwide campaign to end the disease began in earnest in the late 1960s and by 1980 smallpox was officially eradicated.
Planet Aid anticipates the day when AIDS, too, will be stopped. To this end, we have been helping mobilize communities around the globe to increase HIV/AIDS prevention and care. With this special issue of the Planet Aid Post, we focus on the battle ahead. We also extend a warm welcome to those joining us on the forefront of this work,
A Geographic Epidemiological Review of Viral Hepatitis Biosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Tuberculosis Control in Cuba and Haiti
1. Tuberculosis Control
in Cuba & Haiti
Kathryn Cicerchi, Colorado School of Public Health
June 25, 2015
Photo:one.org
2. Tuberculosis
Infectious disease caused by mycobacterium
tuberculosis
Most commonly attacks lungs
Can attack any part of the body, such as kidneys,
spine, brain
Can be fatal if not treated properly
Second greatest killer worldwide due to single infectious
agent
In 2013, 9 million people contracted active TB and 1.5
million died
Two types of infection:
Latent
Active
Sources: CDC, WHO 2015
3. Latent TB
1/3 of the world’s population is infected, though
most are not ill and cannot transmit TB
Walled off by healthy immune system
Many with latent TB never progress to active
disease
Those who do:
Become sick within days of infection
Can develop active TB years later when immune
system compromised (malnutrition, diabetes, HIV co-
infection)
Lifetime risk of progressing from latent TB to active
disease is 10% (WHO)
Sources: CDC, WHO 2015
4. Active Tuberculosis
Symptoms:
Coughing (sputum, blood)
Chest pains
Weakness
Weight loss
Fever
Night sweats
Spread person to person through droplets
Treatable with antibiotics
Risk factors: extreme poverty, lack of health care, poor
environmental and hygienic conditions (overcrowding)
Drug resistance (MDR-TB and XDR-TB) now a major
worldwide concern
Sources: CDC, WHO 2015
5. Background & Health Indicators
Cuba
11.26 million population
77% urban
Life expectancy at birth: 79.3
years
Years of healthy life: 67 years
Aging population with
median age of 40 (2013)
2014 HDI: 45/187 countries
1.7% unemployment (2008,
PAHO)
GNI per capita: $19,844
(2013)
Haiti
10.3 million population
56% urban
Life expectancy at birth: 63.1
years
Years of healthy life: 52 years
Young population with
median age of 22 (2013)
2014 HDI: 168/187 countries
39% (rural)- 49% (PaP)
unemployment
GNI per capita: $1,636 (2013)
6. Health Systems
Cuba
Free, universal care
Based on primary care
Consultorios, polyclinic in
every community
Highly integrated system
500,294 workers in health
sector
6.7 physicians per 1,000
population (2015, WHO)
Haiti
700 primary care facilities &10
departmental hospitals with
half of health facilities
concentrated in Port-au-
Prince
Health system faces complex
organizational & managerial
problems
Limited availability
Poor quality
Fragmented system
supported by thousands of
NGOs and private groups
0.25 physicians per 1,000
population (1998, WHO)
7. National TB Control Programs
Cuba
$27 million budget in 2012
Directly observed therapy,
short course (DOTS) in place
as of 1982
Currently 100% DOTS
coverage
Family physician responsible
for case finding, treatment
(DOTS), contact tracing,
community education
Haiti
$12 million budget in 2012
5% domestically, 34%
internationally, 61%
unfunded
DOTS coverage only 37% as
of 2002
Global Fund grant of $13.6
million through 2011 to
increase DOTS coverage to
80% (progress inadequate)
Current Global Fund grant of
$21.6 million to expand DOTS
coverage to 70% through
community organizations &
fund 100% of anti-TB meds
(promising progress)
8. National TB Control Programs
Cuba
Active surveillance
Decentralized labs
Newborn vaccination (BCG)
Active contact tracing
All cases investigated
Contacts checked for
respiratory symptoms
Contacts meeting certain
criteria are treated
prophylactically with
isoniazid
Local doctors perform all case
finding, treatment, prophylaxis,
education
Haiti
Working on improving
surveillance system,
supported by CDC
CDC supporting improving
lab quality and capacity
BCG vaccination
recommended (55% in 2010)
Much of contact tracing
provided by NGOs, CHWs
More transient population
makes tracing and follow
up difficult
Treatment supported by
NGOs
9. Current Situation
Incidence (23x higher)
206 per 100,000
population
Prevalence (19.5x higher)
254 per 100,000
population
Incidence
9.3 per 100,000
population
Prevalence
19.5 per 100,000
population
Cuba Haiti
Source: WHO 2015, rates as of 2013
11. Mortality
Cuba
TB not a major cause of
death
Mortality rate of 0.33 per
100,000, excluding HIV (WHO,
2014)
Haiti
TB is 9th major cause of
death, 2.8% of all deaths in
2012 (WHO)
TB is 4th cause of death for
children under 5 (PAHO,
2012)
Mortality rate of 26 per
100,000 population,
excluding HIV
12. MDR-TB & HIV Co-Infection
MDR-TB
Estimated 390 cases
Only 81 detected (21%)
59 confirmed cases treated
with second-line drugs
(73%)
TB/HIV
Highest prevalence of HIV
among TB cases in the
region at 42% (PAHO, 2013)
81% of notified TB cases
tested for HIV- 20% were
positive
MDR-TB
Estimated 11 cases
8 cases detected (73%)
8 confirmed cases treated
with second-line drugs
(100%)
TB/HIV
Increasing
83% of notified TB cases
tested for HIV- 9% were
positive
Cuba Haiti
13. TB Elimination in Cuba?
Cuba is on track to eventually eliminate
tuberculosis
Low rates of MDR-TB
Relatively low HIV co-infection
Efforts need to focus on adjusting indicators to be
more sensitive
Improve case detection by focusing on
vulnerable groups within Cuba
Increase quality of preventive services
Keep an eye on MDR-TB and HIV co-infection
14. Lessons Learned
TB can be controlled in low-resource settings with strong
health system
In Haiti, TB is both a cause and symptom of
underdevelopment
Recommendations for Cuba
Procure/make adequate supply of second-line TB drugs to
control MDR-TB before resistance spreads
Target vulnerable groups
Increase funding for final stretch toward elimination
Recommendations for Haiti
Strengthen health system
Increase funding—and completely fund— TB programs
Commence aggressive active case finding and prophylactic
treatment for active and latent disease
Improve vaccination
Strengthen supply chain of first- and second-line drugs
16. References
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Editor's Notes
In Haiti: 14% of MoH employees died in January 2010 earthquake
In Haiti: 14% of MoH employees died in January 2010 earthquake
In Haiti: 14% of MoH employees died in January 2010 earthquake
In Haiti: 14% of MoH employees died in January 2010 earthquake