Control of diseases and economic development 2

STRATEGIES FOR CONTROL OF DISEASES

PRESENTATION BY DR F D E MTANGO

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

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

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

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

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

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

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

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.

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

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.

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

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

Types of epidemicity

• EXOTIC DISEASE

• SPORADIC DISEASE

• EPIDEMIC DISEASE

• ENDEMIC DISEASE

• HYPERENDEMIC DISEASE

• HOLOENDEMIC DISEASE

EXOTIC DISEASE

• OCCURRENCE OF A DISEASE IN A COUNTRY WHERE IT HAS BEEN ELIMINATED, AND THUS ONLY ONE CASE OCCUR AND NO MORE

SPORADIC DISEASE

• ONLY A FEW CASES OF DISEASE OCCUR SCARTERED IN TIME AND SPACE

EPIDEMIC DISEASE

• OCCURRENCE OF A DISEASE IN A FREQUENCY WELL AND ABOVE THE EXPECTED

ENDEMIC DISEASE

HYPERENDEMIC DISEASE

HOLOENDEMIC DISEASE

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

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

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

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

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

DISEASES OF POVERTYLET US BRAIN STORM

• DIARRHEAL DISEASES, DUE TO POOR ENV. SANIT.

• TRACHOMA

• TUBERCULOSIS

• SCABIES

• INTESTINAL HELMINTHS

DISEASES OF AFLUENCE, LET US BRAIN STORM

• OBESITY, WHY? HEART DISEASES (ATHEROSCLOEROTIC VASCULAR DISEASES). BUT RHEUMATIC HEART DISEASE- THIS IS A DISEASE OF POVERTY.

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

AGE STANDARDIZED DEATH RATE DUE TO CORONARY HEART DISEASE PER 100,000 IN VARIOUS INDUSTRILIZED COUNTRIES IN

MALES AND FEMALES

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

AGE STANDARDIZED DEATH RATE DUE TO CORONARY HEART DISEASE PER 100,000 IN VARIOUS INDUSTRILIZED COUNTRIES IN MALES AND FEMALESCOUNTRY YEAR TOTAL MALE FEMALESCOTLAND 1983 192 284 124FINLAND 1980 177 284 102SWEDEN 1982 158 232 98AUSTRALIA 1981 156 224 100ENG\WALES 1982 155 231 95USA 1980 155 220 104DENMARK 1982 153 221 97CANADA 1982 145 205 95ITALY 1980 80 114 52FRANCE 1981 47 72 28JAPAN 1982 30 39 22

AGE STANDARDIZED DEATH RATE DUE TO CORONARY HEART DISEASE PER 100,000 IN VARIOUS INDUSTRILIZED COUNTRIES IN

MALES AND FEMALESCOUNTRY YEAR TOTAL MALE

FEMALESCOTLAND 1983 192 284 124FINLAND 1980 177 284 102SWEDEN 1982 158 232 98

AUSTRALIA 1981 156 224 100ENG\WALES 1982 155 231 95

USA 1980 155 220 104DENMARK 1982 153 221 97CANADA 1982 145 205 95ITALY 1980 80 114 52FRANCE 1981 47 72 28JAPAN 1982 30 39 22