Global Health

This bundle contains notes of the lectures on Global Health. These lectures are part of the half minor Global Health at Leiden University, academic year 2021/2022.

Bundle items:

Introduction to Global Health

Collaborative trans-national research and action for promoting health for allAchieving health equity by study, research and practiceCost effectiveness is a very important aspect of Global Health. National representativeNetherlands course in Global Health and Tropical Medicine, 28 months WHO: a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity → practically impossible to achieveS. van der Geest: the proper functioning of the bodyM. Hubert: the ability to adept and self-manage Determinant: a factor that decisively affects the nature or outcome of somethingModels of determinants of health are:Lalonde framework: assumes no interaction between determinants of healthSkolnik model: more complex model used in this courseDifferent determinants influence each other. Health care has a relatively low impact on health status. Social determinants of health are particularly important for the wellbeing of patients.According to epidemiologists Wilkinson and Pickett, “equality” in itself is a determinant of health.Long and healthy life is a precondition for development, which stimulates participation in the society. Generally, high income relates to a good health status. Therefore, economic development is a precondition for a long and healthy life.However, the Blue Zone Project shows that there are additional factors such as social cohesion and lack of stress that stimulate a long and healthy life. Indicator: measure that tells something about the state or level of something. Health indicators are often ratios or rates with a numerator and a denominator.Ratio: compares two measures of the same dimensionRates:...

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Global Health: Neglected Tropical Diseases

NTD is a relatively new identity. The term NTD was first used in 2003. It was coined by Peter Hotez and colleagues to counterbalance the attention given to HIV/AIDS, tuberculosis and malaria. There are 20 NTDs on the list, even though different sources give different numbers of NTDs. This is relevant because it is very difficult for diseases not on the list to find money for research and therapy. The 3 most recent diseases listed by the WHO are mycetoma, scabies and snakebites. Snakebites is the only non-infectious disease on the list.Several NTDs are not restricted to the tropics, such as:SnakebitesScabiesRabiesEchinococcosisLeprosy NTDs which are restricted to the tropics because of climate are:African Sleeping SicknessChagasOnchocerciasisSchistosomiasisDengueBuruli ulcerLeishmaniasisSoil-transmitted helminthiasesMycetomaYawsLymphatic filariasisThese diseases all need a vector, which can only survive in tropical areas. NTDs occur in the most poor communities of the world:Common, poverty related, risk factorsOccur in 149 endemic countriesPeople are infected with at least one NTDOften, if one has 1 NTD, they have many NTDs because the risk factors are the same. The advantage of this is that multiple diseases can be controlled at the same time. NTDs can be caused by:BacteriaBuruli ulcerLeprosyTrachomaYawsViruses: the rarestRabiesDengue and chikungunyaParasitesProtozoaChagas diseaseLeishmaniasisHuman African TrypanosomiasisHelminths: occur the most oftenCysticercosisGuinea-worm diseaseEchinococcosisFoodborne trematodiasesLymphatic filariasisSoil-transmitted helminthiasesSchistosomiasisRiver blindnessThere is no existing vaccine against helminths. Most NTDs have a high morbidity and disability, while the mortality is low → many NTDs are chronic...

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Global Health: Non-communicable diseases and the "Big 3"

37,7 million people are living with HIV globally, of which 25,4 million live in Africa. Especially in southern African countries, the prevalence of HIV is very high:ZambiaBotswanaNamibiaSouth AfricaEswatini/SwazilandMozambiqueZimbabweAlthough the number of new infections is declining worldwide, the majority of new infections occur in Africa. These infections mainly (>60%) occur among women, while in Western Countries mainly men are affected. In general, the transmission rate from men to women is higher, women in Sub-Saharan Africa aren’t in the position to negotiate about safe sex and are often involved with older men. There are different HIV subtypes circulating. In Africa, HIV-1 subtype C is most common, while in Western Countries most infections are HIV-1 subtype B. This means that research mainly is done for HIV-1 subtype B, while in Africa medication for subtype C is necessary. Subtype C and D also appear more pathologic than subtype B. In 1996, a life-saving combination triple therapy was found. This therapy was very effective in suppressing the virus. However, ART (antiretroviral treatment) was hardly covered in the African region. This was the cause of many protests → ART for Africa. This led to an international response to AIDS:2000 Durban conference “Breaking the Silence” → the first conference held in an African countryIt finally became clear how big the problem was2001 UN Declaration of Commitment on HIV/AIDSMade sure that people who needed it, would get their medication2002 Global Fund to Fight AIDS, TB and Malaria (GFATM)A lot of money was necessary to get the drugs where they were needed2003 PEPFAREmergency plan for AIDS reliefMeanwhile, UNAIDS was in discussion with several pharmaceutical companies to reduce the price of ART’s → the price...

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Global Health: Nutrition, culture & technology

Nutrition is part of a balance:Undernutrition: immunosuppression and susceptibility to infectionOptimal nutrition: normal immune functionOvernutrition: immune-activation and susceptibility to inflammatory diseasesThere is malnutrition in case of undernutrition and overnutrition. Undernutrition is an insufficient intake of macro- or micronutrients to meet nutritional needs. Macronutrients are proteins and fat, micronutrients are vitamins and minerals. There are 2 types of undernutrition:Growth failureMicronutrient malnutritionOvernutrition is an excess amount of energy leading to overweight and possibly chronic disease. Besides a demographic and epidemiologic transition, there also is a nutrition transition. There is interaction between these 3 transitions. Nutrition transition is the pattern from scarcity to over-consumption → a change from an active lifestyle and whole grain foods to a sedentary lifestyle and ready-made convenience foods. A nutritional transition has different stages:Paleolithic man/hunter-gatherersSettlements begin → famine emerges → high prevalence of undernutritionIndustrialization → receding famine → slow mortality declineNutrition related noncommunicable diseases predominateDesired societal/behavioral change → focus on medical intervention, policy initiatives and behavioral changes There are different types of macronutrient undernutrition:Normal: normal weight and heightWasted: thinner than normalStunted: shorter than normalWasted and stunted: thinner and shorter than normalWasting is indicative of acute undernutrition, such as in famine or emergencies requiring humanitarian assistance. Stunting is indicative of chronic undernutrition and is common in low income populations in non-emergency cases. Wasting: extreme...