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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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Cost effectiveness is a very important aspect of Global Health.
Models of determinants of health are:
Different 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.
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:
NTDs which are restricted to the tropics because of climate are:
These diseases all need a vector, which can only survive in tropical areas.
NTDs occur in the most poor communities of the world:
Often, 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:
There is no existing vaccine against helminths.
Most NTDs have a high morbidity and disability, while the mortality is low → many NTDs are chronic and don’t immediately cause death. This is why the diseases are so often neglected. NTDs promote poverty and interfere with economic development.
The most prevalent NTDs are the soil-transmitted helminths (STH):
1,5 billion people have a STH. The NTD intestinal nematodes (STH) costs the highest burden of disease around the world, because so many people are infected with them.
3 NTDs with the highest case fatality rate are:
In case of these diseases, as soon as there are symptoms and there is no treatment, the patient dies.
2 NTDs which cause blindness are:
3 NTDs which are a stigma, causing high social-economic impact, are:
Multiple NTDs have a common treatment and share a similar way of intervention:
For example, by deworming communities and schools, the burden of helminthic diseases can
.....read more37,7 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:
Although 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:
Meanwhile, UNAIDS was in discussion with several pharmaceutical companies to reduce the price of ART’s → the price reduced from $10.000/year to $900/year.
However, around 2004, there were challenges for ART access in Africa:
Nevertheless, after 2004 the number of people on ART started rising and is now similar to the numbers in Western Countries. This led to a huge increase in life expectancy → a 25-year-gap. The availability of ART also resulted in less people getting infected with HIV.
In 2002, the WHO made guidelines for when to start ART in LMIC. These guidelines evolved over time:
In 2015, the START and TEMPRANO trials looked into when ART should be started. It appeared that when ART was initiated immediately, the CD4-cell
.....read moreNutrition is part of a balance:
There 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:
Overnutrition 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:
There are different types of macronutrient undernutrition:
Wasting 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.
Protein energy malnutrition, also known as Marasmos, is an extreme protein and energy deficiency. It results in an appearance of skin and bones with little or no subcutaneous fat and a pronounced loss of muscle mass. It can lead to limited brain growth and development. It is a very serious condition of undernutrition.
Protein and vitamin deficiency, is also known as Kwashiorkor. It can lead to oedema, retention of some subcutaneous fat, red coloring of the hair, apathy and growth retardation. It is a very serious condition of undernutrition.
The 4 most prevalent micronutrient deficiencies are:
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