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Honduras

I will be providing information on Honduras, which is one of the poorest countries in the western hemisphere. I have had the chance to witness first-hand how poor the country is, and how little the people there have. In both 2015 and 2016, I had the privilege to spend a week there, working with a surgical team in a hospital to do procedures for people free of charge. They ranged from relatively simple hernia repairs and cholecystectomies to more advanced things like moving the esophagus and removal of large tumors. Honduras seemed to rank around the 125-130 mark for most of the information I found.

The country has a population of just over 8 million, with about half residing in urban areas (WHO, 2017). They also ranked around that area for infant mortality, which was 17.7%, and literacy rate runs around 89% (Factbook, n.d.), which surprisingly ranks it as 149th, well below half of the other countries in the world. Life expectancy averaged 71.1 years, broken down to 69.5 years for males and 72.8 years for women (WHO, 2017). Surprisingly, 93% of the population are subscribers of cell phone service (U.N., 2016). Healthy life expectancy at birth was 64.9 years, slightly lower than average life expectancy. Cause of death registration coverage was very low at 17%. Many of the people in the country work either in some type of agricultural setting or working to make textiles. Knit sweaters and knit t-shirts both account for about 12% of exports. Coffee came in at the same percentage. Banana exports are about 4% of total exports, and sadly the major money from that is not kept in-country.

The companies that own the plantations and factories do not have an interest in the country and send the money elsewhere. Insulated wire is another large export with 9% of the exports from that. 1.9% of exports are created from rolled tobacco, mostly cigars (OEC, n.d.). As a cigar aficionado, I believe they produce fine tobacco there. Textile scraps, narrow woven fabric, undergarments, melons and other fruit, fish, vehicle parts, soap, gold, and petroleum each hold less than 2% each of export totals. All are important to the economy of the country. The country ranks very low in many health-related areas. For example, the cause of death registration coverage does not seem very high.

One of the patients I dealt with in the hospital had been in a motorcycle accident and had a severe closed head injury. He eventually died, but they continued to manually ventilate him until his heart stopped on its own. His heart rate fluctuated for many hours due to the swelling in his head, but I am unsure how they documented his death, whether it be cardiac arrest or a vehicle accident. There is little to no tracking of patients in a hospital, and there are many risks associated with that. Patients do not wear identification and their charts are stacked at the nurse's desk. Documentation is all done on paper, which can be misread or even get lost. Access to healthcare is limited to those who can afford it, and I would not say they have much of a public health system. While nurses, physicians, and other healthcare providers are highly educated, many citizens that work other jobs do not have the need or luxury for obtaining further education.

There is an obvious gap between those who have money and those who do not. There is not much of a middle-class, as we have here in the United States. While the country has improved slightly over the past decade, it is still far from being a developed country. Nearby countries like Belize and Costa Rica offer tourism, which can draw in money to improve conditions. Unfortunately, the biggest draw for Honduras tourism is the island of Roatan. This does not provide much income to the country. Hopefully, the trend of improvement will continue for years to come, and increase the level of health in the country.

coffeekangaroo879

Case Study

Skolnikland is in Eastern Africa, with a population of 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.

The citizens come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.

According to World Bank criteria, Skolnikland is among the poorest countries in the world. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.

About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihood in agriculture but there is an increasing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.

The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There is an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.

The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of them are of very low quality.

Only about 50% of citizens have access to safe water. Only about 30% have access to sanitary disposal of human waste.

HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria is rampant in the plains.

Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.

Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, which the better off people do not attend. The health system is not very effective or efficient and is generally of low quality. The HIV, TB, and malaria programs are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.

QUESTION 26

What is a DALY?

Refer Case Study from question 1 to answer this question.

A. An indicator that compares the burden of deaths across the population of different countries.

B. A composite health gap indicator that measures the amount of health and disability-free life that is lost because of disease, injury, and premature death.

C. A WHO indicator used to summarize the expected number of years to be lived in good health.

QUESTION 27

What is an example of a conditional cash transfer that you can use to improve child health?

Refer Case Study from question 1 to answer this question.

A. Provide tax breaks to families with children.

B. Give money to mothers whose children received a full course of vaccination.

C. Pay higher fees to vaccination programs with better outcomes.

QUESTION 28

What usually takes place during the demographic transition?

Refer Case Study from question 1 to answer this question.

A. Fertility falls before mortality falls

B. Mortality falls and then fertility falls

C. Mortality and fertility fall at the same time

QUESTION 29

Which force is likely to have the greatest direct impact on epidemiological change in the medium and long terms on today's middle-income countries?

Refer Case Study from question 1 to answer this question.

A. Population growth

B. Population aging

C. Urbanization

QUESTION 30

Which is the most accurate statement about the distribution of age at death in Niger (a very low income country) and Norway (a very high income country) today?

Refer Case Study from question 1 to answer this question.

A. About 5% of the deaths in Niger are among those under 15, while the overwhelming majority of deaths in Norway are among those over 65.

B. About 30% of the deaths in Niger are among those under 15, while the overwhelming majority of deaths in Norway are among those over 65.

C. The overwhelming majority of deaths in both countries occur among people aged 65 and over.