PHC 3440 Lecture Notes - Lecture 1: Micronutrient Deficiency, Low Birth Weight, Plasmodium Falciparum
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● Malaria (#1 killer), HIV (#2), TB(#3) are the 3 major pathogens in GH
●No vaccines, experts at “evading” the immune system
●Disease of poverty
●Resistance issues: drugs, pesticides
●1. Parasite (Plasmodium), 2. Vector (Mosquito), 3. Human
The Parasite and Its Vector:
●Genus: Plasmodium, single-celled parasite
●4 species: P. falciparum, P. malariae, P. ovale, P. vivax (India, E. Africa)
●P. falciparum is the most common and the most dangerous
●Transmitted by the female Anopheles mosquito -- stays indoors, nocturnal, feeds on humans
Malaria in Africa:
●Africa accounts for 80-90% of all malaria deaths worldwide
●80-90% of those deaths occur in children under 5 years
●Macro-level: suitability of rainfall and temperature
●Micro-level: associated with poverty
●Climatic conditions: temperature, humidity, rainfall
●Geographic: seasonal variations, relief, watercourses
●Deforestation, well drilling, dams, irrigation (creation of breeding sites)
●House construction, potted plants, bad roads
●Urbanization (usu. decreases risk)
Artemesinin Combination Therapy (ACTs) are the mainstay of treatment
●Insecticide-Treated Bed Nets - among the most effective tools for preventing transmission. High
coverage and regular use can reduce all-cause mortality rates in children under age five by nearly
20% in malaria-endemic areas.
●IRS (Indoor Residual Spraying) - a highly effective tool, especially in high-transmission settings
and in managing epidemics
●Environmental Management, Larviciding - can be effective and cost-efficient in some areas. Have
been used successfully in India, Mexico and Central America
●Control and prevention measures
●Social, behavioral, economic and political factors
●HIV is a virus that attacks the T-cells, and uses them for replication.
●HIV is transmitted person-to-person through fluids
●HIV is a strong risk factor for TB and other infectious diseases
Common Exposure Points:
●Vertical transmission from mothers to children in utero
●Transmission from mother-to-child in breast milk
Epidemiology and HIV Burden:
●Incidence - number of new cases by population and time (cases/100,000/year)
●Mortality - deaths by population and time
●Prevalence - number of people with HIV at any point (number infected / 100,000)
●South Africa has the highest rates of HIV infections in Sub-Saharan Africa
Key Interventions and Controlling Transmission:
●Treatment - HAART (highly active anti-retroviral therapy)
-Improves the health of those with HIV (reduced viral loads and increased CD4 counts)
-Reduced likelihood of transmission to partners or children
●8 million people were treated in 2011
●54% of the 15 million who are eligible
Males: For males, the mortality rates are higher than in females. Most deaths occur at a range from 35-55
years, with the majority occurring between 40-45 years of age. (68 deaths per 100,000 - male) (14 deaths
per 100,000 - female)
Females: For females, the mortality rates are lower than in males. Most deaths occur at a range from 30-
50 years of age, with the majority occurring between 40-45 years of age.
Incidence Rates by Year: The highest incidence rates for both sexes occur at a range from 1990-1995.
Both peak at around 1993, with males having a much higher number of incidence than females.
2013 (females), 20-34 years of age, 13 cases per 100,000.
2013 (males) 25-34 years of age, 27 cases per 100,000.
Incidence Rates by Age: According to the Global Burden of Diseases website, I can conclude that the
average incidence rates by age for males are between 20-30 years of age. For females, the incidence rates
by age are also between 20-30 years of age. The incidence rates for males are higher than females.
However, the current level of incidence rates are relatively low for both sexes.
Both males and females average incidence rates by age are between 20-30 years of age.
Prevalence: The highest prevalence rates for both male and female occur at around 20-30 years of age.
However, the prevalence rates for males are much higher than for women.
1990: ages 20-24 highest; Females: 300; Males: 880
2013: ages 25-29 highest; Females: 100, Males: 200