HLTH 230b Lecture 4: DALYs and Malaria

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Yale University
Global Health Studies
HLTH 230b
Kristina Talbert- Slagle

GLOBAL HEALTH: CHALLENGES AND RESPONSES  Measuring effects of disease: Disability-adjusted life years (DALY) 1. Measures health gaps as opposed to health expectancies a. Difference between a current situation and an ideal situation where everyone lives up to the age of standard life expectancy in perfect health b. Gap between the actual health status of a population and some “ideal” or reference status, using time as the measure 2. Two key value choices: a. How long “should” people in good health expect to live? b. How should we compare years of life lost through death, with years lived with poor health or disability of various levels of severity? 3. DALY = (YLL years of life lost to premature death) + (YLD years lived with disability) a. YLL: Difference between age of death and highest life expectancy globally for that age b. YLD: years of life lived with disability multiplied by weight assigned to condition  DALY is very important when considering a public health intervention 1. Treating one group of 20s age group is more beneficial than treating another group of 50s- 60s, more DALY assisted. 2. Disability weight: number 0-1 describing effect of disease one a person a. 0= stability b. 1= death 3. Activities of daily living (ADL) a. Can I feed myself? b. Can I get out of bed? Etc. 4. Accounting for comorbidities a. No individual can contribute more than 1 disability weight because 1 is death 5. Discounting: assigns greater value to near-term benefits than one that might accumulate in the future a. Potentially skews against interventions that have long-term benefits  R0= 1 does not factor that there are people in population who are not as susceptible to malaria 1. Those that have partial immunity  Malaria 1. Has been with humans for at least 10,000 years 2. Efforts that have been made to reduce malaria suggest that it is not strictly a tropical disease; it has existed in non-tropical areas in the past but has been controlled in those regions 3. 1955-1969: Global Malaria Eradication Program a. Used DDT to almost eradicate malaria, then realized that DDT had disastrous environmental effects, so stopped using and malaria returned 4. Malaria existed in Europe a. 90,000 causes before 1995, now eradicated there  Malaria: parasitic disease 1. Plasmodium genus has >100 species 2. Four species can infect humans a. P. vivax b. P. ovale c. P. malariae d. P. falciparum 3. Infection most commonly 4. *much more complicated to kill/treat than bacteria or virus because it is a whole organism  Life cycle 1. Mosquito inserts sporozoites 2. Replicate in liver cells and released into body as merozoites 3. Infect red blood cells and form ring 4. Another complex life cycle before rupturing 5. Two components, multiple cell types, life cycle inside mosquito too, 6. Resistance occurs during parasite replication in human  Gold standard for diagnosing malaria 1. Looks for parasite in blood smear  Vector-borne disease 1. Vector is female mosquito 2. 3,500 species of mosquitoes, 41 genera 3. Human malaria only transmitted by females of genus Anopheles  Factors affecting spread of malaria 1. Extrinsic a. control and preventative measures b. Social, behavioral, economic, political factors c. Environmental conditions 2. Intrinsic a. Human b. Parasite c. Mosquito  Countries endemic for malaria 1. Endemic: disease stays in population
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