Containment - lecture 1&2 - Introduction and assignment theory

endemic EXAM

• endemic is a current burden (naturally present in communities)

epidemic

• epidemic is when the disease is on the rise

pandemic

• pandemic is worldwide increase in the disease.

communicable disease

• an illness that is transmitted from a person animal or inanimate source to another person either directly, with the assistance of an intermediate host or by a vector.

zooonotic disease

• transmitted from human to animals and vice versa

• the animals also get sick

difference isolation and quarantine

• isolation - lock someone up when you have a confirmed case

• quarantine - it is suspected that someone may have a case.

Spanish flu

• 1918 and 1919

• killed 100 million people

• 1/3rd of world population infected

• biggest take away was quarantine led to less affected areas

• spain was the first to report about it.

most important scientific findings in infectious diseases

• antibiotics (penicillin)

• vaccines → edward jenner invented first vaccine (1796)

• before Jenner in ottoman / china already experiments with vaccines were done. 

• vaccines are very succesful, control eliminate and even eradicate diseases but there is increasing societal resistance

HIV - Aids

• infectious disease but treatment is chronic

• HIV learned a lot from tuberculosis

• mobilizing global funds is very important

• VCT - voluntary counseling and testing (people do not know when they have it)

• behaviour change groups

swine flu (mexican)

• ruined more than that we learned

• little people died, we got complacent

containment strategies

• inteventions that control, eliminate and eradicate disease

EIDM

• evidence informed decision making

  • evidence matters

  • context matters - what works where for whom?

  • integration of Evidence, Epistemiological justice (TDR) - all knowledge matters when we design things.

5 steps in health intervention

these are the 5 steps of Jenkins

1. what is the problem

2. what factors cause the problem (show references in assignment, tools to identify causes epidemiological triangle and the problem tree).

3. how can these factors be changed

4. what overall intervention strategies are most appropriate and cost effective (including what do people want and what are their needs)

5. what needs to be done to reach the goals? with what (sub)populations shall work be done, and in what sequence, to solve the problem?

precede / proceed model

• framework for designing, implementing, and evaluating health promotion programs

• this is a planning and evaluation framework for developing health promotion programs. starting with the desired outcome and working backward.

epidemiological triangle

• disease is always the interaction between a host, agent and in an environment.

• how susceptible is the host (host is where reproduction of the agent takes place). individual level.

• environment needs to be favourable. (climate, health system, public transport, education level of the country). societal level.

• vector - not always present, can be a mosquito, needle etc.

how can the factors of the epidemiological triangle be changed

• change / kill agent

• raise host resistance (vaccines)

• modify environment (remove mosquito breeding places etc.)

• separate agent from host

• interrupt transmission (isolation)

social determinants of health

problem tree

• helps to understand where to intervene

primary, secondary, tertiary prevention

• P → prevent a health problem (vaccination, sleeping under bed net)

• S → early detection and treatment, hardly any symptoms (pap smear, breast cancer screening).

• T → preventing the disease from getting worse

selecting best intervention

• also called multi criteria decision making

• choose the right intervention, that can be implemented with limited negative side effects.

• important criteria

  • medical effectiveness (vaccination better than face mask, more evidence for this). look at most effective intervention

  • cost effectiveness