Global health Flashcards

Question

IMCI process for pneumonia

Answer 1

− The actual IMCI process is outlined below (for pneumonia); 1. Check for general danger signs - Not able to drink or breastfeed - Persistent vomiting (vomiting everything) - Convulsions - They are lethargic or unconscious - Stridor in a calm child - Malnutrition - If a child is positive for any of these danger signs, it indicates that the child is very sick and requires immediate attention, probably referral 2. Assess the main symptoms - Cough - Difficulty breathing - Diarrhoea - Fever - Ear problems 3. Assess nutrition, immunization status and potential feeding problems (and check for other problems) 4. Classify condition and identify treatment actions - The IMCI is predominately concerned with pneumonia and diarrhea - There are 3 levels of severity, Pink (most severe), yellow and green - Pink: If the patient has any general danger signs or stridor in a calm child. These children must be referred to hospital and given an appropriate dose of antibiotic - Yellow: If the patient has chest indrawing or fast breathing. These children can be treated in outpatient health care facilities - Green: If the patient has no signs of pneumonia or other severe diseases. These children can be treated at home following counselling on how to give oral drugs, continue feeding, when to return immediately and when to come back for a follow up 5. Provide treatment - Using the above guidelines treatment should be provided appropriately 6. Counsel and Follow-up - How to treat - What to watch for - When to come back - Prevention advice − It is important to note that the IMCI has deliberately been kept simple so that they are more accessible and user friendly for community-based health workers (who aren’t doctors or nurses)

Answer 2

− Is a mosquito borne infectious disease caused by the plasmodium parasite − It is an incredibly serious infectious disease, which has a number of extremely severe effects (particularly in communities where malaria transmission is uncontrolled) for example; - Low Birth Weight - Stillbirth - Child Mortality - Sick or anaemic adults - Reduced productivity / economic activity - Costs to the health system − When considering what we can do to reduce the burden of malaria in communities, it is important that we look at the different patterns of transmission − The reason it is important to consider the patterns of transmission is because it can have an effect on both the clinical presentation of the disease and the preventative measures that can be implemented to improve the community’s situation

Answer 3

1. Stable transmission - Describes communities where rates of malaria are high and constant - Malaria is around all the time, and people are being infected constantly and will always have some sort of parasitaemia (parasites in the blood) going on - In these areas (e.g. Sub-Saharan Africa) adults develop a level of immunity meaning whilst they may have a parasitaemia or small degree of anaemia, they are rarely sick with malaria - Instead, those at risk in these populations are children (who have not yet built up an immunity), pregnant women and those with HIV. It is these populations that typically develop a severe illness 2. Unstable transmission - Occurs in populations where there are typically low transmission rates, with occasional epidemic outbreaks - Because adults have not developed immunity, they too get severe disease (meaning there are different clinical patterns)

Answer 4

− Plasmodium is the parasite responsible for the mosquito born disease malaria − The incubation period varies, but usually falls between 9 to 18 days − Basically, this parasite wants to get in, multiple, then get out to infect someone else − The lifecycle of plasmodium follows the following progression; 1. A mosquito bites a human and inject sporozoites into the blood stream along with their saliva (which causes anticoagulation to increase the amount of blood they can take) - Antibodies attack these sporozoites 2. These sporozoites infect the liver cells known as hepatocytes where they go in and multiply - CD4 and CD8 T Cells kill intrahepatic parasites - CTLs kill infected hepatocytes 3. Once they have multiplied, they burst out of the cell as merozoites and go into the blood stream once again - Antibodies target merozoites by blocking cytoadherence to RBCs 4. Once here they infect RBCs and develop into schizont cells - Cell mediated immunity and ADCC is important in this stage 5. Some of these cells will develop into gametocytes which are picked up by a mosquito biting a human - Antibodies block this stage 6. These gametocytes then go into the mosquito and form sporozoites starting the process once again (takes several days) − Symptoms include: headache, nausea, vomiting and diarrhea, severe anaemia, organ failure (brain, lung, liver, kidney all from hypoxia), periodic fevers and death − It is important to note that plasmodium has a number of essential lifecycle stages within mosquitos meaning that it doesn’t bite someone, then immediately have the ability to transfer the disease to another person. Instead it requires a week or two to develop within the mosquito

Answer 5

− Is defined as a patient who presents with symptoms of malaria, has a positive parasitological test (Microscopy or Rapid Diagnostic Test), but has no features of severe malaria − The signs and symptoms of uncomplicated malaria are very nonspecific, which are outlined below; - Headache and fatigue - Lassitude (a state of physical or mental weakness, lacking in energy) - Abdominal discomfort - Muscle and joint aches - Fever and chills - Anorexia - Sweating, vomiting and worsening malaise - Can also have a cough / diarrhoea (which makes the differential diagnosis even wider) − Because of its nonspecific symptoms, it is often over-diagnosed in endemic areas - Need to perform a blood smear - Check Growth and Nutrition status - Check immunisation status - Check Hydration status - Take respiratory rate (check for fast breathing) - Check glucose and whether he is anaemic

Answer 6

− Is nearly always caused by Plasmodium Falciparum that shows one or more of the following clinical features; 1. Impaired consciousness (Glascow Coma Scale less than 11) 2. Seizures 3. Severe anaemia (less than 50g/L) 4. Acidosis 5. Hypoglycaemia (less than 2.2 mmol) 6. Other less common features include; - Prostration - Severe jaundice - Renal failure - Shock - Pulmonary oedema - Significant bleeding - Hyper-parasitaemia (more than 10% of RBC’s are infected) − Patients with severe malaria have an extremely high case fatality rate (10 – 20% even with treatment) − This type of malaria commonly occurs in pregnant ladies and children in areas of stable transmission, travellers to areas of stable transmission or anyone in areas of unstable transmission

Answer 7

1. Rapid Diagnostic Test (RDT) - They are quick, cheap, can be used at a community level and do not require a microscope or lab technician - It is important to note that once a child has caught malaria, they remain positive for a while, meaning that it may not be malaria causing the fever this time (furthermore, in stable malaria transmission areas, many people constantly have a low parasitaemia which will cause a positive result) - These RDTs also don’t provide any information on the parasite count and species of parasite, which can be extremely useful clinically 2. Thick and thin blood films - Thick films are used to make the diagnosis and have higher sensitivity - Thin films are used to look at the parasite count and the species − If after the above investigations have been performed the child gets a positive malaria reading, they must be treated for malaria

Answer 8

Aside from infectious causes, here are the others 1. Inadequate access to basic needs - Clean water: - Sanitation: - Food security and Safety - Access to healthcare 2. Environmental and Living conditions - Natural and man-made disasters - Overcrowding or displacement - Lack of protection from the elements - Dry environment - Insecurity 3. Culture and Education - Food preparation (e.g. no refrigeration) - Use of latrines/toilets - Funeral practices (e.g. a person’s body that has died from cholera is highly infectious, so when you pair that with the cultural practice of everybody visiting the deceased, you run into issues with infectious control) − It is important to realise that there are a number of very serious complications associated with diarrhoea. Some of these include; - Dehydration (most people that die from diarrhoea die from dehydration) - Hypoglycaemia - Electrolyte disturbances - Acute renal failure - Malnutrition - Predisposition to other infections (due to weakened immunity) − From a public health perspective, we would then want to investigate any potential outbreaks (particular if Shigella or Cholerae is the cause) that may have caused the diarrhoea, so that we can manage that concurrently (to prevent further cases) − We also need to asses any special circumstances that may affect the management of the case like their nutrition status (if they are malnourished it changes the rehydration treatment plan), whether they have any co-existing infections

Answer 9

− Transmission is via Salmonella Typhi/paratyphi through contaminated food or water − Clinical features include; - Prolonged fever plus some of - Severe malaise - Abdominal pain - Headache, confusion, delirium - Diarrhoea or constipation - Cough - Anorexia − Diagnosis is via blood culture and is treated with antibiotics (resistance) − Prevention is through access to safe water and sanitation, hygiene among food handlers and vaccinations (moderately efficacy with limited duration)

Answer 10

− Transmission is via contaminated food or water, direct contact with an infectious person − Clinical features include; - Fever - Malaise - Loss of appetite, diarrhoea, nausea, vomiting and abdominal discomfort - Dark urine and jaundice − Treatment is non specific (supportive, symptom management) and recovery can be slow − Prevention is through vaccine (effective), sanitation/hand washing, safe water, and food

Answer 11

− Clinical features include; - Acute or chronic diarrhoea - Greasy stool - Cramps, bloating and flatulence - Fatigue, anorexia - Nausea, weight loss − Symptoms can last weeks to months − Diagnosis is through stool microscopy for cysts or trophozoites − Treatment includes metronidazole if symptoms persist

Answer 12

Oral rehydration salts - It is a special combination of sodium and potassium, sugar and water - This assists in rehydration as sodium and glucose are co-transported across the GIT lumen (if you want to absorb more sodium, you need glucose with it) - The sodium then aids water reabsorption in the dehydrated patient - This decreases stool output and vomiting ZINC SUPPLEMENTATION − Zinc is an important micronutrient for overall health and development − It is lost in high quantities in patients with diarrhoea − Zinc supplementation as apart of treatment of acute diarrhoeal illness has been shown to; - Reduce the duration by 25% - Reduce the volume by 30% - Lower the incidence of diarrhoea in the following 2 – 3 months − In terms of dosage, as per treatment Plan A, the following guide should be used; 1. Up to 6 months: 1⁄2 tablet per day for 10 – 14 days (10 mg) 2. 6 months or more: 1 tablet per day for 10 – 14 days (20 mg)

Answer 13

VACCINATION − Vaccinations against a number of infectious agents are fundamental and extremely successful in prevention of diarrheal illness − Rotavirus is the most common cause of severe diarrhoea, which causes more than 215,000 deaths in children under 5 years of age every year. We already have an extremely effective vaccination against this making these deaths highly preventable − Other vaccine preventable causes of diarrhea include Measles (weakens a person’s immunity making them more susceptible to diarrhoea) and Cholera

Answer 14

− Ensure access to water and sanitation for all - 6.1 By 2030, achieve universal and equitable access - 6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations − By completing this goal, we are addressing one of the most significant underlying factors that contribute to diarrhoea

Answer 15

HIV − Globally ~38 million people are HIV in 2020 with 1.5 million being newly diagnosed − Since 2010, new HIV infections have declined by 31% − In Australia we have a low prevalence as it stands at 0.1% in 2017. Similarly incidence declined by 7% from 2013-2017 with 90% of diagnoses made in males − Higher rates of diagnosis in Indigenous Australians than non-Indigenous (4.6 to 2.8/100,000) − Higher proportion attributed to heterosexual contact and injecting drug use − People with HIV have experience more severe outcomes and have higher comorbidities TB − Is the leading cause of mortality from a single infectious agent − Estimated 10 million people fell ill with TB in 2019 but the global incidence is falling at approximately 2% per year but numbers of MDR-TB increased by 10% in 2019 − Incidence of TB in Australia remains one of the lowest in the world with ~1300 per year − Incidence of TB in Indigenous Australians remains 6x higher than non-Indigenous Australians − Cross border movements between Papua New Guinea and the Torres Strait by traditional inhabitants poses risk of TB spread especially MDR-TB

Answer 16

− HIV: 1. No poverty – economic empowerment removes risk factors and increases opportunities to get treatment 3. Good health and well-being - universal health coverage to get access to care 5. Gender equality - women more adversely affected (stigma, violence, abuse) 8. Decent work and economic growth - care can reach more people (migrants, bisexual, etc.) and people with HIV are 3x more likely to be unemployed (stigma, discrimination) 16. Peace, justice, and strong institutions - people centred accountability provides a platform for inclusive and appropriate services

Answer 17

− TB: 1. No poverty - inverse relationship between income and TB incidence rates for countries 2. Zero hunger - undernutrition which can lead to TB 3. Good health and well-being - access to universal health care to get treatment as well as addressing co-morbidities 5. Gender equality - females have a lack of access to care (present later to care) thus under detection and notification of TB in women 7. Affordable and clean energy - air pollution (indoor with cooking or outdoor) increases risk of infection of TB, so clean energy can improve air quality and decrease risk of TB

Answer 18

− Refers to patients who are infected to both HIV and Tuberculosis (active or latent forms) − The risk of death from tuberculosis is much greater in HIV positive patients compared to their HIV negative counterparts − This is incredibly damaging for patients as HIV speeds up the progression of latent tuberculosis to active tuberculosis whilst TB accelerates the progression of the HIV infection − Acquisition of these diseases however is still separate (that is, a person still needs to be infected by HIV and the Mycobacterium Tuberculosis along their normal disease progressions. Simply having HIV doesn’t mean you all of a sudden get TB or vice versa) − People that should be screened for co-infection are people living with HIV in Australia who are from or have travelled to high-burden TB countries − Latent TB infection - Diagnosis can occur through TST (Mantoux) or IGRA (QuantiFERON-TB Gold) tests - Lower cut-offs used for TST in HIV-positive population - False positive TSTs can be seen in patients who have previously received BCG vaccine - Several preventative treatment options (QH preferred regime is 9/12 INH and Vit B6) − Active TB infection - Prompt initiation of anti-TB drug regime and combined ART - Monitor for development of TB-IRIS (unmasking vs paradoxical)

Answer 19

− Transmission in pregnancy may occur antepartum, intrapartum (most common) and postpartum − Primary determinant of transmission is absence of maternal ART − Prevention of mother to child transmission can occur through: - Universal antenatal HIV screening - Maternal ART (transplacental transmission) and postnatal ART for newborn (breastmilk transmission) - Avoidance of breast feeding

Answer 20

− Are a class of antiretroviral drug that act as competitive substrate inhibitors (or in other words act as false substrates) - These drugs are analogues of specific naturally occurring nucleosides/tides - Once inside, nucleosides (not nucleotides) are phosphorylated by cell enzymes - Because they are structurally similar, once inside the cell they act as competitive substrate inhibitors by competing with natural deoxynucleotides for incorporation into the viral DNA chain - However, unlike natural deoxynucleotides, NRTIs lack the 3’hydroxyl group required to extend the DNA chain - As a result, the viral DNA chain is terminated, stopping viral DNA synthesis

Answer 21

− Are a class of antiretroviral drug that work by inhibiting reverse transcriptase − Unlike NsRTIs, these drugs do not require intracellular phosphorylation to become activated − The complete mechanism of action is outlined below; - These drugs enter the cell and non-competitively block the reverse transcriptase enzyme (RNA-dependent and DNA dependent polymerase) - They do this by binding and inducing a conformational change that reduces the efficiency of the catalytic site of the enzyme (meaning it can’t do its usually job) - Reverse transcriptase is the enzyme responsible for making a DNA copy of the viral RNA, meaning that if its action is blocked, viral DNA synthesis is reduced − These drugs can cause nausea, vomiting and occasionally a rash − These drugs are potent inducers of cytochrome P450 meaning they will reduce the concentration of some drugs

Answer 22

- As is outlined in the above virology of HIV, mRNA that has been transcribed from the provirus is translated into too biochemically inert polyproteins - Without these proteins, HIV maturation and replication cannot occur - HIV-Protease inhibitors work by blocking the action of this protease, preventing the formation of a functioning virus (which stops infection of new host cells) − These have a number of GI adverse effects, and even cause hyperglycaemia (due to inhibition of GLUT 4 transporters)

Answer 23

- This chromosomal integration is facilitated by a viral enzyme known as Integrase - Integrase inhibitors work by blocking the effect of this enzyme, which prevents the insertion of the viral DNA ends into the hosts genome

Answer 24

− Is a chemokine receptor antagonist used as an antiretroviral drug − The complete mechanism of action is outlined below; - In order for HIV to bind and enter into a host cell, a number of interactions must occur (gp120 AND gp41 on HIV must bind to CD4 receptors, as well as CCR5 co-receptors) - Maraviroc works by inhibiting the chemokine receptor 5 (CCR5) located on the surface of some immune cells (macrophages) - If this occurs, HIV binds to the CD4 receptors, however is unable to interact with the co-receptors CCR5, which prevents fusion of the virus envelope with the host cell membrane - Effectively blocking HIV entry into the host immune cell

Answer 25

− Is an antiretroviral drug that works in a similar fashion to entry inhibitors − The complete mechanism of action is outlined below; - In order for HIV to bind and enter into a host cell, a number of interactions must occur (gp120 AND gp41 on HIV must bind to CD4 receptors, as well as CCR5 co-receptors) - Fusion inhibitors work by binding to gp41, which prevents the initiation of fusion of the virus envelope and the cell membrane - HIV is therefore unable to gain entry into the host immune cell − These drugs are only used as a last line for most patients (as they incredibly expensive and not available in Australia anymore)

Answer 26

- These drugs inhibit the effects of CYP3A4 (which normally breaks down a number of drugs, including a number of antiretroviral drugs that are mentioned above) - Because many antiretroviral drugs are expensive and have a number of side effects, these drugs (ritonavir) are used in conjunction with Protease Inhibitors to reduce cost and permit the use of lower doses (avoid the adverse effects)

Answer 27

− When treating a patient with drug sensitive tuberculosis, the minimum treatment course is 6 months using four drugs (which can be remembered by the acronym RIPE); 1. Rifampicin 2. Isoniazid 3. Pyrazinamide 4. Ethambutol − All four drugs should be used for the first 2 months, followed by Rifampicin and Isoniazid for the next 4 months (4 for 2 then 2 for 4)

Answer 28

END TB STRATEGY − Is a WHO initiative that wants to end TB by 2030 − The strategy itself has 3 main targets; 1. 90% reduction in number of TB deaths 2. 80% reduction in TB incidence rate 3. Zero TB-affected families facing catastrophic costs due to TB − In order to achieve this goal it requires; - Expanding the scope and reach of interventions - Eliciting full benefits of health and development policies and systems - Pursuing new scientific knowledge and innovations - Provide universal health care with access to treatment

Answer 29

− Refers to any HIV treatment that uses a combination of two or more drugs − Without ART, most patients with HIV will eventually develop progressive immunodeficiency that is marked by; - Progressive CD4 T lymphocyte depletion - AIDS defining illnesses - Premature death − The primary goal of ART is to prevent HIV-associated morbidity and mortality (by inhibiting HIV replication which keeps the viral load / plasma HIV-1 RNA) levels below limits of detection − This is because high viral load is a major risk factor for HIV transmission − Effective ART can reduce viremia and transmission of HIV to sexual partners by more than 96% − The secondary goal of ART is to reduce

Answer 30

− It is important to note some of the key adverse effects of ART, which are outlined below; 1. Lipodystrophy - Is a condition in which the body is unable to produce and maintain healthy fat tissue - It causes peripheral lipoatrophy and central fat accumulation, as well as insulin resistance and dyslipidaemia - Occurs with NRTIs and HIV-Protease Inhibitors 2. Hyperglycaemia - Caused by HIV-Protease Inhibitors 3. CV disease risk 4. Lactic acidaemia - Seen with NRTIs 5. Hepatotoxicity - As a result of the mitochondrial toxicity 6. Bone loss and Rash

Answer 31

− Is a form of tuberculosis that is resistant to drugs − Treating drug resistant TB is harder, takes longer, has more side effects and is more expensive − There are 2 different types of drug resistant Tuberculosis; 1. Multi-drug Resistant Tuberculosis - Is resistant to Isoniazid and Rifampicin 2. Extremely Drug Resistant Tuberculosis - Is resistant to Isoniazid and Rifampicin, as well as to Fluoroquinolones and one of the injectable second line drugs − Drug resistant TB is either primarily acquired or as a result of mismanagement of a normal case of tuberculosis (either as a result of drug mismanagement or by inadequate clinical care) − As with all these horrible things, there is a global plan that is attempting to prevent it from wiping us out. This plan has 5 main priority actions to address the emerging global MDR-TB crisis; - Prevent the development of drug resistance through high quality treatment of drug-susceptible TB - Expand rapid testing and detection of drug resistant TB cases - Provide immediate access to effective treatment and proper care - Prevent transmission through infection control - Increase political commitment within financing

Answer 32

− These 4 main disease all share the same big 4 modifiable risks factors; Physical inactivity, alcohol abuse, tobacco use and an unhealthy diet − Non-communicable disease account for 70% of deaths worldwide, 15 million of which occur before the age of 70 - Almost ¾ of the total deaths occur in low- and middle-income countries - Of the early deaths (that occur before the age of 70), 85% are in low- and middle-income countries

Answer 33

− NCDs are on the rise, which is driven by urbanisation, economic situations and infrastructure − Poverty contributes to non-communicable disease (through exposure to modifiable risk factors), and non-communicable disease contributes to poverty (because if you are unwell or disabled, you cannot earn an income. Furthermore, the cost of healthcare also tends to force families into poverty). Plus NCDs are a large cost to the health system

Answer 34

CLINICAL FACTORS − Clinics perspective of non-communicable differs greatly from that which they are used too − Typically they treat a patient until they are better, and only see a patient again if it hasn’t worked − Another factor that needs to be addressed from the clinical perspective is the lack of patient education. It is important that clinics contribute to patients understanding of their condition so that they can follow their treatment − So, just as how the patients need to change, so do the clinics − Some interventions at a clinic level to develop of we manage people with chronic disease includes things like; 1. Regularly review patients (appointment system) and patient-centred care 2. Require a recall system with increased team work and referral 3. Because their will be more people coming in, they need strategies to manage increased numbers of patients (so staff need to learn new management protocols) 4. Record keep is crucial 5. Need to educate patients as they are responsible for some of the care 6. Ongoing medication is required to treat these conditions, so need to consider supply and cost considerations HEALTH SERVICE − Interventions to improve how the health service manages non-communicable disease include things like; 1. Medication availability / cost (ongoing medication needed) 2. Referrals and shared care system set up 3. Health practitioner training and increasing numbers of the workforce 4. Protocols for best practice strategies to reduce the burden of disease

Answer 35

− Are the interventions that are identified by the WHO to be the most effective in terms of benefit and cost regarding non-communicable disease prevention and management − More specifically they are interventions that been chosen because they; - Have demonstrated measurable effect - Show a clear link to one of the NCD targets - They have a cost-effective analysis of less than $100 per Disability Adjusted Life Year (DALY) - They are feasible - They impact on health equity − These best buys aim to; 1. Reduce harmful alcohol use 2. Improve diets 3. Reduce physical inactivity 4. Manage CVD and Diabetes 5. Manage COPD 6. Strengthen health systems 7. Manage tobacco use and cancer − The theory is that these best buys provide nations with good recommendations so that they can start rapidly on the fight against non-communicable diseases (because they’ve already done the hard work for them by coming up with the solutions)

Answer 36

WHO-PACKAGE OF ESSENTIAL INTERVENTIONS FOR NCDS (WHO-PEN) − Is a tool to improve access to cost effective interventions for the poor even in resource constrained settings − They are a package that can be used to develop detection, prevention, treatment and care of risk factors for the 4 main non-communicable diseases (cardiovascular disease, diabetes, chronic respiratory disease and cancer) in the primary health care setting − The package itself involves the following things; 1. Essential medicines list 2. Minimum equipment / technology list 3. Staff training 4. Auditing and data collection 5. Patient records 6. Evidence based protocols for screening, assessment and treatment of common conditions 7. Health education messages 8. Referral pathways − The theory is, a struggling health care system can grab this package and dramatically improve the detection, prevention, treatment and care they can provide for their patients

Answer 37

UNIVERSAL HEALTH CARE IN NCDs − 5 priorities include: 1. Prevention 2. Primary health care 3. Equitable access to medicines 4. Sustainable financing and investments 5. Engaged and empowered communities TARGETS − For the past few years (since 2007) there have been a global set of voluntary targets for preventing and controlling non-communicable disease − The targets were established for completion by 2025, and are relative to a countries baseline − The complete list of targets is provided below; 1. A 25% relative reduction in overall mortality from cardiovascular disease, cancer, diabetes or chronic respiratory disease. 2. At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context. 3. A 10% relative reduction in prevalence of insufficient physical activity. 4. A 30% relative reduction in mean intake of salt or sodium. 5. A 25% relative reduction in the prevalence of hypertension or maintain the prevalence of hypertension in accordance with the national circumstances. 6. Halt the rise in diabetes and obesity. 7. At least 50% of eligible patients should receive drug therapy and counselling to reduce the incidence of myocardial infarctions and stroke. 8. An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major non-communicable disease in both public and private facilities.

Answer 38

− Is a set of rules within international law which seek to limit the effects of armed conflict by; 1. Protecting persons who are not participating in the hostilities 2. Restricting the means of warfare (e.g. the types of weapons and war tactics) 3. Definitions of refugees and asylum seekers 4. Outlines the rights of refugees and asylum seekers

Answer 39

− Stands for the United Nations High Commission for Refugees − The UNHCR declares that everyone has the right to seek asylum and fine safe refuge in another state by either returning home, integrating or resettling − In emergency situations, the UNHCR aim to; 1. Coordinate agencies 2. Provide emergency assistance 3. Advocacy 4. Registration and Legal protection 5. Long term solutions (resettlement, repatriation, integration) − They provide clean water, sanitation, healthcare, shelter, blankets, household goods and food supplies, as well las arrange transport and assistance packages for people who return home and income generating programs for those who resettle − Registration with UNHCR gets a person a refugee card − Every refugee goal aligns with the SDGs

Answer 40

− Prima facie refugees is the term used for refugees who experience a mass movement due to conflict or violence − An asylum seeker is an individual whose process for a refugee status have not yet been processed − Internally displaced people are those who flee from their homes due to the aforementioned reasons, but do not cross a border into another country (for whatever reason)

Answer 41

− Attend to the immediate health needs of the individuals − There are a number of important logistical things to consider about refugee camps; 1. Registration 2. Site planning and safety 3. Water and Sanitation 4. Rubbish, Waste and Vector Control 5. Food and Nutrition 6. Health care in an emergency 7. Education

Answer 42

REGISTRATION − Registration of refugees as they enter the camp is the responsibility of the host government as it is a vital aspect of planning − Individuals should be provided with documents that enable them to access services (like ration and healthcare cards)

Answer 43

− Refugees should be asked about their end goal, whether that is; 1. Voluntary repatriation - Is the return of refugees to their home country, of their own free will once conditions have become safe - There must be a guarantee of protection from their country’s government 2. Resettlement - Is the organised movement of refugees from refugee camps or other temporary situations into a third country where they can live permanently - It is the only way to guarantee protection of a refugee who is at risk of forcible return or who faces serious problems in that country 3. Local integration - When refugees seek to attain rights similar to those enjoyed by the citizens of the country in which they have sought refuge - Some may be able to attain citizenship

Answer 44

− The site should be planned in accordance with the following guidelines; - 30 – 45m2 of space per person - Firebreaks every 50 to 300m - 1 to 1.5m between tents - Roads should account for 20 – 35% of the site (to ensure access for supplies and emergency services) − Local resources and business should be utilised in order to provide an economic benefit to the country which is hosting the camp − Resources should be identified and provided including clothing, bedding, tents, stoves, fuel and lighting − Some organisations who help in this process include; UNCHR, UNICEF, UN organisations, MSF and the Red Cross

Answer 45

WATER AND SANITATION − In order to provide the camp with adequate water and sanitation infrastructure, the following provisions should be made; 1. Water - Approximately 20L per person per day of water is required as a minimum for drinking, cooking and hygiene in an emergency there should be 5L - To achieve this, one tap per 250 should be provided (the water supply must be approximately 7.5L/minute) as well as 2x 10 – 20L water containers per household 2. Soap - 250g of soap per month per person - Does not include a plan for handwashing at the toilet and cooking facilitates 3. Acceptable material for menstrual hygiene - Needs to be culturally appropriate - Liaising is required with the refugees 4. Toilets - 1 toilet per 50 people is a minimum but ideally 1 toilet for each house - Needs to be segregated by sex - They need to be closer than 50m from the dwellings to ensure access - They must not contaminate groundwater sources (must be 30m away from groundwater sources, bottom of the toilets need to be a minimum of 1.5m above the groundwater level)

Answer 46

WASTE CONTROL − Vectors like mosquitoes, mice, rats and lice must be controlled − 100L bins should be provided per every 10 households (collected 2 times a week and taken to pits a minimum of 100m away from the households) − Appropriate medical waste and corpse disposal should be implemented

Answer 47

FOOD SUPPLY − Food and nutrition should be supplied locally to support the host country whilst being acceptable to the refugee’s culture to ensure they are aware of how to prepare the food − Needs to be diverse to prevent malnutrition and nutritional deficiencies (2100 calories/day) − Needs to be age-appropriate food available and can test middle upper arm − There should be a method for orderly access to the food supply

Answer 48

HEALTHCARE − Should initially address the immediate threats to life including mental health, compromised physical injuries, communicable disease and non-communicable diseases − It should be organised such that it can; - Cope with high volumes of patients - Have an active case finding capability (because refugees may not be trusting of the health services) – diagnose, document, manage and prevent - Provide basic level of care for a variety of illnesses - Be flexible enough in order to adapt to challenges (like outbreaks i.e., leptospirosis) − Both curative and preventative mechanisms are required so vaccinations programs should be implemented. Still require primary health care with referrals and dental services − In terms of the requirements of healthcare; 1. Outpatient department should be provided 1 per 5000 2. Inpatient department should be provided 1 per 10,000 3. Referral hospitals are those within the host country (surgery, labour, endemics such as malaria, HIV, TB, tetanus, diphtheria, measles)

Answer 49

CONFLICT RELATED SEXUAL VIOLENCE − As of February 2019, The penal code has been revised to include conflict-related sexual violence as a war crime − The aim is to humiliate women which has a flow on effect to humiliate men (further exacerbated if children are implicated) − An individual’s vulnerability to experiencing conflict related sexual violence continues through the movement process, creating a risk of unwanted pregnancies and the children resulting from them

Answer 50

− Symptoms: fever, rash, coryza/conjunctivitis/cough − Management: - Active case findings and early intervention - Nutrition via food supplements and vitamin A - Antibiotics – RTI, otitis media and pneumonia - Supportive management – skin sores, mouth ulcers, encephalitis - Diarrhoea – oral rehydration solution − Prevention: vaccination

Answer 51

− Investigate and confirm outbreak - Definition: severe dehydration/death with watery diarrhoea - Diagnosis: positive cholera in stool or vomit − Management: - Oral rehydration for mild/moderate cases - IV fluids and possible antibiotics for severe cases − Prevention: chlorinate water, infection control and health promotion (food, water and toileting) 1. Reducing mortality - Can be achieved through Cholera Treatment Centres and by Effective Case Management 2. Reducing epidemic spread - Can be achieved by improving water and sanitation, developing hygiene practices and through public education 3. Co-ordination - Can be really challenging are there are a number of different parties involved - As an example of the parties involved: Ministry of Health, WHO, World Food Programme, Other non-government organisations, Local leaders and community groups, within your own organisation your working with

Answer 52

− Refugee healthcare is based on the principle ASK; 1. Ask 2. Screening and health check-ups 3. Kindness − The majority of the medical care provided to refugees in Australia is free, including; - Public hospital including in-patient, out-patient, emergency and elective surgery - Ambulance - Community health - Dental health - Catch-up immunisations - Interpreters

Answer 53

ASK − It is important to take a full and comprehensive history including aspects which may unique to a refugee patient − The important aspects of the history and medical history are outlined below; 1. Refugee history - Country of origin and transit countries to determine which diseases should be screened for - Ethnic background as some ethnicities are risk factors for diseases - When did the patient arrive in Australia, what type of visa and time spent in detention (as detention is a risk factor for developing a mental health condition) - Languages spoken, preferred language and interpreter preference. - Occupation and access to education in their country of origin - Current stressors including housing security, housing condition, financial stress, education, training and work-related stress - Gender preference – this is important in some cultures as it may be deemed culturally inappropriate to discuss sensitive manners with the opposite sex - Current priorities about their health and personal needs 2. Medical history - History of or contact with patients with an infectious disease (e.g. TB, malaria, HIV) - History of non-infectious diseases including any complications with hearing, vision and dentition, pregnancy as well as CVD, COPD, diabetes and cancer - Perinatal and postnatal history for all children, growth and nutrition history to identify malnutrition and micronutrient deficiencies and developmental milestones - Past medical history including family, allergies and medication - Current health (SNAP) - Mental health should be assessed through asking about sleep, appetite, mood, anxiety and behaviour (It is not advisable to ask directly about a patient’s experience of torture or trauma)

Answer 54

MENTAL HEALTH − Common mental health issues present within the refugee population include PTSD, depression, anxiety, substance abuse, cognitive impairment and somatisation (making something psychological physical) − Substance abuse is particularly prevalent offshore as medications may not be accessible

Answer 55

TORTURE AND TRAUMA − 1 in 3 refugees will have experienced trauma – however, the number is much higher if they have experienced offshore detention - 80% of women will have experienced sexual abuse or torture - 70% of refugees will have experienced physical or psychological violence − Asylum seeker syndrome is prevalent but almost never registered (It is clinically referred to as post-traumatic stress syndrome (PTSD) − Patients who have experienced torture and trauma should be referred to the Queensland Programme for Assistance of Survivors of Torture and Trauma (QPASST) as they are entitled to counselling and support

Answer 56

− Critical situations that require an interpreters include taking the first clinical history, getting consent for procedures/treatment, pre and post-surgery information, results given, etc. − Why can’t use family/friends - Inaccuracy (is a specialist skill) - Possible withholding or distorting information - Non-objective viewpoint as the family member - Possible inadequate communication - Confidentiality standards may not be met − Consider language, political, religious or cultural sensitivities, gender or whether specialist knowledge is required − 2 types of interpreters are available. The advantages of both are seen below: - On-site: non-verbal cues, better for longer and stressful interviews - Telephone: cheaper, available anywhere and at any time and anonymity

Answer 57

− Refugees encounter a variety of barriers including; 1. Language and education 2. Torture and trauma 3. Prolonged poverty 4. Family separation and loss 5. Unfamiliar with the Australian healthcare system 6. Uncertainty about the future 7. Racism

Answer 58

INVESTIGATIONS − Investigations which may be of benefit for refugee populations include; 1. Eosinophil level as eosinophilia is indicative of parasitic infections. 2. Hepatitis B 3. Strongyloidiasis 4. HIV 5. LTBI 6. H. Pylori 7. STI 8. Nutritional deficiencies − Investigations which should be provided for patients dependent upon their risk level include; - Schistomiasis - Malaria − The actual tests include: serology, nutrition screening, stool and urine testing

Answer 59

CONTRACEPTION − Access barriers include knowledge, agency and availability − Contraception reduces maternal mortality rate (MMR) - Fewer unintended pregnancies and less exposure to risk of unsafe abortion - Fewer pregnancies per woman and fewer complications per pregnancy (if reduce pregnancy in very young or older mothers - Users of contraception are more likely to access other health care - Possible improved economic standard of living and more likely to be able to pay for emergency obstetric care if required − When contraception fails it often results in unsafe abortion (cause of 8% of maternal death) − Complications of unsafe abortion include: - Incomplete abortion - Haemorrhage - Infection - Uterine perforation - Damage to genital tract

Answer 60

SKILLED BIRTH ATTENDANTS − Are accredited and educated health professionals (midwife, nurse or doctor) − May attend home delivery or work from clinic or hospital − Proportion of births attended by an SBA is climbing (80% globally) − They are strangers to the community and can often be dispassionate. However they have the ability to; 1. Access necessary equipment and medications 2. Access referral centres 3. Develop birth and emergency plans 4. Monitor progress and identify complications early 5. Provide antenatal care (including antiretroviral HIV treatment)

Answer 61

BASIC ESSENTIAL OBSTETRIC CARE − Is the basic care all pregnant women should receive by healthcare centres. It includes the following aspects; 1. Parenteral antibiotics (e.g. ampicillin and gentamycin) 2. Parenteral oxytocic drugs, which should be given prophylactically to all women at the 3rd stage of labour to reduce the risk of haemorrhage (are the drugs which cause uterine contractions) 3. Parenteral anticonvulsants for pre-eclampsia and eclampsia (e.g. magnesium sulfate) 4. Manual removal of placenta 5. Removal of retained products of conception 6. Assisted vaginal delivery (vacuum extraction) 7. Newborn resuscitation COMPREHENSIVE EMERGENCY OBSTETRIC CARE − Is provided by district hospitals, and should include the basic essential obstetric care in conjunction with; 1. Surgical intervention (caesarean section) 2. Blood transfusions

Answer 62

1. Elevate the position of women in the health and care workforce 2. Increase women’s participation and leadership in science and public health 3. Reduce non-communicable diseases among women 4. Ensure quality sexual and reproductive health for all - Maternal mortality rate (MMR), Discrimination, Harmful practices, Contraception 5. Prevent and respond to violence against women - Human trafficking 6. Address gender inequality in the COVID-19 response and recovery

Answer 63

− Unequal power relationships between men and women − Social norms that decrease education and paid employment opportunities − An exclusive focus on women’s reproductive roles − Potential or actual experience of physical, sexual and emotional violence

Answer 64

There are 3 key contributing factors of this maternal mortality; 1. Delay in seeking care (they don’t recognise a complication so there is a delay in deciding to act and seek help such as low status, previous poor health experiences) 2. Delay in arrival at health care facility (travel issues, financial problems) 3. Delay in the provision of adequate care (lack of resources) The main causes of maternal mortality include; Pre-existing conditions (indirect) Haemorrhage Pregnancy induced hypertension Infections Obstructed labour Abortion complications Blood clots/embolis (indirect – biggest cause in Australia

Answer 65

ANTENATAL CARE − WHO recommends at least a minimum of 8 antenatal care − Benefits include emotional support and advice, medical care and relevant and timely pregnancy information − There are 3 phases to antenatal care: - Early: dates and screening e.g. ultrasound, syphilis, HIV, Hep B, Hb, give iron and tetanus vaccine - Mid x2: checking BP, fetal growth, maternal wellbeing and anaemia - Late: fetal lie, delivery planning (where, with SBA, education on recognising problems, having a transport plan, etc.)

Answer 66

– FEMALE GENITAL MUTILATION (FGM) − FGM compromises of all procedures involving the removal of the external female genitalia or other injury to the female genital organs for non-medical reasons − Is a human rights violation and is illegal in most countries − Short term medical complications: pain, infection, haemorrhage and tetanus − Long term medical complications: dyspareunia, dysmenorrhoeal, dysuria, incontinence, PTSD and obstetric complications

Answer 67

− Is the recruitment, harbouring or transporting of people into a situation of exploitation through the use of violence, deception or coercion and are forced to work against their will − There are many different forms of exploitation including forced prostitution, forced labour, forced begging, forced criminality, domestic servitude, forced marriage and forced organ removal − Individuals who are victims of human trafficking are preyed on in accordance with their vulnerabilities − Patients may experience severe physical, sexual and psychological abuse which may result in sexually transmitted disease and unwanted pregnancies − Patients who have experienced human trafficking may be hesitant to speak and defer to a partner when asked questions. They may also be unable to engage in a private examination

Answer 68

− A common problem that occurs with adolescent pregnancy is obstetric fistulas. This is an abnormal hole between the vagina and the rectum or bladder caused by prolonged labour - It is caused by the compression of the urogenital organs during prolonged labour which causes ischemia and therefore necrosis of the tissues forming a fistula - Obstetric fistulas cause urinary or bowel incontinence, meaning these women leak and smell causing social ostracism (shame, stigma and even outcast from family/community) − Obstetric fistulas are preventable through; 1. Delaying age of the first pregnancy (allows the pelvis to develop more) 2. Cessation of harmful traditional practices (e.g. female genital mutilation) 3. Timely access to obstetric care

Answer 69

One health recognises health of people is connected to health of animals and ecosystems. Collaborative, multisectoral and transdisciplinary approach – working at local, regional, national and global levels Transdisciplinary – team of people; question each other in expert knowledge from the community Not necessarily just zoonosis Understanding systems thinking – thinking in loop structure; behaviour emerges from structure of its feedback loops. Root causes are not individual nodes – they are forces emerging from other feedback loops. Health individual does not exist in isolation. All members of larger community with multisectoral interactions with different animals. Climate change, urbanisation and poor environmental regulation results in deforestation and destruction of habitat. Global trade is easy, travel is fast meaning previously isolated pandemics potential to rapidly spread. The environment, animals and disease all overlap. New diseases emerge. Our efforts to secure a safe, adequate food and water supply, our efforts to protect the environment and our efforts to prevent and protect from human disease must subsequently all overlap 🡪 One Health approach which fosters collaborative relationships between human, animal and environmental health with improved communication between sectors, coordination of disease surveillance and delivery of uniform messaging to the public

Answer 70

Human populations are growing and expanding into new geographic areas 🡪 as a result, more people live in close contact with wild and domestic animals. Close contact provides more opportunities for diseases to pass between animals and people The earth has experienced changes in climate and land use, such as deforestation and intensive farming practices 🡪 disruptions in environmental conditions and habitats provide new opportunities for diseases to pass to animals. International travel and trade has increased 🡪 diseases can spread rapidly across the globe.

Answer 71

Schistosomiasis Clinical importance: Acute infection – rash from penetration of cercariae. Fever, myalgia, eosinophilia (Katayama Fever) Chronic infection leading to inflammation and fibrosis as an immune reaction to the eggs laid in the worm Intestinal (Several species) – in intestine and liver: abdominal pain, diarrhoea, blood in stool, signs of portal hypertension – e.g. hepatomegaly, ascites Urogenital (Schistosoma haematobium) – bladder, genital lesions: haematuria, dysuria, longterm bladder cancer or infertility Distribution: Africa, China and PNG +/- Some parts of South America (Brazil, Puerto Rico, Venezuela)

Answer 72

Leptospirosis Leptospirosis is an infection in rodents and other wild and domesticated species Outdoor and agricultural workers (rice-paddy and sugar cane workers for example), recreational hazard to those who swim or wade in contaminated waters In endemic areas – number of cases may peak during the rainy season and may reach epidemic proportions in case of flooding because the floods cause rodents to move to the city

Answer 73

Cysticercosis Clinical importance: primary neurocystercosis causing epilepsy or other neurological symptoms Cysts can be in the brain, eye or spinal cord Taenia Solium tapeworm mostly asymptomatic – people tend to present for treatment only if they notice passage of segments of tapeworm in their stool Taenia Solium: Human ingests infected pork, poorly cooked and laden with cysts 🡪 T solium eggs are ingested by pork which is intermediate host. Also can spread to humans via ingestion of faeces – human cysicercosis

Answer 74

Schistosomiasis Control of schistosomiasis will require collaboration between human health, animal health and environmental sectors. Humans can be treated to eliminate parasite excretion and prevent clinical illness but if this is the only strategy, reinfection happens very rapidly. The snail vector needs control and a suggested method is by protecting fish stocks - which in turn requires alternative agricultural and aquaculture methods of generating food. Sanitation is also needed to prevent contamination of water sources by infected people.

Answer 75

Leptospirosis Control human infection via wearing protective clothing for individuals with occupational risk and avoidance of swimming in water that could potentially be contaminated. Leptospirosis can be controlled in vectors via targeted vaccination, focused culling programs, rodent control. Finally, environmental (built and natural) factors can be mitigated through climate change mitigation (flood-spoofing infrastructure in flood-prone areas) and public health education to reduce exposures to risk environments.

Answer 76

Cysticercosis Controlling human infection through treatment of taeniasis cases, improved sanitation, health education including general hygiene and food safety. Controlling the vector can involve intervention in pigs (vaccination plus anthelmintic treatment) together with strategic mass drug administration for taeniasis. Improved environmental practices – improved pig husbandry, meat inspection and regulation.

Answer 77

NCDs Need for coordinated, multisector actions in order to appropriately manage the direct manifestation of noncommunicable disease in the individual, for example, testing and case-management of Chronic Obstructive Respiratory Disorder (COPD). Wider systemic considerations needed too – for example, in regard to environmental health. Accordingly a multi-sectoral action may be minimization of fossil fuel use, leading to lesser carbon emissions and subsequent decreases in air pollution. This is inherently a causal relationship in which poor environmental health (i.e. polluted air) contributes to human disease and as such a coordinated, transdisciplinary approach is needed between the public health, government and environmental scientists.

Answer 78

Epidemic: increased number of infectious illness above expected levels in place of region Pandemic: Extension epidemic beyond regional boundaries. Information needed – cases so far: symptom profile, deaths, locations and potential sources of infection. Features of the disease: symptoms, incubation period, modes of transmission, infectivity period, expected fatality rate, available treatment, effective, preventative strategies and historical data. Recognise outbreaks and prepare to investigate – normal rates, cases related to each other? Verify diagnoses and confirm outbreak exists Establish case definition and find cases – Determine risk population Develop hypotheses – what is it? Where did it come from? How is it spreading? Who is at risk? Why now? Test hypotheses epidemiologically – as necessary, reconsider, refine and re-evaluate Carry out further studies if necessary Implement control and prevention measures specific to the situation Communicate findings

Answer 79

Climate change and disruption of natural ecosystems has resulted in considerable disruption of the insect population in certain regions. This has significant implications for changing patterns of Dengue and Malaria transmission. Need for public health adaptation measures (WHO 2008 working document dedicated to this). Vastly changing ecosystems will affect different populations in different ways.

Answer 80

Large mediator of climate change can be linked to anthropogenic climate emissions, particularly in the form of CO2 from burning fossil fuels. This has clear links with Chronic Obstructive Pulmonary Disease (COPD) and other respiratory disorders – bidirectional relationship between the things we as humans doing affecting our environment (air we breathe) and the air we breathing affecting out health. In order to tackle this, there needs to be concerted and multi-sectoral approach to health, understanding that wider civil society, government regulation and individual choice are all critical factors in ameliorating carbon emissions and improving respiratory disease Need for planning for disaster risk reduction and mitigation in communities which will be affected the most. The United Nations Development Programme was introduced as a pilot program which aimed at increasing capacities of National Health systems to the effects of climate change. Focus on early warning of disasters and outbreaks and early intervention: Jordan has been working on control of diarrhoeal disease through improved sanitation (risk is mediated through lack of water 🡪 open defecation in waterways that supply drinking water). Climate change will worsen water supply and salinity risk. Bhutan and Kenya are rolling out vector-disease risk reduction in highland areas. China is focusing on greening metropolitan centres which retain heat and pose threats of heat stroke

Answer 81

− Malaria chemoprophylaxis can be achieved by any of the below 3; 1. Doxycycline - Taken daily from 1 day before, to 4 weeks after leaving the malarious area - Side effects: Photosensitivity, GI upset - It is cheap - It requires prolonged use and compliance 2. Atovaquone-proguanil (Malarone / Promozio) - Taken daily from 1 day before, for 1 week after leaving the area - Side effects: vomiting and diarrhoea (less common) - Shorter duration than doxycycline however they are expensive 3. Mefloquine (Larium) - Taken once weekly - Side effects are rare, but some may experience neuropsychiatric complications − It is also important to give travellers that won’t have access to medical care: Rapid test kits and an initial treatment course (Artemether-lumefantrine) − A fever in a traveller up to 3 months after returning from an at-risk country is malaria until proven otherwise − Requires a blood film for diagnosis

Answer 82

− The basics that we want to cover with every traveller is listed below; 1. Childhood vaccines - MMR, Varicella, Polio, Hep B and HiB 2. Tetanus (10 years, 5 years for bad wound) / Whopping cough / Diphtheria 3. Influenza 4. Pneumonia (child or over 65) Others include Hep A, Typhoid (Salmonella Typhii) , RabiesMeningococcus (Neisseria Meningitidis), Cholera (Vibrio Cholerae), Malaria, Yellow Fever, Japanese Encephalitis

Answer 83

Non-Bloody Travel Diarrhoea The most common illness from neglecting basics of: Hand hygiene Safe drinking water Boil, bottle and peel Food handling is a significant contributor Avoid cooked food that has been allowed to cool Beware of seafood and dairy products Biggest culprits are ice cubes and ice cream No Vaccination.

Answer 84

Hepatitis A Faecal oral transmission, typically transmitted by undercooked shellfish, or inadequately cooked or frozen fruits, vegetables or other foods. Budget travel, backpackers and trekkers have greater risk Standalone vaccination = Avaxim: 3 year coverage with booster at 6-12 months giving lifelong immunity

Answer 85

Typhoid (Salmonella Typhii) Food and drink contaminated with faeces. 10% fatality in untreated cases. Highest in Asia, Africa and ME 90% protection with vaccination HepA+Typhoid = Typhim injection: coverage for 3 years

Answer 86

Rabies Progressive CNS infection from Lyssavirus Dogs, monkeys or any mammal NEED post-exposure prophylaxis or universal mortality. IM: 3 doses needed at days 0,7,28 Booster needed at 3y depending on risk/titre If pre-exposure prophylaxis = need to post-exposure vaccines only at day 0 and 3 No PReP = Rabies Ig + Vax @ days 0,3,7,14

Answer 87

Meningococcus (Neisseria Meningitidis) Potentially fatal bacterial infection 6 major serogroups – A,B, C, W, X, Y Highest incidence: C and W: Sub-saharan Africa (Meningitis belt) and pilgrimage to Mecca B and C: Industrialised countries, schools and close quarters Approved for >2years (on immunization schedule at 12 months) Quadrivalent vaccination recommended for travel (ACWY) – currently on immunization schedule. Approved up to 55 years old.

Answer 88

Cholera (Vibrio Cholerae) Contaminated water Free living bacteria – invade crustaceans and fish too Dukoral (oral inactivated) Primary course needed is 2 doses at least 1 week apart Booster at 2 years, repeat course if longer than 5 years Efficacy of 85%, declining from 6 months Also coverage for Enterotoxigenic E. Coli (efficacy of 60%, 3-6 months)

Answer 89

Malaria Most common cause of fever in returned travels Prominent in Australian travel community Prevention is key – Chemoprophylaxis: Doxycycline daily – 1 day before, 4 weeks after leaving malaria area. SE: photosensitivity and GI upset. Cheap but need prolonged course and adherence. is Vaccination

Answer 90

Yellow Fever Flavivirus transmitted by Aedes Aegypti, common in Sub-Saharan Africa and South America Low risk of transmission but very high risk of mortality Stamaril – live vaccination, do not give to IC, breastfeeding or pregnancy Given to protect individual and prevent international spread Lifelong protection

Answer 91

Japanese Encephalitis Flavivirus spread in Asia through Culex mosquito Year round transmission in SE Asia, seasonal in China and Japan. High risk in agricultural regions 30% fatality + serious neurological sequelae JEspect vaccination – inactivated, 2 doses, 96% cover Imojev – live attenuated, single injection from >9 months, 95% cover.

Answer 92

Altitude Sickness Acute Mountain Sickness, High-Altitude Cerebral Oedema (HACE) and High-Altitude Pulmonary Oedema (HAPE) Prevent via acclimatization and slow ascent Acetazolamide (Diamox) – for rapid ascent to altitudes >2,800m. Improves acclimatization

Global health Flashcards

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