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Why is measurement is critical for global health? (1-5)

1. To understand disease trends and set priorities
2. To assess progress towards targets
3. To evaluate the Effectiveness of interventions
4. To better plan interventions/programs
5. To monitor and evaluate health systems and services


Why is measurement is critical for global health? (6-9)

6. To provide feedback to improve performance
7. To advocate for resources and investments
8. To measure impact of donor aid
9. For granting agencies to evaluate their investments and strategies


What are the 4 steps to creating literature/relevant global health data?

1. Discovery research [basic sciences/observational sciences]
2. Development research [validation through RCTs or observational studies demonstrating efficacy and then effectiveness]
3. Delivery/Implementation research [transitioning to scale]
4. Monitoring and Evaluation of Impact [health systems, behaviors, coverage, outcomes (morbidity, mortality)]

Note: Flow goes in both directions


What is a concern about data from RCTs?

RCTs don’t tell us anything about the real world, they’re controlled, small population. Studies can be impacted by the Hawthorne effect.

RCT functions more as ‘proof of concept’


What are some disadvantages of data collected through national demographic surveys?

1. they are large and don’t focus on any specific issue
2. published by the government, so if I government doesn’t want to look bad or something they may omit it from the survey


What are the impacts of an intervention?

Impact is not the same as effectiveness, impact is looking at the effect of the intervention on:
1. Health outcomes
2. Health systems
3. Sustainability
4. Environment
5. Gender


What are some challenges to measuring the impact of an intervention? (6)

1. Data are often unreliable or irrelevant

2. Insufficient planning and funding for measurement (many projects never quantify impact)

3. Denial: do we really want to know the truth?

4. Advocacy, sometimes, is more impactful than measurement and evidence (e.g. advocacy promoting breast cancer screening vs evidence)

5. No guarantee that Evidence will change what we do or lead to policies to support it

6. Politics (self interest) will almost always TRUMP science


What are 3 key health indicators?

1. Morbidity
2. Mortality
3. Disability


What is Morbidity?

sickness or any departure, subjective or objective, from a psychological or physiological state of well-being


What is Disability?

temporary or long-term reduction in a person’s capacity to function


What is Prevalence?

number of people suffering
from a certain health condition over a
specified time period


What is Incidence

- the rate (#s/time) at which new
cases of a disease occur in a population


What is a ratio?

Ratios: numerator is not derived from
(# maternal dealth/100,000 live births)


What are 5 key health status indicators?

1. Maternal mortality ratio
2. Neonatal mortality rate
3. Infant mortality rate
4. Under-five mortality
5. Life expectancy


What is Health-Adjusted Life Expectancy (HALE) ?

A health-expectancy measure

Summarizes expected number of years to be lived in what might be termed the equivalence of good health

To calculate the HALE: the years of ill health are weighted according to severity and subtracted from the overall life expectancy


What is Disability-Adjusted Life Years (DALYs)?

The sum of years lost due to premature death (YLLs) and years lived with disability (YLDs). DALYs are also defined as years of healthy life lost

Indicates losses due to illness, disability and premature death in a population, accounting for health conditions like mental illness that rarely cause death

Disabilities are weighted


What is the Global Burden of Diseases, Injuries, and Risk Factors Study?

over 1,000 people from over 100 countries put together all the world’s data on more than 1,000 different clinical outcomes

- It describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels


What has happened to DALY rates from all causes since 1990s

Dalys improving over time: the biggest impact is due to survival of children under 5


According to DALY, a year lost under 5 is worth more or less than a year lost in early 20s? Why?

the ‘value’ of a year lost under 5 is less than that of someone in their early 20s
This is because of all the resources put into young adults and their potential for productivity in the coming years


What are the 3 types of conditions?

What are the trends in these 3 types?

1. Communicable, maternal, neonatal, and nutritional diseases
2. Non-Communicable diseases
3. Injuries

Over time, decrease in communicable but no change in injuries. Non-communicable now represents a greater part of the ration in comparison to the two other ones


What are the 2 biggest causes of death within Communicable diseases?

pneumonia and diarrhea


What are the 5 diseases with the highest burden? *****

1. Cardiovascular
2. Diarrhea and other infectious diseases
3. Cancers
4. Other non-communicable
5. Neonatal disorders


Where have the highest burden for non-communicable diseases?

Mongolia, Afghanistan, Russia, and Eastern Europe


Who is at highest risk for road traffic injuries?



What is The Epidemiologic Transition

It is a shift in the burden of disease that almost all low income countries are going through

Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease

Communicable still high, but Rising NCD burden due to change in lifestyles and increasingly attributed to pollution & climate change

Progressive declines in mortality as epidemics become less frequent

Finally, further declines in mortality, increases in life expectancy, and the predominance of noncommunicable diseases


What determines the pace of the Epidemiologic Transition?

Sociodemographic status explains more than 50% of the variance between countries and over time for Group 1 causes ( diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases).

BUT explained less than 10% of the variance in DALY rates for group 2 and 3 causes (cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence).

* note: specific causes are there as examples, do not memorize


What are the top risk factors for death globally?

1. Poor diet
2. high systolic blood pressure
3. Smoking


What is the the top risk factors for death in children under 5 globally?

1. undernutrition


What are the 5 groups of social determinants of health?

1. Neighbourhood and built environment
2. Social and community Context
3. Economic Stability
4. Education
5. Health and Health care


Which social determinant did the prof say is most important for continuing to reduce mortality in women and children?