Intro to Public Health - Blog 12

Any given public health problem has a multitude of determinants and cases of determinants. There is never one direct, simple cause. A determinant is something that causes the problem at hand. There are different cases of determinants that include biological, social and cultural, clinical, environmental, economic, and political. The problem that I have been researching, maternal mortality in Sierra Leone, has an extremely long list of determinants in all different classes.

Biological:

Biological factors probably affect the mortality rate in Sierra Leone the least. One example is the prevalence of malnutrition and malaria throughout the country. Both of these illnesses can lead to complications in a pregnancy, such as anemia. When a pregnant woman has anemia it is more likely that she will need a blood transfusion, something that is hard to come by in this poor country.

Social and Cultural:

In Sierra Leone, women are essentially powerless when it comes to their sexual and reproductive health. They are not capable of making their own decisions about things such as how many children they have, how far apart they have children, and/or when to go to a health clinic. Related to this, the majority of women do not use contraceptives, often because their partner doesn’t want to. Also, women are often married and begin having children very young, increasing their risk of death during pregnancy significantly. Women are also subjected to female genital mutilation, a traditional practice in Sierra Leone. Furthermore, women rarely have access to education about sexual and reproductive health.

Clinical:

The clinical factors (ones having to do with medical or health care) probably contribute the most to the high mortality rate. One of the biggest issues is access to care. Many women have to travel miles in before they reach a facility. But even once they make it to the facility there is no guarantee that the facility will be adequate. Most facilities lack the necessary drugs or medical equipment. Also, not many facilities are open 24 hours. If a women were to go into labor at night she would most likely have to wait until morning when it would already be too late. Most importantly, there are not nearly enough trained professionals staffed in health clinics across the country. Women often rely on traditional birth assistants, women of the town who are not properly trained, to deliver their babies. There are also too few emergency obstetric care facilities. Pregnant women are dying from easily treatable diseases but a majority of them have no access to a facility that could help them.

Environmental:

One of the environmental factors that contribute to this problem is the uneven distribution of the facilities. Some areas of the country have a lot more facilities in their region than another one. This is also true of the urban and rural areas. The people of the rural areas often have much farther to travel than do the people living in urban areas. Also, the terrain and roads are not always conducive to traveling and can cause obstacles.

Economic:

Sierra Leone is a very poor country and often the cost of accessing care stops a woman from going to see any doctors at all. Families can be in debt for years after the birth of just one child. Even just getting transportation to a facility can cost a lot and most families just can’t afford it and opt to give birth at home, significantly raising their risk of death. Also, it is common for a man to have many wives. While this may increase his power and status in the community, a polygamous household is often very poor.

Political:

In order to take steps to fixing this problem, the Sierra Leonean national government needs to give its unwavering support. The country is in need of policies that actually need to put into practice, rather than be ignored. Currently, there is a decentralized health system, in which not every facility is equal in training, medical supplies, etc. Little to no communication occurs between the health facilities scattered throughout the country. Sierra Leone is also a war-torn and corrupt country that is still reeling from its brutal civil war that ended in 2002. 

Intro to Public Health - Blog 11

So I’ve finally narrowed down my focus for the final paper to one clear-cut problem definition. I've decided to write about the high maternal mortality rate in the Sub-Saharan African country of Sierra Leone.

One of the main tactics used by public health officials is surveillance. It allows people to see where their resources are most needed. Surveillance, which is the monitoring of the health of a community, is especially important in determining the health of pregnant women and mothers. Surveillance of this one statistic should be the priority of many communities. A few weeks ago we read an article that stressed the importance of improving maternal survival rates because it is one of two major indicators of the health of the community overall.

Assessing the magnitude of a problem is always important for the field of public health. The ways by which problems are measured are through indicators, which can tell you whether your problem is actually one that needs to be addressed. In my research I found some alarming statistics exemplifying that maternal mortality in Sierra Leone is indeed something that needs to be addressed. The maternal mortality ratio, which is calculated by the number of maternal deaths divided by the number of live births times 100,000, was reported to be 860 between the years of 2003 and 2008 (UNICEF: 2010). But this is the unadjusted rate (not including underreporting and misclassifications). The adjusted rate was more than double this at 2100 for the year 2005 (UNICEF: 2010). It is also reported that the lifetime risk of maternal death is 1 in 8 (UNICEF: 2010). These numbers are all direct indicators, which are numbers that directly measure the problem at hand. They clearly show the severity of the problem. But any given public health issue has indirect factors that influence it as well. Some indirect indicators of this problem include the amount of health clinics or hospitals and amount of trained medical personnel in the country. Trained personnel are not always present during births in Sierra Leone, significantly adding to the risk of maternal death (Stanley, Wachuku-king: 1994).  Another factor that adds to this problem is state of civil unrest in the country. Although the ten-year civil war has ended, the country remains fragile politically. Pregnant women are far from safe in this country and something needs to be done about it.

Often when doing projects like this, it’s hard to know how much truth there is behind your facts. Although I did find small discrepancies in the statistics I found across various websites, the numbers were all relatively close to each other. However, as I mentioned earlier in the blog, it’s hard to know how many deaths may not have been reported or were declared incorrectly. But I think that the sources I did use are recognized as pretty reliable resources globally.

I really find my topic interesting and enjoyed doing all this research this week! I’m excited to actually start writing the paper soon! Check back next week to hear more about my topic and paper!

Sources:

"Sierra Leone: At a Glance." UNICEF, 2 Mar. 2010. Web. 17 Nov. 2010. <http://www.unicef.org/infobycountry/sierraleone_statistics.html#64>.

"BBC News - Country Profile: Sierra Leone." BBC News - Home. 28 Jan. 2010. Web. 17 Nov. 2010. <http://news.bbc.co.uk/2/hi/africa/country_profiles/1061561.stm>.

Wachuku-king, S., and S. Stanley. "The State of Motherhood in Sierra Leone." PubMed. Sept. 1994. Web. 19 Nov. 2010. <http://www.ncbi.nlm.nih.gov/pubmed/12318870>.

Intro to Public Health - Blog 10

Hi Guys!

So we’ve finally gotten the process of writing our papers underway. In our past two classes we’ve been given an overview of the Public Health Problem Solving Framework. I’ve known from pretty much the beginning that I wanted to write my paper on something having to do with international health. I toyed around with a bunch of different ideas and I’m pretty settled on writing about Global Reproductive Health and maternal and infant mortality and morbidity. I’d like to focus specifically on this problem as it occurs Sub-Saharan Africa. In our lecture focused on International Health, Dr. Mosley talked about the Millennium Development Goals (MDGs), a list of goals made by the United Nations. Two of the highly prioritized targets on this list include: to reduce by two-thirds, between 1990 and 2015, the under-five mortality rate and to reduce by three-quarters the maternal mortality ratio. The statistical numbers in Sub-Saharan Africa for these two issues are alarmingly high and no other region really comes close to what is exhibited in this area of the world. Two factors that contribute to high mortality in both mothers and children include high fertility and marrying at an early age. Women in Sub-Saharan Africa get married at a very young age and often give birth to many children, leading to a high mortality rate in children and mothers. Also, the health services there are very rarely up to par with what it should be to keep mothers healthy during pregnancy. Being one of the 15 MDGs, this is obviously a very prevalent challenge that we face. Multiple organizations and committees are aware of this pressing problem and working to accomplish the goals set by the United Nations. Even before hearing Dr. Mosley’s lecture, I knew I was most interested in International Health. His lecture just further excited me. We also had a blog assignment a few weeks back in which we had to read an article about global health. In the article, it mentions how important both infant and maternal health are to the rest of the health of the community. I’m really excited to continue researching this topic and learning more about it. 

Intro to Public Health - Blog 9

Hey everyone!

The semester seems to just be flying by. I can’t believe it’s already mid-November. The lecture series of our Intro to Public Health class has already come to an end! It feels like just yesterday when I was writing my first ever blog post! We had our exam on Wednesday and now the rest of the class will be focused around our term papers. In our papers, we will chose a specific issue that interests us and assess the problem and create a practical intervention. Although I really liked the lecture portion of the class and learning about such a large scope of public health information, I’m excited to narrow my focus and apply everything we’ve been learning into my paper.

Throughout the course of the semester, some of my favorite lectures included Public Health Preparedness and Disaster Management, Public Health and the Law and Firearms and the Law. But the topic that was most interesting to me was International Health and the United Nations Millennium Development Goals (MDGs). One of the things that Dr. Mosely touched on in his lecture was how quickly the population is growing and the effect of that. Some of the numbers he was throwing at us were staggering! In Sub-Saharan Africa, the annual number of births has increased/will increase 43% from 1990 to 2015. Only 22% of women are using some sort of contraceptive in this region as well. Unfortunately, this fact is mostly because the women’s husbands want hordes of children. It’s something that, in their culture, gives them status and power even if the women don’t agree. I thought that all MDGs were intriguing but the two that I found most important were to improve maternal health and reduce child mortality (something that was mentioned in the reading for one of our blogs a few weeks back!). It’s vital that these two factors be addressed and dealt with in order to improve international health as a whole.

One of the most surprising aspects of public health is how little its recognized and appreciated. Over the past century, there have been multiple public health victories that have been extremely beneficial to society yet the field still does not get as much credit as it deserves. Some of these include improved motor vehicle safety, safer and healthier foods, immunizations, and better control of infectious diseases. Even still, there is a huge discrepancy between the amount of money spent on biomedical care compared to public health. There is also a considerable amount of controversy surrounding public health, adding to its unpopularity. The issue of individual right versus overall health of the community often comes up. Some people feel that public health policies are stifling their freedom to do certain things but they don’t realize how much they’re actually being helped!

In my first blog, I talked about how I took this class in order to get a broad understanding of public health in general. I feel like I did get that from this class but I think I might enjoy taking a class that’s more specific next semester and learning about various topics more in depth. 

Intro to Public Health - Blog 8

Hey again everyone!

This past week we learned about public health law in class and all had to read a case that falls under that category of law. The suit was brought about by Mary V. Kirk against the Board of Health of the city of Aiken, South Carolina. It was found that Mrs. Kirk was afflicted with leprosy, a very contagious disease. The board of health then passed resolutions requiring her to be isolated in the city hospital for infectious diseases in order to protect the rest of the community. Miss Kirk alleged that the kind of leprosy she had was not contagious and that the conditions of her isolation were too vile for a woman of her “culture and refinement.” After the board was asked to show cause, Miss Kirk was granted a temporary injunction, preventing the board from moving her to the city hospital. They deemed it unnecessary for her to be sent into isolation when her house and property had already been quarantined, which, as far as the courts could see, she did not violate. In order to stop the spread of infectious diseases and protect the general public, public health officials rely on two different strategies: isolation or quarantine. Isolation is for the people who are already ill and must be moved away from the healthy population. Quarantine is the restriction of movement of those who have been exposed to an infectious agent and are putting the healthy population at risk. In the situation of Miss Kirk, the courts believed that her quarantine was effective in protecting the health of the citizens of Aiken.

This type of issue is one that is often brought up in the field of public health. Individual rights versus protection of the community. Individuals, like Mary Kirk, are frequently upset by the restrictions or mandates placed on them by various health boards that are meant to improve the health of the greater community. I think it’s important that we have these boards looking out for the population on a large scale. If after a thorough investigation, the board deems it necessary, I think they definitely have the right to decide if someone should be isolated or quarantined. But the board must be absolutely sure that the community is at high risk. In the case of Miss Kirk, she had a less contagious form of leprosy and the people around her really weren’t in jeopardy. It’s important that the courts exist so that they can make sure the boards aren’t going to far. I think that it’s better if there’s an error on the side of the individual (which the court can fix), rather than an error on the side of the community. This utilitarian approach will protect the most amounts of people.  A state would rather have one sick person rather than an entire sick community, which would cost them astronomical amounts of time and money.

Intro to Public Health - Blog 7

This week we all had to read an article called “The Challenge of Global Health.” The article basically discusses the state of global public health today and the various obstacles and challenges that need to be faced and addressed. In the past few decades or so, there has been an incredible increase in public and private money being donated towards numerous pressing global health issues. You would think this is a good thing but, unfortunately, the efforts that the money is going to are very disorganized. Also, the money is being directed at specific diseases, rather than at general public health. Another huge problem for the developing countries is their shortage of doctors and nurses. Reasons for this include that more and more local talent from developing countries are coming to the more developed countries for work and leaving their countries behind.

I think that this lack of staff is one of the most valid reasons for why public health is worsening in the developing world. The numbers are quite staggering. In Ghana, for example, of the 871 medical officers that were trained between 1993 and 2002, 604 of them now practice overseas. These types of numbers are similar in Zimbabwe, Zambia, Malawi, and many other developing nations. Another factor contributing to the shortage is how large a percentage of the healthcare workers are infected with HIV/AIDS themselves. One study estimates 18-41 percent of the healthcare force in Africa to be infected. The workers are dying faster than they can be treated, triggering the entire system to collapse. What good are the drugs if there is no one to distribute them? But this problem is being addressed! There is now a $270 million plan in place, supported by PEPFAR (President’s Emergency Plan for AIDS Relief), trying to bring back half of the lost health care workers using financial incentives and training.

Another thing that is stressed in the article is that increased maternal survival rates and increased overall life expectancy should be the two main goals of the world health community. Instead of money being funneled into hundreds of different, single diseases, they should be aimed at these two simple goals. The rate of maternal mortality is very telling of the status and efficiency of the overall healthcare system. With clean surgical facilities staffed by enough well trained professionals using sterile equipment, there should be a low maternal mortality rate. Similarly, life expectancy gives an idea of the overall public health services. With safe drinking water, nutritional food, easily accessible immunizations performed with sterile tools, there should be high life expectancy.

While it is great that there has been such a surge in aid and finances, faulty systems and lack of sustainability of funds often lead to the disease states that are worse than originally seen. According to a World Bank report, half of all funds donated for health efforts in Sub-Saharan Africa, such as HIV/AIDS, TB, or malaria, never reach the end of the line. Money is lost along the way to payment of ghost employees, padded prices, selling of drugs to the black market, and the sale of fake medications. There needs to be more oversight and guidance of the massive funds being donated. Another issue is how dependent these underdeveloped countries become on foreign aid. Without proper exit strategies, the entire system could collapse once the wealthier countries transfer control to the underdeveloped nations, helping no one in the process.

This article was super informative and very interesting to read. Global health is and will be one of the greatest challenges for my generation and generations to follow!

Intro to Public Health - Blog 6

This week the entire class was assigned to read an article recently published in the Washington Post entitled “Whooping Cough Makes a Comeback.” While many people may think that whooping cough “is a disease of the past”, it has been becoming more and more prevalent over the past few years. In California alone, nine infants have already died this year while 600 more have become extremely ill. 4,100 cases have been reported in what people are calling the worst outbreak of pertussis in the state’s history since 1955.  The article discusses a couple of possible reasons for the spike in amount of cases. In California, it is much easier than in Maryland, for example, to a parent to refuse vaccination for their child. Although it has been discredited, many parents believe that vaccines can cause autism in their children. The article mentions that in 2009 in Marin County, an affluent county north of San Francisco, 13 percent of kindergarten parents refused vaccination of their children. Marin County is one of the highest infected counties of the year. Another possible cause listed by the article is the vaccine itself. In the mid-90’s the vaccines changed from acellular vaccines to whole-cell vaccines.  The whole-cell vaccines were effective against the cough but causes seizures, high fevers, and have been blamed for rare brain damage. The new vaccine does not always protect from the cough but patients often get lighter versions of the disease. The article does say, although, that increased vaccination is the best way to lower the increased rates of whooping cough. This refers to the public health theory of “herd immunity.” This is when the immunization of a certain amount of the population protects the portion of the population that has not been immunized. The more people that are vaccinated, the lower the chance a susceptible individual will come in contact with someone infected with the disease. While this theory is true to some extent, the more people that rely on this, the larger the portion of the population that does not have the vaccination.

There are a variety of reasons why a child would not receive a vaccine. Two reasons that originate from parents include fear of developing a disease like autism or too high of a reliance on the idea of “herd immunity.” A physician may discourage a vaccination because he or she has never seen it in any of their patients. The article actually mentions a woman who had whooping cough with an infant son and whose doctor told her she didn’t need to wear a mask because “we don’t see it anymore.” Reasons not to get immunized relating back to the healthcare system may be that a family simply can’t afford the shot because they don’t have a healthcare plan. 

Clearly, the priority of public health policymakers should be focused on increasing vaccine rates throughout the country.  In order to get this accomplished, strict restrictions on vaccinations must be made mandatory in every state. But even with these strict rules, parents will still be nervous. One way to deal with that would be to have some sort of database where they could read all the information pertaining to vaccines. Often parents base their fears off of silly rumors without really doing any thorough research.