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Rice BIOE 301 - Lecture Notes

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Bioengineering and World HealthLecture Two:Defining “Developing vs Developed” CountriesLeading Causes of Mortality, Ages 0-4Geoff PreidisMD/PhD candidateBaylor College of [email protected] of Lecture 1 Course organization Four questions we will answer Technology assessment – The big picture Health data and its uses Quantitative measures of health Incidence Prevalence Mortality Rate Infant Mortality Rate QALY, DALYOverview of Lecture 2What are the major health problems worldwide?Defining “Developing vs Developed” CountriesLeading Causes of Mortality, Ages 0-4A Tale of Two WomenSierra LeoneJapanEconomic Data Per capita GDP Per capita health spendingEconomic Data Per capita GDP Per capita health spending Purchasing power parity Take into account true costs of goods and services How much does a loaf of bread cost? Human Development Index  Average achievements in health, education and income.Human Development IndexGreen = High developmentYellow & Orange = Medium developmentRed: Low DevelopmentUN Human Development Report, 2006One View of The World Developed vs. Developing Countries There is no universally accepted definition of what a developing country is Usually categorized by a per capita income criterion Low income developing countries: <$400 Middle income developing countries: $400-$4,000 WTO members decide for themselves if they are a developing country; brings certain rightsLeast Developed Countries In 1971, the UN created a Least Developed Country member category Countries apply for this status Low national income (<$900 per capita GDP) Low levels of human capital development Economic vulnerability Originally 25 LDCs As of 2005, 637 million people live in world’s 50 least developed countries  Population growth expected to triple by 2050www.unctad.orgLeast Developed CountriesHealth and Other Data in LDCs Average per capita GDP: LDCs: $235 All other developed countries: $24,522 Average life expectancy: LDCs: 51 years Botswana – expected to be only 27 years by 2010 Industrialized nations: 78 years 1 child in 10 dies before his or her 1stBday in LDCs 40% of all children under 5 are underweight or suffering from stunted growth in LDCs Half the population in LDCs is illiterateHealth and Other Data in LDCs Mortality rate for children under five: LDCs: 151/1,000 live births High income countries: 6/1,000 live births Average annual health care expenditures: LDCs: $16/person High income countries: $1,800/person A child born today in an LDC is more than 1,000 times more likely to die of measles than one born in an industrialized country.Group 1Group 1 Communicable diseases, maternal/perinatal conditions, nutritional deficienciesGroup 2Group 2 Non-communicable diseases (cardiovascular, cancer, mental disorders)Group 3Group 3 InjuriesRatio of Mortality Rate0.01.02.03.04.05.06.07.00-4 5-14 15-29 30-44 45-59 60-69 70-79 80+Age GroupMortality Rate in Developing Countries / Mortality Rate in Developed Countries WHO, 2002Child Mortality 10 million children under the age of 5 die every year 98% of these deaths occur in developing countries Number of children who die each year in developing countries is more than two times the number of children born each year in the US and Canada 2/3 of deaths could be prevented today with available technology feasible for low income countries 40% of deaths in this age group occur in first month of life (neonatal period) 25% of deaths occur in childbirth and first week of life (perinatal period)http://globalis.gvu.unu.edu/Leading Causes of Mortality: Ages 0-4 Developing world1. Perinatal conditions2. Lower respiratory infections3. Diarrheal diseases4. Malaria Developed world1. Perinatal conditions2. Congenital anomalies3. Lower respiratory infections4. Unintentional injuries1. Perinatal Conditions Burden of Perinatal Conditions Common Perinatal Conditions Preventing Perinatal Mortality Maternal Morbidity and Mortality Obstetric FistulaBurden of Perinatal Conditions 2.5 million children each year die in perinatalperiod (birth through first week of life) Most perinatal deaths are a result of inadequate access to healthcare Poor maternal health and nutrition No health care during pregnancy and delivery Low birth weight Many cultures… Don’t celebrate child’s birth until weeks have passed Mother and child isolated during this period Can reduce incidence of infection Can result in delays in seeking healthcareCommon Perinatal Conditions Infections  Acquired during exposure to the maternal genital tract Acquired using non-sterile technique to cut the umbilical cord “ToRCHeS”Common Perinatal Conditions Birth Asphyxia Baby does not breathe at birth Umbilical cord wrapped around baby’s neck Birth Trauma Mechanical forces in obstructed labor prevent descent through birth canal (e.g. cephalopelvic disproportion) Can result in intracranial hemmorhage, blunt trauma to internal organs, injury to spinal cord or peripheral nervesPreventing Perinatal ConditionsNo good screening tests to indicate who will need emergency careAll births should be attended by a skilled health care workerFetal UltrasoundPreventing Perinatal Conditionswww.obgyn.netPreventing Perinatal ConditionsPartographPATH Delivery KitSimple technologiesMaternal Morbidity and Mortality >500,000 women die from complications due to childbirth Severe bleeding Infections Hypertension (pre-eclampsia, eclampsia) Unsafe abortions Obstructed delivery 50 million women suffer from acute pregnancy-related conditions Permanent incontinence, chronic pain, nerve and muscle damage, infertilityObstetric Fistulahttp://www.endfistula.org/index.htm2. Lower Respiratory Infections Burden of LRIs Pathophysiology of Pneumonia Diagnosis of Pneumonia Direct Fluorescence Assay Vaccines for Lower Respiratory InfectionsBurden of Lower Respiratory Infections One million children each year die from lower respiratory tract infections, mostly pneumonia Until 1936, was #1 cause of death in US Can be cured with antibioticsPathophysiology of PneumoniaPathophysiology of Pneumonia Infection of the lungs Multiple organisms cause pneumonia Bacterial Infection Causes about ½ of all


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