BIOE 301/362Lecture 2:Leading Causes of Mortality, Ages 0-4Geoff PreidisMD/PhD candidateBaylor College of [email protected] of Lecture 1 Course organization Course goals Four questions we will answer Technology assessment – The big picture What is health? Role of WHO Health data and usesReview of Lecture 1 Incidence Rate Prevalence Rate Mortality Rate Infant Mortality Rate Relative Risk DALY Disability adjusted life year Measures years of disability free life lost when a person contracts a disease. Combines mortality and morbidity.Review of Lecture 1 DALY Examples: Stroke: 6 DALYs Car accidents: 9 DALYs Self inflicted injuries: 17 DALYs Violence: 9 DALYs Lower respiratory infections: 1 DALY HIV: 28 DALYsOverview 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 rightsUN: Least 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 49 least developed countries Population growth in LDCs expected to triple by 2050www.unctad.orgHealth 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 The Campaign to End FistulaBurden of Perinatal Conditions 2.5 million children each year die in perinatal period 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 Infections Birth asphyxia Birth traumaBurden of Perinatal Conditions Strongly related to conditions during childbirthWHO 2005Common Perinatal Conditions Infections acquired during exposure in maternal genital tract Infections of the umbilical cord Many cultures… Don’t celebrate child’s birth until after first weeks of life Mother and child isolated during this period Can reduce incidence of infection Can result in delays in seeking healthcareCommon 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 ConditionsNo good screening tests to indicate who will need emergency careAll births should be attended by a skilled health care workerFetal UltrasoundPreventing Perinatal Conditionswww.obgyn.netPreventing Perinatal ConditionsPartographPATH Delivery KitSimple 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, infertilityThe Campaign to End Fistulahttp://www.endfistula.org/index.htm2. Lower Respiratory Infections Burden of LRIs Pneumonia Causes of Pneumonia Diagnosis of Pneumonia Direct Fluorescence Assay Vaccines for Lower Respiratory
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