Case Study of a Face Eating Parasite

After marking hundreds essays about HIV over the summer, the typical case study of an infectious disease, and becoming increasingly bored of the lack of variation when there are so many other important infectious diseases in the world I decided it was time to introduce my students to something new: a FACE EATING parasite!

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HEALTH IN THE UK

REGIONAL VARIATIONS IN HEALTH AND MORBIDITY

Revision suggestion – Try marking all the descriptions on an outline map and annotating it with explanations. Then try doing it again from memory.

NB: Links between illnesses and factors such as age, income, wealth etc are difficult to establish. Remember, just because lots of people in a poor area are ill it doesn’t necessarily mean than they are ill because they are poor or vice versa. It is just a possible reason it does not provide evidence 100%, there could be many other factors involved.

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MALNUTRITION AND FAMINE

IN ETHIOPIA

BACKGROUND INFORMATION

·        Ethiopia is a land-locked country in Eastern Africa. Wadla, in the Amhara region is badly affected

·        One of the least developed and poorest countries in the world with a GDP of $470 per capita

·        Malnutrition is one of the main health problems facing the population; they have also experienced several prolonged and widespread famines and many Ethiopians are chronically hungry.

CAUSES

·        Drought:  is the most commonly given reason for famine is drought, and parts of Ethiopia have unpredictable rainfall that can lead to droughts. e.g. in 2011 the March-May rainy season failed, which was thought to be caused by La Nina, an abnormal cooling of waters in the Pacific Ocean. Wadla is in an arid region and experiences extreme diurnal temperature ranges which can damage crops

·        Poverty: The main factor leading to famine in Ethiopia is poverty. Poor people do not have the resources to deal with shocks, and are more likely to be pushed into unsustainable ways of coping such as selling equipment, sending children out to work or eating less. Wadla is an isolated area with a lack of infrastructure: only 13.5m of road and no electricity, transport, telephone or postal services.

·        Agriculture:. In Ethiopia, individuals do not own land; it is assigned according to the size of a family, and redistributed every few years. Every time land is redistributed it is divided between more people, so each farmer gets less. Lack of investment, and the need for large yields from a small area, leads to land degradation. The average amount of land for a household in Wadla is only 1.1 hectares. Over-exploitation of wood for fuel and timber has led to deforestation while overcrowding means that it is not unusual to graze up to 40 sheep on 0.1 hectare of land. These factors have led to severe soil erosion.

·        Conflict: There have been frequent conflicts in Ethiopia. In the early 1990s, 60% of the national budget was being spent on war. Obviously this reduces the money available to improve agriculture or provide relief for hungry people. The Arab Spring across the Middle East and North Africa led to a decline in the demand for livestock exports from Ethiopia, reducing the incomes of the affected communities

·        Trade: Unequal trading systems also contribute to hunger in Ethiopia. The Ethiopian government purchase crops from farmers at low fixed prices. International organisations encourage Ethiopia to produce cash crops to export, which reduces the land available for growing crops. The world price for agricultural exports such as coffee is also very low. In Wadla over 95% of people depend on subsistence farming and there are very few opportunities for formal work. People with little or no land find it especially hard to ensure they have enough food.

CONSEQUENCES

·        Malnutrition can severely affect the growth and development of children, 44% of children in Ethiopia are affected by stunting; a word used to describe the diminished physical and mental capacity of children who do not receive enough vitamins and nutrients from an early age. E.g. a 15 year old child may have the mental capacity and height of a 6 year old.  Many children are so badly affected they do not survive.

·        Malnourished people are more susceptible to other infections and more likely to suffer complications.

·        Those who survive have a reduced capacity to contribute to the economy of the country as they are less able to learn new skills and less productive in their work.

·        It has been estimated that the annual value of the loss in productivity that can be attributed to child stunting is 2.9 billion ETB (Ethiopian Birr). Moreover, iodine deficiency, which results in irreversible impairment of intellectual capacities, has been estimated to cost the Ethiopian economy 1.35 billion ETB per year.

STRATEGIES TO MANAGE THE ISSUE

·        Charities such as ActionAid work with local people to: provide short term food aid; improve farming methods; provide farmers with loans to buy new equipment and train locals in land conservation.

·        They also train people in other skills e.g. carpentry so they have an alternative income rather than relying on subsistence farming and improve infrastructure to create easier access to markets and food aid.

Discussion point: What is the biggest cause of famine in Ethiopia and can it be overcome?

Obesity in the USA

FACTS

·        People with a BMI of 25+ are considered overweight and people with a BMI of 30+ are obese.

·        Becoming an increasing health problem with 1.4 billion adults worldwide and 2.8 million deaths per yr.

·        More than one-third of U.S. adults (35.7%) are obese.

·        Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese

·        Since 1980, obesity prevalence among children and adolescents in the US has almost tripled

CAUSES

·        Inactive lifestyle – developments in technology mean less physical activity e.g. in 1960 nearly half the jobs in the US required moderate physical activity but in 2010 it was only 20%. In their spare time people spend more time watching TV than in outdoor recreation.

·        Oversized food portions. Americans are exposed to huge food portions in restaurants, fast food places, gas stations, movie theatres, supermarkets, and even at home. E.g. a typical can of soda in the US usually consumed as one portion contains 2.5 servings.

·        Lack of access to healthy foods, for example in poorer areas, combined with increasing availability and advertising of fast food. School lunch programs in poorer areas are often exploited by fast food outlets.

·        Not having area parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active.

 CONSEQUENCES

·        Obesity-related conditions include heart disease, stroke, hypertension, type 2 diabetes and cancer.

·        Obesity can put extra pressure on joints and limbs, making activity quite difficult and in turn making the obesity worse. It can also reduce your life expectancy by up to 9 years 

·        There are many obesity related conditions and direct medical spending on diagnosis and treatment of these conditions, therefore, is likely to increase with rising obesity levels. Rising obesity levels will also have put pressure on the resources that the health centres do have.

·        The estimated annual medical cost of obesity in the U.S. is $200 billion while the medical costs for people who are obese is on average 36% higher per year than those of normal weight.

·        Weight gain has also been linked with poor concentration levels and poor academic success 

·        Weight stigma increases vulnerability to depression, low self-esteem, reduced quality of life poor body image, maladaptive eating behaviours and exercise avoidance.

·        There is strong evidence to suggest an association between obesity and poor mental health in both children and adults.  

MANAGING OBESITY

·        The FDA (US food and drug administration) is working to reduce the burden of obesity by food labelling and education campaigns such as the ‘Lets Move’ campaign recently launched by Michelle Obama. However, it is difficult to change people’s habits overnight.

·        Grants are provided by the CDC (The Centre for Disease Control) for state-focused nutrition programs, which have so far been started in 27 states.

·        Obesity legislation has been passed such as the ‘Healthy Outdoor Kids Act’ in 2011, which aims to increase physical activity. ‘Obamacare’ now requires health insures to do more to help obese patients.

·        The Obesity Action Coalition provides information and support groups to people who experience obesity stigma.

 

Discussion point: What would you say is the biggest cause of obesity in the USA?

Leishmanisis - Case Study of an Infectious/Communicable Disease

GLOBAL DISTRIBUTION

o More than 90% of global cases of visceral leishmaniasis occur in only 6 countries including India, Sudan and Brazil.

o Cutaneous leshmaniasis is more widely spread in 3 main epidemiological regions including South America and the Mediterranean basin with Sudan, Afghanistan and Brazil having some of the highest rates.




IMPACTS

HEALTH
o Parasitic disease caused by the leishmania parasite and transmitted by the female phlebotomine sand fly; associated with malnutrition, famine and weak immune systems

o Cutaneous and mucocutaneous leishmaniasis affect the skin and mucous membranes of the mouth and nose leading to disfiguring scars and deformities

o Visceral leishmaniasis causes a swollen liver and spleen and can kill without treatment

o Health impact has been grossly underestimated until recently, now thought to be second to Malaria

o Could be due to a high morbidity and low mortality, although some epidemics of VL have high case-fatality rates e.g. 100 000 deaths caused in Sudan between 1984-94

o 70 000 deaths per year from VL

o HIV and Leishmaniasis are mutually reinforcing

o Leishmaniasis stimulates the HIV virus to replicate and people with HIV are up to 2000 times more likely to catch leishmaniasis because their immune system is supressed




ECONOMIC DEVELOPMENT
o Affects the ‘poorest of the poor’ making it impossible to earn and thus affecting their whole family

o Cost of treatment in Bangladesh estimated to be 1.2x annual per capita income

o People have to sell or rent their assets or take loans to pay medical bills

o Delays socioeconomic development

o For example epidemics of the disease have delayed the implementation of development projects in the Amazon basin as money is needed for treatment instead

o Puts strain on the economic productivity of a country’s workforce as people are unable to work




LIFESTYLE
o Social stigma due to disfiguring scars can cause anxiety, depression and quality of life

o Associated with illiteracy and low levels of education as people don’t know how to avoid it

o People don’t understand the disease so patients are victimised and isolated, especially those with active lesions, e.g. Afghan refugees have become known for their scars

o HIV-leishmaniasis sufferers can experience even more physical and psychological pain



o Particularly affects women and associated with gender discrimination

o Cultural expectations of women mean that any disability may cause abandonment by their husbands, in societies where women are very dependent.

o Most severely affected group children under 15, which could cause bullying and children to become a burden on the family




Discussion point: Which form of the disease do you think is the worst and why?