Diseases in Developing Countries

Diseases of Adults and Children in Developing Countries

• The objective is to understand the causes of mortality/morbidity in developing nations and their trends.
• A second goal is to appreciate the mother's function in safe growth and the overall development of children.
• It is important to understand the magnitude of maternal mortality and it's causes.

Causes of Death and Chronic Disease

• Sanitation, healthcare, and immunization improvements have decreased cases of infectious disease.
• There has been a shift in disease burden globally in past decades toward non-communicable diseases.
• Morbidity measures became as important as mortality measures because of the high burden of non-communicable diseases.
• The first Global Burden of Disease report came out in 1993.
• The need to monitor SDGs has additionally impacted health measurements.
• At the time of the first Global Burden of Disease report, there was a divide between developed and developing.
• Transition countries such as China, Brazil, India, and Indonesia now sees impacts on communicable and non-communicable diseases due to growing class distribution.

Common Causes of Mortality

• WHO classifies causes of death under 3 main groups.
• Group 1: encompasses communicable, maternal, perinatal, and nutritional disorders.
• Group 2: includes non-communicable ailments.
• Group 3: includes injuries.
• The world shifts from high pediatric mortality due to Group 1 causes, toward increased Group 2 disease death rates in older populations.
• Cardiovascular disease causes one third of all female deaths.
• Unintentional and accidental injuries are common in men when compared to women.
• Global vascular disease is the most common cause of death worldwide, which includes heart attacks/strokes.
• High-income countries see the most deaths from diseases associated with wealth and aging populations (heart attack, strokes, diabetes, dementia, etc.).
• Diarrheal diseases, HIV, TB, malaria, and diseases of infancy are still the dominant causes of death in the poorest nations.
• Heart attacks, obesity, and strokes are beginning to increase, even in the poorest of countries.
• The existence of poverty and urban chaos is present through road injuries, and tuberculosis in certain regions.

Common Causes of Morbidity and the Burden of Chronic Diseases

• DALYs, or Disability-Adjusted Life Years, were used by the WHO to determine mortality rates in a 1990 report.
• The report recognized the prevalence of infectious childhood disease and neuropsychiatric disorders burden in the developing world.
• DALYs can have many errors due to biases.
• To look at a disease burden, first count its prevalence.
• Next, the cumulative burden is quantified on a population using DALYs to assess medical intervention expenses vs. gains.

Major Risk Factors

• Hospital-based Western style medicine to improve population health in poor countries was popular in the 20th century.
• The medical care failure was recognized at the Alma Ata meeting in 1978.
• Afterwards, primary health care, or PHC, was adopted.
• PHC emphasizes research, prevention, risk factors, and underlying causes.
• Proximal risk factors treatment packages were created.
• The treatment packages were given to people through initiatives such as 1980s UNICEF-sponsored Child Survival Revolution.

Ghana Health Assessment Team

• The Ghana Health Assessment Team (GHAT) used epidemiological health data in 1981.
• They also used the concept of years of potential life lost, risk analysis, and costs vs. benefits information.
• They met the needs of the local population through their limited health budget (the health of rural populations).
• Commended for its pioneer use, GHAT emphasized community-based health care strategies.
• Research has produced population health measures meant to integrate morbidity and mortality into a single number.
• The Disability-Adjusted Life Expectancy (DALE) was published for 190 countries in 1999.
• The Disability-Adjusted Life Year (DALY) was used as a basis for the 1990 and 2000 Global Burden of Disease studies.

Child Health: Mortality Rates

• Child deaths have been monitored since the 1950s.
• The UN Population Division and UNICEF joined forces towards organizing data from 1960 onwards in 1990.
• Diseases that are readily preventable/treatable with cost-effective interventions cause most child deaths in developing countries.
• Child death reduction has made progress since 1990.
• Under-five deaths went from 12.7 million to 5.9 million in 2015.
• 98% of under-five deaths take place in developing countries.
• The poorer the country, the higher the rate.
• Major causes have the ability to be avoided through immunization.
• The remainder are able to be efficiently treated.

Measurements of Child Mortality

• There are 3 measurements of mortality commonly used.
• The under-five mortality rate indicates the number of deaths before age 5 per 1,000 live births.
  • This is the main indicator of a country's child health because it represents the results of all adverse factors averaged over 5 years.
• The infant mortality rate indicates the number of deaths before the first birthday per 1,000 live births.
  • Children are susceptible to poor social and economic factors in the first year.
  • This rate strongly correlates with social standards and competence as well as child health.
• The neonatal mortality rate indicates deaths before day 28 of life per 1,000 lives births.
  • Neonatal mortality measures delivery and newborn standards in a country.
  • These standards are similar for both neonatal and maternal mortality.
• Under-five 2015 child killers included preterm birth complications (18%), pneumonia (15%), birth asphyxia and trauma (11%), and diarrhea (9%).
• Almost half of all under-five deaths are due to undernutrition.
• Childcare from healthy, educated women can protect infants infections and environmental dangers through post-natal care and advice.
• Female health, specifically education, gender equality, and pregnancy-related medical care, are needed to improve child mortality.
• Maternal-child health, maternal-newborn health, and maternal, newborn and child health are all used to view women and children health concerns .
• Approximately half of maternal deaths occur during the day of labour.
• A majority can occur commonly from blood loss, sepsis, obstructed labour, and eclampsia during that month.
• A quarter of newborn deaths takes place on day 1, and another half occurs within the first week, commonly from prematurity, birth asphyxia, and infections.
• Maternal and child deaths are preventable, avoidable, and treatable in poor countries through proper health care.
• Maternal-neonatal health includes regular clinics to assess risk factors, monitor growth, provide iron and folate supplements, deworming, malarial treatment, HIV/syphilis screening, treatment of bed nets, and counselling from trained birth attendants.
• Newer versions focusing on reproductive health of women include access to contraception, and nutrition.
• Basic delivery includes monitoring by a skilled birth attendant, good hygiene, third stage management to prevent hemorrhage, newborn care, and applying an HIV protocol for mothers testing positive.
• Emergency provisions include training for birth attendants to recognize emergencies. -A referral is to be available by ambulance. -The referral center is to have the facilities to provide antibiotics, oxytocin, magnesium sulfate, intravenous fluid, blood transfusion, anesthesia and surgical staff for C-sections.
• Postnatal care for the mother needs attendants to recognize complications such as bleeding and infection.
  • Mothers need counseling about breastfeeding, and family spacing.
• Nurses need three-day follow up visits to the woman's home.
• Newborn care consists of drying and wrapping the newborn, exclusive breastfeeding, and clean umbilical cord care.
• The child and mother need a review within 3 days after home discharge as well as training to detect key problems liker poor weight gain and infections.

Maternal Health

• Women suffer from effects of war, personal violance, less education, and HIV/AIDS in the developing world.
• Maternal mortality is the death of a woman either during pregnancy or within 42 days of the termination of that pregnancy. -This is either from direct causes from pregnancy/delivery or indirect causes due to a pre-existing disease such as heart failure.
• Maternal mortality can be determined from indicators.
  • The maternal mortality ratio is maternal deaths per 100,000 live births used to determine the risk of birth injuries or lifetime death.
  • Maternal Mortality Rate equates to maternal deaths per 100,000 women of reproductive age.
  • It is also good evaluate the lifetime risk of pregnancy-associated death.
• Maternal mortality measurements are difficult without detailed knowledge and few birth/death statistics from developing countries.
• Direct household surveys, the sisterhood method, and reproductive age mortality studies assist in obtaining data.
• Although maternal mortality ratio improvements are seen, South Asia and African regions are behind world averages.
  • The 1-in-36 lifetime risk of death during delivery is present in African countries.
• Presence of trained attendants are needed for delivery as well as family planning information and available contraception.
  • 40% of deliveries in poorest countries are without access to trained attendants.
• Although women's healthcare is improving, poor Asian and African countries require special attention.
• Women that pass away from maternal deaths in developing countries are likely to have lived if they were in a developed country.
  • 99% of maternal deaths occurs in developing countries, specifically sub-Saharan Africa and India.
• Every woman that dies is linked to millions who suffer chronic disabling complications.
• Nearly 140 million women giving birth each year roughly experience complications (Ashford, 2002).
• 10 to 15% of these women can develop chronic disabilities (severe anemia, incontinence, fistulae, depression, chronic pain, and infertility).
• Interventions to lower neonatal death includes prenatal care, care during delivery, and post-natal care.

Practical Solutions

• Prenatal care: should include regular HIV and syphilis testing, preventative malaria treatment, micronutrient supplements, and macronutrient supplements.
• Care during delivery: should include trained midwife, easy access to higher care and safe transportation, blood transfuision, treatment for infections, hypertension, and access to Caesarean sections.
• There must also be newborn equipment (suction, incubator, and oxygen).
• Women with HIV need national protocols backed by antiretroviral supplies.
• Postnatal care: includes infant immunizations, access to breastfeeding advice, delivery/medical/family planning advice, and follow-ups.

Every Woman Every Child

• The Global Strategy for Women and Children's Health was founded by the UN in September 2010.
• Every Woman Every Child, a multi-stakeholder movement supports women and children's health.
• Over 300 organizations like governments, civil societies, foundations, academia, businesses, and international organizations have made 400 commitments ranging from service delivery to advocacy/finances.
• Every Woman Every Child has promoted attention/action to areas most needed, such as newborn survival, stillbirths, family planning, etc.

Conclusion

• The burden of disease globally is non-communicable excluding areas such as sub-Saharan Africa and South Asia due to slow progress in life expectancy.
• There is still concern in maternal and child health due to poor infrastructure and health access.
• Developing regions accounted for 99% (302,000) of global maternal deaths in 2015 with a majority in Sub-Saharan Africa (66%) followed by South Asia (66000).
• New global strategies are addressing this by using joint efforts such as Every Woman Every Child.