Tropical Disease and Tropical Disease and Wellness Promotion: Wellness Promotion:

Healthful InterventionsHealthful Interventions

A Project of Hope (APOH) Board A Project of Hope (APOH) Board MeetingMeeting

February 21, 2010February 21, 2010Presented by: Susan Sanner, Ph.D., R.N., ACNS-Presented by: Susan Sanner, Ph.D., R.N., ACNS-

BC, CNE BC, CNE

ObjectivesObjectives

Discuss the factors and conditions that increase Discuss the factors and conditions that increase the development of tropical diseases. the development of tropical diseases.

Define tropical diseases prevalent in Malawi and Define tropical diseases prevalent in Malawi and under-developed areas in general. under-developed areas in general.

Discuss the general treatment of tropical Discuss the general treatment of tropical diseases. diseases.

Identify strategies aimed at promoting the health Identify strategies aimed at promoting the health and wellness of individuals living in high risk and wellness of individuals living in high risk areas. areas.

Recognize the multiple approaches and Recognize the multiple approaches and possibilities available to address health issues of possibilities available to address health issues of people living in under-developed areas. people living in under-developed areas.

Factors Which Aggravate Factors Which Aggravate Tropical DiseasesTropical Diseases

PovertyPoverty Poor sanitationPoor sanitation Climate Climate

Centers for Disease Control and Centers for Disease Control and Prevention’s Healthy People in a Healthy Prevention’s Healthy People in a Healthy

WorldWorld Global Health Promotion:Global Health Promotion: Global health will Global health will

improve by sharing knowledge, tools and other improve by sharing knowledge, tools and other resources with people and partners around the resources with people and partners around the world.world.

Global Health Protection: Global Health Protection: Americans at home Americans at home and abroad will be protected from health threats and abroad will be protected from health threats through a transnational prevention, detection and through a transnational prevention, detection and response network. response network.

Global Health Diplomacy: Global Health Diplomacy: CDC and the United CDC and the United States Government will be a trusted and effective States Government will be a trusted and effective resource for health development and health resource for health development and health protection around the globe.  protection around the globe. 

CDC Global Health Promotion CDC Global Health Promotion ObjectivesObjectives

Prevent and control infectious diseases Prevent and control infectious diseases and their consequences globally. and their consequences globally.

Prevent infant and child morbidity and Prevent infant and child morbidity and mortality globally. mortality globally.

Prevent non-communicable diseases and Prevent non-communicable diseases and their consequences globally. their consequences globally.

Prevent injuries and their consequences Prevent injuries and their consequences globally. globally.

Promote safe, healthy, and accessible Promote safe, healthy, and accessible physical environments globally. physical environments globally.

CDC Global Health Protection CDC Global Health Protection ObjectiveObjective

Prepare for, prevent, detect, respond Prepare for, prevent, detect, respond to, and contain health threats to, and contain health threats globally. globally.

CDC Global Health Diplomacy CDC Global Health Diplomacy ObjectivesObjectives

Support achievement of international and Support achievement of international and national goals for the acceleration of national goals for the acceleration of control, and the eradication and control, and the eradication and elimination of diseases. elimination of diseases.

Develop sustainable public health capacity Develop sustainable public health capacity among partner organizations and among partner organizations and governments globally. governments globally.

Prevent maternal morbidity and mortality Prevent maternal morbidity and mortality globally. globally.

Improve response to natural and Improve response to natural and manmade disasters, including complex manmade disasters, including complex humanitarian emergencies globally. humanitarian emergencies globally.

CDC Activities in MalawiCDC Activities in Malawi

CDC Malaria Malawi Program CDC Malaria Malawi Program (CDCMMP) (CDCMMP) (http://www.cdc.gov/malaria/cdcactiv(http://www.cdc.gov/malaria/cdcactivities/malawi.htmities/malawi.htm

CDC Global HIV/AIDS Activities – CDC Global HIV/AIDS Activities – Malawi Malawi (http://www.cdc.gov/globalaids/Preve(http://www.cdc.gov/globalaids/Prevention/)ntion/)

WHO Strategic Plan (2008-2013)WHO Strategic Plan (2008-2013)

Created the Biennial Work Plan to support Created the Biennial Work Plan to support work in emergencies and crises. work in emergencies and crises.

Priority Areas: Emergency preparedness Priority Areas: Emergency preparedness and capacity development; Emergency and capacity development; Emergency response and operations; Recovery and response and operations; Recovery and transition; Partnerships and coordinationtransition; Partnerships and coordination

WHO Strategic Plan: Global Initiatives are WHO Strategic Plan: Global Initiatives are focusing on health and nutrition tracking focusing on health and nutrition tracking and providing support during crises and and providing support during crises and disasters. disasters.

Health IndicatorsHealth Indicators

Malawi is one of the world's poorest Malawi is one of the world's poorest nations and has among the worst health nations and has among the worst health indicators (164th out of 175, according to indicators (164th out of 175, according to UNDP's Human Development Index). Life UNDP's Human Development Index). Life expectancy is declining, the maternal expectancy is declining, the maternal mortality rate has almost doubled in the mortality rate has almost doubled in the last decade, and the infant mortality rate last decade, and the infant mortality rate has improved only marginally in the last has improved only marginally in the last 10 years.10 years.

Health Delivery Systems in Health Delivery Systems in MalawiMalawi

A number of public and private A number of public and private organizations and individuals provide organizations and individuals provide health services: health services:

Government (60%) Government (60%) Christian Hospital Association of Malawi Christian Hospital Association of Malawi

(CHAM) (receives some funding from (CHAM) (receives some funding from government) (37%) government) (37%)

Ministry of Local Governments (1%) Ministry of Local Governments (1%) Other providers, chiefly private hospitals, Other providers, chiefly private hospitals,

commercial companies, and army and commercial companies, and army and police (2%) police (2%)

Malawi Ministry of Health (MoH)Malawi Ministry of Health (MoH)

Has major hospitals in all three Has major hospitals in all three regions. regions.

Seeks to achieve health for all Seeks to achieve health for all Malawians by delivering health Malawians by delivering health services and disseminating health services and disseminating health information to the general public. information to the general public.

MoH MissionMoH Mission

Raise the level of health status of all Raise the level of health status of all Malawians by reducing the incidence of Malawians by reducing the incidence of illness and occurrence of death in the illness and occurrence of death in the population;population;

Accomplished through the development of Accomplished through the development of a sound delivery system capable of a sound delivery system capable of promoting health, preventing, reducing promoting health, preventing, reducing and curing disease, protecting life and and curing disease, protecting life and fostering general well being and increased fostering general well being and increased productivity. productivity.

MoH ObjectivesMoH Objectives Range and quality of health services for mothers Range and quality of health services for mothers

children under the age of 5 years expanded children under the age of 5 years expanded Better quality health care provided in all facilities Better quality health care provided in all facilities Health services to general population Health services to general population

strengthened expanded and integrated strengthened expanded and integrated Efficiency and equity in resource allocation Efficiency and equity in resource allocation

increased increased Access to health care facilities and basic services Access to health care facilities and basic services

increased increased Quality of trained human resources increased, Quality of trained human resources increased,

improved equitably/efficiently distributed improved equitably/efficiently distributed Collaboration and partnership in health sector Collaboration and partnership in health sector

strengthened strengthened Overall resources in health sector increased Overall resources in health sector increased

MalariaMalaria

Is a disease caused by a parasite Is a disease caused by a parasite that can infect people’s blood cells. that can infect people’s blood cells.

Spread by the bites of infected Spread by the bites of infected mosquitoesmosquitoes

Malaria Signs and SymptomsMalaria Signs and Symptoms Flu-like symptomsFlu-like symptoms High feverHigh fever ChillsChills Muscle painMuscle pain DiarrheaDiarrhea A more serious form of malaria can cause A more serious form of malaria can cause

heart, lung, kidney, brain problems, and heart, lung, kidney, brain problems, and death. death.

Symptoms may appear in cycles and is a Symptoms may appear in cycles and is a major indicator that one may have major indicator that one may have malaria. malaria.

Malaria TreatmentMalaria Treatment

If a person gets malaria, it is treated If a person gets malaria, it is treated with a drug. with a drug.

Drug treatment is based on the Drug treatment is based on the species of the parasite.species of the parasite.

Chloroquine is the drug of choice for Chloroquine is the drug of choice for treating infection. treating infection.

Malaria: Reducing the RiskMalaria: Reducing the Risk

Take steps to prevent mosquito bitesTake steps to prevent mosquito bites• Insecticide-treated bed nets Insecticide-treated bed nets

Take preventative medication: will Take preventative medication: will reduce the chances of getting the reduce the chances of getting the infection if bitten by a mosquito infection if bitten by a mosquito carrier. carrier.

Malarial vaccines-no evidence if they Malarial vaccines-no evidence if they are effective.are effective.

Drugs Used to Prevent MalariaDrugs Used to Prevent Malaria

ChloroquineChloroquine MefloquineMefloquine DoxycyclineDoxycycline PrimaquinePrimaquine Malarone Malarone

Malaria: Healthful Interventions Malaria: Healthful Interventions (CDC)(CDC)

Focus on prevention effortsFocus on prevention efforts Educate about the need to comply with Educate about the need to comply with

preventative medication: e.g. it is necessary to preventative medication: e.g. it is necessary to take the medication exactly as prescribed. take the medication exactly as prescribed.

Education on the signs and symptoms of the Education on the signs and symptoms of the disease and the need to seek early treatment.disease and the need to seek early treatment.

Close tracking and follow up of high-risk Close tracking and follow up of high-risk individuals and those on preventative therapy. individuals and those on preventative therapy.

*Use of mosquito nets treated with long-lasting *Use of mosquito nets treated with long-lasting insecticide, a very cost-effective method; insecticide, a very cost-effective method;

*Indoor residual spraying of insecticides. *Indoor residual spraying of insecticides.

CholeraCholera Cholera is an acute, diarrheal illness caused by Cholera is an acute, diarrheal illness caused by

infection of the intestine with the bacterium infection of the intestine with the bacterium Vibrio choleraeVibrio cholerae. .

is still common today in other parts of the world, is still common today in other parts of the world, including the Indian subcontinent and sub-including the Indian subcontinent and sub-Saharan Africa.Saharan Africa.

The infection is often mild or without symptoms, The infection is often mild or without symptoms, but sometimes it can be severe. but sometimes it can be severe.

Approximately one in 20 infected persons has Approximately one in 20 infected persons has severe disease characterized by profuse watery severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. diarrhea, vomiting, and leg cramps.

In these persons, rapid loss of body fluids leads to In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death dehydration and shock. Without treatment, death can occur within hours. can occur within hours.

Getting CholeraGetting Cholera Drinking water or eating food contaminated with the Drinking water or eating food contaminated with the

cholera bacterium. cholera bacterium.

In an epidemic, the source of the contamination is In an epidemic, the source of the contamination is usually the feces of an infected person. usually the feces of an infected person.

The disease can spread rapidly in areas with The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. inadequate treatment of sewage and drinking water.

The cholera bacterium may also live in the The cholera bacterium may also live in the environment in brackish rivers and coastal waters. environment in brackish rivers and coastal waters.

The disease is not likely to spread directly from one The disease is not likely to spread directly from one person to another; therefore, casual contact with an person to another; therefore, casual contact with an infected person is not a risk for becoming ill. infected person is not a risk for becoming ill.

Cholera TreatmentCholera Treatment Cholera can be simply and successfully treated by Cholera can be simply and successfully treated by

immediate replacement of the fluid and salts lost through immediate replacement of the fluid and salts lost through diarrhea. diarrhea.

Patients can be treated with oral rehydration solution, a Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with prepackaged mixture of sugar and salts to be mixed with water. water.

Severe cases also require intravenous fluid replacement. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients With prompt rehydration, fewer than 1% of cholera patients die. die.

Antibiotics shorten the course and diminish the severity of Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration. the illness, but they are not as important as rehydration.

Persons who develop severe diarrhea and vomiting in Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical countries where cholera occurs should seek medical attention promptly. attention promptly.

Prevention and Education is Prevention and Education is Best Healthful InterventionsBest Healthful Interventions

Sterilization: Proper disposal and Sterilization: Proper disposal and treatment of the germ infected fecal waste treatment of the germ infected fecal waste produced by cholera victims.produced by cholera victims.

All materials (such as clothing and All materials (such as clothing and bedding) that come in contact with cholera bedding) that come in contact with cholera patients should be sterilized in hot water patients should be sterilized in hot water using chlorine bleach.using chlorine bleach.

Teach proper hand washing techniques. Teach proper hand washing techniques. Sewage: Treatment of general sewageSewage: Treatment of general sewage

before it enters the waterways.before it enters the waterways.

Prevention and Education is Best Prevention and Education is Best Healthful Interventions-ContinuedHealthful Interventions-Continued

Water purification: All water used for drinking, Water purification: All water used for drinking, washing, or cooking should be sterilized by washing, or cooking should be sterilized by boiling or chlorination in any area where cholera boiling or chlorination in any area where cholera may be present. may be present.

Water filtration, chlorination, and boiling are by Water filtration, chlorination, and boiling are by far the most effective means of halting far the most effective means of halting transmission. transmission.

Cloth filters have significantly reduced the Cloth filters have significantly reduced the occurrence of cholera when used in poor villages occurrence of cholera when used in poor villages that rely on untreated surface water. that rely on untreated surface water.

Public health education and appropriate Public health education and appropriate sanitation practices are important to help prevent sanitation practices are important to help prevent and control transmission. and control transmission.

Other Diseases Having a Other Diseases Having a Significant ImpactSignificant Impact

HIV/AIDS: issues related to HIV HIV/AIDS: issues related to HIV testing; stigma; cost of medications; testing; stigma; cost of medications; compliance with medication; safe sex compliance with medication; safe sex practices. practices.

TuberculosisTuberculosis

A Project of Hope (APOHE)A Project of Hope (APOHE) ARTICLE II of our Bylaws - PURPOSEARTICLE II of our Bylaws - PURPOSE The purpose is to acquire and administer funds The purpose is to acquire and administer funds

and property, which, after payment of necessary and property, which, after payment of necessary expenses, shall be devoted exclusively toexpenses, shall be devoted exclusively to:  serve :  serve individuals and families in the poorest individuals and families in the poorest communities of developing countries promoting communities of developing countries promoting symbiotic, sustainable solutions to problems symbiotic, sustainable solutions to problems having poverty and illiteracy as their root causes; having poverty and illiteracy as their root causes; promoting health, hope, and lasting change by promoting health, hope, and lasting change by strengthening capacity for self-help and strengthening capacity for self-help and delivering relief during periods of emergent need.delivering relief during periods of emergent need.

Comprehensive Approach to Comprehensive Approach to Addressing Health-Related NeedsAddressing Health-Related Needs

Strategic plan to set prioritiesStrategic plan to set priorities Establishment of subcommittees to work Establishment of subcommittees to work

on specific areason specific areas Align ourselves with the vision and Align ourselves with the vision and

missions of global organizations (CDC, missions of global organizations (CDC, WHO and others)WHO and others)

Build partnerships (extremely importantly Build partnerships (extremely importantly when trying to secure funding)when trying to secure funding)

Seek funding based on priorities identified Seek funding based on priorities identified in the strategic plan.in the strategic plan.

Preparing to Seek Funding as a Preparing to Seek Funding as a Non-Profit OrganizationNon-Profit Organization

http://foundationcenter.orghttp://foundationcenter.org Specific training aimed at non-profit Specific training aimed at non-profit

organizations. organizations. Provides a combination of free Provides a combination of free

webinars and some classes requiring webinars and some classes requiring a fee. a fee.

ConclusionsConclusions The effects of tropical diseases or any disease has The effects of tropical diseases or any disease has

devastating effects on vulnerable populations.devastating effects on vulnerable populations. Treatment and prevention measures are not Treatment and prevention measures are not

complicated.complicated. But, in under-developed countries unique and But, in under-developed countries unique and

comprehensive approaches are needed to comprehensive approaches are needed to improve human capacity to manage disease. improve human capacity to manage disease.

APOH can provide a service and ultimately make APOH can provide a service and ultimately make a global impact on the lives of vulnerable a global impact on the lives of vulnerable populations and under served nations. populations and under served nations.

Thank You!Thank You!