Download Disease Control Priorities in Developing Countries, April 2006 PDF

TitleDisease Control Priorities in Developing Countries, April 2006
Author
LanguageEnglish
File Size18.2 MB
Total Pages1413
Table of Contents
                            Front Matter
	Cover
	Contents
	Dedication
	Foreword
	Preface
	Editors
	Advisory Committee to the Editors
	Contributors
	Acknowledgments
	Disease Control Priorities Project Partners
	Abbreviations
& Acronyms
I. Summary &
Cross-Cutting Themes
	1. Investing in Health
	2. Intervention Cost-Effectiveness - Overview of Main Messages
	3. Strengthening Health Systems
	4. Priorities for Global Research & Development of Interventions
	5. Science & Technology for Disease Control - Past, Present & Future
	6. Product Development Priorities
	7. Economic Approaches to Valuing Global Health Research
	8. Improving the Health of Populations - Lessons of Experience
	9. Millennium Development Goals for Health - What Will It Take to Accelerate Progress
	10. Gender Differentials in Health
	11. Fiscal Policies for Health Promotion
& Disease Prevention
	12. Financing Health Systems in the 21st Century
	13. Recent Trends &
Innovations in Development Assistance for Health
	14. Ethical Issues in Resource Allocation, Research &
New Product Development
	15. Cost-Effectiveness Analysis for Priority Setting
II.
Selecting Interventions
	16. Tuberculosis
	17. Sexually Transmitted Infections
	18. HIV-AIDS Prevention &
Treatment
	19. Diarrheal Diseases
	20. Vaccine-preventable Diseases
	21. Conquering Malaria
	22. Tropical Diseases Targeted for Elimination - Chagas Disease, Lymphatic Filariasis, Onchocerciasis &
Leprosy
	23. Tropical Diseases Lacking Adequate Control Measures - Dengue, Leishmaniasis &
African Trypanosomiasis
	24. Helminth Infections - Soil-transmitted Helminth Infections &
Schistosomiasis
	25. Acute Respiratory Infections in Children
	26. Maternal &
Perinatal Conditions
	27. Newborn Survival
	28. Stunting, Wasting
& Micronutrient Deficiency Disorders
	29. Health Service Interventions for Cancer Control in Developing Countries
	30. Diabetes - The Pandemic &
Potential Solutions
	31. Mental Disorders
	32. Neurological Disorders
	33. Cardiovascular Disease
	34. Inherited Disorders of Hemoglobin
	35. Respiratory Diseases of Adults
	36. Diseases of the Kidney &
the Urinary System
	37. Skin Diseases
	38. Oral &
Craniofacial Diseases and Disorders
	39. Unintentional Injuries
	40. Interpersonal Violence
	41. Water Supply, Sanitation &
Hygiene Promotion
	42. Indoor Air Pollution
	43. Air & Water Pollution - Burden &
Strategies for Control
	44. Prevention of Chronic Disease by Means of Diet &
Lifestyle Changes
	45. The Growing Burden of Risk from High Blood Pressure, Cholesterol &
Bodyweight
	46. Tobacco Addiction
	47. Alcohol
	48. Illicit Opiate Abuse
	49. Learning &
Developmental Disabilities
	50. Loss of Vision &
Hearing
	51. Cost-Effectiveness of Interventions for Musculoskeletal Conditions
	52. Pain Control for People with Cancer &
AIDS
III.
Strengthening Health Systems
	53. Public Health Surveillance - A Tool for Targeting &
Monitoring Interventions
	54. Information to Improve Decision Making for Health
	55. Drug Resistance
	56. Community Health &
Nutrition Programs
	57. Contraception
	58. School-based Health &
Nutrition Programs
	59. Adolescent Health Programs
	60. Occupational Health
	61. Natural Disaster Mitigation &
Relief
	62. Control &
Eradication
	63. Integrated Management of the Sick Child
	64. General Primary Care
	65. The District Hospital
	66. Referral Hospitals
	67. Surgery
	68. Emergency Medical Services
	69. Complementary &
Alternative Medicine
	70. Improving the Quality of Care in Developing Countries
	71. Health Workers - Building &
Motivating the Workforce
	72. Ensuring Supplies of Appropriate Drugs &
Vaccines
	73. Strategic Management of Clinical Services
Glossary
                        
Document Text Contents
Page 2

TABLE OF CONTENTS



Dedication

Foreword
Jaime Sepúlveda.

Preface

Editors

Advisory Committee to the Editors

Contributors

Acknowledgments

Disease Control Priorities Project Partners

Abbreviations and Acronyms

Summary and Cross-Cutting Themes

1. Investing in Health
Dean T. Jamison.

2. Intervention Cost-Effectiveness: Overview of Main Messages
Ramanan Laxminarayan, Jeffrey Chow, and Sonbol A. Shahid-Salles.

3. Strengthening Health Systems
Anne Mills, Fawzia Rasheed, and Stephen Tollman.

4. Priorities for Global Research and Development of Interventions
Barry R. Bloom, Catherine M. Michaud, John R. La Montagne, and Lone Simonsen.

5. Science and Technology for Disease Control: Past, Present, and Future
David Weatherall, Brian Greenwood, Heng Leng Chee, and Prawase Wasi.

6. Product Development Priorities
Adel Mahmoud, Patricia M. Danzon, John H. Barton, and Roy D. Mugerwa.

7. Economic Approaches to Valuing Global Health Research
David Meltzer.

8. Improving the Health of Populations: Lessons of Experience
Carol Ann Medlin, Mushtaque Chowdhury, Dean T. Jamison, and Anthony Measham.

Page 706

Angina is the characteristic pain of IHD. It is caused by
atherosclerosis leading to stenosis (partial occlusion) of one or
more coronary arteries. Patients with chronic stable angina
have an average annual mortality of 2 percent or less. Acute
myocardial infarction (AMI) is the total occlusion of a major
coronary artery with a complete lack of oxygen and nutrients
leading to cardiac muscle necrosis. AMI is usually diagnosed
by changes in the electrocardiogram; by elevated serum
enzymes, such as creatine phosphokinase and troponin T or I;
and by pain similar to that of angina. Thirty-day mortality
after an AMI is high: even with best medical therapy it
remains at about 33 percent, with half the deaths occurring
before the individual reaches the hospital. Even in a hospital
with a coronary care unit where advanced care options are
available, mortality is still 7 percent. In a hospital without
such facilities or therapies, the mortality rate is closer to 30
percent. Even though mortality among patients who have
recovered from an AMI has declined in recent decades,
approximately 4 percent of patients who survive initial hospi-
talization die in the first year following the event (Antman
and others 2004).

Stroke. Stroke is caused by a disruption in the flow of blood to
part of the brain either because of the occlusion of a blood
vessel (ischemic stroke) or the rupture of a blood vessel (hem-
orrhagic stroke). Many of the same risk factors for IHD apply
to stroke; in addition, atrial fibrillation is an important risk fac-
tor for stroke. The annual risk of stroke in patients with non-
valvular atrial fibrillation is 3 to 5 percent, with 50 percent of
thromboembolic stroke being attributable to atrial fibrillation
(Wolf, Abbott, and Kannel 1991). Chapter 32 discusses the
diagnosis and management of the clinical syndromes in greater
detail.

Congestive Heart Failure. CHF is the end stage of many heart
diseases. It is characterized by abnormalities in myocardial func-
tion and neurohormonal regulation resulting in fatigue, fluid
retention, and reduced longevity. CHF is caused by pathological
processes that affect the heart; IHD and hypertension-related
heart disease are the most common etiologies. The risk of
developingCHFis twotimesmore inhypertensivemenandthree
times more in hypertensive women compared with those who are
normotensive. CHF is five times more common in those who

646 | Disease Control Priorities in Developing Countries | Thomas Gaziano, K. Srinath Reddy, Fred Paccaud, and others

Glossary

ACE inhibitors (angiotensin-converting enzyme
inhibitors): a group of antihypertensive drugs that exert
their influence through the renin-angiotensin-aldosterone
system.

Antiplatelets: drugs that interfere with the blood’s ability
to clot.

Atheroschlerosis: a chronic disease characterized by
thickening and hardening of the arterial walls.

Atrial fibrillation: an abnormal rhythm of the heart that
can result in an increased risk of stroke because of the for-
mation of emboli (blood clots) in the heart.

Beta-blockers: a group of drugs that decrease the heart
rate and force of contractions and lower blood pressure.

Cardiogenic shock: poor tissue perfusion resulting
from failure of the heart to pump an adequate amount of
blood.

Cardiomyopathy: a disorder of the muscle limiting the
heart’s function.

Chagas disease: a tropical American disease caused by a
parasitic infection. Chronic symptoms include cardiac
problems, such as an enlarged heart, altered heart rate or
rhythm, heart failure, or cardiac arrest.

Dyslipidemia: a condition marked by abnormal concen-
trations of lipids or lipoproteins in the blood.

Embolus: a blood clot that moves through the blood-
stream until it lodges in a narrowed vessel and blocks
circulation.

Endocarditis: inflammation of the lining of the heart and
its valves.

Hypertension: abnormally high arterial blood pressure.

Reperfusion: restoration of the flow of blood to a previ-
ously ischemic tissue or organ.

Statins: a group of drugs that inhibit the synthesis of cho-
lesterol and promote the production of low-density
lipoprotein (LDL)–binding receptors in the liver, resulting
in a decrease in the level of LDL and a smaller increase in
the level of high-density lipoprotein (HDL).

Thrombolysis: the breaking up of a blood clot.

Thrombus: a blood clot that forms inside a blood vessel or
cavity of the heart.

Transient ischemic attack: transient reduced blood flow
to the brain that produces strokelike symptoms but no
lasting damage.

Page 707

have had an AMI than in those who have not. The prognosis for
those with established CHF is generally poor and worse than for
those with most malignancies (McMurray and Stewart 2000) or
AIDS, with a one-year mortality rate as high as 40 percent and a
five-year mortality between 26 and 75 percent.

The worldwide burden of CHF is substantial and continues
to rise. Throughout the developed world the prevalence is
about 2 to 3 percent, with an annual incidence rate of 0.1 to 0.2
percent (McMurray and Stewart 2000). However, the incidence
and prevalence of CHF rise dramatically with age. Prevalence is
27 per 1,000 population for those older than 65, compared with
0.7 per 1,000 for those younger than 50 (McKelvie 2003). CHF
occurs more frequently in men, and incidence and mortality
differ substantially according to gender and socioeconomic sta-
tus. CHF causes 53,000 deaths in the United States each year
and contributes to another 213,000, and the death rate attrib-
uted to CHF rose by 155 percent from 1979 to 2001 in the
United States (American Heart Association 2002). CHF is the
first-listed diagnosis in 1 million hospitalizations.

Rheumatic Heart Disease. RHD is the consequence of an
acute rheumatic fever (ARF)—that is, a poorly adapted
autoimmune response to group A �-hemolytic streptococci. It
affects the connective tissue, mainly the joints and the heart
valves. The most serious complications are valvular stenosis,
regurgitation following the valvulitis, or both (Ephrem,
Abegaz, and Muhe 1990). RHD is also a predisposing factor for
infective endocarditis, a disease of younger adults, predomi-
nantly males (Koegelenberg and others 2003).

According to 2001 estimates, RHD accounts for 338,000
deaths per year worldwide, two-thirds of them in Southeast
Asia and the Western Pacific (WHO 2002b). About 12 million
people in developing countries, most of them children, suffer
from RHD (WHO 1995). Steer and others’ (2002) review of
developing countries suggests that RHD prevalence in children
is between 0.7 and 14 per 1,000, with the highest rates in Asia.
RHD and ARF are the most common causes of cardiac disease
among children in developing countries (Ephrem, Abegaz, and
Muhe 1990; Schneider and Bezabih 2001; Steer and others
2002) and account for almost 10 percent of sudden cardiac
deaths (Kaplan 1985).

Until the 1950s, ARF accounted for a substantial portion of
cardiovascular problems among schoolchildren in developed
countries, and even though it is now far less common, out-
breaks still occur (Carapetis, Currie, and Kaplan 1999),
suggesting that neither antibiotics nor other public health mea-
sures have been totally effective in controlling ARF.

The Epidemiological Transition

Over the past two centuries, the industrial and technological
revolutions have resulted in a dramatic shift in the causes of

illness and death. Before 1900, infectious diseases and malnu-
trition were the most common causes of death; however,
primarily because of improved nutrition and public health
measures, they have gradually been supplanted in most high-
income countries by CVD and cancer. As improvements con-
tinue to spread to developing countries, CVD mortality rates
are increasing.

Known as the epidemiological transition, this shift is highly
correlated with changes in personal and collective wealth (the
economic transition), social structure (the social transition),
and demographics (the demographic transition). Omran
(1971) provides an excellent model of the epidemiological
transition that divides it into three basic ages: pestilence and
famine, receding pandemics, and degenerative and human-
created diseases (table 33.1). Olshansky and Ault (1986) add a
fourth stage: delayed degenerative diseases.

The consistent pattern for most high-income countries going
through the epidemiological transition has been initially high
rates of stroke, mostly hemorrhagic. Only in the third phase,
with the presence of increased resources, but coupled with
increased diabetes and smoking rates and adverse lipid profiles,
do rates of IHD climb. This phase is also accompanied by better
control of severe hypertension, reducing the rates of hemor-
rhagic stroke, which is then replaced by ischemic stroke. Most
regions appear to be following this pattern and have a predomi-
nance of IHD. The two exceptions are East Asia and the Pacific
and Sub-Saharan Africa. The pattern in East Asia and the Pacific
is dominated by China and appears to be a result of China’s stage
in the transition but may also be following a pattern similar to
Japan’s—that is, dominated by more strokes and fewer IHD
deaths—whereas Sub-Saharan Africa is in an earlier phase of the
epidemiological transition.

Even though countries tend to enter these stages at different
times, the progression from one stage to the next tends to pro-
ceed in a predictable manner. The six World Bank regions are
at various phases of the epidemiological transition (table 33.1),
and where development has occurred, it has often been at a
more compressed rate than in the high-income countries.
Although rates of IHD and stroke fell 2 to 3 percent per year in
the high-income countries during the 1970s and 1980s, the rate
of decline has since slowed. Overweight and obesity are esca-
lating at an alarming pace, while rates of type 2 diabetes, hyper-
tension, and lipid abnormalities associated with obesity are on
the rise. This trend is not unique to the developed countries,
however. According to the World Health Organization, world-
wide more than 1 billion adults are overweight and 300 million
are clinically obese. Even more disturbing are increases in
childhood obesity that have led to large increases in diabetes
and hypertension. If these trends continue, age-adjusted CVD
mortality rates could increase in the high-income countries in
the coming years. These trends are discussed in greater detail in
chapter 45.

Cardiovascular Disease | 647

Page 1412

Vrijhoef, H. J., J. P. Diederiks, C. Spreeuwenberg, and B. H. Wolffenbuttel.
2001. “Substitution Model with Central Role for Nurse Specialist Is
Justified in the Care for Stable Type 2 Diabetic Outpatients.” Journal of
Advanced Nursing 36 (4): 546–55.

Vrijhoef, H. J., J. P. Diederiks, G. J. Wesseling, C. P. Van Schayck, and C.
Spreeuwenberg. 2003. “Undiagnosed Patients and Patients at Risk for
COPD in Primary Health Care: Early Detection with the Support of
Non-Physicians.” Journal of Clinical Nursing 12: 366–73.

Waghorn, A., and M. McKee. 2000. “Why Is It So Difficult to Organise an
Outpatient Clinic?” Journal of Health Services Research and Policy 5:
140–47.

WHO (World Health Organization). 1985. “The Rational Use of Drugs:

Review of Major Issues.” Paper prepared for the Conference of Experts
on the Rational Use of Drugs, Nairobi, Kenya, November 25–29.

———. 2000. World Health Report 2000: Health Systems: Improving
Performance. Geneva: WHO.

———. 2001. Innovative Care for Chronic Conditions. Geneva: WHO.

———. 2002. Community Home-Based Care in Resource-Limited Settings:
A Framework for Action. Geneva: WHO.

Yip, W., and W. Hsiao. 2003. “Autonomizing a Hospital System: Corporate
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A. S. Preker and A. L. Harding. Washington, DC: World Bank.

1352 | Disease Control Priorities in Developing Countries | Alexander S. Preker, Martin McKee, Andrew Mitchell, and others

Page 1413

Glossary


ACE inhibitors: (angiotensin-converting enzyme inhibitors) a group of antihypertensive drugs that exert their

influence through the renin-angiotensin-aldosterone system.



Antiplatelets: drugs that interfere with the blood's ability to clot.



Atheroschlerosis: a chronic disease characterized by thickening and hardening of the arterial walls.



Atrial fibrillation: an abnormal rhythm of the heart that can result in an increased risk of stroke because of the

formation of emboli (blood clots) in the heart.



Beta-blockers: a group of drugs that decrease the heart rate and force of contractions and lower blood pressure.



Cardiogenic shock: poor tissue perfusion resulting from failure of the heart to pump an adequate amount of blood.



Cardiomyopathy: a disorder of the muscle limiting the heart's function.



Chagas disease: a tropical American disease caused by a parasitic infection. Chronic symptoms include cardiac

problems, such as an enlarged heart, altered heart rate or rhythm, heart failure, or cardiac arrest.



Dyslipidemia: a condition marked by abnormal concentrations of lipids or lipoproteins in the blood.



Embolus: a blood clot that moves through the bloodstream until it lodges in a narrowed vessel and blocks circulation.



Endocarditis: inflammation of the lining of the heart and its valves.



Hypertension: abnormally high arterial blood pressure.



Reperfusion: restoration of the flow of blood to a previously ischemic tissue or organ.



Statins: a group of drugs that inhibit the synthesis of cholesterol and promote the production of low-density

lipoprotein (LDL) binding receptors in the liver, resulting in a decrease in the level of LDL and a smaller increase in

the level of high-density lipoprotein (HDL).



Thrombolysis: the breaking up of a blood clot.



Thrombus: a blood clot that forms inside a blood vessel or cavity of the heart.



Transient ischemic attack: transient reduced blood flow to the brain that produces strokelike symptoms but no

lasting damage.

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