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lecture4_1_11_11_long - LECTURE 4 The Puzzle of...

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LECTURE 4: The Puzzle of Low-Adoption Rates in the Demand for Health
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Puzzle: •As we’ve discussed, there seem to be simple, inexpensive, highly-efficacious technologies and services for many of the ading causes of morbidity and mortality in poor countries leading causes of morbidity and mortality in poor countries •However, even when they are made available at low (or no) cost d i b lt h dt i t f t hli i and are accessible, the adoption rate of many technologies is very low •Why?
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(1) Malaria: Insecticide-Treated Bed Nets (ITNs d LLINs) and LLINs) • Caused by protazoan parasites carried by Anopheles mosquitoes; Infects 300-500 million people annually, kills 1-3 million people annually idespread DDT spraying (to kill nopheles mosquitoes carrying Wdespe d sp y g(o p osqu oes c y g malarial parasite) responsible for large reductions in burden of disease due to malaria during the Global Malaria Eradication Campaign (1955- 969), especially in Central and Latin America and South Asia 1969), especially in Central and Latin America and South Asia – Ongoing expense “unsustainable,” environmental concerns – Indoor residual spraying continues erratically • Emphasis today on vector control through the use of ITNs (treated with yrethroid insecticides pyrethroid insecticides ) – Untreated nets far less effective – Re-treatment required several times per year, more recently, LLINs
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(2) Diarrheal Diseases: Point-of-use Drinking Water isinfectants Disinfectants • Caused by any of a large number of bacterial and viral agents ansmitted by fecal- ral pathways; Roughly 4 billion cases transmitted by fecal oral pathways; Roughly 4 billion cases annually, kills 2 million people annually • Ongoing water/sanitation infrastructure projects, but enormously expensive – usual problems of public sector management, rruption corruption •E m phasis today on point-of-use drinking water disinfectants and basic hygiene (handwashing) – Many variants: chlorine based, UV-based, etc.
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(Remember our friend the goat?)
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(3) Diarrheal Diseases: Oral Rehydration Therapy (ORT) Not preventative, but effectively treats acute symptoms, preventing severe dehydration • Simple combination of salt, a sugar, and water – as little as 30mL per hour can keep a dehydrated infant alive • Among the most used of simple health technologies – but far from universal use conditional on contraction of diarrheal disease and lack of other treatments
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(4) Stunting and Wasting: Dietary Vegetable rotein Supplements Protein Supplements • Calculating deaths and burden of disease due to malnutrition is difficult and controversial – actually responsible for many infectious disease deaths – WHO claims malnutrition to be the single “risk factor” responsible for the largest burden of disease worldwide • Famous case of “Incaparina,” developed in Guatemala in the 1960s by PAHO’s Institute of Nutrition of Central America and Panama NCAP) (INCAP) – Variants worldwide made with indigenous ingredients; original
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lecture4_1_11_11_long - LECTURE 4 The Puzzle of...

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