One of the big 3: TB, malaria, HIV will be on there
Only 70% is infectious disease– 30% will be NCDs, refugee camps
- WHO and CDC guidelines are where many of the examiners turn for their questions
Preventive Medicine Paper
1. GIS Question:
- What is the role in public health?
- GIS is computer aided database managemnt and mapping
- GIS adds dimension of demographic analysis to IT linking data to map
- Determining geographic distribution
- Analysing spatial and temporal trends
- Mapping populations at risk
- Stratifying risk factors
- Assessing resource allocation
- Planning and targeting interventions
- Monitoring diseases and interventions over time
- Guinea worm
- Maps drawn showing regional occurrence
- Unsafe groundwater sources
- Filters
- Temephos – biodegradable larvacide
- Systematically track all villages
- Identify infected and reinfected
- Detect target resoures
- Monitor process towards eradication
- Still in Southern Sudan and Chad
- Community based surveillance – look for painful blister relieved by dipping in water
2. Polio eradication what is required (10 marks) and what are the obstacles (10 marks)?
- Required
- Surveillance of AFP with virology stool samples
- Routine vaccination
- Catch-up vaccinations/ mass vaccinations
- Targeted mop-up campaigns
- Other causes AFP: Guillan-barre, WNV, novel eneterovirus
- Obstacles
- Political will
- Sanitation
- Vaccine refusal
- Increased costs as cases reduced
- Violence against owkers
- Vaccine-associated polio strains
- Transition from IPV to OPV
- Financing
- Vaccine Supply
- Trouble countries: India, Syria, Pakistan, Nigeria, South Sudan
- Infrastructure
- Cultural/religious beliefs
3. NCDs. Using either Type 2 DM or epilepsy describe how you would organize delievery of care to a rural community in central Africa (20 marks)
- Diagnosis
- Diagnose with fasting or glucose challenge
- Establish system to diagnose problem
- Treatment
- Essential medicine list, ensure no stockouts
- Move care to Primary Health Centre
- Set targets
- Use simple regimens of cheap, effective drugs
- Nurse-led clinical algorithms
- Follow-up
- Encourage and check compliance
- Access to Care
- Education
- Educate patients and carers
- Educate health care staff
4. HIV. Why is HAART important to take on time (5 marks)? In setting of Africa, describe strategies to ensure compliance (15 marks)?
- Take all drugs on time to ensure ideal drug level. Sub-optimal drug levels may provide pressure to select for resistant strains/mutations. HIV has a rapid mutation rate and is highly prone to developing resistance so having 3 drugs at active levels at all times is critically important.
- Strategies
- Avoid stockouts
- Treatment buddies (relatives)
- Educate patients
- Educate health care workers
- Mobile phones/SMS
- Simplified regimens
- DOTs if needed
- Adeherence counselling
- Standardized adherence measures
- Free drugs
- Recall systems to prevent loss to follow up
- Expert patients
5. HPV: Should you accept a donation of Cervarix or Garasil for three years
- Vaccine basics
- Highly effective
- Expensive
- Cost
- Sustainability
- Are there other health/social interventions to be given alongside?
- Studies needed for acceptability, proportion of disease from 16/18
- How do you market? Cancer prevention or STIs
- Outside of typical vaccine target ages, how to be done?
6. Discuss 4 key messages that you would put into an information leaflet for men considering being circumcised (20 marks)?
- Interventions: condoms, syndromic management, ART, cirucmcision
- Shown repeatedly to prevent men acquiring HIV by almost half
- Will not protect you from other means of infection
- Keep using condoms
- Don’t have sex for 6 weeks until wound is healed because it increases chance until then
7. 6 critical public health measures for diarrhoeal prevention
- Clean water
- Nutritional supplementation: vitamin A, zinc
- Rotavirus immunization
- Exclusive breastfeeding
- Wat/san
- Hand hygiene
- Hygienic nutritious weaning foods (not just rice)
- ? Anti-helminthic
- Main causes (GEMS Trial): Rotavirus, Cryptosporidium, Shigella, Enterotoxigenic E. Coli
Trachoma
- Wat/san
- Latrines
- Access to safe water