Epidemiology In Public Health

The health issues are known to take place when metabolism of body is altered or is subjected to failure due to the pathogen or pollutant that are considered as the disease. On the other hand, the epidemic disease is referred to as wide spread of the disease that occurs in other regions than that of the expected area at the given time period.

Overview of key health problems

Cholera

Cholera is regarded as the infectious disease, which results in the severe diarrhea, leading to the dehydration and death in some cases. This occurs by consumption of contaminated food with the bacterium known as Vibrio cholerae.

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Nature

It is generally termed as the acute enteric disease as per the variation in severity. Most of the infections are regarded as asymptomatic. In the mild cases, the diarrhoea takes place without any further symptoms. The disease of cholera has been observed to pandemic in the initial cases in past 200 years. In addition, the cholera has also been documented in the epidemic form, which was widespread in the areas of South America as well as Yemen.

Extent

The impact of cholera has been identified to be highly severe among the human population, with the estimation of about three to five million cases of cholera and about 100000-120000 death tolls worldwide.

Why is it a public health issue

In the year of 2016, the report of 132,121 cases of cholera and about 2420 deaths has been presented to WHO globally. The outbreaks have continued to make an impact on the several countries. Overall, about 54% cases have been observed from Africa, 13% reported from Asia and about 32% reported from Hispaniola. With all these, cholera sustains the position of major public health issue that primary continues to affect populations of developing world without process accessibility of sanitation resources or water.

Influenza

It is referred to as the respiratory illness, which is contagious and is caused by the influenza virus. It can lead to mild and severe illnesses and can even lead to death in few cases.

Nature

It has been characterized by the annual and seasonal epidemics followed by the pandemic and sporadic outbreaks that involve the influenza strains belonging to the zoonotic origin.

Extent

As per the estimation of WHO, the annual epidemics has resulted in approximately one billion infections, including the three to five million cases of the severe illness.

Issues on identifying the health problems or population affected and data sources and evidence gathering

The issues have been observed in the identification of health populations, which involve the assessment of the risk factors, effectiveness of the vaccine and patterns related to the utilization of the healthcare. These include the challenges, which involve the biases that are in association with chosen participants of the population, difficulty in the adjustment for the confounders as well as restricted specificity due to the reliance on the syndromic definitions for the disease limits (Wójcik, Chunara and Johansson, 2014).

Epidemiological methods and approach

The epidemiological methods are necessary for the disease surveillance in identifying the significance of the hazards. Besides that, the methods are also effective in identifying the risk factors that are crucial in evaluating the public health issues. The epidemiological method approach used in this context of article is the participatory surveillance that refers to the participation of community in the disease surveillance. In this research method, the public engagement is transformed with the help of participatory surveillance systems, which enables public to report on the diseases through the internet (Wójcik, Chunara and Johansson, 2014).

Summary of data on distribution of the health issue according to population characteristics

Age

It has been identified that there has been about 11 million cases of cholera that occurs globally among the children belonging to the age group of 5 years. However, it also causes severe impact among the adolescents and adults along with high mortality rate in all the age groups (World Health Organization, 2018).

Sex

The girls and the women have developed higher risk of incidence regarding the cholera due to their high exposure to household activities such as handling of the contaminated water and raw food. Thus, there has been excess burden of disease among school going girls and women (Unicef.org, 2017). It has been identified that the young boys have a tendency of higher rate of incidence among the young children and the infants, which is reversed among adults and older children, where higher rate is for females.

Ethnic groups

Cholera has been a widespread disease, which is evidently observed on the developing countries as well as catastrophically on the content of Africa, which has recorded about 2.4 million cholera cases and about 120,000 deaths in few decades (Unicef.org, 2017).

Environmental attributes

Geographical

Cholera has been evidently widespread on the African continent that has contributed to the epidemic spread. In addition to that, the epidemic influence of cholera has also been witnessed in South America (OSes, Duker and Stein, 2016).

Socio-economic

The risk factors of the known cholera population level include the lack of the development, poverty along with the high population density. The other aspects such as the poor sanitation, housing, and lack of proper water supplies and synergy of the poverty majorly contributed in enhancing the exposure to the cholera pathogen (World Health Organization, 2018).

Education

It has been observed that the lack of education and exposure to the knowledge is mainly associated with higher incidence rate of cholera among population. Unicef.org (2017) have stated that low status of education acts as a crucial risk factor of the disease in the areas of Bangladesh (OSes, Duker and Stein, 2016).

Temporal variation

The temporal variation of the epidemic cholera is linked with the forces such as the temperature of sea surface and patterns of rainfall. Studies have observed there has been environmental associations with the pathogen that involves depth, water temperature and depth, which contributes in the secular and seasonal trends in outbreaks (OSes, Duker and Stein, 2016).

Population distribution

Age: The people who suffer from the greater risk of evidence includes the pregnant women, the children under fifty-nine months and the elderly individuals who are more than 65 years old (Who.int, 2019).

Sex: It has been observed that the reported infection incidence with the seasonal influenza is relatively prevalent in the developing countries such as Spain and the USA, where the rate of affected males is slightly higher than that of females (Who.int, 2019).

Ethnicity: The influenza is highly prevalent across the globe, with the annual attack rate of about 5-10% in the adults and about 30% among the children, majorly affecting people belonging to white ethnicity and non-Hispanic individuals (Who.int, 2019).

Socio-economic and demographic distribution

Geographical: In the temperate regions, the influenza is referred to as the seasonal disease that mainly occurs in the months of winter and affects northern hemisphere from the month of November to April as well as southern hemisphere from month of April to September. In the tropical regions, there is an absence of clear seasonal pattern and the influenza circulation is prevalent yearly typically at peak during the monsoon period (Apps.who.int, 2019).

Socio-economic conditions and education: It has been found that the poor consequences from the seasonal influenza involve, involve the obesity and diabetes. In addition, diabetes mellitus is another risk factor for the severe influenza with the potential association with the increased morbidity. Therefore, it can be said that the individuals belonging to the low socio-economic condition are at higher incidence rate of influenza (Apps.who.int, 2019).

Strengths and limitation of article

Strengths

The participatory surveillance research method comprises of various strengths, one of which includes the easier method of the collection of the data, as compared to the traditional surveillance research method identified in the previous literature. The new surveillance research approach comprises of the convenient internet based form which exhibits increased accessibility from various locations (Wójcik, Chunara and Johansson, 2014). This in turn, is identified to be highly effective in decreasing the costs that are associated with the operation of the participatory surveillance system. Apart from that, scalability is referred to as another technical strength that is linked with the new surveillance research approach that has been identified in the article.

Limitations

The research method that has been used is the participatory surveillance system, comprises of certain limitations, which involves the population of the participants which shall not be representative of general population. The majority of the participants that have been taken into consideration in the studies comprise of women. However, the elderly individuals and children are likely to make use of the internet. In addition, it also comprises of limitation regarding the collection of the data from the participants. Thus, it has been found that amount of the resources such as the computation, finances, time and personnel, which are required to be expanded is minimal as compared to the traditional method approach (Wójcik, Chunara and Johansson, 2014).

Policies and their impacts on the public health issues

The treatment related benefits are considered to be private, the spillovers might interpret that it is carried out in the personal interests of the rich countries for paying the AV related treatments in the poor countries. The major cost effective policy that has been identified for the rich countries is the donation of the doses to source of outbreak in the country. However, it has also been identified that the donation of the doses to the poor countries in the proportion of the population, might also be termed as cost effective. These are highly dependent on flu strain transmissibility, antiviral efficacy in the reduction of the transmissibility along with the proportions of the infections, which can be treated and identified. The policy focuses on the mitigation of spread of the flu with the administration of the antiviral for the individuals with the symptomatic infections. In absence of the international cooperation’s, it has been assumed that there is a variation in the antiviral stockpiles along with per capita income, where the poor countries are deprived of the antiviral stockpiles. In this regard, the rich countries are expected to pay for the stockpiles, which are then distributed to the poor countries. This is then, judged by the success of the control strategy in accordance with the rate of the infected population at the year end. The influence of the policy response of in form of the influenza treatment is dependent on size of the treatment externalities, which are identified to be large if the pandemic occurs in source country. In the case where the pandemic spreads through the air, the externalities comprise of a strong association with the anti-viral treatments that are smaller (Hirve, 2016). This means that the treatment of the infectious people in the residing country shall lead to decline in the local attack rate. It has always been evident from the study that the wealthy countries are expected to carry out purchase and distribution of the anti-virus doses in outbreak country. In other case, the private marginal benefits for treating the local patients exceed the marginal benefits from the donation of the doses that are being outsourced. However, if the prosperous countries are able to retain the stockpile of the antiviral drugs, that are sufficient for treating the domestic cases. This may lead to the increase of the welfare by the paying of for purchase as well as distribution of the additional doses to outbreak country. The donation of the antivirus to the outbreak country has led to the reduction of the number of the influenza related cases in the rich countries by around 4.76 million influenza cases after one year. This policy donation has been regarded as the wealth enhancing aspect for the wealthy countries at 0% case of the fatality rate.

The policies related to the identified health issue of cholera involves the case management policy, which makes use of the effective treatment in residing in the prompt rehydration through administration of the ORS (oral rehydration salts) or the intravenous fluids, as per the case severity. It has been observed that about 80% of the patients could be treated in an adequate manner with the ORS administration. The dehydrated patients are required to be treated through administration of the intravenous fluids along with the appropriate dosage of the antibiotics, which is to be provided in the serious cases. In addition to that, the cholera has been widely referred as the water-borne infection, which can take place due to poor sanitation, hygiene along with the consumption of the contaminated water and food (Wójcik, Chunara and Johansson, 2014). Thereby, it has been observed that the implementation of the HWT system intervention is not suitable for the outbreak of the epidemic disease. Thus, the policy response has been exclusively focused on the WASH intervention policy that further states that the water and sanitation supply for the improved hygiene has yielded higher rate of decline in the disease in comparison to those for the water quality (Ali and Sack, 2015). This has been facilitated with by execution of the water and sanitation policy related interventions. Further research conducted in the HWT studies have been considered to have combined decrease in the diarrhoeal disease by about 35%, thus contributing to the improvement of the access to the sanitation and water. The policy has also provided an exposure to the implications regarding the maintenance of the hygiene, improvement in quality of the water, which in turn, creates a positive impact on the reduction of the incidence rate of diarrhoea. From the recent reviews, it has been identified that there has been shortage of the accurate evidence for the intervention policy of WASH in case of emergencies. These interventions are found to have significant impact in the reduction of the diarrhea among the adults along with the decline in the rate of absenteeism among the children in the school. The impact related to the WASH has been documented in a proper manner, which has signified considerable evidence in the reduction of the disease of cholera by the implementation of the WASH intervention policy.

Recommendations

The participatory epidemiology has been referred to as the application of the participatory methods in the disease surveillance as well as the epidemiological research approaches. It has been considered as the proven technique that is effective in overcoming the various limitations regarding the epidemiological conventional methods, which in turn, is crucial in solving number of the human public health surveillance and the research issues (Jost CC, 2017). The approach has been developed in the small scale, then further applied to the major control effects regarding the epidemic disease. The research approach has adopted the participatory epidemiology as the surveillance tool in carrying out the further research. In addition, this approach has been subsequently applied in both the urban and rural settings in the regions of Asia and Africa, for the diarrhoea related diseases along with the highly pathogenic influenza. Apart from that, the participatory disease surveillance has been identified in making significant contribution in controlling of the epidemiology related disease risks. Thus, the authorities are required to review principle applications related to the applications regarding the participatory epidemiology followed by the implications related to the field applications. This in turn, the research further needs to carry examinations regarding the future challenges, considering the new areas for the research. Another type of the gathering of the data that should be taken into consideration is the analysis of the collection of the data. All the epidemiological data regarding the cholera in the epidemic as well as the sporadic cases is to be obtained from the registered documents that are in accordance with the Center for Disease Control and Prevention of Ministry of Health and the education, that is based on the WHO and CDC definition. This is to be facilitated with the analysis of the data that has been recorded on the systems. Last but not the least, the descriptive data shall be applied for the expression of the data (Jost CC, 2017).

Either the guidelines related to the cholera shall be able to incorporate the necessary standards, international or national that has been outlined by World Health Organization such as the water quality, case management as well as the surveillance. Based upon national context, the authorities are required to support government in the development of the intersectoral guidelines of cholera that covers the sectors related to health, protection, education and communication as well as dissemination and training the personnel. The policy related to the WASH intervention strategy is found to be highly effective in the improvement in the lifestyles of the individual population. Thus, the data on the facility functioning as well as usage needs to be gathered following the implementation. Further, the research has been required for the evaluation of the intervention along with the delivery method in the outbreak setting. The research shall be focusing on the cholera, along with the external additional benefits that are to be gained in reducing the diarrhoeal diseases. In addition to that, WASH related interventions are required to seek guidance as well as leadership, which in turn, is crucial in the evaluation of health impact of the activities. Apart from that, the policy needs to be implemented, which shall be emphasizing on the education of the public regarding the outbreak of the epidemic diseases and evaluate an effective planning for taking the protective measures for avoiding such diseases. These shall be including the cooking of the food in a thorough manner, washing hands properly, taking ORS in order to avoid the risks related to diarrhoea and seeking immediate help for the diarrheal illness.

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