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Welcome to this lecture more due to what you in one second part principles of mass work programs if you remember in the Fareast. Lecture we talked about was the fairest half of this election we talked about. The principles of said race so in this we win this one I want to because most drug programs or the mass. Destruction approach has been used to control many of the plastic in fiction so we want to talk about it in general and from the next module we'll be talking about specific examples. Our objectives what is a mass Drug Administration controlled programs we want to know what what when we see M.D.A. what we mean by that. And we want to know about the methods which are used in applying such programs. And we want to know about the methods. Which precede the program said villains when we talk about the elements of surveillance in their previous section one of their the sets of the issues. So. Look at this kind of torn and then it shows you how. The. The way you do things it influence the decision and the action taken. So what do you mean by mass Drug Administration. It means you are giving the treatment. Or the drugs to the horde population irrespective of who is effected and who's not how for example you go to a sitting. Community and you see if I find a prevalence of more than fifty percent of this particularly fiction among these people to everyone how would you determine that they have to present by taking any present the sample. So you use samples of population and then decide based on their preferences and then based on outcome and then intervene with the treatment. Here you have to be also able to determine which. Groups are believe what I mean for example population X. three score say fiction. And the way you do this I knew a little way you didn't mean the prevalence and the way you do all the things as we said from the first part of the set of lectures. In detainments it is determined by the type of the disease and their investigation. So what are the steps that we take in and empty a program first of all we start by said V.A. to determine the prevalence of that class to go to. Health issues. The middle of a survey may vary based on which disease we are talking about I will give you an example in this in the end of this lecture when compared to the difference that of these decide on areas to be covered. Which Communities Act that high risk of infection and which ones you want to treat. A. Depends to certain degree on the objectives of your program. Also City Mission and international transmission. Also health education without informing your state. The people who are going to receive these the treatment. That. That that that the chance for success is minimal especially when the M.D.A. program it has to beat it repeated over period of time you have to inform the community and you have to. Get them involved participate in the process. And then you decide on the my **** at Mr Drug Administration we thought. Through that just one of the best ways to do it is do is to make sure that the community participate in the process community participation as I said before especially if that to me. Needs it needs to be sustained over a long period of time here you need the help from the community and you need their involvement. How we see when we go in more you tool talking specifically about the mass truck administration. To control that river blindness cases but. You train them. Some people from within the community leaders. And then you ask them to do studio the treatment and their supervision of Hill's work or the health workers under the supervision of that. Well over the. Hills or thirty's and her thirty's coordinating with different partners things yours and task forces and all these bodies. So when we say to me has to be repeated. And it's not it's not only have. I wanted to be an event sometimes you have to be the treatment for fifteen years that's why. You need to plan for sustainable sustainability and the ability to continue to be using that. The treatment through. The community classification. Now other. Things that to put in mind the utility who is going to do that with men and who is not supposed to know that it is breastfeeding killed in the years that. Two years for example. People who are ill acute illness all these. Now that they have to be excluded. And then you have you must you need to have a method. For you can really assessment how how how are you really went to determine who is legal or who is not my question in interviews and this question interviews are going also to be done by several years themselves. So. The drug itself how are you going to determine that those said by age is it by weight is it by link is also something that you have to train if you use that Steve uterus. What it covered it. So even when you start you know that you have a target you say for example I need to cover my ninety percent of the communication so that is you covering So that is the real target and then you do need to have a method. To monitor this started to see if it has been achieved or not. So you need to find a way to check on the stevia to do this to check on the number of residents. And to. When he turned the program over if you have time. Until you achieve to do do do you target. This distribution. There are two factors here which are important and you see examples of the course it carries that frequency how many times you want to distribute the drug and you want for example it once a year or twice a year every month or so and the length for how many years do you want to continue but many factors are involved here that some of that this which that they. Look at they relate to a type of transmission some of the factors that it is a parasite itself how long it leaves some of the factors it could lead to the type of drug you are using targeting would you still have the kind of side so these all are factors which I'm told in utilization that decide on the length and the frequency of the treatment. So you need to know all of these factors we do know about the parasite life cycle. Times throughout the transmission pattern. And you will object to what what are you what do you want to achieve that I'd occasionally diminish and what I was well controlled well. I mean objective you have here an independent survey or complaint from compliance so they sent people flee human population that reported that they had swallowed that truck you would have to have a mere thought or you have to have a follow up to see if you have achieved your target on if you see if you if your program is based on for example eighty five percent coverage or you see that I won't. To make sure that eighty five percent of the population. They have received the treatment they have seen at least me so if for example need help and without getting on these. If for example your coverage was only fifty percent of course the program is not going to work I'm going to interrupt so you know you want to have a myth what to monitor and check on your coverage. So for ethical point it's causing Gratian. Also you have to be careful. What do we mean by that if we can. Consider consideration for example I. Know that is a very huge big deviate and some of the control projects. That he's. Had he for example they have their masks they have their mask treatment. For the whole community but what about people who are suffering from certain particular complications are those in fiction or what if you come across it in part to get other conditions while you're distributing these are things which you need to be able to handle for if you can reasons. So five hundred million people are affected by neglected disease. And out of these they look this is they're not all parasites but the car sites they have the lion's share of this and I know. In the in that in many cases the whole population which is infected is treated to guard lists of who's infected and who's not but of course that has to be that's going to be done after three many surveys that shows that reference in that in the past if you're sitting in on the creation widespread problem and you. Use of chemotherapy. Is one of the outcomes of these programs so you have to get on my what are what I want exactly what it's what is the best way to address the whole issue and. So also we have to think about what do you do this you may and having developed as distance so are you thinking on the life. In the future. Or the life in the present. You need to make sure that what white when you are treating people now. You are also putting in mind what's going to have to go to the. Next Generations. So. Some people they say. Why do we we don't we don't I mean care a lot about the future because it is and setting many things that can happen many facts kind of intervene or kind. For example walls in meeting diseases but. What is the makers. They always think about it and they make decisions that benefit most of the people present and the future so there are those who do the drug not whether thinking what if you know that that the price I had to come to distant what happens in the future as it was and so because if there is a systems you cannot even see the cases in the future so the things they have to be put in mine you know that's why I can't public health. You know. The actions. Which you take. To intent to intervene with certain particular health issue you always combine. I wish to continuously see as you all should we should all be. Scientifically. Try to see to have. Insight of a long period of time of what is going to happening and that can only be done through consent decree seems. So well I'll have selected an evidence based strategy to sort of properly set apart a good health problem and then divide your target population into segments. And these different things that have of course to have to seem like they sticks. And also the same time to tell me and we should locally there is an organization have an influence on a target population this is very important to assure their success of their intervention if it is if the treatment you because people don't listen to their leaders they miss you they will. Follows instructions and do what they are told to do conduct a reset with each segment to live it is prescription of the benefits of. And the years to each see little evidence based strategies you need to know how they will your top license to talk to your strategies or actions you need to know how the community will react to those certainties condors it is seriously these leaders and of the nations to live in their assessment of the select evidence based since so you are working at two levels where there is a level with the population segment and the liberals will. Work with the leaders because a leader says he has a court order on the basis of that he says finding determine how best to dissimulate this elected strategies in ways that P. that population. What's which is true because it can be vaccination it can be treatment it can be. Water food is going to be the city to the people so it depends on which is disease we're talking about design and then after you start on the action then you design the student channels and I put it in the case of the opposite cases we are we have used to fill us three and be used to you I've worked in treatment and you see next more you. Conduct academic research test the air force of those who need it in this mist cities including any this the security in the Phoenix I'm on various But we're concerned because this has to happen all the time for example if this treatment is are there any signs of resistance if you are talking about a site that you something a part of the person is gaining it is habits evolution evolutionary So these are early says she's always needed. So we think about what's going on the current policies all human lives should be valued equally you can not think about the present and neglect the future. So if you think that we. Are. The best option to deal with things fictions is it is it for ethical reasons is eradication if you like to get it. That is it. That is a benefit for the president of the future. But in many cases. Now in the field I know of minutes Jewish and where there's a big debate going on for example yes we are trying to for example it had any particular ideas he's from setting particular locations what would happen. What about that already affected people people who had certain particular political team as it is out of the fiction. But if you're doing fiction that's not enough you need to have you need to do something more so what is the ethical reasons those people they would have to find the appropriate. I mean handing. So eradication benefit both present and future. What if you fail to eradicate. If it's not possible to get at least make you a target to leave large population that it user morbidity and use the number of cross-eyed cities that use this that would be the opposite disease. What are the risks in mass Drug Administration to grounds programs we should depend on treatment mastery can treat everybody. That's just. Not the full amount of ministers of course. And this will have. A. Negative effect if if this is developed. You are not going to achieve their eradication for example. You are not going to be able to see see the individual cases because this is the same thing that if you had sued into everyone it is the same treatment which you use in case of. C.V. illness but only individual basis. Policies should quite account for evolution of the part of sites put in mind that part of site itself is changing how are you going to look at that is that research. Should always be a decision. They look at this does how can you solve it how can you solve the problem with progress and there are many studies our policies which we deeply that development of resistance. For example continues and you can see asking for new drugs and up proper use of the drugs one of the reasons that there is a in the military in years and it is a quote a community distance we call that sitting together times any fever used to be considered military and either treatment immediately we don't even seen that but it's like well that was some of those that that led to the distance. In the Russians transmission gets us into education. So if you cannot eradicate. If if if if interruption of the Army has a has a. Positive impact on the population. So ways that is it you want to get out to hear it or interrupt transmission which one will benefit that kind and the future population will. Then reassure the world health organization controlling many of their mass the record Mr mission. Knows that drugs will eventually thing if you keep using them so what can we do. Try to deliver as he says developing. My system passed by adopting second particular policies. So what are these what what what what are the story here the developed world example of for a significant price lights they have control themselves in the developed countries how we work with the advancement in their sanitation. Modernization that our sides they have much less impact on the populations of the developed world so. When that happens in the developing country how many years do we need time resources so that is something to think think of. The future must Drug Administration programs that are to use. Global efforts to control neglected disease. So we need to do to tool a combined efforts because if if you combine in force the effect on the target will be maximized. And we need to use compare his tools so if we it's always more successful. If you can. Involve the community community based programs. If you can combine more than one has tried to fifty to control with the treatment. And training you get is that the pollution. They invited me to change is if you combine all these things you are also now minimizing So use of the drug and of course there is always basically said to develop more effective neck Gnostic methods for his diction. To develop a preventive my friends I want vaccines all of my lactic. Agents. And make sure to always stay ahead of that was like the point of science as changing of it trying to find a way to avoid tools. To adapt the. And. They examine which you are going to spend a lot of time talking about is the example of the Old Course of cases where my last Drug Administration control program in both Latin America and in Africa. This program has eliminated blindness in West Africa. There are huge problems in the sustainability and you can see why because this program passed to the treatment has to continue for. Many many years fifteen twenty years and that's a problem hundred million people must be treated annually for a long period of time and it million and you know that that that that the producer over there the drug addict to make these and he's giving a drug free the problem is how the studio to it's that he's not an easy task. So. An example here what some of the good work which he's always been done by Bill and Melinda Gates Foundation. They are always. Trying to introduce a little condition border in that the drilling and I get it is finding synergies between water sanitation and hygiene these are one of the they are they are supporting D.C.H. that we lead to that are going to provide more information on where these concepts and this will reduce Also the use of drugs suggestion for I need an integrated intellect of Roche sometimes ease that as a pressure on the use of chemotherapy. I. Didn't know why thinking about people in the future. And that well isn't it so what they're doing these fall for example their money down there you know I'm in the Gates Foundation they are. Giving money for all three series shooters to do research. And find solutions for problems said Head of time but then I don't for a. Sceptic So just think scientific possible sceptic solutions to use that pressure on the end of the considerably and to control that he's going to make sure. That they reassure the World Health Organization. Now. And you and my Drug Administration. Well actually fear and we must trust Mr nation and the date of course for mice and musician that Drug Administration you. Know. You're going to go on injections for example so you won't see what used drugs and they have tried to do to distribute Brezec one thing I've been working on benders all together to count all three different you kitchen she saw my sister said cases and we fix that he says. Now you see what happens here so they have depended on this to district health officers. They call this integrated integrated to it meant. That it integrated treatment areas or good lighting in the city so you need years where these infections. Could have at present all of them. So. What happens you have she someone is and she's coping with it because if I mean that way we did not have so much in Sydney deals it's not like her that. You know. If Larry Aaron. Had different methods or that Moses saw as everybody here that different he's different. So we when they did this in ninety ninety nine they had no quick way of that nosing one of my pink or St being two so mice. So in two places. They received. This is in Nigeria. Nine point three million dollars I reckon I've been doing. Targeting not fighting on court only for the crazy but at least compared to only now I. Was seven hundred in one so I wasn't. One hundred one thousand was acquitted to beat me. So it shows you that the mapping with that that you saw mazes well behind the speech here is you know synchronized with a difference in the way so we need to develop a different set of a miracle for schistosomiasis and this is a conclusion here need for a similar mapping method for some eyes faster on like the one which we use for. Sport For example for the local example for opposite cases what they do they call it they call it gravity to Munich and mapping they see that forty fifty men from the community and they get them then for the presence of not yours said if they're not no use the prevalence of the lot is over thirty percent or that they consider it as musical and identical in population and they think so but the situation is different for you so much as they have depended on they have is I mean look for I mean it distances so why this what would you do you have to examine feces. So so it takes more time. Well. There was a case is that we need maybe more you're going to use or transit point deal has two sides you know the ability to administer three drugs at the same time we need to be fish and in doing it these. Problems in the area will flood in extinction we know that now in the scope of this. People who have mixed in fiction. They can suffer. A lot when they come by if they see the treatment and we're talking about must it must immediately to look when the people one by one you just get it you could help in that petition has a mix of fiction because not so I was involved in one of the research projects that was also funded by my India. Neeleman that it. Don't always I mean for good of the people there they give a lot of money for different research centers to try to find a very easy field usable. Way differentiate between the people who are carrying single infection and mixed infection thirty's. And maybe has not been published yet but one of the labs was able to come with that type it with the ability to count the Michael Flutie when I pick up a lot of sedation so these are things which man and I when they when they when they send a call for that league Asians they put their condition easy method we think we want the easy method that can be used forth in the field distinguish between the people what if it was only one type of Larry mixing fiction so these are the type of research studies which needed to help him that the people he's in there you know. On the Syria. What we're going to do from the next morning on the next morning we are going we are going to take. Specific examples. And see how that Master look at Mr mission is being done and then as we move on we'll talk more about how with the morning turning off the long term wanted telling of the programs that. China use the problems as we move on and our our first example will be Dr weld. The control program opposite this is already going to blindness in Latin America that in Africa I do need next week and I wish you in good time and thank you.

HM-888-Module-1-Principles-of-MDA

From pblhlth Program in Public Health October 12th, 2015  

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