BUGEMA UNIVERSITY

Mid Term Examinations

Course: master of public health

Communicable disease and non communicable diseases

LECTURER: DR. AJOK

Student name: Abdirahman Ali Sabrie

I.D number: 21/MPH/BU/G/1011
YEAR 2020/21, SEM 1

SECTION A. (ANSWER ALL COMPULSORY)

1) Using key concepts and terms applicable to communicable and Non-communicable

diseases prevention and control; briefly explain the following concepts and terms
with relevant example.

i. What are the Causative organisms in communicable or infectious diseases? With

examples.

The causative organisms include the following:

Bacteria- microscopic single cell organisms that almost live everywhere on earth –live in air,
water or soil- live on plants, animals and human.

Also there are bacteria which are harmless or beneficial to all living things. However, we are
looking at the harmful bacteria that cause diseases and are known as Bacterial infection and this
type of bacteria can affect any part of the body. Examples: Pneumonia, meningitis, food
poisoning.
Viruses- are much smaller cells; viruses cannot reproduce on their own rather it reproduces by
infecting the host and using the host’s DNA repair and replication system to make copies of
itself. Examples common cold disease comes with headache, cough etc.

Parasites- these are organism that survive or live on others. Without the host, parasite can’t
survive. They are not disease but they because diseases by living and flourishing in the host
invading the protective system and subsequently making the host sick example: malaria parasite

Protozoa cause parasitic diseases example plasmodium- malaria

Fungi- poisoning, parasitic and allergies

ii. What are the favorable conditions for communicable diseases transmission?

There are situations that must be present for communicable diseases transmission to occur these
include: Agent, Host and the environment and some instances the vector

a. Agent- refers to the disease causing organism characteristics e.g. habitation, breeding
migration, infectivity, climatic and environmental factors favoring its existence

b. Vector- is a vehicle that some of the agents or disease causing organism require being move
from one point to the other, some require it to complete their developmental cycle e.g. a
mosquito in transmission of malaria. Not all communicable diseases require a vector for
transmission

c. Host- refers to the biological makeup of the individuals that make the vulnerable to the
specified illness e.g. physical condition, genetic make-up, habits etc.

d. Environment- refers to the ecological conditions that favor the interaction of host and agent
e.g. swampy areas, bushes within households, sanitation etc.

iii. What are the clinical and epidemiological classifications of diseases?

There are two ways of classifying communicable disease: Clinical and epidemiological
1) Clinical classification: this type is based on manifestation of the disease in terms of
symptoms and signs. This type of classification is significant in helping to treat the symptoms
and signs that are common to/shared by individuals who suffer from different diseases

Example of disease based on clinical classification-

a) Diarrhoea are clinically classified as diarrhoeal diseases. The common treatment for this
class of disease includes fluid replacement
b) Febrile illnesses, because they all have the main symptom of fever, for example, malaria
c) Respiratory diseases are another clinical classification; their main symptoms include
cough and shortness of breath, as in pneumonia

2) Epidemiological Classification: This classification is based on the main mode of

transmission of the infectious agent.

The importance of this classification is for choosing appropriate prevention and control measures
which are common to communicable diseases in the same class, so as to disturb the mode of
transmission. For example Cholera and typhoid fever are two different diseases which can be
transmitted by drinking contaminated water. Therefore, they are classified as waterborne
diseases, using the epidemiologic classification. The common prevention measures for the two
diseases, despite having different infectious agents, include protecting water sources from
contamination and treatment of unsafe water before drinking, for example by boiling or adding
chlorine

iv. What are the elimination and eradication of communicable diseases?

ELIMINATION: this refers to the reduction to zero (or very low defined target of new cases in
defined geographical areas elimination requires continued measures to prevent re-establishment
of disease transmission

For example: some diseases eliminated in some parts of the world such as malaria, trachoma.
ERADICATION: this refers to the complete and permanent worldwide reduction to zero new
cases of the disease through deliberate efforts. If a disease has been eradicated, no further control
measures are required. For example Smallpox was declared eradicated in 1979/80

Diseases that are targeted for eradication (Global disease elimination priorities) 2030 diseases
targeted for eradication: Bill gates by 2030

1) Polio 2) Measles 3) River blindness 4) Rubella syphilis 5) Guinea Worm, tape worm,
hookworm 6) Rinderpest 7) Yaws 8) Rabies 9) HIV&AIDS 10) Malaria

v. What are the Notifiable disease and Neglected tropical disease?

Notifiable disease: is a disease that is required by law to be reported to government authorities.

The collation of information allows the authorities to monitor the disease and provide early
warning of possible outbreaks. Example 1956 health Act mandates health workers to report to
the medical officers (MoH) any patient they have reasonable suspicion is suffering from a
notifiable disease

Examples of internationally notifiable diseases:

Cholera, Plague, Yellow fever, Ebola Etc.

NATIONALLY NOTIFIABLE DISEASES

Measles, Meningitis, Whooping cough, Rheumatic fever

Acute gastroenteritis Infectious pulmonary TB

NEGLECTED TROPICAL DISEASES: These are a group of diseases that cause substantial
illness for more than one billion people globally. Affecting the world’s poorest people

NTDs impair physical and cogitative development, contribute to mother and child illness, death
and limit productivity

Example- Leprosy, Buruli ulcers, Guinea worm disease, rabies, trachoma,

2) Briefly explain the following terms as applies to non-communicable diseases prevention
and control and give relevant examples for each (9 marks)

i. what is modifiable risk factors?

Modifiable Risk Factor: is a behavioral risk factor that can be reduced or controlled by
intervention, thereby reducing the probability of disease.

WHO has prioritized the following: 1) Physical inactivity, 2) Tobacco use, 3) Alcohol use, and
4) Unhealthy diets (increased fat and sodium, with low fruit and vegetable intake).

ii. What is Non-modifiable risk factor?

Non-Modifiable Risk Factor: a risk factor that cannot be reduced or controlled by intervention;
for example: 1) Age, 2) Gender, 3) Race, and 4) Family history (genetics).

iii. What is metabolic risk factor?

Metabolic Risk Factors: this is refers to the biochemical processes involved in the body's
normal functioning Behaviors (modifiable risk factors) can lead to metabolic/physiologic
changes.

WHO has prioritized the following four metabolic risk factors: 1) Raised blood pressure 2)
Raised total cholesterol 3) Elevated glucose 4) Overweight and obesity

3) Briefly explain the following methods of controlling communicable and infectious

diseases with relevant examples (9 marks)

a) What is elimination of reservoir?

The elimination reservoir includes the following:

i. Man as reservoir: When man is the reservoir, the eradication of an infected host is not a
viable option. Instead, the following options are considered:

 Detection and adequate treatment of cases: arrests the communicability of the disease (e.g.
Treatment of active pulmonary tuberculosis).

 Isolation: separation of infected persons for a period of communicability of the disease.

Isolation is indicated for infectious disease with the following features:

 High morbidity and mortality

 High infectivity

 Quarantine: limitation of the movement of apparently well person or animal who has been
exposed to the infectious disease for duration of the maximum incubation period of the disease.

ii. Animal reservoir: Action will be determined by the usefulness of the animals, how intimately
they are associated to man and the feasibility of protecting susceptible animals. For example:

 Plague: The rat is regarded as a pest and the aim would be to destroy the rat and remove it
from human habitation.

 Rabies: Pet dogs can be protected by vaccination but stray dogs are destroyed.

 Infected animals used for food are examined and destroyed.

iii. Non living reservoir: Possible to limit man’s exposure to the affected area (e.g. Soil, water,
forest, etc.). Communicable Disease Control

b) Interruption of transmission

This involves the control of the modes of transmission from the reservoir to the potential new
host through:

 Improvement of environmental sanitation and personal hygiene

 Control of vectors
 Disinfections and sterilization

c) Protection of susceptible host

This can be achieved through:

 Immunization: Active or Passive

 Chemo-prophylaxis (e.g. Malaria, meningococcal meningitis, etc.)

 Better nutrition

 Personal protection: for example wearing of shoes, use of mosquito bed net, insect repellents,
etc.

4) With reference to integrated disease surveillance and response (IDSR) system define
and explain the following (6marks)

i. What is threshold?

Thresholds are markers that indicate when something should happen or change. They help
surveillance and program managers answer the question, “When should I take action, and what
will that action be?”

Thresholds are based on information from two different sources:

• A situation analysis describing who is at risk for the disease, what are the risks, when is action
needed to prevent a wider outbreak, and where do the diseases usually occur?

• International recommendations from technical and disease control program experts.

There are two types of thresholds: an alert threshold and an epidemic threshold. Not every
disease or condition uses both types of thresholds, although each disease or condition has a point
where a problem must be reported and an action taken.
In practice, the national level is responsible for communicating the thresholds for priority
diseases to all reporting sites in the health system. In practice, the national level is responsible for
communicating the thresholds for priority diseases to all reporting sites in the health system.

ii. What is an alert threshold?

An alert threshold suggests to health workers and the surveillance team that further investigation
is needed. Depending on the disease or condition, an alert threshold is reached when there is one
suspected case (as for an epidemic-prone disease or for a disease targeted for elimination or
eradication) or when there is an unexplained increase for any disease or unusual pattern seen
over a period of time in weekly or monthly summary reporting.

iii. What is an epidemic threshold?

An epidemic threshold triggers a definite response. It marks the specific data or investigation
finding that signals an action beyond confirming or clarifying the problem. Possible actions
include communicating laboratory confirmation to affected health centers, implementing an
emergency response such as an immunization activity, community awareness campaign, or
improved infection control practices in the health care setting.

Several thresholds have been proposed for action based on disease surveillance findings. For rare
diseases or diseases targeted for eradication, detection of a single case suggests an epidemic. In
such situations, one case is unusual and is a serious event. This is because these rare or targeted
diseases have the potential for rapid transmission or high case fatality rates.

In other situations, a number of cases will trigger a response. For example, the epidemic
threshold for cerebrospinal meningitis in countries of the meningitis belt is 10 cases per 100,000
populations, and the alert threshold is 5 cases per 100,000.

5) The road nature and conditions are the major attributing factor to road traffic incidents
or accidents in Uganda discuss (6 marks)

Over years, Uganda has not been spared from the heavy burden of RTIs. At present, it
experiences road traffic incident deaths at 28.9 per 100,000 populations. This is quite concerning
as it even exceeds the 24.1 per 100,000 population for the AFRO and 18.0 per 100,000
population global average for deaths respectively.

The most common factors that cause road traffic incidents or accident In Uganda is because of
rapid motorization, sometimes coupled with poor road conditions, rapid population growth, lack
of safety features in cars ,mostly crowded roads, poor road maintenance, and lack of police
enforcement.

Also there are other different factors that contribute Accidents in Uganda such as:
Drivers these are always happen because of Over-speeding, rash driving, and violation of rules.
Pedestrian: such as Carelessness, illiteracy, crossing at wrong places moving on carriageway.
Vehicles: including Failure of brakes or steering, tire burst, insufficient headlights, overloading,
projecting loads.

The state of mind this sometimes occur when the person is highly agitated and unable to think
for example listening like music or move while driving.

SECTION B (60 MARKS). (ESSAY QUESTIONS ANSWER 3 QUESTIONS. QUESTION

ONE OF THIS SECTION IS COMPULSORY)

Question 1: Compulsory

“Prevention is better than cure” this is an old saying that is commonly told, as a student of
public health, discuss with relevant examples, the levels of prevention of disease
transmission

THE LEVELS OF PREVENTION OF DISEASE TRANSMISSION

There are three levels of prevention of disease transmission: primary, secondary, and tertiary.

A) PRIMARY prevention: The main aim here is to promote health, prevent exposure, and
prevent disease.
Promotion of health: This consists of general non-specific interventions that increase health
and the body’s ability to resist disease, such as measures aimed at the improvement of socio-
economic status through the provision of enough lipoid jobs, education and vocational training,
affordable and adequate housing, clothing, and food, old-age pension benefits; emotional and
social support, relief of stress, etc. In short it is any intervention that promotes a healthier and
happier life.

Prevention of exposure: - This includes actions such as the provision of safe and adequate
water, proper excreta disposal, vector control, safe environment at home (e.g., proper storage of
insecticides and medicines, out of children’s reach), at school and at work (e.g., proper
ventilation, monitoring of harmful substances in factories), and on the streets (e.g., driver
licensing laws).

Prevention of disease:-This happens during the latency period between exposure and the
biological onset of disease. An example for this is immunization.

Active immunization means exposing the host to a specific antigen against which it will
manufacture its own protective antibodies after an interval of about three weeks (during which
the immunized person remains susceptible to the disease).

Passive immunization means providing the host with the antibodies necessary to fight against
disease.

Both forms of immunization act after exposure.

Breastfeeding is an example of an intervention that acts at all three levels of primary prevention:

Health promotion: by providing optimal nutrition for a young child, either as the sole diet up to
four months of age, or as a supplement in later months.

Prevention of exposure: by reducing exposure of the child to contaminated milk.

Prevention of disease after exposure: by the provision of anti-infective factors, including

antibodies, white blood cells, and others.
B) SECONDARY PREVENTION: After the biological onset of disease, but before permanent
damage sets in. The aim here is to stop or slow the progression of disease so as to prevent or
limit permanent damage, through the early detection and treatment of disease. (E.g. breast cancer
(prevention of the invasive stage of the disease), trachoma (prevention of blindness), and syphilis
(prevention of tertiary or congenital syphilis)

C) TERTIARY PREVENTION: After permanent damage has set in, the aim of tertiary
prevention is to limit the impact of that damage. The effect can be physical, psychological, social
(social stigma or avoidance by others), and financial.

Rehabilitation refers to the retraining of remaining functions for maximum effectiveness, and
should be seen in a very wide sense, not simply limited to the physical aspect. Thus the provision
of special disability pensions would be a form of tertiary prevention.

Question 4: In line with the integrated disease surveillance and response (IDSR) steps of
reporting, identify at least three steps and discuss with practical examples

Three steps/practices in reporting diseases:

1) Report immediately reportable diseases

In this case, immediate reporting, and the firstly step is verbal reporting.

You can report by using Phone call, SMS, email, radio call, by road etc. from the health in
charge to the district health office or whoever is responsible in the district.

Second level is written based on case report form or using electronic computer devices,
completed online and submitted.

Laboratory specimen forms with clear labels identifying the patient must be clearly spelt out and
transported in the recommended condition.

For example urgent cases such as covid 19 should be reported immediately.

 2) Report summary information on epidemic and pandemic prone diseases

If no cases of immediately reportable diseases were analyzed during the week from different
reporting levels, zero (0) number must be indicated on the standard case report form. Leaving it
blank communicates different messages.

At the district level, the surveillance officer who is mandated to compile all the reports and then
draws an epidemic curve to see if the epidemic thresholds for specific diseases have been
crossed. In the same report, case fatality rate, high risk groups, age, location, sex and exposure-
food poisoning, occupational hazards. With the improved reporting system, most districts are
able to report electronically (forms stored electronically) to the next level of reporting following
the reporting levels.

3) Report routine summary information for other diseases of public of public health
importance

Summary data on all priority diseases, conditions, events under surveillance should be made
available to the next level each month. It normally entails:

 Disease specific program

 intended to monitor progress on prevention and control activities

to detect any emergent, unexplained or unusual events or disease pattern

Each month health facilities report summaries cases seen, death reported for specific
condition/disease (outpatient and inpatient records separately) to the next

Question 5: Road Traffic incidents/accidents is a global pandemic discuss

Introduction

The low and middle-income countries suffer the heaviest burden of all road traffic incidents
(RTIs) in the world at an average of 85% t0 15% (LWICs and HICs respectively.
According to WHO (2013), RTIs have caused approximately 1.3 million deaths, and 20 to 50
million injuries (2011-2015).

The African regions (AFRO) alongside the Eastern Mediterranean region (EMRO) have the
highest rate of road traffic deaths, which are described as a global pandemic and development
problem.

What does that mean- Global Pandemic?

 Death- on spot or after some days (.3 million deaths, and (2011-2015)

 Disability (20 to 50 million injuries)

 Trauma

 Emergency response/care (hospital capacity) personnel, facilities, logistics etc

Causes of increase in RTIs

These are common way of behaving that results RTIs

[Link] Speeding Most of the deadly accidents occur due to over speeding, faster vehicles are
more prone to accident than the slower one and the severity of accident will also be more in case
of faster the severity of accident will also be more in case of faster vehicles.
2. Drunken Driving such as drinking of drugs and alcohol
[Link] to Driver Distractions could be outside or inside the vehicle. The major
distraction now days are talking on mobile phone while driving.

Some other distractions on road are:

a. Adjusting mirrors while driving

b. Stereo/Radio in vehicle
c. Animals on the road
4. Red Light Jumping the common misconception is that stopping at red signal is wasting of
time and fuel. But many Studies indicate that traffic signals followed accurately by all drivers
save time and passengers reach destination safely and timely. A red light jumper not only effect
his/her life but also the safety of other road users
[Link] Safety Gears like Seat belts and Helmets Wearing seat belts and helmet has been
proven that these two things reduce the severity of injury during accidents. Wearing seat belts
and helmets increase the chances of survival in a serious accident. Safety Gears keep you intact
and safe in case of incidents.

Preventive measures for incidents:

The most common measures for preventing incidents are:

1. Education and awareness about road safety

2. Strict Enforcement of Law
3. Engineering:
(a) Vehicle design (b) Road infrastructure