Updated 8-26-13 Course Syllabus PubH 6365 Section 001 Epidemiology of Global Health Fall, 2013 Credits: 2 Meeting Days: M, W (09/04/2013 - 10/21/2013) Meeting Time 11:15 A.M. - 01:10 P.M. Meeting Place: Mayo A110 Instructor: Alan Lifson, MD, MPH Office Address: WBOB 492 Office Phone: 612-626-9697 Fax: 612-624-0315 E-mail: [email protected] Office Hours: By appointment I. COURSE DESCRIPTION This course will focus on the considerable burden due to infectious and noninfectious diseases within middle and low-income countries, as well as the underlying risk factors that lead to their emergence and spread. Students will learn about and review different measures of disease burden and health status. Different diseases of international public health significance will be reviewed, with a focus on epidemiologic research and methods used describe and analyze disease determinants. The course will also expose students to different interventions (prevention and control strategies) that have been used in both emergency situation, and to reduce the burden of more endemic diseases that significantly impact the health of populations. The scientific literature concerning specific diseases of interest will be examined and discussed in order to illustrate these principles. We recognize that it is impossible to cover all subjects in global health. Using a case-study approach, the course will instead select a variety of diseases or health problems of international importance. We will focus instead on approaches to dealing with these different problems, and some of the methodologies used to study them. This course will allow students to gain both skills and a greater understanding of public health research and practice as it applies to international health. II. COURSE PREREQUISITES This class if available to Masters or Doctoral students from the School of Public Health; additional students may be admitted by permission of the instructor. Prerequisites include PUBH 6320 Fundamentals of Epidemiology or PUBH 6341 Epidemiologic Methods I 1 Updated 8-26-13 III. COURSE GOALS AND OBJECTIVES Learning objectives include greater appreciation and understanding of: • Major indicators of health and health disparities on a global basis, including disease surveillance) • Selected global diseases of major public health significance • Social, economic, cultural and other determinants of health and health disparities on a global basis, such as poverty, urbanization and war • Different methodologies used to conduct analysis on global health topics, and review of different publications in the literature illustrating these methodologies • Prevention and control strategies to reduce the burden of disease in different global populations IV. METHODS OF INSTRUCTION AND WORK EXPECTATIONS This course will utilize a case-study approach, and facilitated class discussion. After a general orientation to global health, we will select 12 diseases of international importance along with specific countries in which this disease has been a major public health problem. The last class will serve as a synthesis of information and concepts discussed in the class, V. CASE STUDY APPROACH: Each class will last two hours. Lecture (first hour of class) The first hour will be a lecture on some general topic in global health. These lectures are intended to complement assigned readings from the course textbook. Class Discussion (second hour of class) There will be two types of class discussions: a. Discussion of Published Article For each class, the instructor will also select a journal article that represents either an epidemiologic investigation of the determinants of this disease, or an intervention study (clinical or community trial) to reduce disease burden. Students are expected to read this article in advance of the class. The class discussion will include the following points in relation to the article: 1. What is the research question? What is the study design? 2. What is the study population? How were they recruited? What are inclusion and exclusion criteria? 3. What were the primary and secondary outcomes? How were they measured? 4. What was the intervention, or primary exposures of interest? What were secondary exposures/determinants of outcome/potential confounders? How were they measured? 5. What were the main stated conclusions? What are the implications for global health and prevention of disease? What additional research questions remain? 6. What are the limitations of this study, and cautions in its interpretation? 2 Updated 8-26-13 b. Class Discussion of a "Challenging Problem" Students will be assigned to groups, and asked how they would address a "challenging problem" in global health. Students will have two group presentations over the course of the semester. The goal for each team is to tackle a real-life global health-related problem and to come up strategies for how this can best be addressed. The class presentation should include discussion of the following points: 1. Describe the problem to be solved, including its epidemiology in the context of the specific country or geographic area. 2. What are some of the risk factors (both immediate and underlying) that may be contributing to this problem? 3. What are the main objectives of your intervention or approach to control or minimize this problem? 4. What specific intervention or strategic approach do you recommend to help control or minimize this problem? 5. Which organizations/stakeholders will you partner with to implement this intervention? 6. As part of your monitoring and evaluation plan, what measures or outputs will you use to help assess program impact? 7. What do you see as the challenges/barriers/limitations in implementing this intervention? VI. COURSE TEXT AND READINGS The required text for this course is: Michael Merson, Robert Black, Anne Mills. Global Health: Diseases, Programs, Systems and Policies. Copyright 2012. (Jones & Bartlett) Additional assigned readings will be posted to the course web site. 3 Updated 8-26-13 VI. COURSE OUTLINE/SCHEDULE WEEK 1: 9-4-12 Introduction to Global Health Lecture: Introduction to Global Public Health: Concepts, Overview Data Used To Monitor Global Health (Morbidity/Mortality) Readings: Merson: Introduction: xviii-xxiv Chapter 1: Measures of Health and Disease in Populations Lozano et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095-228 WEEK 2: 9-9-12 Lecture: Culture, Behavior and Health Hepatitis E Class Article: Hepatitis E Outbreak Readings: Merson: Chapter 2: Culture, Behavior and Health Chapter 5: Infectious Diseases (read over few weeks) Boccia D, et al. High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan. Clin Infect Dis 2006;42:1679-84. CDC. Investigation of Hepatitis E Outbreak Among Refugees — Upper Nile, South Sudan, 2012-2013. MMWR 2013; 62:581-6. 9-11-12 Lecture: Social Determinants of Health Lymphatic Filariasis, Onchocerciasis Class Article: Mass Drug Administration and Filariasis Readings: Merson: Chapter 3: Social Determinants of Health Simonsen PE, et al. Lymphatic filariasis control in Tanzania: effect of six rounds of mass drug administration with ivermectin and albendazole on infection and transmission. BMC Infect Dis. 2013 Jul 21;13:335. WHO. Transmission assessment surveys on the Global Programme to Eliminate Lymphatic Filariasis: WHO Position Statement. Wkly Epidemiol Rec 2012;48:478-82. 4 Updated 8-26-13 WEEK 3: 9-16-12 Lecture: Design of Health Systems Class Discussion: Polio Eradication in Pakistan (class presentation) Readings: Merson: Chapter 12: Design of Health Systems Poliomyelitis: In: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook - 12th Edition (May 2012) 9-18-12 Lecture: Management and Planning for Global Health Class Discussion: Childhood Diarrhea in Nicaragua (class presentation) Readings: Merson: Chapter 13: Management and Planning for Global Health Kotloff KL et al. The Burden and Etiology of Childhood Diarrhea in Asia and Africa. Lancet 2013;382:209-22. WEEK 4: 9-23-12 Lecture: Globalization and Health Class Discussion: Multidrug resistant TB in prisons (class presentation) Readings: Merson: Chapter 18: Globalization and Health Simooya OO. Infections in prison in low and middle income countries: Prevalence and prevention strategies. Open Infect Dis J 2010; 4, 33-37 9-25-12 Lecture: Mental Health Injury Prevention Class Article: Suicide and Pesticides Readings: Merson: Chapter 9: Global Mental Health Chapter 8: Unintentional Injuries and Violence Yip et al. Means restriction for suicide prevention. Lancet 2012; 379: 2393–99 Gunnell, Eddleston. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003;32:902–9 5 Updated 8-26-13 WEEK 5: 9-30-12 Lecture: Health and the Economy Substance Abuse Class Article: Harm reduction for injection drug abusers Readings: Merson: Chapter 15: Health and the Economy Mathers BM, Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733-45. ASSIGNMENT 1 DUE 10-2-12 Lecture: Complex Emergencies Class Discussion: Malnutrition in Kenyan refugee camp (class presentation) Readings: Merson: Chapter 11: Complex Emergencies Chapter 6: Nutrition WEEK 6: 10-7-12 Lecture: Reproductive Health Class Discussion: Family planning/population control in Ethiopia (class presentation)