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Diverse Population Memo/Issue Brief
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Leadership Role in Healthcare Policy: Diverse Population
The purpose of this assignment is to provide your audience with healthcare information necessary to provide person-centered-care for the vulnerable/diverse population you selected
Because of the disproportionate risk, cost, quality, overlapping issues (intersectionality), you will need at least two or three-pages (SINGLE SPACED) for an Issue Brief. APA for references and in-text citations (The link below takes you to an excellent example of an issue brief).
Be sure to speak to your audience when writing. You can keep the audience you used previously or select another audience.
You may use any or all of the information you submitted for the Diverse Population Assignment in Lesson 5
Kaiser Family Foundation has an Issue Brief that should be very helpful
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Issue Brief Part II Instructions
Use the following as a guide for your issue brief (formally named issue memo). I know it will be impossible to cover all of the information below, cover key issues/components.
1) Identify the vulnerable/diverse population you selected
Briefly explain to your audience why the diverse groups are vulnerable to disparities and why the disparities matter.
2) What is the status of the diverse group currently
Is the vulnerable/diverse population you selected, at disproportionate risk of being uninsured, lack access to care, and unable to pay for care, likely experience worse/adverse health outcomes.
Is the vulnerable/diverse population you face overlapping systems (intersectionality) with various social stratification, such as class, race, sexual orientation, age, income, disability, and gender, etc
Diverse Population Memo/Issue Brief
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4) What are some vital healthcare reform initiatives to address the vulnerable/diverse population selected?
5) What are some of the significant risks for the diverse group if there are no healthcare system changes to the population you selected?
6) As a professional nurse, at what point(s) in the Public Policy Process (Lesson 2) would you recommend advocating for the population you selected?
7) Are there risks for a professional nurse regarding professional nursing standards and the Nursing Practice Act when providing care for the selected population? (Example: During the Pandemic, nurses were allowed to work in other states, strong feelings about a population can cause nurses to do more than within their scope of practice, etc.) Cite the nursing standards or practice act you are aligning with in your brief.
8) References
Diverse Population Memo/Issue Brief
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Effective communication in Consumer Health Education
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Effective communication in Consumer Health Education
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Effective communication in Consumer Health Education
Purpose
The purpose of this assignment is to engage learners in evaluating factors that contribute to effective communication and health literacy in consumer health education materials.
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Effective communication in Consumer Health Education
STEP 2: EVALUATE
Publication Information
Identify the publication title, author(s), year/date of publication, and source location (URL).
Purpose and Intended Audience
In one paragraph, summarize the purpose of the material and the intended audience. Describe the target audience that the authors want to address (e.g., persons who have diabetes, are sexually active, are caregivers to persons with dementia, the general public, etc.).
Effective communication in Consumer Health Education
Category Analysis
Evaluate the material using the 7 categories of the CDC Clear Communication Index: 1) Main Message and Call to Action; 2) Language; 3) Information Design; 4) State of the Science; 5) Behavioral Recommendations; 6) Numbers; and 7) Risk.
This section can be formatted as a list, bullet points, or in paragraph format. Include examples of how clearly the main message is communicated and prominently located within the material, how main ideas and supporting ideas are organized, use of visual cues and headings, language considerations, how graphics, colors reinforce the main message; how or whether scientific evidence or authoritative sources inform the main message or recommendations; how or whether actionable behavioral recommendations are provided; whether and how numbers are used to communicate recommendations or risk, and how the risk associated with the health condition or behavior applies to the target audience or health outcomes.
Strengths and Recommendations for Improvement
In one-to-two paragraphs describe three strengths of the material and at least one recommendation for improvement based on your evaluation.
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Effective communication in Consumer Health Education
STEP 3: SUBMIT
Prepare your evaluation using a word processor such as MS Word. Upload the file to the assignment link as either a Word document or PDF.
Review your work for content quality and depth, organization, and grammar. Use the grading rubric to guide your preparation.
Be sure to include the reference for the resource in APA Style format.
If the material is not available electronically, please scan and upload the document with your analysis.
Effective communication in Consumer Health Education
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Health Literacy Evaluation
Purpose
The purpose of this assignment is to engage learners in evaluating factors that contribute to effective communication and health literacy in consumer health education materials.
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STEP 2: EVALUATE
Publication Information
Identify the publication title, author(s), year/date of publication, and source location (URL).
Purpose and Intended Audience
In one paragraph, summarize the purpose of the material and the intended audience. Describe the target audience that the authors want to address (e.g., persons who have diabetes, are sexually active, are caregivers to persons with dementia, the general public, etc.).
Category Analysis
Evaluate the material using the 7 categories of the CDC Clear Communication Index: 1) Main Message and Call to Action; 2) Language; 3) Information Design; 4) State of the Science; 5) Behavioral Recommendations; 6) Numbers; and 7) Risk.
This section can be formatted as a list, bullet points, or in paragraph format. Include examples of how clearly the main message is communicated and prominently located within the material, how main ideas and supporting ideas are organized, use of visual cues and headings, language considerations, how graphics, colors reinforce the main message; how or whether scientific evidence or authoritative sources inform the main message or recommendations; how or whether actionable behavioral recommendations are provided; whether and how numbers are used to communicate recommendations or risk, and how the risk associated with the health condition or behavior applies to the target audience or health outcomes.
Health Literacy Evaluation: Strengths and Recommendations for Improvement.
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Water Treatment Practices
Approximately 2 out of 10 people across the globe lack access to safe drinking water. Due to increase in population and climate changes in the global, more water crises are experienced (Ferrey, 2010). Therefore, this paper provides examples of how water treatment practices and systems provide for water needs for people across the globe and Bloomington Indiana.
There exist a number of technologies of water purification, depending on the use of and level of purity required. Some few examples of these technologies include activated sludge model, activated sludge systems, anaerobic digestion, and chemical addition wastewater treatment. Many countries have not yet embraced the use of recycled water for drinking, mainly because many are not of the idea of toilet water in their tap. Although a few countries like Australia, Namibia, and Singapore, and states in the US like Virginia, California, and New Mexico are drinking recycled water, proofing that purified water is clean and safe for drinking.
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Two wastewater treatment plants and one drinking water plant is what provides for water needs of the people in the city of Bloomington. The city buys water from the state of Indiana then it treats and distributes. Dillman road and Blucher Poole wastewater treatment plants (WWTPs) handles the sewage treatment in the city. Activated sludge systems are the technology used to treat the sewage by the facility. Bloomington helps ease water shortage by purifying water for drinking and other needs (Bannerman & Hornewer, 2003).
In conclusion, many countries are using purified water for all their needs. There are several ways by which water is treated at Bloomington and other parts of the world. The right technologies in water treatment helps to demonstrate that recycled wastewater is safe and clean for drinking, cooking, and other needs.
Lack of Proper Education on Patient with Type 2 Diabetes
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Lack of proper education on patient with type 2 diabetes
Locating the Best Evidence
Often, type 2 diabetes patients lack proper education mainly because of the different barriers that they face as well as the receiving education that lacks a proper algorithm. Therefore, there is a great need for these measures to be acted upon so that the patients can realize more positive outcomes. Mshunqane, Stewart and Rothberg (2012) indicated that diabetes type 2 is associated with numerous complications, many of which can cause death if not managed appropriately.
In addition to this, at the worldwide level, the disease is acknowledge as a main challenge that nags the policymakers each day. There is presently some staggering statistics of the increasing prevalence as well as the linked economic and health impact.
Further, the World Economic Forum, World Health Organization, as well as the United Nations recognize the challenge. All these bodies suggest for collective dedication to improve the life quality of the patients as well as prevent the disease. They are clear that the challenge is universal, urgent, and critical. There is also the acknowledgment that the disease is serious for two main reasons (Stults-Kolehmainen & Sinha, 2014).
First is the health impacts linked to it which are more critical including increased likelihood for lower limb amputations, blindness, heart attacks, kidney failure, as well as stroke. Second, there are indirect and direct costs which are a major drain on the healthcare budgets as well as productivity.
The issue is very urgent considering that its prevalence is rising. Moreover, managing the complications associated with the disease is very costly, same as incorporating appropriate measures to ensure that the patients lead a high quality and independent life. The mentioned bodies also agree that proper education is one of the strategies through which the disease can be prevented and managed efficiently.
However, there are a number of barriers that prevent this and the education algorithm normally used is inappropriate. Therefore, this systematic review will aim at finding information suggesting the appropriate algorithm as well as the common barriers as well as how they can be addressed.
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Methods
Search strategy
Peer-reviewed academic journals will be sought from different databases, and these will be used to conduct the systematic review (Lee et al., 2013). The intention will be creating a proper algorithm on diabetes type 2 education, as well as identify some of the barriers to proper education and how they can be addressed. The databases to be used for the systematic review are CENTRAL, Social Science Citation Index, Science Citation Index, PSYCLinfo, Medline, ERIC, and CINAHL.
The references to the articles that were selected were also evaluated for leads. Reading the reviews was necessary as it helped identify if the article was appropriate. In relation to the inclusion criteria, there was selection of articles that were not older than five years. Particularly, there was selection of those discussing the barriers to proper diabetes type 2 education and their solutions, and those discussing proper education standards (Kapoor & Kleinbart, 2012).
Critically Analyzing the Evidence and Synthesis
Proper education algorithm
Type 2 diabetes education preventive measures will be informed to all the people through local barazas. This would ensure that all people engage in appropriate lifestyles to prevent the disease. Cultural competent educators, and those with proper listening and communication skills will be used to offer the education so that no one can be left behind (Garber, Gross & Slonim, 2010).
It will be necessary to educate the patients on all aspects of the disease including the causes, risk factors, predisposing factors, preventive strategies, available treatments, and management. In addition, awareness on how a patient can ensure self-care should be offered, same as the complications and the direct and indirect costs that a family can suffer because of the disease.
Moreover, the educator should go into details when elaborating on the preventive measures including the diet and physical activity. The more the patients and all people know about the disease and how it is connected to other chronic conditions, the more efficiently they can engage in self-care (Green, 2014).
Barriers and addressing them for patients to be able to receive the recommended type 2 diabetes education, they should really be concerned about their healthcare and ready to access or seek quality medical education. However, because of the ignorance some patient have, they prefer using over-the-counter medications or seeking traditional medicine men. They never seek the quality healthcare services because of their ignorance and low socioeconomic backgrounds.
Therefore, even the use of preventive services among these patients is very minimal. To address this, the local authorities will be given a chance to mobilize people from their living areas, so that education can start at the grassroots level before even being offered at the healthcare institution (Zoepke & Green, 2012).
In addition, there are many elderly people suffering from type 2 diabetes and with hearing, memory, and vision challenges. These will be offered the education in the presence of caregivers who can assist them around (Chijioke, Adamu &Makusidi, 2010).
Feasibility, Benefits, and Risks
Feasibility
The project of delivering proper education to the type 2 diabetes, patients is feasible, especially if the most appropriate education is being delivered, with a consideration of the personal factors, and if the barriers that might hinder the education have been considered and measures to address these put in place. Healthcare providers would only need to offer patients attending the institution for medical care services the pamphlets containing all the necessary information.
However, when dealing with type 2 diabetes patients, it would be necessary to find out first what they already know and later creating awareness while dispelling the misconceptions. This would be relatively cheap. It would also be necessary to explore other factors that affect individual patients so that advice can be offered (Rosenstock & Owens, 2008).
Barriers
After proper education is offered and the barriers to it addressed, some patients might still lack the funds to purchase even the affordable local foods. Considering that some patients might be elderly, there might be issues such as improper vision, hearing loss, and memory loss, which might influence practice of the education.
Benefits
Ensuring that the patients are receiving proper education and implementing it is essential in that it can go a long way in reducing the high prevalence of the disease, preventing complications, reducing the high costs needed to treat and manage the condition, as well as the losses related to loss of productivity and need for a higher quality of life (Ruffin, 2016).
Risks
Some of the anticipated risks include limited resources to ensure that adequate and proper education on type 2 diabetes is being delivered to the patients (Valencia &Florez, 2014). In addition, there might be absence of cultural competence professionals to deal with patients from different backgrounds. In addition, tracking the patients at their homes to ensure that they are implementing the proper education appropriately can be difficult and costly.
Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Green, B. (June 06, 2014). Diabetes and diabetic foot ulcers : an often hidden problem : review. Sa Pharmacist’s Assistant, 14, 3, 23-26.
Kapoor, B., & Kleinbart, M. (2012). Building an Integrated Patient Information System for a Healthcare Network. Journal of Cases on Information Technology (jcit), 14, 2, 27-41.
Mshunqane, N., Stewart, A. V., & Rothberg, A. D. (January 01, 2012). Type 2 diabetes management : patient knowledge and health care team perceptions, South Africa : original research. African Primary Health Care and Family Medicine, 4, 1, 1-7.
Rosenstock, J., & Owens, D. (January 01, 2008). Treatment of Type 2 Using Insulin: When to Introduce?.
Ruffin, T. R. (January 01, 2016). Health Information Technology and Change.
Stults-Kolehmainen, M. A., & Sinha, R. (January 01, 2014). The Effects of Stress on Physical Activity and Exercise. Sports Medicine, 44, 1, 81-121.
Valencia, W. M., &Florez, H. (January 01, 2014). Pharmacological treatment of diabetes in older people. Diabetes, Obesity & Metabolism, 16, 12, 1192-203.
Zoepke, A., & Green, B. (January 01, 2012). Diabetes and diabetic foot ulcers : an often hidden problem : general review. Wound Healing Southern Africa, 5, 1, 19-22.
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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)
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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)
Abstract
This proposal is designed to halt the increasing rate of childhood obesity. Modifications in nutrition, behavior and physical activity are well documented to produce successful outcomes for obesity with the main change agent being the individual. Due to the complexities of childhood obesity, an intervention that includes proven elements that prevent obesity and addresses the special factors that affect children is needed.
Parents Take Charge (PTC) is a multi-component family-based childhood obesity intervention that includes modification in nutrition, behavior and physical activity, but focuses on the parent(s) being the primary change agent for the child, age 10-13 years. Addressed in this evidenced-based proposal are the assessment of need, an analysis of best evidence, design aspects, implementation, evaluation, integration and maintenance of the practice change in a primary care setting.
The focus of the intervention is to teach healthy lifestyle behaviors to the child through parental involvement instead of focusing on weight reduction as the primary outcome.
Weight Management For Overweight/Obese Children: Parents Take Charge (PTC)
Quality care can be defined as appropriately identifying, evaluating, diagnosing and treating patients. The term quality in healthcare is correlated to professional knowledge and desired health outcomes (Institute of Medicine, 2012). It is also defined as being closely associated with patient safety (Mitchell, 2008). Clinical excellence is the goal of providing quality care. The process for achieving clinical excellence includes patient-centered care.
The patient is the focus and includes their concerns regarding their illness, values, beliefs and support network. Making the patient an active participant in their health care results in informed decision-making by the patient. Autonomy, nonmalfeasance, beneficence, justice and fidelity are ethical principles that are addressed as definitions of providing quality care and achieving excellence in primary care.
America Nurses Association, American League of Nursing, and Center for Applied and Professional Ethics are organizations that set guidelines for excellence (Stanley, 2011). Quality and excellence in a clinical site is achieved through appropriate, comprehensive and timely care.
Examples of methods of providing clinical excellence include providing evidence-based treatment, the timely manner in which patients are seen from when they sign in, the offer of generics versus brand-name medications, patient education, open dialogue with patients and referrals to specialist as needed. Ethical considerations taken in account are the patient’s autonomy. The patient is provided information for full understanding of their illness, evaluation, treatment and alternative treatments so that the capability for informed decision-making is established.
Guidelines for the prevention, identification, assessment and management of overweight and obesity in adults and children include how to assess whether people are overweight or obese; what should be done to help people lose weight; how to care for people who are at risk due to their weight and how to help people improve their diets and increase their physical activity (The National Institute for Health and Clinical Excellence NHS, 2012).
The intention of this paper is to present an evidence-based project (EBP) proposal for childhood obesity. Included in this paper is assessing the need for change in practice, appropriate theoretical models and frameworks, statement of problem, intervention, goals, systematic review of current research and design. Assessing the need for change in practice consists of identifying stakeholders, collecting internal data about current practice, comparing external data with internal data, identifying the problem and linking the problem with interventions and outcomes (Larrabee, 2012).
Step 1: Assessing the Need for Change in Practice
Stakeholders
The first step for the model of evidenced-base change is assessing the need for change in practice. To facilitate this, identification of stakeholders is needed. The target population is children, age 10-13 years and their families. Final decisions to change behaviors lies with the children, but parents have great influences over the young child’s meals, snacks and physical activities.
Participating parents therefore, will be the change agent, adding them to the list of stakeholders. Parents make informed decisions regarding the health of their children with the help of a primary healthcare provider (Burns, Dunn, Brady, Starr, & Blosser, 2013). Primary healthcare providers or nurse practitioners (NPs) are stakeholders that will assist in facilitating and implementing change.
Barriers to Change
Barriers for children’s outcomes include their maturity level; ability to understand or commit to the program and their parents, if they are reluctant to participate. The primary barrier to change is participation of the parents. Physical activity and dietary behaviors will need modification in and out of the home. Without the participation of the parents the goal for long lasting results will not occur.
Barriers for the parents include health literacy level; language, if the primary language is not English and attitudes towards modifying foods and physical activity. Another barrier is the participant’s adherences to the nutritional guidelines provided because diet plans do not include the cultural foods that the family consumes.
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Facilitators to Change
Facilitators to change include support from their primary care provider or NP that the participants know and trust, educational classes that will be designed to meet their family’s cultural and specific needs and physical activities that can be done as a family that includes utilizing the workout facilities and pool in the local gym.
Internal Data
Internal data (date retrieved within Porterville Valley PromptCare Medical Center) provides overweight/obesity information that is defined by height, weight, body mass index (BMI), frequency of physical activity and anthropometric measurements of children in rural Tulare County, California.
External Data
External data (data retrieved outside of Porterville Valley PromptCare Medical Center) include the following (Ogden, Carroll, Kit & Flegal, 2012; California Center for Research on Women & Families, 2011):
a). Approximately 31.8 percent of children and adolescents aged 2—19 years are obese in the United States
b). Approximately 1 in 3 (33.2 percent) of children and adolescents age 6 to 19 years are considered to be overweight or obese in the United States
c). An estimated 30.5% of children and adolescents aged 10-17 years are presently overweight or obese in California
d). The total percentage of overweight and obesity from 1999 to 2009 rose from 34.0% to 37.6% for 9-11 year olds in California
e). For teens ages 12-17 years in California, African American youth had the highest percentage of overweight/obesity (39.9%), followed by Latinos (29.4%), Asian/other (18.0%) and white youth (12.0%)
Internal data presents an estimated 30% of the children seen in Porterville Valley PromptCare Medical Center are overweight or obese. When comparing Internal data and External data a change in practice is needed to prevent the incidence of childhood obesity from continuing to grow at an alarming rate.
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Theoretical Model and Framework
Since this EBP proposal involves changes in physical activity and dietary behaviors understanding the effects of behavioral and social aspect of the child is necessary. With this in mind, the Transtheoretical Model will be discussed as an integral element in the design of PTC, an overweight/obese child intervention proposal.
Transtheoretical Model (TM)
The TM integrates clinical psychology and concepts to support a framework to understand the behavior and motivate behavioral change. The concepts of TM are decisional balance, processes of change, self-efficacy and temptation. The five stages of the transtheoretical model are the following: precontemplation (not intending to change), contemplation (considering a change), planning or preparation (actively planning change), action (actively engaging in a new behavior) and maintenance (taking steps to sustain change and resist temptation to relapse) (Kadowki, 2012).
Decisional balance occurs in each stage and involves the weighing of advantages and disadvantages towards changing behavior. The processes of change are the steps that facilitate understanding and behavioral change. Self-efficacy is essential and will vary depending on the TM stage. Temptation to revert back to previous stages will exist throughout the model. Support from the individual’s social network will provide the encouragement to continue within the program’s parameters.
Problem
A correlation between obesity and chronic diseases such as cardiovascular disease, diabetes mellitus and hypertension has been documented. Life expectancy for those who are obese is lower than those that maintain a normal Body Mass Index (BMI) (Centers for Disease Control and Prevention, 2011). Earlier death rates in adulthood have been linked to excess weight in the younger ages (American Heart Association, 2013).
The prevalence of obesity has increased three-fold over the past few decades and is reported as a public health problem within the United States (Singh & Kogan, 2010). The cost of health care for obesity-related diseases (diabetes mellitus, hypertension, cardiovascular disease, etc) has skyrocketed and is predicted to continue to grow.
In the year 2000 an estimated $117 billion and $61 billion was spent both directly (medical costs) and indirectly (lost work time, disability, premature death and subsequent loss of income, etc) on overweight and obese individuals in the United States (Ward Smith, 2010). Chronic diseases linked to obesity were once seen mainly in adults, but are now becoming more and more prevalent in children.
The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Adolescent and School Health (2010) reported “the prevalence of obesity among children aged 6 to 11 years increased from 6.5% in 1980 to 19.6% in 2008…and among adolescents aged 12 to 19 years increased from 5.0% to 18.1%” (NCCDPHP, Division of Adolescent and School Health, 2010). Health concerns for obese children are a reality that must be addressed since the effects of early obesity will impact their health for the rest of their lives.
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Problem Statement
The problem addressed in this EBP proposal is the growing rate of childhood obesity and the negative effects on the child, parents, family and community.
Possible Interventions
Intervention of childhood obesity includes early identification and participating in health promotion activities such as eating healthier and becoming more physically active, as early as possible, to reduce the likelihood of chronic diseases and increase the health in those at risk. Wojcicki and Heyman (2010) stated “studies have shown that early interventions can potentially prevent the development of obesity in school-age children, along with associated health conditions” (Wojcicki & Heyman, 2010, p. 1457).
Interventions of childhood obesity include promoting a balanced diet and increased frequency of physical activity. But, with the complexity behind childhood obesity, it requires other interventions as well. Vos, Wit, Pikl, Kruff and Houdijk (2011) stated their family-based cognitive behavioral multidisciplinary lifestyle treatment “aims to establish long-term weight reduction and stabilization, reduction of obesity related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques” (Vos et al., 2011).
Education and physical activity should be provided to the whole family in order to ensure successful lifestyle change to occur for the child. It is hoped that by encouraging whole family participation that a lasting positive outcome would result.
Pender, Murdaugh and Parsons (2011) stated “the significant role the family plays in the development of both health-promotion and health-damaging behaviors, beginning at a very early age is well documented” (p. 243). Golley, Magarey, Baur, Steinbeck and Daniels (2007) stated “parenting-skills training combined with promoting a health family lifestyle may be an effective approach to weigh management in prepurbertal children, particularly boys” (p. 517).
Critical Outcome Indicators
Outcome indicators aim to achieve results that matter to the patient (Larrabee, 2012). Critical outcome indicators include improved BMI, improved laboratory measurements, improved health behavior, improved dietary patterns and increased frequency of physical activity.
Goals and Purpose
The health goal is to improve outcomes of obese children living in rural Tulare County, California. Quality goals are to improve access to diagnostics, early treatment and continuity of care with the use of evidence-based practices that include family participation. Quality measures include the participant’s understanding of the nature of obesity, treatment, the negative impact of obesity on lifestyle and overall health. These aspects will be measured through documentation of BMI status, weight classification, percent of physical activity and nutritional counseling.
Purpose Statement
The purpose of the EBP proposal is to promote health and well being in overweight/obese children and their whole family through participation in a nine-week multi-component, family-based community intervention program.
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An analysis of policy to Prevent Smoking during Pregnancy in England
Executive summary
The incidence rates of smoking during pregnancy, and complications associated with it are still rampant in England. This is attributable to issues such as lack of strong leadership in policy implementation and inadequate infrastructures to raise awareness and training on how to prevent increase of smoking incidences during pregnancy. The proposed projects aims at evaluating the government strategies of tackling direct smoking during pregnancy on unborn child in England, with the aim of evaluating their effectiveness or establish if there is need for review.
Chapter 1: Introduction
Cigarette smoking carries a threat both to the expecting mother and her newborn. Approximately, 20% of the women smoke through their pregnancy in the UK (Department of Health, 2012). This trend is associated with numerous adverse effects such as premature births, miscarriages and prenatal mortality. Direct smoking during pregnancy is associated with number of respiratory disorders and pregnancy complications (Free et al. 2011). It is also associated with financial crisis. It is estimated that treating mothers and their children on healthcare complications associated with direct smoking during pregnancy is about £20-£87.5 per annum (Bauld, Hackshaw, and Ferguson, et al 2012).
Given these damages associated with the tobacco used on the unborn child. This paper conducts an analysis of policy to Prevent Smoking during Pregnancy in England. Although it is the government responsibility to ensure that child has the best start of life, the government policies have done very little in protecting the children from the dangers of tobacco use pre and post-birth (Chen et al. 2012).
Background/Study rationale
It is estimated that approximately 10 million adults in the UK are smokers. In England, 17% females and 22% males are smokers. Research indicates that the prevalence rates ate highest among the young population between the ages 25 and 34 years and lowest among the elderly population (McEwen et al., 2012). Smoking At Time of Delivery (SATOD) indicates that there is high rates of prenatal smoking in England. Although comparative studies indicates some decline in prenatal smoking proportion (from 15.1% to 12.7% in 2006/7 and 2012/13 respectively), the declining rate is very low (Chen et al. 2012).
Approximately, 12.7% of the women practice prenatal smoking. The national average highlights big disparities on prenatal smoking across the nation. For instance, in Blackpool, one in four (27.4%) expectant mothers smoke during pregnancy as compared to 1 in every 100 expectant mothers who smoke during pregnancy (0.5%) in Westminster. The tobacco control plan for England has established national ambition to reduce smoking during pregnancy by 11% by end of 2016 (Department of Health 2011).
Smoking has generally been banned in all public places and even in workplaces since July 1, 2007. The implementation of this rule had followed earlier implementation of similar legislation in Scotland, Northern Ireland, and Wales. Healthy Lives, healthy people tobacco plan, which was published in March 2011. It aimed at stopping promotion of tobacco use through the regulation of tobacco products.
The English government takes these responsibilities very seriously. The NHS England is expected to collect adequate data about smoking throughout pregnancy using the Carbon monoxide (CO) screening strategies. This is not compulsory requirements, indicating that current data on smoking pregnant women may not be the true picture, and may not be the most effective strategy to evaluate the extent of smoking during pregnancy (Department of Health 2011).
To start with, the government has improved its actions to stop the promotion of tobacco. This has been done through the implementation of tobacco displays and regulation of images and portrayals in the entertainment industry. Other measures include the policy of increasing taxes, introduction of initiatives to help quit and increased regulation of the tobacco products. However, the incidence rates of smoking during pregnancy, and complications associated with it are still rampant in England.
This is attributable to issues such as lack of strong leadership in policy implementation, reduced mass media campaigns, poor role models and champions that people can emulate to discredit smoking as well as enlightening the populations about dangers associated with smoking, and inadequate infrastructures to raise awareness and training on how to prevent increase of smoking incidences during pregnancy (Godfrey et al. 2010). Therefore, what are the government’s effective strategies of tackling prenatal smoking in England?
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Aims and objectives
AIM
To critique government policy to prevent Smoking during pregnancy in England
Specific Objectives
To examine the increase in prevalence rate of smoking during pregnancy
To examine government plan to reduce incidence rates of smoking during pregnancy
To examine the effectiveness of the government policy i.e. is there need for review?
Literature search strategy
The key questions that were used during literature search were structured from the study objectives. This included;
Why is there an increase in prevalence rate of smoking during pregnancy?
What is government plan or initiatives to reduce incidence rates of smoking during pregnancy?
Are the established government plans effective?
The main focus of the literature review was articles that gave definitive information from the controlled trials, randomized experiments, systematic reviews and any other article that had additional information on research topics. The inclusion criteria included papers published not more than six years ago, written in English and peer reviewed articles. Articles written in other languages, Newsletters and articles published more than six years ago were excluded.
The aim of this research was to investigate the impact of government policy on smoking during pregnancy. This aimed at evaluating the government plan to reduce incidence rates of smoking during pregnancy, and to establish if these interventions are effectiveness or there is need for review.
The standard search strategies were applied, which involved querying of the main data bases namely, London Metropolitan University Library MetCat, British Medical Journals, Library Catalogue, Wiley online library, Science Direct, Worldcat.Org, Sage journals online, NHS.Gov, NICE guideline, Parliament UK, and Local Government Website-Census. The querying was done using the key words below,
Key Words
‘stop smoking’ OR ‘Tobacco control’ OR
AND
‘government policy’ OR ‘Pregnant women’ OR
‘Smoking education’ OR ‘Quit smoking’
AND
‘Government strategies’ OR ‘Policy review’
The potentially relevant articles in identified in these databases were those written in English, published less than six years ago and strictly are peer reviewed journals. However, some articles published earlier were included into the study, to build up on the study history to current trends. (Chen et al. 2012).
From the analysis, 218 articles relating to smoking during pregnancy met the inclusion criteria. Three quarters of them were highlighting on the negative health consequences associated with prenatal smoking, only 10% of the articles tackled the issue of English policy on tobacco use. Out of these 21 articles, eight articles were analysed as indicated in Table 1.1
Ethics and anti-oppressive practice consideration
This paper will deal with ethical concerns that affect indirectly and directly the well-being of the human beings. The issue of maternal autonomy is very important. Irrespective of child’s interest, pregnant women have the right to make their own decision. This is because forcing decisions to pregnant women are ineffective strategies, and are both unconstitutional and unethical in deontological perspectives. If other members of the society have the freedom to smoke and to drink alcohol; the rights must not disappear with pregnancy (Free et al. 2011).
According to the utilitarian theory, moral imperative must take precedence over the freedom of choice. This is because the pregnant women are carrying another life, whose rights must remain reserved. Despite the increased foes in the newspaper, researchers are obliged under international laws to conduct research in a way that protects and promotes human health, including prenatal and maternal health. All ethical regulations that protect and uphold individuality, the aspects of autonomy and protection of human rights as proposed by the government and other institutions that promote ethics will be observed (Fleming et al. 2012).
Project outline
The proposed proposal consists of four chapters. These chapters help critiquing the England policy on prenatal smoking. Chapter 2 is the literature review, which consist of thematic headings including the overview of prenatal smoking in the UK, the prevalence rates of prenatal smoking in the UK, factors associated with prenatal smoking, impact of smoking to the mother and unborn child and the socio-physiological impact of prenatal smoking. This helps in understanding the general attitudes to smoking during pregnancy, and the identification of the key legislations that help reduce and prevent smoking during pregnancy.
Chapter 3 explores the theory and practice. This reflects on the government policy initiative- Smoke free legislation: The Health Act 2006. A critical analysis of the policy impact was done. To understand the policy impact better, the agency link identified is Action on Smoking and Health (ASH). This agency link is chosen because it is mainly concerned with the impact of prenatal smoking on children health, their parents and relatives.
The programme intervention identified was Framework Convention on Tobacco Control. This programme changes, strengths and weaknesses are analysed (Mackenbach, 2011). The ethical tensions and dilemmas associated with the programme are also described. Chapter 4 is the last chapter and generally consists of study conclusions, reflections, and study recommendations.
References
Bauld, L., Hackshaw,,L., and Ferguson, J. et al (2012). Implementation of routine biochemical validation and an ‘opt out’ referral pathway for smoking cessation in pregnancy, 2012, Addiction, 107 Supplement 2: 53-60
Chen, y.-F., et al., (2012). Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health technology Assessment, 16(38).50.
Department of Health (2011). Healthy lives, healthy people: a tobacco control plan for England, London, Department of Health, 2011.
Free, C., et al., (2011). Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single blind, randomized trial, Lancet, 378(9785): 49-55
Godfrey C. et al. (2010). Estimating the costs to the NHS of smoking in pregnancy for pregnant women and infants, 2010. York: Department of Health Sciences, The University of York. Cited in NICE, Guidance aims to protect thousands of unborn babies and small children from tobacco harm’. Available from: http://www.nice.org.uk/
Mackenbach, J. (2011). What would happen to health inequalities if smoking were eliminated?. BMJ, 342(jun28 1), pp.d3460-d3460.
McEwen. A. et al (2012). Evaluation of a programme to increase referrals to stop-smoking services using Children’s Centres and smoke-free families schemes,. Addiction, 2012, 107: 8–17.
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Obesity Awareness Organizations
Obesity -connected conditions such as stroke, heart attack, type 2 diabetes to mention but few are known to be epidemic and is growing rapidly and directly impacts the lives of approximately thirty four point nine percent (34.9 or 78.6 million) of adults in the USA, (CDC, 2015). Although there has been increased and misinformation and facts about the disease, thus, the establishment of Save the Children and Healthy Kids as well as Healthy community were established to increase public awareness on obesity.
Symbolic interaction theory address this sociological problem by addressing the subjective meanings imposed to people. This theory suggests that people behave according to what the society believes and what is not objectively true. The fundamental aspects of the obesity such as race and gender are better understood using symbolic interactionist lens. These two organizations are working to increase awareness on health risks that are associated with the disease, while providing aid to the morbidly obese individuals and also provide information and resources on exercise, nutrition and counselling on how to seek medical recommendation associated obesity disorders (Jator, 2014).
Functionalist theory is mainly concerned with stability order in the society. For instance, Healthy Kids, Healthy communities is an organization established by the Robert Wood Johnson Foundation which aims at preventing child hood obesity. The organization was launched in December 2007. This organization is helping approximately 49 communities in the USA. It helps eliminate the issue of eating disorders and obesity in the USA by advocating for changes to local policies; with the aim of establishing a safe environment, one that fosters healthy lifestyle.
This organization has established programs that lay special emphasis to communities who are at higher risk of developing obesity due to their ethnic group and geographical location of socio-economic impacts in the society (Healthy Kids Healthy Communities, 2015).
Since its establishment, the organizations have supported more than 85 policy changes that target the environment to support healthy living. Some of the efforts have mainly focused on encouraging healthy eating and physical activeness. For instance, in Jafferson County, Ala, the organization advocated for changes to promote healthy eating and physical activity in 360 child care centres that were previously been exempted from these regulations by the local government because they were faith based organization (Healthy Kids Healthy Communities, 2015).
Conflict theory focuses mainly on the causes and consequences of obesity. This theory’s social constructs function based on what people perceive as true about what certain people look like. These constructs are used by these agencies to decide whom they should help and how to do so. According to this perspective, establishing a social structure will help eradicate obesity in America. Looking at the existing social arrangements, they tend to evaluate on what functions it performs to the society (Leon-Guerrero, 2011).
In silver City, N.M., the organization advocated for policy change to new policy that would allow community garden in each land-use zone. The changes also included the complete street policies which aimed at directing officials to design and maintain environments that are safe and accessible by bicyclists, walkers, and the transit users.
Other solutions that have been advocated for by this organization includes partnering with the local government to establish policies that improves access to healthy food, advocate for employee wellness and construction of safe environment that promote physical activeness in both adults and children (Healthy Kids Healthy Communities, 2015).
Critical theory critiques the society aspects with the aim of understanding and explaining the aspects of obesity. It digs beneath the surface of the social life so as to unveil the assumptions and misconceptions of obesity in the society. Social interactionist mainly focuses in micro-sociological interactions between the small groups in the society. The latent function in this case is to investigate the relationship between poverty, women empowerment, and obesity (Leon-Guerrero, 2011).
For instance, Save the Children organization was established in 1919 which aimed at fighting for children rights in order to save these children live and to give hope for better future. This program invests in childhood with the aim of giving them a healthy start across the world. The organization believes that by giving the children a healthy start; they provide them with an opportunity to learn, which offers a prospect to transform their course in the future.
One in five kids in the America lives in poverty. This organization have education and health programs to ensure that these children can access simple things that are critical including things such as books, pre-school educative programs, and healthy places where they can exercise and play. These simple things are crucial in order to help the kids thrive in mind and body (Save the Children, 2015).
The feminist perspective to tackle the obesogenic environments is inspired by the interest to help the poor minority, especially women and children from these communities (Leon-Guerrero, 2011). Save the Children program has established a program to fight obesity based on the feminist perspectives. The organization program is dubbed as “Hunger in America” is ironical. How can an advanced country be malnourished and obese at the same time?
When children live in poverty, they live in society and families that are struggling between making a healthy choice (implying no food at all) and putting cheaper but unhealthy food on the table. Consequently, more than half of these kids living in poverty stricken areas end up becoming obese or overweight. According to this organization’s report, 59% of the children are not able to access fresh healthy foods and in some areas, the statistics is as high as 98% (Save the Children, 2015).
Evidently, it is every person’s right to have a healthy live, and that each child deserves an opportunity to have a healthy start. Functionalist theory focuses more in the consequences than the intent. This is challenging as sometimes latent functions consequences are not usually so obvious. Therefore, it is imported for the Nation to get concerned on how the social arrangements benefits get distributed
(Conflict theory). This includes focusing on who benefits, wins or loses from specific social arrangement. This is important in that the society is constantly changing and conflict of these dynamic social arrangements are the main source of change. It is important to expose children and adults to healthier ways of living by promoting nutrition lessons and support to ensure that the balanced food choices are available to each member in the community, and to ensure that the community members remain physically active (Leon-Guerrero, 2011)
Jator, E. (2014). Predicting Obesity among Adolescents in the United States Using Modified Logistic Model. AJPHR, 2(3), 86-90. http://dx.doi.org/10.12691/ajphr-2-3-4
Leon-Guerrero, A. (2011). Social problems: community, policy and social action (Third ed). Thousand Oaks, California: Pine Forge Press.
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Cholera Outbreak
Introduction
Cholera is a diarrheic condition that is caused by bacteria known as Vibrio cholerae. The bacterium is an enterotoxin that affects the ileum. Patients with this disease present with a sudden onset of rapid watery stool that is painless (Sekar, 2012). Early stages of cholera are manifested by rapid vomiting and nausea. When cholera is not treated, it can results into hypoglycemia in children, circulatory collapse, dehydration, renal failure and acidosis.
The infection is transmitted by asymptomatic carriers. Cholera is mostly asymptomatic or occasionally causes moderate diarrhea particularly with EI T micro-organisms or biotype. Death occurs within a few hours in severely dehydrated cases where by the rate of case-fatality may go beyond the 50% mark. However, timely and effective rehydration reduces the death rate to 1%.
Background
A cholera outbreak was first detected in The Central African Republic (CAR) in the early months of 1997 and hit the country for the second time in 1999.
The affected regions within the country included the sub-prefecture of Ngaoundaye. This is located along river Oubangui which is located near the border with Chad(Dworkin, 2010). Sékia moté village had the very first few reported cases and within a short period, the outbreak had spread to the prefecture of Lobaye and its environs and to the city of Bangui. Ombella Mpoko district and seven other villages where the Oubangui River passed later became part of the tragedy.
The outbreak was primarily discovered after the chief’s son of Sékia mote village became sick and passed away after showing signs of profuse diarrhea, abdominal pains and fever. The chief of Sékia mote village reported the case to the district’s governor on the very same day it occurred, who then alerted the Ministry of Health immediately later that day.
Both private and public health facilities in the Central African Republic (CAR) recorded extraordinary cases of watery diarrhea from Sékia moté village and several other villages to the Ministry of Health (Kamradt, 2015).
On the 25th of September 2011, a stool sample was obtained from a patient that had been transferred and got admitted at the community clinic in Bangui by two of the laboratory technicians from the Central African Field Epidemiology and Laboratory training Program (CAFELTP)(Nair, 2014).
After three days of thorough testing, the National Laboratory in Bangui (NLB) isolated Vibrio cholera sero group 131 from the earlier submitted specimen of stool with the help of a laboratory expert, from the NCIRD/GID.
This fostered the drive of Global Immunization Division, Immunization Systems, and Centers for Disease Control and prevention (CDC) since they were certainly convinced that the disease was cholera. On September 30th, cholera outbreak was declared officially in CAR. Rapid response team was put in place by the Minister of Health (MOH). The team comprised of CAFELTP residents, WHO, MSF staff, UNICEF, MOH staff, and others. The team established a series of control and preventative guidelines that would curb the spread of the outbreak.
The first measure entailed enhancing treatment capacity and cholera surveillance at the already existing health facilities. Secondly, the city of Bangui and affected villages had to have cholera treatment facilities. Thirdly, endorsing practices such as improved sanitation, proper food preparation, proper funerals and burial. The fourth measure was on affected people were to be advised on usage of oral rehydration solution and encouraged to seek medical attention at the onset of watery diarrhea. Finally, there were to be provision of chlorine for treatment of drinking water.
The rapid response team had a report of the case as by October 23rd. The record indicated that there were a total of 172 individuals who were suffering from acute watery diarrhea and also recorded 16 cholera deaths. This study was carried out with the goal of identifying risk factors associated with cholera outbreak. Moreover it also focused on assessing how prepared the affected districts were in controlling the outbreak.
Cholera Investigation
Environmental investigation
Many households were constructed along river Oubangui. The distance between the river and these households was approximately 20 meters. Generally, there was poor hygiene in the village characterized by mud and stagnant water (Kurjak, 2015). The children in the village were playing and walking bare feet in the mud and at times not fully dressed. Villagers were commonly using pit latrines whose maintenance was poor. Oubangui river was has many uses which include a source of drinking water, fishing, swimming and defecation.
Epidemiological investigation
The Ministry of Health requested CAFELTP resident advisors to assist in investigation and control of cholera outbreak in Central Africa Republic. The CAFELTP officials formed a rapid response team that worked in the affected areas. The team members were assigned different duties. For instance, one of the epidemiological officials was charged with the responsibility of reporting and collecting data on cholera outbreak where as two other lab technicians had the responsibility of collecting and analyzing samples.
Moreover, the advisors of these officials arrived in Bangui after two weeks. Upon arrival, they were taken through the events in Bangui by the CAFELTP staff and the officials from the MOH on the matter at hand and evolution of cholera. A data collection instruments and a protocol were developed by the residents and RAs. The main risk factors were highlighted as follows, lack of infrastructure for sanitation, drinking untreated water, and attending a cholera case funeral. Cholera Treatment Facility in Mbobo and Bangui district held arena for questionnaires pre-testing. In-country procedures such as mission orders, submission of terms of reference were followed before going to the field.
Coincidentally, during the outbreak investigation several campaigns on cholera awareness were underway in different areas of the country. The awareness involved sessions of community education and use of mobile Information Education Communication (IEC) resources presented on posters, TV, radio, cars, and mobile phones prevention messages.
Confirmation of the outbreak
The term outbreak is simply defined as a sudden increase or start of disease of fighting. It can also be defined as a sudden increase in numbers of a harmful organisms particularly the insects within a specific area. A disease outbreak is the occurrence of diseases in excess beyond the normal expectations in a specific geographical area, season or community.
An outbreak may emerge in a restricted geographical area or even spread to several countries. Its duration may be a few days, weeks or several years(Sekar, 2012). Definition of an outbreak enables those responsible for managing an outbreak occurrence to report the condition in its early stages to the responsible authorities.
The director of disease control conducted training sessions on cholera management in the hospitals as well as the community. The training was done to the health personnel in the affected districts. Weekly review notification records under joint custodian of the (WHO) and MOH, found 172 individuals diagnosed with suspected cholera. In the CAR from September 20th to October 26th, national case fatality rate was 9.3%.
Data on the number of individuals infected with cholera was sourced from the WHO Bangui office, cholera treatment centers and health centers in the affected areas. Medecins Sans Frontiers (MSF) were responsible for collection of the data on infected individuals. These information was used by the investigators in performing a comprehensive analysis of cholera outbreak.
Assessment on the level of epidemic readiness and response was carried out in each district using a checklist. General hygiene in the affected areas termed environmental investigation was also assessed. Stool and water samples were taken to the lab to be examined for Vibrio cholerae.
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Epidemic preparedness and response (surveillance)
None of the visited districts had either an epidemic readiness plan or a committee in place prior to the outbreak. There was provision of IV fluids and protective materials after the event of the outbreak. Some of the health centers such as Kamba had a radio system that was functional for communication, the health centers in Ngazi and Mogo had no means of communication. Unfortunately they had to travel for about 35 Km by bicycle or foot to the health facility (Shah, 2016).
Epidemic management funds were not available in the country before the occurrence of the outbreak. However, there were disinfectants in the entire health district that was visited. Chlorine used for water treatment was distributed by ministry of health to the two villages. Centers for chlorine treatment were planted at Bangui hospital, Ngazi and Mbombo health facilities. At the time of visit, these centers were functional although each had at least one cholera patient.
One personnel in Ngazi and Mongo village managed the public health surveillance system. The system was exempted prior to the occurrence of the epidemic.
Case definition
Case definition entails a standard criterion that categorizes an individual as a case. It includes criteria for person, time, clinical features and place. The criteria should be specific to the outbreak under investigation (Madoraba, 2010).
Place
Most houses were constructed along the Oubangui River. The distance between the river and the houses was less than 20 meters. There was generally poor hygiene in the village (Dale 2013). Mud and stagnant water were everywhere. Children played and walked in the mud bare feet and at times not fully dressed. There was common use of pit latrines; however, the latrines were poorly maintained. The Oubangui River served as a source of drinking water and swimming, fishing and defecation.
Person
Diarrhea: Diarrhea as a result of cholera usually has a milky, pale appearance that resembles water that has been used to rinse rice, hence the name rice-water stool.
Dehydration: dehydration develops within hours after the commencement of the symptoms of cholera. The ranges of dehydration vary from mild to severe depending on the amount of fluid lost. Severe dehydration is characterized by a loss of 10% or more of total body weight.
Nausea and vomiting: occurs during the early phase of cholera. Sometime vomiting may occur for hours.
Other signs and symptoms of cholera include lethargy, irritability, dry mouth, and sunken eyes, dry skin that bounces back slowly after it has been pinched into a fold, extreme thirst, little urine output, irregular heartbeat (arrhythmia) and low blood pressure
The people of Bangui expressed symptoms that are consistent with the case definition of cholera outbreak. The environment in Bangui also had conditions that are likely to predispose people to developing cholera
Cases
Cases are categorized into three types; confirmed, possible and probable cases. Confirmed cases are the laboratory confirmed cases such as the cholera victims who had their stool tested for Vibrio cholerae. However probable cases have characteristics clinical features of the disease but they lack laboratory confirmations (Ramamurthy, 2011). For example, there were residents of Mbaika district who had bloody diarrhea but without laboratory testing. Finally, possible cases are those with some clinical features such as abdominal cramps and diarrhea such as three stools in a 24-hour period.
Cholera is a point source epidemic. It arises due to common sources such as contaminated food or an infected food handler. The period for incubation ranges from a few hours to 5 days after infection. Suspected cholera case was defined as any individual of any age that presented with acute watery diarrhea. The most affected individuals were the women living in villages along Bangui River.
Hypothesis
The cholera outbreak in Mbaika district, Central Africa Republic where 170 patients and 16 cholera deaths reported, were related with risk factors that were food borne. There is a substantive association between cholera and eating cold cassava leaves. Epidemiological studies from Zambia indicated that the major transmission vehicle of cholera outbreak is contaminated food.
Vibrio cholerae could be inoculated into cooked food during preparation by an asymptomatic but infected person (Howard, 2011). However, the cause of contamination of cassava leaves may vary and the study did not determine its course. This hypothesis is true because earlier studies indicate that soiled kitchen ware can contaminate food and the Vibrio cholerae live for up to 2 days.
Discussion
Cholera outbreak caused many deaths in the region. The death rate rose up to 24.2% in Matuu which is higher than the countrywide rate of 9%. MOH in collaboration with various partners assisted in the management of cholera. The investigation produced important results. The outbreak of cholera in Kamba district, Central African Republic where by more than 170 cases and 16 deaths reported, was as a result of risk factors that were food borne.
The case control investigation associated cholera with consumption cold leaves of cassava. Epidemiological study from Zambia indicated that during an outbreak, the major transmission vehicle of cholera is contaminated food. When food is prepared, Vibrio cholerae could be inoculated by asymptomatic but affected person. The source of contamination varies in cassava leaves. The study did not determine its course. According to previous studies, soiled kitchen ware can contaminate food where the Vibrio cholerae persists for 1-2 days.
There was lack of association between the outbreak and water-related risk factors. Cholera transmission through direct waterborne ways was not very evident in these areas. Other previous investigations have reported that drinking water sold in the streets was responsible for the outbreak of cholera in Latin America.
The study ruled out the link between cholera and drinking contaminated water, poor sanitation and attending burials that are cholera related in the district. Households in the two villages are built along the river which makes the area vulnerable especially during floods. Consumption of untreated water from Oubangui River was not proven risky but it should be avoided.
Delay in the analysis of stool samples should be discouraged. It leads to delayed confirmation of an outbreak as well as delayed implementation measures. According to this case, the delay occurred because the outbreak emanated outside Bangui. On the other hand, Bangui National Laboratory (NLB) did not have a means of transport for collecting stool samples from outside Bangui. It is very vital to have all the appropriate resources during an outbreak. Availability of epidemic readiness plan and a committee present in a district results in effective and timely management of the outbreak. Public health surveillance system management by only one individual in the entire district may not be effective in handling all the threats in public health.
Conclusion
The outbreaks of cholera in Central Africa are still ongoing but in a slow rate compared to the past three week. Considerable association between cholera and eating cold cassava leaves was identified. First and seventh regions were the only ones affected by the outbreak (Lewenson, 2013). Women and children living along the Oubangui River were the most affected by the outbreak. Lack of transport of samples to the National Laboratory delayed outbreak confirmation. Effective measures in cholera treatment there were to be implemented include; establishment of cholera treatment center, treatment of drinking water, health education on good food and general hygiene.
Lessons learnt
The study provided epidemiological information that leads to cholera. They include consuming untreated water, poor sanitation and attending cholera areas.
The major transmission vehicle of cholera is contaminated food.
Consumption of water sold in the street can also result into cholera outbreak.
Lack of laboratory materials transport and communication causes delay in analysis of an outbreak
There is need for a stand by epidemic readiness plan and committee in the district that ensures well-timed management of the outbreak.
Recommendations
Health education and social sensitization on habits of eating, community hygiene and personal, sanitation and burial practice.
System for public health surveillance should be strengthened by the administration.
Encouragement of eating food when still hot.
Each region should be supported in development of a functional epidemic readiness plan and response committee and a definite epidemic readiness control plan as soon as possible.
Ministry of health in conjunction with that of water should ensure that the communities have access to clean water.
Laboratories should have basic resources to avoid delaying in laboratory confirmations.
The surveillance system should be able to identify outbreaks and report in time.
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