Global Health 1014th Editionrichard Skolnikmodel Policy Briefjapanese ✓ Solved

Global Health 101, 4th Edition Richard Skolnik Model Policy Brief Japanese Encephalitis in Nepal From: Secretary of Health, Nepal To: Minister of Finance, Nepal Introduction: Nepal has the second highest prevalence of Japanese encephalitis (JE) in South East Asia1. One in five cases of JE results in death and those who survive frequently suffer from residual neuropsychiatric disorders2. Most cases occur in children ages 5-15 years living in rural plain areas of the western, mid-western, and far-western regions of Nepal that border India1. JE has recently been confirmed in 54 of the 75 districts in Nepal2. Those not using insecticide treated bed nets (ITNs), living amongst animal reservoirs of the disease and practicing poor agricultural practices in JE-endemic areas are most at risk3.

Most JE cases are asymptomatic and therefore undetected4. No effective drug treatment for JE exists and few are aware of the JE vaccine2. JE contributes to high levels of malnutrition, lack of education, and poverty3. Integration of JE immunization on National Immunization Days and increased ITN use are the most effective means to decrease JE incidence rates4. Despite efforts from Government and non-government organizations, JE constitutes a major cause of morbidity and mortality in our country and remains a priority for public health intervention.

Nature and Magnitude of the Problem: Japanese encephalitis has manifested as a major burden for our people in the last three decades. Between 1978 and 2003, 26,667 cases and 5,381 deaths have been reported with case fatality rates ranging from 9.8 percent to 46.3 percent during that time4. Since 2005, 1,802 cases and 283 deaths have been reported, yielding a case fatality rate of 16 percent1. Of those who survive, about 30 percent develop some form of permanent neurological debility6. Only about 10 percent will recover to their pre-infective health status6.

One in five JE cases will rapidly progress to severe encephalitis and progressive coma2. Acute encephalitis syndrome (AES) manifests as an acute onset of fever and a change in mental status (e.g., confusion, disorientation, coma, or inability to talk) or an onset of seizures5. Surveillance of JE is mainly documented based on the number of AES cases that are laboratory-confirmed within the first 4-7 days after infection2. However, JE has an incubation period of 4-14 days and rarely causes clinical symptoms2. More accurate surveillance of JE must be ensured, as only 1 case is reported for every 300 asymptomatic cases6.

JE immunization and use of ITNs are the most effective known control measures. Only about 32 percent of Nepalese people are aware of JE7. In households surveyed for JE, 52 percent had at least one family member not protected by an ITN7. Only 14 percent of those aware of JE are aware of the JE vaccination7. Increased socioeconomic status is associated with knowledge and awareness of JE and reduced risk behavior7.

Affected Populations: Children that are male and under the age of 15, living in rural areas, are most affected by Japanese encephalitis. About half of all JE cases are reported in children under the age of 15 and the incidence rate is the highest amongst children age 5-15 years6. Of those infected, about 60 percent are male6. The most fatalities and residual neurological and psychiatric disorders are seen in children under the age of 102. JE is seasonally endemic in the Terai region and in villages along the river banks between hills3,5.

Recently, JE has also been reported and is now endemic in the Kathmandu valley in the hill region5. From 2004 through 2006, laboratory-confirmed JE cases have also been reported in the hill and mountain regions where JE was previously not suspected to be endemic5. Risk Factors: Our entire population is at risk for JE, but those most at risk are uneducated people living in rural parts of endemic areas without access to ITNs and JE vaccines. A higher level of educational attainment directly relates to better awareness of JE and influences bed net use7. The use of ITNs directly reduces the risk of JE transmission and serves as an effective preventative measure7.

Incorrect or lack of use of ITNs leaves our people at high risk for infection4. Those living on pig farms are also more at risk because pigs serve as reservoirs for JE3. Risk is also increased during exposure to areas with mosquito breeding grounds after the monsoon season, between the months of July to September6. Poor agricultural practices increase the amount of available breeding grounds for the mosquito vectors and therefore also contribute to increased risk6. Social and Economic Consequences: Japanese encephalitis contributes to malnutrition, lack of education, and poverty.

Children infected with JE often suffer from gastrointestinal dysfunction that leads to malnourishment2. Malnutrition from JE and other infectious diseases is associated with high rates of child stunting3. JE contributes to our high under-five mortality rate of 91 deaths per 1,000 live births3. Residual neuropsychiatric disabilities from JE infection restrict learning ability and school performance, contributing to our country’s 52 percent literacy rate3. Such disabilities also inhibit physical performance and can lead to unemployment for those living in regions economically dependent on agriculture6.

A poor workforce offers little attraction for potential economic investment in JE-endemic areas. JE not only affects our poor, but it also perpetuates more poverty by restricting our citizens’ opportunities to increase socioeconomic status. Priority Action Steps: In order to control the outbreaks of JE, awareness of the disease must be spread and vector control measures, surveillance practices, and immunization efforts must be intensified1. Community participation should be encouraged to educate citizens about the transmission and prevention of JE3. Community education campaigns are critical to decreasing risk behaviors and improving preventative behaviors for JE7.

Educating people about the use of ITNs and distribution of more ITNs to affected areas helps to decrease the number of humans bitten by mosquitoes carrying the virus from infected animal reservoirs3. Training of health workers on case recognition and intervention strategies must be implemented to enhance JE surveillance7. Improving agricultural practices to prevent flooding of rice fields where mosquito vectors breed will also contribute to decreased levels of JE infection2. Mass immunization campaigns in known JE-endemic areas will most effectively assuage the incidence and mortality of JE5. Large-scale JE vaccination has already been proven effective in significantly decreasing the incidence of JE in regions of China, Japan, and Thailand2.

Of the three types of JE vaccines that exist, two are commercially available internationally and are safe to administer to children2. The costs of the vaccines are relatively low and only two doses at 1-2 week intervals are required for immunity2. More government funding must be directed towards the purchase and distribution of JE vaccines if there is any hope to extinguish JE from our country. _____________________________________________________________________________ References: 1 “Immunization and Vaccine Development: Japanese Encephalitis.†World Health Organization . 3 December 2010. 2 “Japanese Encephalitis Vaccines: WHO Position Paper.†Weekly Epidemiological Record .

6 December 2010. 3 Shiba, K., Kazuko, H., Ayako, A. & Yoshimi, O. (2002). Infectious diseases and malnutrition status in Nepal: An overview. Journal of Malnutrition 8 (2). . 4 “Country Health System Profile: Nepal.†World Health Organization .

3 December 2010. 5 “Japanese Encephalitis in Hill and Mountain Districts, Nepal.†Centers for Disease Control . 6 December 2010. 6 “Epidemiology of Japanese Encephalitis in Nepal.†World Health Organization . 3 December 2010.

“The Nepal Survey on Malaria, Japanese Encephalitis and Kala-azar.†USAID . 6 December 2010. 1 Career Plan Instructions The purpose of this assignment is to prepare you for the next step after you have earned your undergraduate degree. This multi-step project involves planning for alternatives. Here are the steps you will take to complete this assignment: 1.

Section 1 – Salary Discussion: Look up the job you are interested in having in the future. Make sure you notice the salaries and whether they differ by state. 2. Section 2- Graduate School or Marketability- If this position requires a graduate degree, look up the cost of different graduate programs to determine what is the highest and lowest cost of this graduate degree. Discuss the cost and the time it will take to complete a graduate degree if this career/job requires it.

Include whether you are willing to take the economic risk of going to graduate school? If it does not require a graduate degree, discussed in this section how they can improve their marketability while they're earning their bachelor’s degree? For example, internships, volunteering, etc. How can they obtain these opportunities while at FIU? 3.

Research your Parallel Plan: Now, imagine if your ideal career ceases to exist. Perhaps the robots can do it now, or you are unable to get the degree needed to be eligible for that job, or maybe it becomes obsolete for some other reason. You will need to create a parallel or alternate plan. To do so, you will first identify your career-related interests, abilities, values, and goals. Your parallel plan should be a different career than the original career goal you had in mind.

If your plan is to go into a healthcare profession, your parallel plan should be a career goal outside of the healthcare field. For example, if your career goal is to become a doctor then your parallel plan can be to become a school counselor for the K-12 school system. This way you are exploring and learning about diverse career options that can be a great fit for you. Think about the following questions (this is brain storming part- you do not need to include this in the paper): · Why am I interested in pursuing (insert your top choice major here)? · What do I like most about my current major of interest? · What classes have I performed well in and what classes have I disliked or struggled with the most? · What specific careers interest me and why? · What types of work environments do I prefer? · What companies would I love to work for and what is my dream job? · Explore different Majors within your Academic Unit, College, School, etc. · Look up job opportunities that can be done with the same degree you are earning now.

Take note of the fact that the alternate job you’re interested in requires a different degree and consider if you’d be willing to go back to school for another degree. · Pay attention to the job salaries for these alternate jobs/careers. 4. Section 4: Parallel Plan - Create your parallel plan. When developing a parallel plan, answer the following questions in your plan: (REQUIRED) · Are there any common courses between my current major of interest and my alternative major choice? · What courses differ between these majors? · Are there any application requirements or admission standards that I should know about? 5.

Once you have completed all of the above steps, you will prepare document you will be submitting. The document must have the following four sections: · Current job Salary Discussion · Graduate School or Marketability · A one-page resume ready for applying to the job you are interested in pursuing currently. · Discuss your parallel plan with the alternate job(s) you might pursue instead. Specifically, identify and mention what that job/career would be and discuss why you chose it. You must answer the questions included in step 5 above, and feel free to include other questions you considered in the steps above while developing your parallel plan. Make sure you include what the salaries are and if they differ by city, state or region.

Discuss whether you would or would not be willing to go back to school to get the degree or courses required for the alternate job (or if you can complete these requirements currently while earning your current degree). Finally, discuss how job application and resume writing might be different (if at all) with this alternate job versus the current job you are planning on pursuing.

Paper for above instructions

Section 1 – Salary Discussion

For my future career, I am interested in pursuing the role of a public health analyst, particularly focusing on global health issues like infectious diseases, vaccination strategies, and health policy formulation. Public health analysts play a crucial role in evaluating and improving health programs, conducting research, and advising governmental and non-governmental organizations on health-related policies. According to the Bureau of Labor Statistics (BLS), the median salary for public health analysts in the United States is approximately ,000 per year (U.S. Bureau of Labor Statistics, 2023). However, salaries can differ based on location; for instance, analysts in metropolitan areas like Washington, D.C., and New York City may earn upwards of ,000 due to higher costs of living and the concentration of health organizations (Payscale, 2023).

Section 2 – Graduate School or Marketability

Becoming a public health analyst typically requires a master's degree in public health (MPH) or a related field. The average cost of graduate programs in public health varies widely – from approximately ,000 per year at public universities to over ,000 at prestigious institutions such as Johns Hopkins University (Graduate Programs in Public Health, 2023). Most MPH programs take about two years to complete, making the total cost, depending on the institution, range from ,000 to 0,000.
I am willing to consider the economic risk of pursuing a graduate degree, as the potential for a higher salary and increased job opportunities could offset the initial financial investment. Furthermore, while obtaining my bachelor's degree, I plan to enhance my marketability by seeking internships and volunteer opportunities related to public health. Florida International University (FIU) offers ample resources for students to find internships through its public health department, allowing me to gain practical experience while developing professional networks (FIU Public Health Career Services, 2023).

Section 3 – Research your Parallel Plan

In the event that my ideal career as a public health analyst becomes obsolete or inaccessible, I have developed a parallel plan to pursue a career as a health educator. Health educators are vital in teaching communities about health promotion, disease prevention, and healthy lifestyle choices. This role would allow me to leverage my interest in global health while transitioning to a position that also values education and community involvement.

Identifying Career Interests, Abilities, Values, and Goals

My interest in public health stems from a desire to make a positive impact on community health outcomes and contribute to initiatives that can lead to healthier populations globally. I find fulfillment in educating others and facilitating discussions on health topics, which would be a major component of a health educator's role.
The classes that I have excelled in during my undergraduate studies are those focused on research methodologies, epidemiology, and health communication. On the other hand, I have found courses related to advanced statistics challenging. Understanding these personal strengths and weaknesses will help me shape my future academic endeavors and better prepare myself for both public health analyst and health educator roles.
The work environment I prefer is one that involves collaboration with multidisciplinary teams and community engagement. As for companies I would love to work for, organizations like the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and various NGOs focused on health education and disease prevention align with my career aspirations.

Career Comparison

- Common Courses: Both public health analyst and health educator roles typically require coursework in epidemiology, health promotion, and research methods.
- Distinct Courses: Public health analysts may need advanced statistics and economic evaluation courses, whereas health educators may focus more on curriculum development and counseling techniques.
- Application Requirements: For health education positions, a certified health education specialist (CHES) credential might be beneficial, which includes passing an exam and fulfilling continuing education requirements (National Commission for Health Education Credentialing, 2023).

Section 4 – Parallel Plan

In creating my parallel plan, I would like to be a health educator focused on promoting health literacy and preventing lifestyle-related diseases within communities.

Course and Credential Considerations:

- Common Courses: Public health principles, health communication, and behavioral science.
- Courses Differing: Including curriculum design and teaching methods specific to health education, which may not be prominent in an MPH program.
- Credential Standards: Pursuing the CHES credential could be a beneficial addition to my qualifications, alongside my bachelor's degree.

Willingness to School

Although the health educator position may not require a graduate degree, completing an MPH could prove advantageous in acquiring a deeper understanding of public health concepts and practices. It is something I would be willing to pursue if I decide to strengthen my qualifications further.

Job Application Differences

When considering job applications, the emphasis for a public health analyst position would likely revolve around analytical skills, experience in data interpretation, and research capabilities. In contrast, applications for health educator roles would require a focus on communication skills, education experience, and understanding community needs.
Conclusion: In summary, my career aspirations as a public health analyst align closely with my passion for improving health outcomes globally. However, recognizing potential challenges led me to devise a parallel plan as a health educator, allowing me to adapt and remain aligned with my interests in health education and community engagement. Through my academic journey, I remain committed to enhancing my marketability, gaining relevant experience, and strategically planning for my future in the health field.

References

1. U.S. Bureau of Labor Statistics. (2023). "Public Health Analyst." Retrieved from www.bls.gov.
2. Payscale. (2023). "Public Health Analyst Salary." Retrieved from www.payscale.com.
3. Graduate Programs in Public Health. (2023). "Cost of Public Health Graduate Programs." Retrieved from www.graduatepublichealth.com.
4. FIU Public Health Career Services. (2023). "Internship Opportunities." Retrieved from www.fiu.edu.
5. National Commission for Health Education Credentialing. (2023). "Certified Health Education Specialist (CHES)." Retrieved from www.nchec.org.
6. World Health Organization. (2023). "Global Health Education." Retrieved from www.who.int.
7. Centers for Disease Control and Prevention. (2023). "Public Health Career Opportunities." Retrieved from www.cdc.gov.
8. Pew Research Center. (2023). "The Importance of Health Education." Retrieved from www.pewresearch.org.
9. Association of Schools and Programs of Public Health. (2023). "Accreditation of Public Health Schools." Retrieved from www.aspph.org.
10. Occupational Outlook Handbook. (2023). "Health Educators." Retrieved from www.bls.gov/ooh.