Assignment

Introduction to Public Health (PBH101)

General Instructions

This assignment will contribute to 50% of the total mark for this course in this semester.
This is a two-part assignment and students must complete both parts all by themselves.
The deadline for submission is 4th June 2020.

I agree to the terms and condition described above. I hold a copy of this assignment that I can
produce if the original is lost or damaged. I hereby certify that no part of this assignment or
product has been copied from any other student’s work or from any other source except where
due acknowledgement is made in the assignment. No part of this assignment/ product has been
written/ produced for me by any other person where such collaboration has been authorized by
the subject lecturer/ tutor concerned.
Please put your name, ID, and date to indicate your consent.

Tasnova Noushin Auishee 2011557620 17/05/2020

Students Name Student ID Date

Task 1: During this COVID-19 pandemic we are currently living in lockdown situation, that is
affecting our mental and social. Many are suffering from depression, anxiety, internet addiction
(as a coping mechanism) and other mental health issues. Academic activities are suspended
that would affect our professional life later. The country’s economy is suffering a breakdown.
Social life is also affected as we cannot enjoy social gatherings.
However, some people are also using this time to gain positive experiences. Many of us are
having good times with the families, especially for those who lead a busy life or stay away from
home for work or study. Some people are learning new skills or knowledge or brushing their old
hobbies.
Your task is to write your experience during this pandemic lockdown period, both negative and
positive. Describe elaborately what difficulties and opportunities have this lockdown period
presented to you. Your word limit is 500-800 words.
 COVID-19 PANDEMIC LOCKDOWN: DIFFICULTIES AND OPPORTUNITIES

The world is in an adverse situation because of the COVID-19 pandemic. As COVID-19 is a highly
infectious disease, we all are recommended to be extra conscious about washing our hands,
maintaining social distance, and staying at home to prevent this disease. Academic institutions and
workplaces are also closed. We are living in a lockdown situation for almost three months now.
During this lockdown period, I am experiencing some difficulties like everyone, but there are
plenty of opportunities for me as well.

The lockdown situation is creating difficulties by affecting my mental and social health. I cannot
even go outside without thinking about being infected. If I need to go out to buy groceries and
other necessary stuff, all I need to do is to take proper safety measures. Also, I always worry about
my parents and relatives who are working outside in this situation. Some of my relatives have
underlying medical conditions, and some are working as doctors and health workers at corona
units. So I continuously keep worrying about their health. Sometimes I get anxiety attacks thinking
about what if this lockdown situation never ends. I feel depressed thinking about good old days
with my friends now and then. As academic activities are being hampered, I am also distressed
about my professional life in the future. In this lockdown, I am sitting home all day, and there is
nothing much to do in our tiny apartment without surfing the Internet, scrolling through social
media, chatting with people, and watching series or movies. All of these are making me addicted to
the Internet. I am experiencing some health problems like severe headaches, eye burning, muscle
pain in shoulder and hand, etc. because of holding the phone and laptop before my eyes for hours.
The economy of our country is also falling. People are losing their business and jobs. It will be
very hard for our family if my parents lose their jobs. Therefore, I often worry about my family
income source and future condition. There are plenty of people in our country who cannot buy food
for them and their kids. People are getting infected by Coronavirus and dying every day. Some
have lost their family or friends. All these thoughts make me mentally distressed. Also, I cannot
meet my friends and relatives because of the lockdown situation. There are no weddings, reunions,
or other social gatherings. I cannot shake hands and hug people. Even if we meet, we have to
maintain social distancing, and these are affecting my social health as well. So I know that I cannot
ignore the difficulties I am experiencing during the lockdown.

But there are several opportunities for living in the lockdown situation as well. I used to be busy all
day with the university, study, and other stuff that I could not spend time with my parents. But now
as I am staying at home, I can spend time with them as much as I want. We can gossip, watch TV
and have a meal together every day. I can help my mother in the kitchen and watch her happy face.
Also, I finally have a lot of time talking to my old friends. It keeps my mental health well. In this
lockdown, I am having only homemade foods and trying to do some workouts as well. These are
helping me to stay healthy, both physically and mentally. Then, I have started learning some new
skills such as playing Harmonium, speaking French, and doing illustration. My father gifted me a
Harmonium when I was a kid, but I never felt fascinated about playing that. But in the lockdown, I
thought that it would be great if I learn to play a new musical instrument and surprise my father.
Learning French was like a wish for me. Finally, I have time to do online French courses. I am also
trying to learn illustration, which is giving me a lot of mental peace. Nowadays, I am also spending
time in Drawing. Drawing is an old hobby that I missed a lot on my busy days. Most importantly,
now, I can spend time with myself. I can watch series and movies, take a nap whenever I want,
read more books than ever, and do everything that makes me happy. All of these things are keeping
me mentally calm and healthy. These are the opportunities I am getting from the lockdown
situation, and I am thankful for these.

COVID-19 pandemic is a tough time for all of us. Surely we are facing lots of difficulties during
the lockdown situation. But at this moment, we have to be confident. So we can grab the
opportunities of this situation to stay positive and mentally healthy.

Task 2: We have discussed at length during Lecture 3 (Concept of disease and disease
prevention) how communicable and non-communicable diseases progress in our body, how
some people are susceptible to some certain diseases, how they are exposed to disease agent
(communicable diseases) or risk factors and enter the subclinical disease, what happens in the
subclinical stage, how people progress to the clinical stage of disease and then to the stage of
recovery, disability or death.
We have also discussed in the same lecture how we can prevent a disease using different level
of prevention, what activities are done during this stages and which group of people are
targeted in each level.
Now, your task is to reproduce these two models in the according to the topics (infectious
disease /non communicable disease) you choose individually. First describe about the disease
in short paragraph. Then discuss how we can prevent the disease in different levels of
prevention (according to level of prevention). Elaborate on the target groups for each level and
what are the steps taken (or can be taken) in each level. Your answer should be between 800-
1200words.
 CERVICAL CANCER CAUSED BY HPV NATURAL HISTORY AND LEVELS OF
PREVENTION

Introduction:  

Human papillomavirus (HPV) is the most frequent viral infection of the reproductive system. HPV
will infect most sexually active women and men at some point in their lives, and some may be
repeatedly affected. The peak time for getting an infection for both women and men is shortly after
becoming sexually active. Cervical cancer is cancer that arises from the cervix. It is because of the
abnormal growth of cells that can invade or spread to other parts of the body. There are numerous
types of HPV, and many do not create problems. At least 14 of them are cancer-causing or high-
risk type. Usually, HPV types 16 and 18 generate 70% of cervical cancers and pre-cancerous
cervical lesions. After the acquisition, HPV infections generally clean up without any intervention
within a few months. Within two years, about 90% infection clears up. Almost all HPV infections
tidy up on their own, and most pre-cancerous lesions resolve spontaneously. Still, there is a risk for
all women that HPV infection may become chronic, and pre-cancerous lesions progress to cervical
cancer.
 
Global and Bangladesh situation:
 
 
Cervical cancer is the fourth most familiar cancer in women worldwide. Approximately 570000
new cases are found in 2018, representing 7.5% of all cancer deaths in females. More than 311000
women die from cervical cancer every year, more than 85% of these occur in less developed
regions like Bangladesh. In developing countries like Bangladesh, cervical cancer is the second
most common cancer in women. Effective interventions could reduce the high mortality rate from
cervical cancer globally (Age Standardized Rate: 6.9/100,000 in 2018). (1)

 Risk Factors: 
 
There are some risk factors for HPV persistence and the development of cervical cancer. Those are
given below-

 Many sex partners:  There is a 20% chance an uninfected partner can pick up the virus. A
new study includes, if one person in a heterosexual couple has HPV, there's a 20 percent
chance his or her partner will get the virus within six months. That's why a person who has
many sex partners may spread a high-risk type of HPV from one to another.

 Early sexual activity: As sexual behavior regulates exposure to HPV, early age at sexual
intercourse is related to an increased risk of high-risk HPV infection.

 Multiple pregnancies: Parturition of more than five children, or having them at an early age
(under 17 years old), can increase the risk of HPV infection and cervical cancer.
  Smoking and tobacco use: Women who inhale smoke are twice more likely to develop
cervical cancer than those who do not smoke; this is probably because of the harmful
effects of chemicals found in tobacco in the cervix's cells.

 Oral contraceptives: Long-term use of oral contraceptives is associated with an increased

risk of cervical cancer. Women who have consumed oral contraceptives for 5 to 9 years
have about three times the incidence of invasive cancer, and those who used them for ten
years or longer have about four times the risk.

 Immunosuppression: Immune system suppression and its capacity to fight infection are
called Immunosuppression. Generally, it takes 15 to 20 years for cervical cancer to grow in
women with healthy immune systems. In women with weakened immune systems, it can
take only 5 to 10 years.

 Other STIs: Women who have HIV or other STIs are more susceptible to high-risk HPV
infection because their already weakened immune system cannot automatically clear up the
HPV.

Transmission: 

HPV is sexually transmitted, but the transmission does not require penetrative sex. A well-
recognized mode of transmission is skin-to-skin genital contact.

 Cervical cancer progression:

 Stage of susceptibility: The stage of susceptibility refers to the state of being vulnerable;
lack of ability to resist HPV agent. Sexually active women with many sexual partners and
other STIs like HIV are at risk of cervical cancer. Women who consume oral contraceptives
for an extended period, have multiple pregnancy history, have a weakened immune system,
inhale smoke, and use tobacco products are susceptible to HPV exposure. Also, women
who started sexual activity at an early age are high at risk.

 
 Subclinical stage: This stage starts after exposure to the cancer-causing or high-risk HPV
agent. The subclinical stage is the incubation period of the agent. In this time, some
pathological changes happen in the cells of the cervix without showing any symptoms. In
women with a healthy immune system, this stage is 15 years to 20 years long. But in
women who have weakened immunity, the stage is only 5 to 10 years long.

 Clinical stage: When a woman presents symptoms of suspicion for cervical cancer, she
must be mentioned to an appropriate facility for evaluation, diagnosis, and treatment. Here
the clinical-stage begins. Symptoms of early-stage cervical cancer may : 
 Light bleeding between periods in women of conceptive age or irregular blood spotting. 
 Postmenopausal spotting or bleeding
 Bleeding after sexual intercourse; and
 Increased vaginal discharge, sometimes foul-smelling.

 
 As cervical cancer proceeds, more severe symptoms may appear including:

 Persistent back, leg, and pelvic pain

 Fatigue, loss of appetite and weight loss
 Vaginal discomfort and foul-smell discharge
 Swelling of a leg or both lower parts.

                    
     
As soon as the symptoms reveal, a histopathologic examination must make for diagnosis. Staging
is done based on tumor size and the spread of cancer within the pelvis and to distant organs.
Further, prevention depends on the stage of the disease. 

 Stage of recovery or death:  In this stage, a cervical cancer patient recovers if the treatment
works. Cervical cancer can be healed if diagnosed at an early stage. If not diagnosed and
treated or treatment does not work, cervical cancer can spread to other parts of the body and
become deadly.
 
 
Four levels of cervical cancer prevention:
 
 Primordial prevention: In this level of prevention, different programs take action to
minimize future hazards, known to increase the risk of growing cervical cancer from HPV
infection early in life. Primordial prevention includes a healthy lifestyle and safe sex. The
targeted group of primordial prevention is the whole population, especially women.
 
 Primary prevention: Primary prevention aims to reduce HPV infection and cervical cancer
through personal and community efforts at the stage of susceptibility. This prevention level
includes HPV vaccination and health promotion about HPV infection and cervical cancer
in the community. The targeted group of primary prevention (HPV vaccination) is 9-14
years of girls.
 
 HPV vaccination: Currently, three vaccines are protecting against both HPV 16
and 18, which are known to cause at least 70% of cervical cancers. The third
vaccine protects against three additional oncogenic HPV types, which create a
further 20% of cervical cancers. Therefore, WHO recommends vaccinating girls
aged between 9 and 14 years, when most have not started the sexual activity.
 
 Health promotion: Health promotion for HPV infection and cervical cancer
includes-
o Warning about tobacco use and health information
o Sex education tailored to age and culture
o Condom promotion and provision for those engaged in sexual activity
o Male circumcision
 Secondary prevention: Secondary prevention aims to detect and treat cervical cancer at the
subclinical stage and halts the spread of disease. Screening programs are included in this
prevention level. The targeted group of secondary prevention is women aged between 30
years old or older.
  Screening: Cervical cancer screening requires testing for pre-cancer and cancer
amid women who may feel perfectly healthy and have no symptoms. Screening can
ascertain cancer at an early stage, and treatment has a high potential for cure. WHO
currently recommends three types of screening tests:
o HPV testing for high-risk HPV types.
o visual inspection with Acetic Acid (VIA)
o conventional (Pap) test and liquid-based cytology (LBC)
 
 Tertiary prevention: Tertiary prevention is the treatment of invasive cervical cancer at the
clinical stage. The targeted group of tertiary prevention is women who need treatment as
require. This level of prevention includes-
 
 Surgery: Surgery to remove the cervix and some or all the womb. There are three
main types of cervical cancer surgery, such as trachelectomy, hysterectomy, and
pelvic exenteration.
 
 Radiotherapy: This therapy may be used on its own or in combination with surgery
or chemotherapy. The treatment can be delivered either externally or internally.

 Chemotherapy: Chemotherapy can be applied together with radiotherapy to try to

treat cancer, or it can be used as a single treatment for advanced cancer to its
progression.

 Palliative care: The treatment consists of the prevention and relief of suffering
through early identification and assessment and treatment of pain and other forms
of physical, psychosocial, and spiritual suffering.
 
Conclusion: 
 
Cervical cancer is a threat to women's health, indeed, but it can be cured. If we follow each
prevention level carefully, we can prevent HPV infection and cervical cancer from the root level.

References:

(1) https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-
and-cervical-cancer