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HEALTH IMPACT FRAMEWORK/RESEARCH PAPER

Health Impact Framework/Research Paper - Communicable Diseases – Chikungunya – South

America

Chikungunya virus (CHIKV) is a transmitted by mosquitoes, most commonly Aedes

aegypti and Aedes albopictus, with clinical manifestations of abrupt fever, joint pain, muscle

pain, headache, nausea, fatigue, and rash (WHO, 2022). The onset of symptoms can typically

occur four to eight days after a person has been bitten by the mosquito (WHO, 2022). Most

people fully recover from the virus but there are cases of complications and even death with

newborns and older adults (WHO, 2022). Currently there is vaccine for the virus but, symptoms

can be managed with antipyretics, analgesics, plenty of fluids, and rest (Staples et al, 2023).

Prevention is the best way to mitigate the virus by doing the best in protection against mosquito

bites such as repellants, clothing which minimizes skin exposure, insecticides, cleaning

containers that contain water on a weekly basis, and disposing of waste (WHO, 2022). Outbreaks

of CHIKV has occurred in Africa, Asia, the Americas, and Europe (Staples et al, 2023).

Application of the Health Impact Pyramid

The Health Impact Pyramid is a 5-tier pyramid that is a framework to improve health by

indicating interventions with the greatest potential impact and maximize public health benefit

(Frieden, 2011). The five tiers consist of socioeconomic factors, changing the context for health

decisions, clinical interventions, long-lasting protective interventions, as well as counseling and

education (Frieden, 2011). The bottom tier, socioeconomic status, can also be known as social

determinants of health (Frieden, 2011). The second tier, changing the context of health decisions,

is a way for individuals to choose healthier options that wouldn’t normally be the default choice

regardless of their income, education, or societal factors (Frieden, 2011). The third tier, long-

lasting protective interventions, can be things such as immunizations that allow for long term
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protection against a certain disease (Frieden, 2011). The forth tier, clinical interventions, would

be ongoing management of a disease such as keeping up with blood pressures or taking

medication if a person has hypertension (Frieden, 2011). The final tier, counseling, and education

can be the least effective of the tiers because not only does it involve educating the patient on

certain interventions but holding them accountable to follow through with the education

(Frieden, 2011).

Socioeconomic Factors

CHIKV is very significant in locations that are tropical and subtropical regions and

mostly during tropical rainy seasons and subside during dry seasons (Staples et al, 2023).

CHIKV is a of global health significance that is of worldwide circulation (Morgan et al, 2021).

Some climate and socio-economic factors that affect the spread of CHIKV are average

temperature, minimum wind speed, inadequate sanitation, poor water supply, high population

density, and poor housing construction (Morgan et al, 2021). Latin America has seen significant

numbers because not only do they have a tropical climate but, they are limited on medical

resources and vector control programs (Morgan et al, 2021).

Changing the Context to Make Individuals’ Default Decisions Healthy

One way to help the problem with chikungunya in South America is for the government

to help out and create a vector control program. In 2018, the USAID-funded ZICORE project

was started in Guatemala that allowed monitoring and surveillance of mosquitos populations in

order to target effective physical vector control without the use of chemicals (Allen et al, 2018).

The same thing could be done for chikungunya. This project allowed community members to

identify environmental modifications each household could do such as eliminating or covering

containers, so they do not become a breeding site (Allen et al, 2018). The MCDI also conducted
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weekly situation rooms with members from the community to go over data to plan targeted

actions to prevent transmission of Zika, dengue, and chikungunya which allowed for there to be

reduced breeding sites in 49 communities (Allen et al, 2018).

Long-Lasting Protective Interventions

Currently there is not a vaccine to prevent chikungunya but, research is being done to aid

in this although there are barriers that create complications such as lack of funding (Millsapps et

al, 2022). There have been many attempts at creating a vaccine for chikungunya that have made

it to clinical trials however, funding has been a major issue that limits the research that would

make it safe and effective (Millsapps et al, 2022). One of the reasons for lack of funding is

because chikungunya is considered a neglected tropical disease and many cases go unnoticed and

undiagnosed (Millsapps et al, 2022). There is a need for more resources and increased

surveillance to allow the prevalence to be more adequate (Millsapps et al, 2022).

Clinical Interventions

Some ways to manage symptoms of the CHIKV is rest, fluids, antipyretics, analgesics,

and nonsteroidal anti-inflammatory drugs (CDC, 2023). Acetaminophen is the preferred first line

treatment for joint pain but, there is also a risk of hemorrhage (CDC, 2023). There is research

being done for natural treatment options for those in low resource areas around the globe where

the virus affects the most such as South America (Millsapps et al, 2022). These natural treatment

options include homeopathy, such as herbal products and medical plants, physiotherapy, and

home remedies such as rest and fluids (Millsapps et al, 2022).

Counseling and Education

Even though there is no vaccine fight the CHIKV, nurses play a vital role in prevention

education. Teaching patients about the use of DEET, long-sleeve clothing, and reduction of
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stagnant water can help prevent mosquito breeding grounds and getting bitten. This will help the

transmission of the virus. Nurses also play a role in creating a rapport with their patients to learn

their individual needs in order to give them resources that will help.

Future Interventions

Some future interventions that would be helpful when it comes to the CHIKV is a vector

control program, education of prevention, and a vaccine. The vaccine is probably the hardest

intervention to control due to lack of funding and research but, this would help the transmission

of the virus tremendously. Education plays a huge role because it is an easy way to prevent

transmission with limited resources.

Culture & Health Beliefs

Skolnik defines culture as, “a set of rules or standards shared by members of a society,

which when acted upon by the members, produce behavior that falls within a range of variation

the member considers proper and acceptable (2021).” Culture can include some of the following

domains such as family, religion, communication, economy, and social groups (Skolnik, 2021).

Members of the South American community, specifically Latinos, underutilize health care due to

lack of access, cultural beliefs, and structural barriers such as immigration (Gast et al, 2017).

Some cultural beliefs of the Latino community are about gender and family roles. Men may be

more likely to seek out health care if it allows them to still work and care for their families and

not be dependent on others for their health (Gast et al, 2017). Due to their reliance on fatalistic

beliefs, Latinos are less likely to seek medical prevention screenings for diseases and usually do

not know they have a medical concern until it is too late, or they already have the disease (Gast

et al, 2017).

Professional Opportunities
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There is a lot of professional opportunities for global health professionals. Global health

professionals can study different diseases to research treatment plans and mitigating transmission

(Global Health, 2020). Other things a global health professional can do is collaborate with

governmental agencies and relief organizations to promote medical awareness (Global Health,

2020). Individuals who want to become global health professionals should acquire at minimum a

master’s degree in public or international health, a certification in CPR and first aid, and take the

foreign service exam (Global Health, 2020). There are many volunteer opportunities for global

health professionals as well.

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Resources

Allen, T., Barbour, R., Barry, A., Kachur, S. P., Kieltyka, E., Macy, P., Morton, J., Mullins, D.,
Smits, H., Stover, H., & Warhol, A. (2018). 2018 - MCD. MCD Public Health.
https://www.mcd.org/docs/MCD-2018-Annual-Report.pdf

Centers for Disease Control and Prevention. (2023, November 22). Treatment & prevention.
Centers for Disease Control and Prevention.
https://www.cdc.gov/chikungunya/hc/treatment-prevention.html#:~:text=No%20specific
%20antiviral%20treatment%20is,with%20acute%20fever%20and%20pain.

Frieden, T. (2011, August 30). A framework for Public Health Action: The Health Impact
Pyramid | AJPH ... American Journal of Public Health.
https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.185652

Gast, J., Peak, T., & Hunt, A. (2017, June 23). Latino Health Behavior: An exploratory analysis
of health risk and health protective factors in a community sample. American journal of
lifestyle medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933562/

Global health. PublicHealth.org. (2020, June 4). https://www.publichealth.org/careers/global-

health/

Millsapps, E. M., Underwood, E. C., & Barr, K. L. (2022, December 16). Development and
application of treatment for chikungunya fever. Research and reports in tropical medicine.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767026/

Morgan, J., Strode, C., & Salcedo-Sora, J. E. (2021, March 11). Climatic and socio-economic
factors supporting the co-circulation of Dengue, Zika and Chikungunya in three different
ecosystems in Colombia. PLoS neglected tropical diseases.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987142/

Skolnik, R. (2021). Global health 101, 4th edition. Jones & Bartlett Learning.

Staples, E., Hill, S., & Powers, A. (2023, May 1). Chikungunya. Centers for Disease Control and
Prevention.
https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/chikungunya

World Health Organization. (2022, December 8). Chikungunya fact sheet. World Health
Organization. https://www.who.int/news-room/fact-sheets/detail/chikungunya#:~:text=In
%20symptomatic%20patients%2C%20CHIKV%20disease,bite%20of%20an%20infected
%20mosquito.