Global Burden of Disease — MCQs
Which of the following is NOT a core component of the WHO's global STI control strategy?
HIV sentinel surveillance is used for:
To reduce mortality by CHD, best strategy -
According to Sustainable Development Goal 3 (SDG 3) - 'Ensure healthy lives and promote well-being for all at all ages', what is the target for reducing the global maternal mortality ratio by 2030?
WHO global target for prevention and control of non communicable diseases by 2025 is to decrease the prevalence of raised blood pressure (hypertension) by
The most comprehensive indicator of cost-effectiveness analysis is
Transition from increased prevalence of infectious and communicable diseases to man-made diseases is known as
Which of the following best describes the concept of 'Years of Potential Life Lost' (YPLL)?
Which of the following statements is TRUE regarding Disability-Adjusted Life Year (DALY)?
What is the prevalence in a given population of 1000, where there are 50 new cases of lung cancer and 100 old cases of lung cancer in the same population?
Global Burden of Disease Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a core component of the WHO's global STI control strategy?
- A. Case management
- B. Universal mandatory screening (Correct Answer)
- C. Strategic information systems
- D. Prevention services
Explanation: ***Universal mandatory screening*** - While screening is part of STI control, **universal mandatory screening** for all STIs in the general population is not a core component of the WHO's strategy due to feasibility, cost, and ethical considerations. - The strategy emphasizes **targeted screening** for at-risk populations and opportunistic screening. *Case management* - **Case management**, including accurate diagnosis and effective treatment, is a critical component for managing current infections and preventing further transmission. - This involves syndromic or etiologic approaches to treatment and partner notification. *Strategic information systems* - **Strategic information systems** are essential for monitoring trends, evaluating interventions, and informing policy decisions related to STI control. - This includes surveillance data, program monitoring, and research. *Prevention services* - **Prevention services** are a cornerstone of the WHO's strategy, aiming to reduce the incidence of new infections. - These services encompass health education, condom promotion and distribution, vaccination, and pre-exposure prophylaxis (PrEP).
Question 2: HIV sentinel surveillance is used for:
- A. Detection of high-risk group
- B. Prevalence of HIV infection
- C. Monitoring trends in HIV infection (Correct Answer)
- D. Monitoring disease trends
Explanation: ***Monitoring trends in HIV infection*** - **HIV sentinel surveillance** is specifically designed to track **HIV prevalence trends** over time in selected sentinel populations (ANC attendees, STD clinic attendees, high-risk groups). - The primary objective is to monitor **how HIV infection rates change** over time, helping identify emerging epidemics, evaluate intervention programs, and guide public health policy. - As per **NACO and WHO guidelines**, sentinel surveillance provides repeated cross-sectional prevalence measurements at fixed sites to detect temporal trends in HIV infection. *Monitoring disease trends* - This is **too broad and vague** for the specific purpose of HIV sentinel surveillance. - "Disease trends" could refer to AIDS progression, opportunistic infections, or other disease manifestations, which are **not the focus** of sentinel surveillance. - Sentinel surveillance specifically tracks **infection (seroprevalence)**, not general disease patterns. *Prevalence of HIV infection* - While sentinel surveillance **does measure prevalence**, this is a **method rather than the ultimate purpose**. - Prevalence measurements are taken repeatedly at different time points specifically to **monitor trends**, making this incomplete as the primary objective. *Detection of high-risk group* - Identification of high-risk groups is typically done through **epidemiological studies** and behavioral surveys, not sentinel surveillance. - Sentinel surveillance may **include** high-risk populations as sentinel sites, but its purpose is to monitor trends **within** these groups, not to detect them.
Question 3: To reduce mortality by CHD, best strategy -
- A. Secondary prevention
- B. Primordial prevention (Correct Answer)
- C. Tertiary prevention
- D. None of the options
Explanation: ***Primordial prevention*** * This strategy aims to prevent the **development of risk factors** for CHD in the first place, thus preventing the disease itself. * It focuses on promoting healthy lifestyles and environments from early life, targeting populations rather than individuals. *Secondary prevention* * This involves actions taken after an individual has developed **risk factors** for CHD or has been diagnosed with the disease, to prevent recurrence or worsening. * Examples include medication (e.g., statins, antiplatelets) for people with high cholesterol or a history of heart attack. *Tertiary prevention* * This strategy aims to reduce the **impact of an existing disease** on a patient's daily life and prevent further complications, disability, or death. * For CHD, this would include cardiac rehabilitation, surgical interventions like CABG, and managing co-morbidities to improve quality of life and prolong survival. *None of the options* * Given that primordial prevention directly addresses the prevention of risk factors and thus the disease itself, it is the most effective strategy for **reducing overall mortality** at the population level. * Therefore, one of the provided options is indeed the best strategy.
Question 4: According to Sustainable Development Goal 3 (SDG 3) - 'Ensure healthy lives and promote well-being for all at all ages', what is the target for reducing the global maternal mortality ratio by 2030?
- A. 100
- B. 50
- C. 70 (Correct Answer)
- D. 90
Explanation: ***70*** - SDG 3 aims to reduce the **global maternal mortality ratio** to less than **70 per 100,000 live births** by 2030. - This target emphasizes improving maternal health outcomes worldwide and preventing deaths related to pregnancy and childbirth. *100* - While a reduction is sought, a target of 100 per 100,000 live births is **not ambitious enough** to meet the specific goal set by SDG 3. - The established global target is lower, reflecting a greater commitment to maternal health. *50* - A target of 50 per 100,000 live births would be **more ambitious** than the SDG 3 goal. - While desirable, it is not the specific, agreed-upon target for the global average under SDG 3. *90* - A target of 90 per 100,000 live births is **higher** than the established SDG 3 goal. - This value does not align with the specific global maternal mortality ratio target set for 2030.
Question 5: WHO global target for prevention and control of non communicable diseases by 2025 is to decrease the prevalence of raised blood pressure (hypertension) by
- A. 75%
- B. 25% (Correct Answer)
- C. 90%
- D. 55%
Explanation: ***25%*** - The World Health Organization (WHO) set a **global target** to achieve a **25% relative reduction** in the prevalence of **raised blood pressure (hypertension)** by 2025 (compared to 2010 baseline). - This target is part of the **WHO Global Action Plan for NCDs** and the Global Monitoring Framework to combat **non-communicable diseases (NCDs)**. *75%* - A 75% reduction in hypertension prevalence is an **unrealistically ambitious** target given current global health challenges and interventions. - While significant reductions are desired, the evidence-based target set by WHO is a more achievable 25% reduction. *90%* - A 90% reduction is not one of the specifically stated **WHO global targets** for hypertension by 2025. - Such a drastic reduction would require unprecedented public health interventions and is not supported by current evidence. *55%* - 55% is not a recognized **WHO target** for the prevention and control of hypertension by 2025. - The established global target from the WHO NCD Global Monitoring Framework specifically focuses on a **25% relative reduction**.
Question 6: The most comprehensive indicator of cost-effectiveness analysis is
- A. Number of heart attacks avoided
- B. Cost per life year gained
- C. Number of life years gained
- D. QALYs gained (Correct Answer)
Explanation: ***QALYs gained*** - **Quality-Adjusted Life Years (QALYs)** is the most comprehensive measure in cost-effectiveness analysis as it accounts for both the quantity and quality of life - Combines years of life added with a utility score reflecting health-related quality of life during those years - Provides a holistic view that captures both mortality and morbidity benefits of interventions *Number of heart attacks avoided* - Specific to a single clinical outcome and does not account for other health benefits or adverse effects - While important for cardiovascular interventions, it is too narrow to serve as a comprehensive cost-effectiveness indicator - Does not capture broader impact on overall health, quality of life, or longevity *Cost per life year gained* - Focuses on the quantity (length) of life gained but does not consider the quality of those gained years - An intervention might add years of life that are of poor quality, which this measure cannot differentiate - Less comprehensive than QALYs as it misses the health status dimension *Number of life years gained* - Only considers the extension of life without incorporating health status or quality of life during additional years - Provides an incomplete picture as it treats all life years equally regardless of health state - A longer life with significant disability would be valued the same as healthy years
Question 7: Transition from increased prevalence of infectious and communicable diseases to man-made diseases is known as
- A. Demographic transition
- B. Paradoxical transition
- C. Epidemiological transition (Correct Answer)
- D. Reversal of transition
Explanation: ***Epidemiological transition*** - This term describes the shift in **disease patterns** observed in many populations, moving from a predominance of **infectious and communicable diseases** to an increased prevalence of **chronic, non-communicable diseases** (often described as "man-made" due to their association with lifestyle and environmental factors). - This transition is typically linked to advancements in **public health**, sanitation, medicine, and changes in socioeconomic status. *Demographic transition* - This concept describes the historical shift from high **birth rates** and **death rates** to low birth rates and death rates as a country develops from a pre-industrial to an industrialized economic system. - While related to disease patterns through changes in population structure, it directly focuses on **population growth** and age distribution, not specific disease prevalence. *Paradoxical transition* - This is not a recognized or standard public health or demographic term for the described phenomenon. - The term "paradoxical" would imply a contradictory or unexpected outcome, which is not the primary descriptor for the shift in disease patterns. *Reversal of transition* - This term would imply a return to previous patterns, such as an increase in **infectious diseases** after a period of decline. - While possible in specific contexts (e.g., due to antibiotic resistance or weakened public health systems), it does not describe the initial shift from infectious to man-made diseases.
Question 8: Which of the following best describes the concept of 'Years of Potential Life Lost' (YPLL)?
- A. Years lost due to illness or morbidity
- B. Years lost due to premature mortality (Correct Answer)
- C. Years lost due to disability
- D. Years lost due to poor health quality
Explanation: ***Correct Answer: Years lost due to premature mortality*** - **Years of Potential Life Lost (YPLL)** is a measure of premature mortality, calculated by subtracting the age at death from a predetermined standard age (e.g., 75 or 65 years) - It quantifies the **societal and economic impact** of deaths occurring before a statistically expected lifespan, giving more weight to deaths at younger ages - YPLL emphasizes the burden of **early deaths** on society, making it particularly useful for prioritizing public health interventions *Incorrect: Years lost due to illness or morbidity* - This concept describes the **burden of living with illness**, not necessarily dying prematurely - While related to health outcomes, it is distinct from YPLL, which specifically focuses on the impact of **death** *Incorrect: Years lost due to disability* - This is a component of **Disability-Adjusted Life Years (DALYs)**, specifically the **Years Lived with Disability (YLD)** component - It does not directly account for **mortality**, but rather the impact of non-fatal health outcomes - YLD measures the burden of living with health conditions, not years lost to premature death *Incorrect: Years lost due to poor health quality* - This is a broad term that can encompass various aspects of health - While related to the overall societal health burden, it is not a specific, standardized metric like YPLL - YPLL has a precise definition and calculation method focused exclusively on **premature death**
Question 9: Which of the following statements is TRUE regarding Disability-Adjusted Life Year (DALY)?
- A. Years lost due to disability (YLD) are not considered in DALY.
- B. DALY only measures mortality and does not include morbidity.
- C. DALY does not account for both YLD and YLL.
- D. DALY includes both Years of Life Lost (YLL) and Years Lived with Disability (YLD). (Correct Answer)
Explanation: ***DALY includes both Years of Life Lost (YLL) and Years Lived with Disability (YLD).*** - This statement is **correct**. The fundamental formula is **DALY = YLL + YLD**. - **YLL (Years of Life Lost)** quantifies the burden of premature mortality by measuring years of potential life lost due to early death. - **YLD (Years Lived with Disability)** quantifies the burden of morbidity by measuring time lived in states of less than full health. - **DALY** is a comprehensive health metric designed to capture the total burden of disease by integrating both mortality and morbidity components. - This unified metric allows comparison of disease burden across different conditions and populations. *Years of Life Lost (YLL) is not included in DALY calculations.* - This is **incorrect**. YLL is a core component of DALY calculations, representing the mortality burden. *Years lost due to disability (YLD) are not considered in DALY.* - This is **incorrect**. YLD is an essential component of DALY, representing the morbidity burden. *DALY only measures mortality and does not include morbidity.* - This is **incorrect**. DALY explicitly measures both mortality (through YLL) and morbidity (through YLD), making it a comprehensive burden of disease measure.
Question 10: What is the prevalence in a given population of 1000, where there are 50 new cases of lung cancer and 100 old cases of lung cancer in the same population?
- A. 1.50%
- B. 15% (Correct Answer)
- C. 150
- D. 13%
Explanation: ***Correct: 15%*** - **Prevalence** is the proportion of a population living with a disease at a specific time point. It includes both new and existing (old) cases. - **Calculation:** Total cases = 50 (new cases) + 100 (old cases) = 150 cases - **Prevalence rate** = (150 / 1000) × 100% = **15%** - Prevalence answers the question: "What proportion of the population has the disease right now?" *Incorrect: 1.50%* - This value represents a calculation error, likely from dividing 150 by 10,000 instead of 1,000 - It underestimates the actual prevalence by a factor of 10 - Would only be correct if there were 15 total cases, not 150 *Incorrect: 150* - This is the **absolute count** of individuals with lung cancer (both new and old cases) - Prevalence must be expressed as a **proportion or percentage**, not a raw count - Raw counts cannot be compared across populations of different sizes *Incorrect: 13%* - This would only be correct if there were 130 total cases, not 150 - This miscalculation fails to properly sum the new cases (50) and old cases (100) - The arithmetic is incorrect: 50 + 100 ≠ 130
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