Deck 20: Health and Demographics in Skolnikland

Question 1

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In Skolnikland today, approximately what proportion of the burden of disease, measured in DALYs, is likely to be Group I - communicable, maternal, perinatal, and nutrition-related? (Perinatal refers to the period just before and after birth).

A) 60%
B) 35%
C) 25%

Answer 1

A
Skolnikland is a very low-income country in Africa. Group I causes are a much larger share of the burden in these settings than Group II causes, NCDs, or Group III causes, injuries. The only plausible answer is "a". The IHME says that for sub-Saharan Africa (SSA), for example, Group I causes accounted for about 62% of the burden of disease (BOD) in 2017.

Question 2

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were India, a lower middle-income country in South Asia, with a very large share of poor people in its population and a per capita income of about $1,900, then what proportion of the burden of disease, measured in DALYs, would you expect to be Group I - communicable, maternal, perinatal, and nutritional?

A) 60%
B) 10%
C) 30%

Answer 2

C
The only plausible answer is 30%. 60% would be typical only among the very poorest countries in the world. 10% would be typical only of countries that are close to being like the better off countries.

Question 3

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were Ecuador, (which is an upper middle-income country in Latin America with many indigenous people and a per capita income of $6,300), what share of the burden of disease today, measured in DALYs, would likely be Group I - communicable, maternal, perinatal, and nutritional?

A) 5%
B) 40%
C) 20%

Answer 3

C
The only really plausible answer is 20%. Ecuador still has many indigenous people who are poor, with a relatively high burden of Group I conditions. If it were 40%, it would mean that Ecuador would have an even mix of Group I and II causes, which would be more like India than like a middle-income country in Latin America and the Caribbean (LAC). If it were 5%, the BOD would be more like only the very best off countries in the world.

Question 4

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were Chile (a high-income country with a small share of indigenous people), what share of the burden of disease, measured in DALYs, would you expect to be noncommunicable - Group II?

A) 80%
B) 40%
C) 30%

Question 5

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In Skolnikland, what are likely to be three of the ten leading causes of death of under-five children, besides perinatal causes?

A) malaria, diarrhea, measles
B) diarrhea, malaria, pneumonia
C) fire, diarrhea, pneumonia

Question 6

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In Skolnikland, what are likely to be two of the five leading causes of death of adults age 15-49?

A) Stroke, interpersonal violence
B) HIV, TB
C) Stroke, heart disease

Question 7

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were Argentina (an upper middle-income country in Latin America with few indigenous people), what are likely to be two of the five leading causes of deaths of people 50 to 69 years of age?

A) Self harm, lung cancer
B) Ischemic heart disease, stroke
C) Road traffic injury, self harm

Question 8

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In Skolnikland, which of the following risk factors is associated with the least number of deaths among children under five years of age?

A) Secondhand smoke
B) Unsafe water
C) Unsafe sanitation

Question 9

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-What is a DALY?

A) A WHO indicator used to summarize the expected number of years to be lived in good health
B) A composite health gap indicator that measures the amount of health and disability free life that is lost because of disease, injury, and premature death
C) An indicator that compares the burden of deaths across the population of different countries

Question 10

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were India, what risk factor would be associated with the largest loss of Deaths in under-five children?

A) Zinc deficiency
B) Iron deficiency
C) Childhood growth failure

Question 11

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In which of these countries, ranked in order of income per capita, would you expect health expenditure per person in dollars (at purchasing power parity) to be the highest?

A) Skolnikland
B) Nigeria
C) Uruguay

Question 12

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In which of these countries, ranked in order of income per capita and level of development of their universal health coverage (UHC) scheme, would you expect out of pocket costs for health to be a lowest share of total health costs?

A) Skolnikland
B) The Philippines
C) Chile

Question 13

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were Italy, a high-income country with below replacement fertility, what would a graphical portrayal of the population distribution by age and sex most look like?

A) A coke bottle
B) A cylinder
C) A pyramid

Question 14

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland experiences a modest but continuing decline in fertility over the next twenty years, then what you would expect a graphical portrayal of the population distribution by age and sex for 2030 to look most like?

A) A coke bottle
B) A cylinder
C) A pyramid, with a narrower base than for the 2015 population

Question 15

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-The demographic transition is:

A) The shift from high mortality to medium mortality and high fertility to medium fertility
B) The shift from high fertility and high mortality to low fertility and low mortality
C) The shift from high rates of communicable diseases to high rates of non-communicable diseases

Question 16

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-The epidemiological transition includes:

A) The shift from a high rate of non-communicable diseases to a low rate of non-communicable diseases
B) The shift from a high rate of communicable disease to a low rate of communicable disease
C) The shift from high fertility and high mortality to low mortality and low fertility

Question 17

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-What is the most plausible explanation for the exceptionally skewed ratio of men to women in some parts of East and South Asia?

A) Sex selective abortion
B) The fact that boys survive better at birth than girls do
C) Families give better care to boys than to girls

Question 18

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In Skolnikland, what is likely to be the ratio of the maternal mortality ratio for the lowest-income quintile, compared to that for the highest-income quintile?

A) 1 to 1
B) 2 to 1
C) 5 to 1 or greater

Question 19

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-As a larger and larger share of HIV positive people are put on treatment, what would you expect will happen in Skolnikland, at least in the short run, if the rates of new infection stay about where they are now?

A) Prevalence of HIV will go up
B) Prevalence of HIV will go down
C) Prevalence of HIV will stay the same

Question 20

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-Which one of the following is an example of a conditional cash transfer that you could feasibly employ in Skolnikland to improve child health?

A) Give money to mothers whose children get a full course of vaccination
B) Provide tax breaks to families with children
C) Pay higher fees to vaccination programs with better outcomes

Question 21

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-For which of these would the concept of DALYs add the least value, compared to measuring deaths, to capture the true burden of health gaps?

A) Neglected tropical diseases (NTDs)
B) Mental illness
C) Pneumonia among the very old

Question 22

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-Against which metric would you ideally measure the cost-effectiveness of your vaccination program?

A) Cost per DALY averted
B) Deaths averted
C) Number of vaccines given

Question 23

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-Which force is likely to have the greatest direct impact on the burden of disease in the medium- and long-run on today's middle-income countries?

A) Population aging
B) Population growth
C) Urbanization

Question 24

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were to implement a single payer national health insurance program, which would be the most feasible way of financing it in the short run?

A) Central tax fund
B) A combination of Individual premiums and employer premiums
C) Premiums paid by employers

Question 25

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In Skolnikland, the cost for treatment of lower respiratory infections in young children is $20 for community-based care and $30 for clinic-based care. The "cure rate" for community-based care is 50%. The cure rate for clinic-based care is 80%. Which approach is the most cost-effective?

A) Clinic-based care
B) Community-based care
C) They are equally cost-effective

Question 26

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In Skolnikland, what share of the deaths of children under-five are likely to occur among neonates?

A) 10%
B) 30%
C) 60%

Question 27

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If Skolnikland were Denmark, a high-income country that is among the most "developed", what share of the under-five child deaths would be among neonates?

A) 10%
B) 20%
C) 70%

Question 28

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-What is the most accurate statement about the distribution of age at death in Niger (a very low-income country) and Norway (a very high-income country) today?

A) About 30% of the deaths in Niger are among those under 15, while the overwhelming majority of deaths in Norway are among those over 65
B) About 5% of the deaths in Niger are among those under 15, while the overwhelming majority of deaths in Norway are among those over 65
C) The deaths of children under 15 in both countries are a small proportion of total deaths in those countries.

Question 29

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-If you were interested in investing in maternal and child health using a results-based financing scheme, which program would be the most appropriate?

A) A plan to give the local clinic in the village a grant after the clinic demonstrates that its efforts have led to lower under-five child mortality
B) Invest in training more skilled birth attendants in a village
C) Provide all pregnant women in the village with a full course of antenatal vitamins

Question 30

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-During the demographic transition, which of the following generally takes place?

A) Fertility falls before mortality falls
B) Mortality falls and then fertility falls
C) Mortality and fertility fall at the same time

Question 31

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, which would be the highest share of total DALYs, for all age groups and both sexes?

A) Group I
B) Group II
C) Group III

Question 32

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-If Skolnikland were Malawi (a low-income country in southeastern Africa), which would be the highest share of DALYs for all age groups and both sexes?

A) Group I
B) Group II
C) Group III

Question 33

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, what are likely to be two of the three leading causes of death of adults aged 50 to 69 years?

A) Road injuries, Stroke
B) Self-harm, ischemic heart disease
C) Stroke, ischemic heart disease

Question 34

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-If Skolnikland were Malawi, (one of the poorest countries in sub-Saharan Africa, with an 8 percent prevalence of HIV/AIDS in adults and 50 percent of the HIV-affected receiving ART), what would likely be two of the three leading causes of deaths in adults aged 50 to 69 years?

A) COPD, HIV/AIDS
B) HIV/AIDS, TB
C) Ischemic heart disease, chronic kidney disease

Question 35

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following is the largest cause of DALYs in Skolnikland for all age groups and both sexes?

A) Lung cancer
B) HIV/AIDS
C) Ischemic heart disease

Question 36

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-What cause noted below is likely to contribute to the most deaths in Skolnikland among adolescents and young adults?

A) Malaria
B) Lower respiratory infections
C) Road Traffic injuries

Question 37

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following is likely to cause the most DALYs among adolescent and young adult females in Skolnikland?

A) Road injuries
B) Diarrheal diseases
C) Dietary iron deficiency

Question 38

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-To maximize the health of its people, Skolnikland should seek to:

A) Keep disability among its people to a minimum
B) Keep its DALYs to a minimum
C) Keep its deaths to minimum

Question 39

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-We should expect to find the highest contraceptive prevalence rates in Skolnikland among:

A) People in the highlands
B) The rural people in the plains
C) Those with a high school education and above

Question 40

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, the greatest short-run economic losses to poor health would come from:

A) Diarrheal disease among children
B) Pneumonia among aging adults
C) TB among adults

Question 41

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following are direct risk factors for the development of anti-microbial resistance in Skolnikland?

A) The use of counterfeit antibiotics
B) Patient failure to adhere to prescribed regimens
C) A and B

Question 42

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, which of the following would be more cost-effective (there are only two choices)?

A) Community-based treatment of childhood pneumonia at $10 per child, with a 60 percent cure rate
B) Health center based treatment at $12 per child with a 90 percent cure rate

Question 43

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following are basic principles of ethical choices of investing in health:

A) Equity
B) Maximization of health
C) Both A and B

Question 44

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The health system in Skolnikland looks most like that in:

A) Canada
B) Costa Rica
C) India

Question 45

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The "sprit of Alma Ata" refers to:

A) The quest for effective and efficient healthcare
B) The quest for effective and efficient primary healthcare
C) The quest for effective and efficient vaccine programs

Question 46

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The following should be part of Skolnikland's package of primary health care services at the level of about 5,000 people:

A) Well-baby care
B) TB care
C) Emergency obstetric care
D) A and B

Question 47

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-If a complex emergency broke out in Skolnikland that led to the formation of refugee camps, which of the following diseases should be your first concern for those camps?

A) Cholera
B) HIV/AIDS
C) Soil transmitted helminthes
D) TB

Question 48

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which domain most readily lends itself to task shifting?

A) Brain Surgery
B) General Surgery
C) Orthopedic Surgery
D) Surgery for Caesarian sections

Question 49

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following could Skolnikland buy at public expense at the least cost per DALY averted?

A) Anti-retroviral therapy
B) Cardiovascular surgery
C) Childhood immunization with the six basic antigens
D) TB treatment

Question 50

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, which of the following is likely to be the largest cause of DALYs attributable to environmental risk factors?

A) Diarrhea
B) Lead poisoning
C) Poisoning with heavy metals from industrial sites

Question 51

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Arrange the following from least cost-effective to most cost-effective in terms of their likely cost-effectiveness in improving health outcomes in a rural village in Skolnikland. (You can presume that each option is associated with improved sanitation and hygiene and that the analysis of cost-effectiveness does not account for "convenience" benefits): (a) household water connections from a local well, (b) several village hand pumps, (c) household water connections from a municipal water supply system

A) a, b, c,
B) a, c, b
C) c, a, b

Question 52

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, the most cost-effective approach to addressing iodine deficiency would be:

A) Fortification
B) Injection
C) Supplementation

Question 53

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, deficiencies in which of the following two micronutrients are most associated with excess mortality in children under 5?

A) Iodine and Vitamin A
B) Vitamin A and Zinc
C) Vitamin D and Vitamin A
D) Zinc and Iron

Question 54

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Plumpy'nut can be used in the most cost-effective ways with children suffering from:

A) An acute episode of diarrhea
B) Severe acute malnutrition
C) Vitamin A and zinc deficiencies

Question 55

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, which would you expect to have the highest prevalence of among poor, rural children under 15? (Note that this question does intend to refer to children under 15 years of age.)

A) Obesity
B) Stunting
C) Wasting

Question 56

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The nutritional concern in Skolnikland associated with the most DALYs among adults is:

A) Iron deficiency
B) Vitamin B deficiency
C) Vitamin D deficiency

Question 57

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-What groups in Skolnikland should be the first priority for concerns about nutrition?

A) Pregnant and lactating women and children under 1
B) Pregnant and lactating women and children under 2
C) Pregnant and lactating women and children under 4
D) Pregnant women and children under 5

Question 58

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-For women of reproductive age in Skolnikland, which would cause more DALYs?

A) Depressive disorders
B) Diarrheal disease
C) Iodine deficiency

Question 59

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, what would have the biggest impact on reducing the occurrence of obstetric fistula?

A) Having traditional birth attendants (TBA) attend all rural births
B) Strengthening emergency obstetric care
C) Strengthening pre-natal care

Question 60

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The healthiest age range for a woman to bear her first child in Skolnikland is:

A) 14-18
B) 19-26
C) 39+

Question 61

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following is NOT one of the "three delays"?

A) A delay in getting a traditional birth attendant (TBA) to the pregnant woman
B) A delay in identifying complications
C) A delay in providing appropriate emergency obstetric care in the hospital
D) A delay in transporting the woman to care

Question 62

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-If Skolnikland were Malawi, a low-income country in southeastern Africa with a high rate of adult HIV/AIDS, which would likely be the most cost-effective approach to addressing HIV/AIDS?

A) Needle exchange and promotion of correct and consistent condom usage among men who have sex with men
B) Promotion of medical male circumcision and promotion of correct and consistent condom usage among men engaging in heterosexual sex
C) Promotion of school-based education about HIV and mass media campaigns about HIV

Question 63

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, which condition will be responsible for the most deaths of women of reproductive age?

A) HIV/AIDS
B) Ischemic heart disease
C) Road traffic deaths

Question 64

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, where abortion is illegal, which of the following approaches would help to reduce post-abortion complications?

A) Enforce laws against early marriage
B) Provide good quality post-abortion services
C) Increase access to contraception
D) All of the above

Question 65

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of these would have the most impact on reducing maternal mortality in Skolnikland?

A) Distributing iodine tablets
B) Strengthening emergency obstetric care
C) Strengthening pre-natal care
D) Training traditional birth attendants

Question 66

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-What is the greatest direct cause of maternal death in Skolnikland?

A) Obstructed labor
B) Hemorrhage
C) Hypertensive disorders
D) Sepsis

Question 67

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of these are among the top ten attributable risk factors for the deaths of adolescents and young adults globally?

A) Excess alcohol use
B) Drug use
C) Unsafe sex
D) All of the above

Question 68

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In which of the following regions will neonatal deaths be the largest share of total under-5 child deaths?
A North America
B) South Asia
C) Sub-Saharan Africa

Question 69

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, to achieve the best health outcomes for children under five years of age according to WHO norms, which of the following would you promote?

A) Cutting the umbilical cord immediately after birth
B) Hygienic introduction of complementary foods at 3 months of age
C) Universal vaccination

Question 70

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The maximum reduction in deaths of children from birth to six days of age in Skolnikland would come from addressing which of the following?

A) Birth asphyxia
B) Diarrhea
C) Malaria
D) TB

Question 71

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following would be a low-cost approach to saving newborn lives in Skolnikland?

A) Bathe the babies immediately after birth
B) Keep the babies warm with a blanket and cap, starting immediately after birth
C) Treat all newborns with preventive antibiotics
D) Treat all newborns with steroids

Question 72

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-What is the best measure to reduce the risk of diarrhea among one-year-old children in Skolnikland?

A) Immunizations against malaria
B) Improved personal hygiene
C) Iron supplementation
D) Pneumococcal vaccine

Question 73

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Given the present burden of disease in under-5 children, which vaccine would buy the largest amount of healthy years of life for children in Skolnikland?

A) Pneumococcal
B) Polio
C) Rubella

Question 74

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-In Skolnikland, which of the following would contribute to improving the health of adolescents and young adults?

A) Reduce personal violence
B) Reduce intimate partner violence
C) Reduce tobacco consumption
D) All of the above

Question 75

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The "basic antigens" for the Expanded Program on Immunization are:

A) BCG, Polio, DTP, Hib
B) DTP, measles, BCG, rubella
C) Polio, DTP, BCG, measles
D) Polio, DTP, measles, mumps, rubella

Question 76

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following best represents the WHO recommended approach to reducing malaria in Skolnikland?

A) Bed nets and indoor residual spraying
B) Bed nets, vaccination, and indoor residual spraying
C) Bed nets, vaccination, indoor residual spraying, confirmed diagnosis and early treatment with chloroquine, and intermittent treatment of pregnant women
D) Bed nets, indoor residual spraying, confirmed diagnosis and early treatment with ACT, intermittent treatment of pregnant women, intermittent treatment of infants, and seasonal mass chemoprevention in selected settings.

Question 77

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which measures in Skolnikland would prevent the most diarrheal deaths?

A) Oral rehydration and pneumococcal vaccine
B) Oral rehydration, with zinc and pneumococcal vaccine
C) Oral rehydration, with zinc
D) Oral rehydration, with zinc and rotavirus vaccine

Question 78

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-Which of the following would you recommend to foster the health of very young infants in rural communities of Skolnikland, who are substantially underweight but otherwise healthy?

A) Give them breastmilk substitutes
B) Give them supplementary food at 2 months
C) Give them vitamin supplements at 1 year
D) Kangaroo mother care

Question 79

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-The most feasible and cost-effective approach to addressing pneumonia deaths among neonates in rural, poor, and underserved areas of Skolnikland is to:

A) Help families learn to diagnose pneumonia in their new baby and get community-based antibiotic treatment from trained community health workers
B) Provide more licensed medical practitioners in these areas
C) Vaccinate them against rotavirus

Question 80

The Case:
Skolnikland is in South Asia. It has about 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country goes from hills to high mountains. There are two seasons of heavy rainfall, which mostly affect the plains.
The people come from many ethnic groups that tend to live in their own regions and each speaks their own language. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The national language is the language of the ethnic group that is dominant.
Skolnikland is a low-income country by World Bank criteria, with a per capita income of about $850. The economy has been growing at about 5 percent per year on average over the last decade, but had very slow economic growth in the three decades prior to that. About 70 percent of the people live in rural areas and 30 percent live in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. The richest 10 percent of the population controls 90 percent of total income. Sixty-five percent of the population is officially categorized as living "below poverty line."
The total fertility rate is about 2.2, and it has been declining at a steady pace over the past three decades, from just over 5.0. Contraceptive prevalence is high and fertility low for a low-income country. There are an almost equal number of men and women in the population, although men play a dominant role in society. Infant mortality is 30 per 1,000 live births. Maternal mortality is about 260 per 100,000 live births. Twenty-five percent of the children under-five years of age are moderately underweight for age. Ten percent are stunted.
Most people earn their livelihood in agriculture but there are also a number of service industries, small and large. Other export industries are beginning to grow in number, mostly focused on the export of commodities to China.
The adult literacy rate is about 80 percent. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing steadily and most recently at an increasing pace to the point where almost all children are in school. The quality of schooling, however, leaves much to be desired. Only about 60 percent of the people have access to safe water. Only about 40% have access to sanitary disposal of human waste.
HIV prevalence is less than 0.5 percent of the adult population. The number of new HIV cases stabilized over the last few years. There has been some progress in getting people on ART, but only about 50 percent of those clinically eligible are already on treatment. Malaria is common in the plains, but it is still largely caused by P. vivax and is not associated with many deaths. Skolnikland is one of the 22 countries most affected by TB, according to WHO.
Investments in the road system have been growing slowly, but the use of private automobiles has recently begun to increase more rapidly, from a very low base.
Skolnikland has a mixed health system that is made up of public institutions and publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers, among others. NGOs are also very actively involved in the health sector. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. Lacking faith in many public providers, a large share of the poor use private sector health services. Except for a few public and private centers of excellence, the health system is not very effective or efficient and is largely of mixed quality. However, despite this, the country has been very effective in its programs for family planning, vitamin A, TB, and blindness control.
-If Skolnikland were Brazil, which would have been the most significant driver of HIV/AIDS in the early stages of the epidemic?

A) Men who have unprotected sex with men
B) Unsafe injection practices
C) Unprotected heterosexual sex, largely with commercial sex workers