ethansimrm/wmt16_biomed_test · Datasets at Hugging Face

S0042-96862007000600010

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EN

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Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis.

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EN

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abstract

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OBJECTIVE: Height- and weight-based anthropometric indicators are used worldwide to characterize the nutritional status of populations.

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Based on the 1978 WHO/National Center for Health Statistics (NCHS) growth reference, the World Health Organization has previously indicated that the standard deviation (SD) of Z-scores of these indicators is relatively constant across populations, irrespective of nutritional status.

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As such, the SD of Z-scores can be used as quality indicators for anthropometric data.

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In 2006, WHO published new growth standards.

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Here, we aim to assess whether the SD of height- and weight-based Z-score indicators from the 2006 WHO growth standards can still be used to assess data quality.

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METHODS: We examined data on children aged 0-59 months from 51 Demographic and Health Surveys (DHS) in 34 developing countries.

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We used 2006 growth standards to assign height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), weight-for-height Z-scores (WHZ) and body-mass-index-for-age Z-scores (BMIZ).

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We also did a stratified analysis by age group.

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FINDINGS: The SD for all four indicators were independent of their respective mean Z-scores across countries.

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Overall, the 5th and 95th percentiles of the SD were 1.35 and 1.95 for HAZ, 1.17 and 1.46 for WAZ, 1.08 and 1.50 for WHZ and 1.08 and 1.55 for BMIZ.

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CONCLUSION: Our results concur with the WHO assertion that SD is in a relatively small range for each indicator irrespective of where the Z-score mean lies, and support the use of SD as a quality indicator for anthropometric data.

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However, the ranges of SDs for all four indicators analysed were consistently wider than those published previously by WHO.

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S0042-96862007000600012

language

EN

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Assessment of the age-specific disability weight of chronic schistosomiasis japonica.

language

EN

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abstract

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OBJECTIVE: To estimate the age-specific disability weight of chronic schistosomiasis japonica in China.

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METHODS: Between October 2004 and January 2005, residents from two schistosome-endemic counties were screened for Schistosoma japonicum infection using an enzyme-linked immunosorbent assay.

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Disability and morbidity were assessed in seropositive individuals using the European quality of life questionnaire with an additional cognitive dimension (known as the "EQ-5D plus") and ultrasonography.

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The age-specific disability weight of chronic schistosomiasis was estimated based on participants' self-rated health scores on the visual analogue scale of the questionnaire; the relationships between health status, morbidity and disability weight were explored using multilevel regression models.

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FINDINGS: Of 2843 seropositive individuals, 1419 (49.9%) were classified as having chronic schistosomiasis.

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Hepatomegaly was found in 76.3% (1082/1419); hepatic fibrosis was found in 73.3% (1040/1419); and splenomegaly was found in 18.6% (264/1419).

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Diarrhoea was the most common self-reported symptom (46.0%; 653/1419), followed by abdominal pain (32.6%; 463/1419), impaired capacity to work or study (30.7%; 436/1419), and blood in the stool (11.1%; 157/1419).

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More than half of the respondents reported impairments in at least one dimension of the EQ-5D plus questionnaire, particularly pain or discomfort (47.9%; 675/1410) and anxiety or depression (39.4%; 555/1410).

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The overall disability weight was 0.191, and age-specific weights ranged from 0.095 among those aged 5-14 years to 0.246 among those aged > 60 years.

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Multilevel regression models indicated that the disability weight was significantly associated with the participant's sex, grade of hepatic fibrosis, the presence of hepatomegaly, abdominal pain, blood in the stool, impaired capacity to work or study, and cognition.

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CONCLUSION: The disability weight attributable to chronic schistosomiasis japonica is high and increases with age.

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Our findings call for a reappraisal of the disability weights due to chronic schistosomiasis mansoni and schistosomiasis haematobia as well as a re-estimation of the global burden of schistosomiasis.

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S0042-96862007000600014

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EN

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Global comparative assessments of life expectancy: the impact of migration with reference to Australia.

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EN

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OBJECTIVE: To investigate the effect of immigration on life expectancy in Australia for the period from 1981 to 2003, and to compare life expectancy of the Australian-born population with that of other countries in the Organisation for Economic Cooperation and Development (OECD).

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METHODS: Standard life-table methods using age-specific all-cause mortality and population data from 1981 to 2003 were used to calculate life expectancy at birth (e0) for the total Australian population (including migrants) and for people born in Australia (excluding migrants).

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Mean differences in life expectancy for each sex were compared using paired t-tests.

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Rankings of life expectancy among OECD countries were reassessed, and rank changes measured using the Wilcoxon signed rank test.

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FINDINGS: Life expectancy of males and females was significantly lower in the Australian-born group than in the total Australian population.

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During 1981 to 2003, there was a mean difference in life expectancy of 0.41 years (95% confidence interval, CI: 0.37-0.44; t17 = 27.0; P < 0.0001) in males and 0.29 years (95% CI: 0.26-0.31; t17 = 27.6; P < 0.0001) in females between the Australian-born and the total population.

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After excluding migrant groups, Australia no longer ranked among the top five OECD countries with the highest life expectancy in the two most recent years examined.

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CONCLUSION: While Australia has one of the highest life expectancies in the industrialized world, this is partly attributable to immigration of populations with low rates of mortality.

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This effect needs to be considered in international comparative assessments of mortality levels.

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S0042-96862007000600016

language

EN

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Global eradication of polio: the case for "finishing the job".

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EN

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abstract

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While seven years have passed since 2000, the target set for the eradication of polio, success remains elusive.

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In 2006, despite coordinated international efforts, there was no major breakthrough in containing the polio virus, which persists in a few pockets in the four countries in which it is endemic.

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The polio eradication programme faces new hurdles such as importation, re-emergence and failure of political and community mobilization.

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The decreasing morale of health workers and volunteers, doubts about the efficacy of oral polio vaccine and ever-increasing programme costs and funding challenges are other issues to be addressed.

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This paper describes the ongoing conventional strategy adopted for polio eradication, then analyses existing challenges and some possible solutions.

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The author suggests that major modifications and additions to the ongoing conventional strategy are required in order to create a multi-pronged, area-specific strategy that can finish the job of polio eradication.

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This should include an area-specific approach, community dialogue, enhanced political advocacy and compulsory vaccination, as well as the use of inactivated polio vaccine in endemic countries even before the transmission of wild polio virus has been halted.

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This appears to be the best way to achieve eradication at the earliest opportunity.

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S0042-96862007000700009

language

EN

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Prevalence, intensity and associated morbidity of Schistosoma japonicum infection in the Dongting Lake region, China.

language

EN

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abstract

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OBJECTIVE: To determine the prevalence and intensity of Schistosoma japonicum infection and associated morbidity, and to estimate the infected human and buffalo populations in the Dongting Lake region, Hunan province, China.

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METHODS: We used data from the third national schistosomiasis periodic epidemiological survey (PES) of 2004.

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These included 47 144 human serological and 7205 stool examinations, 3893 clinical examinations and questionnaire surveys, and 874 buffalo stool examinations, carried out in 47 villages in Hunan province.

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Serological examinations were performed using the enzyme linked immunosorbent assay technique and human stool samples were examined by the Kato-Katz method.

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Stools from buffaloes and other domestic animals were examined for schistosome infection by the miracidial hatching test.

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FINDINGS: Sero-prevalence was 11.9% (range: 1.3-34.9% at the village level), and the rate of egg-positive stools was estimated at 1.9% (0-10.9%) for the same population.

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The prevalence of infection among buffaloes was 9.5% (0-66.7%).

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Extrapolating to the entire population of the Dongting Lake region, an estimated 73 225 people and 13 973 buffaloes were infected.

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Most frequently reported symptoms were abdominal pain (6.2%) and bloody stools (2.7%).

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More than half of the clinically examined people reported having had at least one prior antischistosomal treatment.

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CONCLUSION: There was a significant reduction in the number of humans infected with S. japonicum since the previous national PES carried out in 1995, partially explained by large-scale chemotherapy campaigns.

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However, a near-stable number of buffalo infections suggest continuing human re-infection, which may lead to future increases in human prevalence.

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S0042-96862007000700011

language

EN

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Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings.

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EN

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abstract

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OBJECTIVE: Trials of environmental risk factors and acute lower respiratory infections (ALRI) face a double challenge: implementing sufficiently sensitive and specific outcome assessments, and blinding.

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We evaluate methods used in the first randomized exposure study of pollution indoors and respiratory effects (RESPIRE): a controlled trial testing the impact of reduced indoor air pollution on ALRI, conducted among children < 18 months in rural Guatemala.

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METHODS: Case-finding used weekly home visits by fieldworkers trained in integrated management of childhood illness methods to detect ALRI signs such as fast breathing.

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Blindness was maintained by referring cases to study physicians working from community centres.

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Investigations included oxygen saturation (SaO2), respiratory syncytial virus (RSV) antigen test and chest X-ray (CXR).

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FINDINGS: Fieldworkers referred > 90% of children meeting ALRI criteria, of whom about 70% attended a physician.

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Referrals for cough without respiratory signs and self-referrals contributed 19.0% and 17.9% of physician-diagnosed ALRI cases respectively.

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Intervention group attendance following ALRI referral was 7% higher than controls, a trend also seen in compliance with RSV tests and CXR.

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There was no evidence of bias by intervention status in fieldworker classification or physician diagnosis.

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Incidence of fieldworker ALRI (1.12 episodes/child/year) is consistent with high sensitivity and low specificity; incidence of physician-diagnosed ALRI (0.44 episodes/child/year) is consistent with comparable studies.

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CONCLUSION: The combination of case-finding methods achieved good sensitivity and specificity, but intervention cases had greater likelihood of reaching the physician and being investigated.

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There was no evidence of bias in fieldworkers' classifications despite lack of concealment at home visits.

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Pulse oximetry offers practical, objective severity assessment for field studies of ALRI.

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S0042-96862007000700013

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EN

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True outcomes for patients on antiretroviral therapy who are "lost to follow-up" in Malawi.

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EN

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abstract

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PROBLEM: In many resource-poor countries that are scaling up antiretroviral therapy (ART), 5-25% of patients are reported as "lost to follow-up".

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This figure is 9% in Malawi.

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There is no published information about the true outcome status of these patients.

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APPROACH: In four facilities in northern Malawi, ART registers and master cards were used to identify patients who had not attended the facility for 3 months or more and were thus registered as "lost to follow-up".

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Clinic staff attempted to trace these patients and ascertain their true outcome status.

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LOCAL SETTING: Of 253 patients identified as "lost to follow-up", 127 (50%) were dead, 58% of these having died within 3 months of their last clinic visit.

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Of the 58 patients (23%) found to be alive, 21 were still receiving ART and 37 had stopped treatment (high transport costs being the main reason for 13 patients).

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Sixty-eight patients (27%) could not be traced, most commonly because of an incorrect address in the register.

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Fewer patients were alive and more patients could not be traced from the central hospital compared with the peripheral hospitals.

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RELEVANT CHANGES:Better documentation of patients' addresses and prompt follow-up of patients who are late for their appointments are required.

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LESSONS LEARNED: ART clinics in resource-poor countries should ensure that patients' addresses are correct and comprehensive.

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Clinics should also undertake contact tracing as soon as possible in the event of non-attendance, consider facilitating access to ART clinics and take loss to follow-up into consideration when assessing death rates.

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S0042-96862007000700015

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EN

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Reducing vector-borne disease by empowering farmers in integrated vector management.

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EN

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abstract

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PROBLEM: Irrigated agriculture exposes rural people to health risks associated with vector-borne diseases and pesticides used in agriculture and for public health protection.

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Most developing countries lack collaboration between the agricultural and health sectors to jointly address these problems.

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APPROACH: We present an evaluation of a project that uses the "farmer field school" method to teach farmers how to manage vector-borne diseases and how to improve rice yields.

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Teaching farmers about these two concepts together is known as "integrated pest and vector management".

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LOCAL SETTING: An intersectoral project targeting rice irrigation systems in Sri Lanka.

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RELEVANT CHANGES: Project partners developed a new curriculum for the field school that included a component on vector-borne diseases.

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Rice farmers in intervention villages who graduated from the field school took vector-control actions as well as improving environmental sanitation and their personal protection measures against disease transmission.

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They also reduced their use of agricultural pesticides, especially insecticides.

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LESSONS LEARNED: The intervention motivated and enabled rural people to take part in vector-management activities and to reduce several environmental health risks.

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There is scope for expanding the curriculum to include information on the harmful effects of pesticides on human health and to address other public health concerns.

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Benefits of this approach for community-based health programmes have not yet been optimally assessed.

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Also, the institutional basis of the integrated management approach needs to be broadened so that people from a wider range of organizations take part.

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A monitoring and evaluation system needs to be established to measure the performance of integrated management initiatives.

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S0042-96862007000800010

language

EN

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Evaluating the potential impact of the new Global Plan to Stop TB: Thailand, 2004-2005.

language

EN

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abstract

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OBJECTIVE: WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB).

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The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004.

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METHODS: In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing.

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The catchment area included 3.6 million people in four provinces.

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We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003).

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FINDINGS: In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000).

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Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%.

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Private facilities diagnosed 634 (11%) of all TB cases.

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In 2005, 1392 (24%) cases were known to be HIV positive.

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The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P< 0.01).

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Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%).

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CONCLUSION: In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB.

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Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness.

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S0042-96862007000800012

language

EN

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Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand.

language

EN

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abstract

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OBJECTIVE: To estimate the incidence and describe the profile of catastrophic expenditures and impoverishment due to household out-of-pocket payments, comparing the periods before and after the introduction of universal health care coverage (UC).

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METHODS: Secondary data analyses of socioeconomic surveys on nationally representative households pre-UC in 2000 (n = 24 747) and post-UC in 2002 (n = 34 785) and 2004 (n = 34 843).

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FINDINGS: Households using inpatient care experienced catastrophic expenditures most often (31.0% in 2000, compared with 15.1% and 14.6% in 2002 and 2004, respectively).

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During the two post-UC periods, the incidence of catastrophic expenditures for inpatient services at private hospitals was 32.1% for 2002 and 27.8% for 2004.

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For those using inpatient care at district hospitals, the corresponding catastrophic expenditures figures were 6.5% and 7.3% in 2002 and 2004, respectively.

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The catastrophic expenditures incidence for outpatient services from private hospitals moved from 27.9% to 28.5% between 2002 and 2004.

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In 2000, before universal coverage was introduced, the percentages of Thai households who used private hospitals and faced catastrophic expenditures were 35.8% for inpatient care and 36.0% for outpatient care.

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Impoverishment increased for poor households because of payments for inpatient services by 84.0% in 2002, by 71.5% in 2004 and by 95.6% in 2000.

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The relative increase in out-of-pocket impoverishment was found in 98.8% to 100% of those who were poor following payments made to private hospitals, regardless of type of care.

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CONCLUSION: Households using inpatient services, especially at private hospitals, were more likely to face catastrophic expenditures and impoverishment from out-of-pocket payments.

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Use of services not covered by the UC benefit package and bypassing the designated providers (prohibited under the capitation contract model without proper referrals) are major causes of catastrophic expenditures and impoverishment.

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S0042-96862007000800014

language

EN

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A comprehensive assessment of maternal deaths in Argentina: translating multicentre collaborative research into action.

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EN

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abstract

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OBJECTIVE: To perform a comprehensive assessment of maternal mortality in Argentina, the ultimate purpose being to strengthen the surveillance system and reorient reproductive health policies to prevent maternal deaths.

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METHODS: Our multicentre population-based study combining qualitative and quantitative methodologies included a descriptive analysis of under-registration and distribution of causes of death, a case-control study to identify risk factors in health-care delivery and verbal autopsies to analyse social determinants associated with maternal deaths.

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FINDINGS: A total of 121 maternal deaths occurred during 2002.

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The most common causes were abortion complications (27.4%), haemorrhage (22.1%), infection/sepsis (9.5%), hypertensive disorders (8.4%) and other causes (32.6%).

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Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26).

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The probability of dying was 10 times greater in the absence of essential obstetric care, active emergency care and qualified staff, and doubled with every 10-year increase in age.

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Other contributing factors included delays in recognizing "alarm signals"; reluctance in seeking care owing to desire to hide an induced abortion; delays in receiving timely treatment due to misdiagnosis or lack of supplies; and delays in referral/transportation in rural areas.

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CONCLUSION: A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data.

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There is an urgent need for a comprehensive intervention to address public health and human rights issues in maternal mortality, and our results contribute to the consensus-building necessary to improve the existing surveillance system and prevention strategies.

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S0042-96862007000800016

language

EN

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Resistance and renewal: health sector reform and Cambodia's national tuberculosis programme.

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EN

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abstract

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Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system.

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The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced.

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This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms.

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It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment.

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S0042-96862007000900011

language

EN

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Risk of arsenic-related skin lesions in Bangladeshi villages at relatively low exposure: a report from Gonoshasthaya Kendra.

language

EN

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abstract

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OBJECTIVE: Arsenic concentrations in 25% of tube wells in Bangladesh exceed 50mg/L, a level known to be hazardous.

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Levels in individual wells vary widely.

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We gathered data on arsenic exposure levels and skin lesion prevalence to address the lack of knowledge about risks where the average arsenic concentrations was lower.

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METHODS: The nongovernmental organization Gonoshasthaya Kendra did three related studies of keratotic skin lesions since 2004: (1) an ecological prevalence survey among 13 705 women aged > 18 in a random sample of 53 villages; (2) a case-control study of 176 cases and age- and village-matched referents; and (3) a prevalence survey of the entire population of 11 670 in two additional villages.

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We calculated prevalence as a function of average arsenic concentrations as reported in the National Hydrochemical Survey, and measured arsenic concentrations in wells used by subjects in the case-control study.

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FINDINGS: The prevalence of skin lesions was 0.37% in people exposed to arsenic concentrations below 5mg/L, 0.63% at 6-50mg/L, and 6.84% at 81mg/L.

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In the case-control analysis, relative risk of skin lesions increased threefold at concentrations above 50mg/L (P < 0.05).

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CONCLUSION: Little serious skin disease is likely to occur if the arsenic concentration in drinking water is kept below 50mg/L, but ensuring this water quality will require systematic surveillance and reliable testing of all wells, which may be impractical.

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More research is needed on feasible prevention of toxic effects from arsenic exposure in Bangladesh.

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S0042-96862007000900013

language

EN

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title

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Measuring health inequalities between genders and age groups with realization of potential life years (RePLY).

language

EN

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abstract

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OBJECTIVE We propose a new method to measure health inequalities caused by conditions amenable to policy intervention and use this to identify health differences between sexes and age groups.

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METHODS: The lowest observed mortality rates are used as a proxy of unavoidable mortality risks to develop a new measure of health outcome - realization of potential life years (RePLY).

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The RePLY distribution is used to measure avoidable health inequalities between sex and age groups respectively.

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FINDINGS: Using RePLY we find that even those countries with very high life expectancy at birth can have substantial health inequalities across different age groups.

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Also, gender inequality is more pronounced among those aged < 30.

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Among countries with a life expectancy < 60 years, there is a much larger prevalence of gender inequality against females; countries with life expectancy > 60 years have comparable numbers of cases of inequality among females and males.

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Finally, high avoidable health inequality is associated with low average income, high income inequality and high population fractionalization.

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CONCLUSION: It is important to distinguish between unavoidable and avoidable mortality when measuring health outcomes and their distribution in society.

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The proposed new measure (RePLY) enables policy-makers to focus on age-sex groups with low realization of potential life years and thus high avoidable mortality risks.

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S0042-96862007000900015

language

EN

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The high burden of injuries in South Africa.

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EN

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abstract

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OBJECTIVE To estimate the magnitude and characteristics of the injury burden in South Africa within a global context.

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METHODS: The Actuarial Society of South Africa demographic and AIDS model (ASSA 2002) - calibrated to survey, census and adjusted vital registration data - was used to calculate the total number of deaths in 2000.

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Causes of death were determined from the National Injury Mortality Surveillance System profile.

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Injury death rates and years of life lost (YLL) were estimated using the Global Burden of Disease methodology.

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National years lived with disability (YLDs) were calculated by applying a ratio between YLLs and YLDs found in a local injury data source, the Cape Metropole Study.

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Mortality and disability-adjusted life years' (DALYs) rates were compared with African and global estimates.

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FINDINGS: Interpersonal violence dominated the South African injury profile with age-standardized mortality rates at seven times the global rate.

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7

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Injuries were the second-leading cause of loss of healthy life, accounting for 14.3% of all DALYs in South Africa in 2000.

sentnum

8

-1

Road traffic injuries (RTIs) are the leading cause of injury in most regions of the world but South Africa has exceedingly high numbers - double the global rate.

sentnum

9

-1

CONCLUSION: Injuries are an important public health issue in South Africa.

sentnum

10

-1

Social and economic determinants of violence, many a legacy of apartheid policies, must be addressed to reduce inequalities in society and build community cohesion.

sentnum

11

-1

Multisectoral interventions to reduce traffic injuries are also needed.

sentnum

12

-1

We highlight this heavy burden to stress the need for effective prevention programmes.

null

S0042-96862007000900017

language

EN

section

title

-1

sentnum

0

-1

Towards sustainable delivery of health services in Afghanistan: options for the future.

language

EN

section

abstract

-1

sentnum

0

-1

Disruption caused by decades of war and civil strife in Afghanistan has led many international and national nongovernmental organizations (NGOs) to assume responsibility for the delivery of health services through contracts with donor agencies.

sentnum

1

-1

Recently the Afghan Government has pursued the policy of contracting for a basic package of health services (BPHS) supported by funds from three major donors - the World Bank, the United States Agency for International Development (USAID) and the European Commission.

sentnum

2

-1

With the gradual strengthening of the public health ministry, options for the future include pursuing the contracting option or increasing public provision of health services.

sentnum

3

-1

Should contracting with NGOs be pursued, a clear strategy is required that includes developing accreditation instruments, better contracting mechanisms and a system for monitoring and evaluating the entire process.

sentnum

4

-1

Should the government opt for an increasing role, problems to be solved include securing the transition to public provision, obtaining guarantees that appropriate financing will be provided and reconfiguration of the public health delivery system.

sentnum

5

-1

Large-scale contracting with the private for-profit sector cannot be recommended at this stage, although this option could be explored via subcontracting by larger NGOs or small-scale trial contracts initiated by the public health ministry.

sentnum

6

-1

Irrespective of the option chosen, an important challenge remaining is the recalcitrant problem of high out-of-pocket payments.

sentnum

7

-1

Sustainable delivery of health services in Afghanistan can only be achieved with a clear national strategy in which all stakeholders have roles to play in the financing, regulation and delivery of services.

null

S0042-96862007000900019

language

EN

section

title

-1

sentnum

0

-1

Improving tuberculosis case detection rate with a lay informant questionnaire: an experience from the Lao People's Democratic Republic.

language

EN

section

abstract

-1

sentnum

0

-1

PROBLEM: In many countries, the tuberculosis (TB) annual case detection rate is below the target of 70%.

sentnum

1

-1

In the Lao People's Democratic Republic in 2005, it did not exceed 55% APPROACH: The DOTS strategy promotes passive case detection of TB.

sentnum

2

-1

In order to increase the detection rate, we validated a questionnaire targeting lay informants at village level to notify patients with chronic cough and assessed the relevance for TB case-finding.

sentnum

3

-1

A three-item questionnaire was sent through the district health departments to all villages in six districts in six provinces.

sentnum

4

-1

The village headmen were asked to notify chronic cough patients.

sentnum

5

-1

Answers were validated in a door-to-door survey (20 villages/district).

sentnum

6

-1

In a sub-sample (four villages/district) all confirmed patients were screened for TB and paragonimiasis.

sentnum

7

-1

LOCAL SETTING: Attapeu, Luang Namtha, Luang Prabang, Saravane, Savanakhet and Vientiane provinces in the Lao People's Democratic Republic.

sentnum

8

-1

RELEVANT CHANGES: Lay informant questionnaires sent from district health offices to villages are cost-effective and foster interaction between the health services and remote and underserved communities.

sentnum

9

-1

Although the correct detection of patients is highly dependent on direct respondents, a substantial number of new TB and paragonimiasis cases were consistently diagnosed in chronic cough patients.

sentnum

10

-1

LESSONS LEARNED: Out of 456 questionnaires, 295 were returned (65%).

sentnum

11

-1

Return rates were highly variable between districts (48-87%), questionnaires' sensitivity (56-98%), positive predictive value (34-88%) and correlation between number of notified and confirmed patients (r: 0.26-0.78).

sentnum

12

-1

In sub-sampled villages (13 541 population) 19 (5.1%) TB and 26 (7.0%) paragonimiasis cases were detected in 374 chronic cough patients.

null

sentnum

13

-1

This quick questionnaire approach proved motivating for district authorities and village key informants, although no incentives were provided.

sentnum

14

-1

The highly operator-dependent approach yielded a consistent detection rate of TB and paragonimiasis cases.

sentnum

15

-1

This approach brings health services and populations in need in close contact, which is particularly crucial in remote and underserved areas.

null

S0042-96862007001000011

language

EN

section

title

-1

sentnum

0

-1

Delivery settings and caesarean section rates in China.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To quantify the influence of increasing use of health-care services on rising rates of caesarean section in China.

sentnum

1

-1

METHODS: We used data from a population-based survey conducted by the United Nations Population Fund during September 2003 in 30 selected counties in three regions of China.

sentnum

2

-1

The study sample (derived from birth history schedule) consisted of 3803 births to mothers aged less than 40 years between 1993 and 2002.

sentnum

3

-1

Multiple logistic regression models were used to estimate the effect of health-care factors on the odds of a caesarean section, controlling for time and selected variables.

sentnum

4

-1

FINDINGS: Institutional births increased from 53.5% in 1993-1994 to 82.2% in 2001-2002, while the corresponding increase in births by caesarean section was from 8.9% to 24.8%, respectively.

sentnum

5

-1

Decomposition analysis showed that 69% of the increase in rates of caesarean section was driven by the increase in births within institutions.

sentnum

6

-1

The adjusted odds of a caesarean section were 4.6 times (95% confidence interval, CI: 3.4-11.8) higher for recent births.

sentnum

7

-1

The adjusted odds were also significantly higher for mothers who had at least one antenatal ultrasound test.

sentnum

8

-1

Rates of caesarean section in secondary-level facilities markedly increased over the last decade to the same levels as in major hospitals (P < 0.001).

sentnum

9

-1

CONCLUSION: The upsurge in rates of births by caesarean section in this population cannot be fully explained by increases in institutional births alone, but is likely to be driven by medical practice within secondary-level hospitals and women's demand for the procedure.

null

S0042-96862007001000013

language

EN

section

title

-1

sentnum

0

-1

Contraceptive injections by community health workers in Uganda: a nonrandomized community trial.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To compare the safety and quality of contraceptive injections by community-based health workers with those of clinic-based nurses in a rural African setting.

sentnum

1

-1

METHODS: A nonrandomized community trial tested provision of injectable Depo Provera (DMPA) by community reproductive health workers and compared it with routine DPMA provision at health units in Nakasongola District, Uganda.

sentnum

2

-1

The primary outcome measures were safety, acceptability and continuation rates.

sentnum

3

-1

FINDINGS: A total of 945 new DMPA users were recruited by community workers, clinic-based nurses and midwives.

sentnum

4

-1

Researchers successfully followed 777 (82% follow-up): 449 community worker clients and 328 clinic-based clients.

sentnum

5

-1

Ninety-five percent of community-worker clients were "satisfied" or "highly satisfied" with services, and 85% reported receiving information on side-effects.

sentnum

6

-1

There were no serious injection site problems in either group.

sentnum

7

-1

Similarly, there was no significant difference between continuation to second injection (88% among clients of community-based workers, 85% among clinic-going clients), nor were there significant differences in other measures of safety, acceptability and quality.

sentnum

8

-1

CONCLUSION: Community-based distribution (CBD) of injectable contraceptives is now routine in some countries in Asia and Latin America, but is practically unknown in Africa, where arguably the need for this practice is greatest.

sentnum

9

-1

This research reinforces experience from other regions suggesting that well-trained community health workers can safely provide contraceptive injections.

null

S0042-96862007001000015

language

EN

section

title

-1

sentnum

0

-1

Are skilled birth attendants really skilled?

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide - the fifth Millennium Development Goal.

sentnum

1

-1

Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications.

sentnum

2

-1

We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement.

sentnum

3

-1

METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard.

sentnum

4

-1

Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations.

sentnum

5

-1

We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I).

sentnum

6

-1

These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II).

sentnum

7

-1

FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps.

sentnum

8

-1

Phase II participants were correct for 62% of the knowledge questions.

sentnum

9

-1

Their average skills scores by area were: active management of the third stage of labour - 46%; manual removal of placenta - 52%; bimanual uterine compression - 46%; immediate newborn care - 71%; and neonatal resuscitation - 55%.

sentnum

10

-1

CONCLUSION: There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications.

sentnum

11

-1

We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger.

null

sentnum

1

-1

A measurement method, some disturbing results and a potential way forward.

null

S0042-96862007001000017

language

EN

section

title

-1

sentnum

0

-1

The Chilean infant mortality decline: improvement for whom?

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To measure socioeconomic inequalities and differential risk in infant mortality on national and regional levels in Chile from 1990 to 2005, and propose new policy targets.

sentnum

1

-1

METHODS: The study analysed Chilean vital events registries from 1990 to 2005 for infant mortality by maternal education, head of household occupational status, cause, age and location of death.

sentnum

2

-1

Annual infant mortality rates and relative risk were calculated by maternal education and head of household occupational status for each cause and age of death.

sentnum

3

-1

Socioeconomic inequalities were then mapped to 29 regional health services.

sentnum

4

-1

FINDINGS: Reductions in the national infant mortality rate were driven by reductions among highly educated mothers, while recent stagnation in the national rate is caused by high levels of infant mortality among uneducated mothers.

sentnum

5

-1

These vulnerable households are particularly prone to infant mortality risk due to infectious disease and trauma.

sentnum

6

-1

We also identify clustering of high socioeconomic inequalities in infant mortality throughout the poorer north, indigenous south and densely populated metropolitan centre of Santiago.

sentnum

7

-1

Finally, we report large inequities in vital statistics coverage, with infant deaths among vulnerable households much more likely to be inadequately defined than in the remaining population.

sentnum

8

-1

CONCLUSION: These results indicate that the socioeconomically disadvantaged in Chile are at a significantly higher risk for infant mortality by infectious diseases and trauma during the first month of life.

sentnum

9

-1

Efforts to reduce national infant mortality in Chile and other countries must involve policies that target child survival for at-risk populations for specific diseases, ages and locations.

null

sentnum

1

-1

Socioeconomic and geographic inequalities in infant mortality, 1990-2005.

null

S0042-96862007001000019

language

EN

section

title

-1

sentnum

0

-1

A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context.

language

EN

section

abstract

-1

sentnum

0

-1

Two decades after the Safe Motherhood campaign's 1987 launch in India, half a million women continue to die from pregnancy-related causes every year.

sentnum

1

-1

Key health-care interventions can largely prevent these deaths, but their use is limited in developing countries, and is reported to vary between population groups.

sentnum

2

-1

We reviewed the use of maternal health-care interventions in developing countries to assess the extent, strength and implications of evidence for variations according to women's place of residence and socioeconomic status.

sentnum

3

-1

Studies with data on use of a skilled health worker at delivery, antenatal care in the first trimester of pregnancy and medical settings for delivery were assessed.

sentnum

4

-1

We identified 30 eligible studies, 12 of which were of high or moderate quality, from 23 countries.

sentnum

5

-1

Results of these studies showed wide variation in use of maternal health care.

sentnum

6

-1

Methodological factors (e.g. inaccurate identification of population in need or range of potential confounders controlled for) played a part in this variation.

sentnum

7

-1

Differences were also caused by factors related to health-care users (e.g. age, education, medical insurance, clinical risk factors) or to supply of health care (e.g. clinic availability, distance to facility), or by an interaction between such factors (e.g. perceived quality of care).

sentnum

8

-1

Variation was usually framed by contextual issues relating to funding and organization of health care or social and cultural issues.

sentnum

9

-1

These findings emphasize the need to investigate and assess context-specific causes of varying use of maternal health care, if safe motherhood is to become a reality in developing countries.

null

S0042-96862007001100010

language

EN

section

title

-1

sentnum

0

-1

Routine offer of antenatal HIV testing ("opt-out" approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe.

sentnum

1

-1

METHODS: Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005.

sentnum

2

-1

Key outcomes during the first 6 months of routine testing were compared with the prior 6-month "opt-in" period, and clients were interviewed.

sentnum

3

-1

FINDINGS: Of the 4551 women presenting for antenatal care during the first 6 months of routine HIV testing, 4547 (99.9%) were tested for HIV compared with 3058 (65%) of 4700 women during the last 6 months of the opt-in testing (P < 0.001), with a corresponding increase in the numbers of HIV-infected women identified antenatally (926 compared with 513, P < 0.001).

sentnum

4

-1

During routine testing, more HIV-infected women collected results compared to the opt-in testing (908 compared with 487, P < 0.001) resulting in a significant increase in deliveries by HIV-infected women (256 compared with 186, P = 0.001); more mother/infant pairs received antiretroviral prophylaxis (n = 256) compared to the opt-in testing (n = 185); and more mother/infant pairs followed up at clinics (105 compared with 49, P = 0.002).

sentnum

5

-1

Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful.

sentnum

6

-1

HIV-infected women reported low levels of spousal abuse and other adverse social consequences.

sentnum

7

-1

CONCLUSION: Routine antenatal HIV testing should be implemented at all sites in Zimbabwe to maximize the public health impact of PMTCT.

null

S0042-96862007001100012

language

EN

section

title

-1

sentnum

0

-1

Mental health reform in the Russian Federation: an integrated approach to achieve social inclusion and recovery.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To facilitate mental health reform in one Russian oblast (region) using systematic approaches to policy design and implementation.

sentnum

1

-1

METHODS: The authors undertook a three-year action-research programme across three pilot sites, comprising a multifaceted set of interventions combining situation appraisal to inform planning, sustained policy dialogue at federal and regional levels to catalyse change, introduction of multidisciplinary and intersectoral-working at all levels, skills-based training for professionals, and support for nongovernmental organizations (NGOs) to develop new care models.

sentnum

2

-1

FINDINGS: Training programmes developed in this process have been adopted into routine curricula with measurable changes in staff skills.

sentnum

3

-1

Approaches to care improved through multidisciplinary and multisectoral service delivery, with an increase in NGO activities, user involvement in care planning and delivery in all pilot sites.

sentnum

4

-1

Hospital admissions at start and end of the study fell in two pilot sites, while the rate of readmissions in all three pilot sites by 2006 was below that for the region as a whole.

sentnum

5

-1

Lessons learned have informed the development of regional and federal mental health policies.

sentnum

6

-1

CONCLUSION: A multifaceted and comprehensive programme can be effective in overcoming organizational barriers to the introduction of evidence-based multisectoral interventions in one Russian region.

sentnum

7

-1

This can help facilitate significant and sustainable changes in policy and reduce institutionalization.

null

S0042-96862007001100014

language

EN

section

title

-1

sentnum

0

-1

Intermittent preventive treatment of malaria during pregnancy in central Mozambique.

language

EN

section

abstract

-1

sentnum

0

-1

PROBLEM: New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management.

sentnum

1

-1

APPROACH: A pilot MiP programme in Mozambique was designed to determine requirements for scale-up.

sentnum

2

-1

LOCAL SETTING: The Ministry of Health worked with a nongovernmental organization and an academic institution to establish and monitor a pilot programme in two impoverished malaria-endemic districts.

sentnum

3

-1

RELEVANT CHANGES: Implementing the pilot programme required provision of additional sulfadoxine-pyrimethamine (SP), materials for directly observed SP administration, bednets and a modified antenatal card.

sentnum

4

-1

National-level formulary restrictions on SP needed to be waived.

sentnum

5

-1

The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses.

sentnum

6

-1

Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcome.

sentnum

7

-1

Key outputs and impacts were measured; 92.5% of 7911 women received at least 1 dose of SP, with the mean number of SP doses received being 2.2.

sentnum

8

-1

At the second antenatal visit, 13.5% of women used bednets.

sentnum

9

-1

In subgroups (1167 for laboratory analyses; 2600 births), SP use was significantly associated with higher haemoglobin levels (10.9 g/dL if 3 doses, 10.3 if none), less malaria parasitaemia (prevalence 7.5% if 3 doses, 39.3% if none), and fewer low-birth-weight infants (7.3% if 3 doses, 12.5% if none).

sentnum

10

-1

LESSONS LEARNED: National-level scale-up will require attention to staffing, supplies, bednet availability, drug policy, gestational-age estimation and harmonization of vertical initiatives.

null

S0042-96862007001200011

language

EN

section

title

-1

sentnum

0

-1

Mapping Africa's advanced public health education capacity: the AfriHealth project.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: Literature on human resources for health in Africa has focused on personal health services.

sentnum

1

-1

Little is known about graduate public health education.

sentnum

2

-1

This paper maps "advanced" public health education in Africa.

sentnum

3

-1

Public health includes all professionals needed to manage and optimize health systems and the public's health.

sentnum

4

-1

METHODS: Data were collected through questionnaires and personal visits to departments, institutes and schools of community medicine or public health.

sentnum

5

-1

Simple descriptive statistics were used to analyse the data.

sentnum

6

-1

FINDINGS: For more than 900 million people, there are fewer than 500 full-time staff, around two-thirds of whom are male.

sentnum

7

-1

More men (89%) than women (72%) hold senior degrees.

sentnum

8

-1

Over half (55%) of countries do not have any postgraduate public health programme.

sentnum

9

-1

This shortage is most severe in lusophone and francophone Africa.

sentnum

10

-1

The units offering public health programmes are small: 81% have less than 20 staff, and 62% less than 10.

sentnum

11

-1

On the other hand, over 80% of Africans live in countries where at least one programme is available, and there are six larger schools with over 25 staff.

sentnum

12

-1

Programmes are often narrowly focused on medical professionals, but "open" programmes are increasing in number.

null

sentnum

13

-1

Public health education and research are not linked.

sentnum

14

-1

CONCLUSION: Africa urgently needs a plan for developing its public health education capacity.

sentnum

15

-1

Lack of critical mass seems a key gap to be addressed by strengthening subregional centres, each of which should provide programmes to surrounding countries.

sentnum

16

-1

Research linked to public health education and to educational institutions needs to increase.

S0042-96862007001200013

language

EN

section

title

-1

sentnum

0

-1

Capacity-building for public health: http://peoples-uni.org.

language

EN

section

abstract

-1

sentnum

0

-1

The development of educational context around free and open-source materials available on the Internet has the ability to help build public health capacity in low- to middle-income countries.

sentnum

1

-1

Inspiration to develop such a programme comes from the free and open-source software movement, where many hundreds of individuals have collaborated in the development of high-quality software freely available on the Internet, and its education counterpart of Open Educational Resource development.

sentnum

2

-1

These reflect societal developments, especially those associated with Web 2.0.

sentnum

3

-1

In a partnership across the global and digital divides, the People's Open Access Education Initiative (http://peoples-uni.org) has been established to embrace three aspects.

sentnum

4

-1

First, identifying open-access materials linked to the competences required to tackle public health problems, with subsequent modifications to the materials by teachers and students to reflect local issues.

sentnum

5

-1

Second, teaching through online facilitation by volunteers in conjunction with members of local universities.

sentnum

6

-1

Third, accrediting learned competences.

sentnum

7

-1

Situation analyses already performed suggest that the need for this education is great and that this solution may be feasible in many countries.

sentnum

8

-1

Several partners have already agreed to be involved and exemplar course modules are being prepared.

sentnum

9

-1

We call for volunteers to help take this initiative further.

null

S0042-96862007001200015

language

EN

section

title

-1

sentnum

0

-1

International perspectives on the ethics and regulation of human cell and tissue transplantation.

language

EN

section

abstract

-1

sentnum

0

-1

The transplantation of human cells and tissues has become a global enterprise for both life-saving and life-enhancing purposes.

sentnum

1

-1

Yet current practices raise numerous ethical and policy issues relating to informed consent for donation, profit-making, and quality and safety in the procurement, processing, distribution, and international circulation of human cells and tissues.

sentnum

2

-1

This paper reports on recent developments in the international debate surrounding these issues, and in particular on the attention cell and tissue transplantation has received in WHO's ongoing process of updating its 1991 Guiding principles on human organ transplantation.

sentnum

3

-1

Several of the organizers of an international working group of stakeholders from a wide range of backgrounds that convened in Zurich in July 2006 summarize the areas of normative agreement and disagreement, and identify open questions regarding facts and fundamental concepts of potential normative significance.

sentnum

4

-1

These issues must be addressed through development of common medical, scientific, legal and ethical requirements for human cell and tissue transplantation on a global basis.

sentnum

5

-1

While guidance must accommodate the distinct ethical issues raised by activities involving human cells and tissues, consistency with normative frameworks for organ transplantation remains a prime objective.

null

S0042-96862007001200017

language

EN

section

title

-1

sentnum

0

-1

The state of the international organ trade: a provisional picture based on integration of available information.

language

EN

section

abstract

-1

sentnum

0

-1

Organ transplantation is widely practised worldwide.

sentnum

1

-1

The expansion of organ transplantation has led to a critical shortage of organs and the development of the organ trade.

sentnum

2

-1

Many patients travel to areas where organs are obtainable through commercial transactions.

sentnum

3

-1

Although the international organ trade is regarded as an important health policy issue, its current state remains obscure because of scarce data and the lack of efforts to synthesize available data.

sentnum

4

-1

This paper is an attempt to integrate information about the current international organ trade and create a tentative global picture based on a systematic review of 309 media reports, journal articles and other documents.

sentnum

5

-1

The international organ trade is described in terms of its forms, the organ-exporting countries, the organ-importing countries and its outcomes and consequences.

null

S0042-96862008000100010

language

EN

section

title

-1

sentnum

0

-1

Global costs of attaining the Millennium Development Goal for water supply and sanitation.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: Target 10 of the Millennium Development Goals (MDGs) is to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation".

sentnum

1

-1

Because of its impacts on a range of diseases, it is a health-related MDG target.

sentnum

2

-1

This study presents cost estimates of attaining MDG target 10.

sentnum

3

-1

METHODS: We estimate the population to be covered to attain the MDG target using data on household use of improved water and sanitation for 1990 and 2004, and taking into account population growth.

sentnum

4

-1

We assume this estimate is achieved in equal annual increments from the base year, 2005, until 2014.

sentnum

5

-1

Costs per capita for investment and recurrent costs are applied.

sentnum

6

-1

Country data is aggregated to 11 WHO developing country subregions and globally.

sentnum

7

-1

FINDINGS: Estimated spending required in developing countries on new coverage to meet the MDG target is US$ 42 billion for water and US$ 142 billion for sanitation, a combined annual equivalent of US$ 18 billion.

sentnum

8

-1

The cost of maintaining existing services totals an additional US$ 322 billion for water supply and US $216 billion for sanitation, a combined annual equivalent of US$ 54 billion.

sentnum

9

-1

Spending for new coverage is largely rural (64%), while for maintaining existing coverage it is largely urban (73%).

sentnum

10

-1

Additional programme costs, incurred administratively outside the point of delivery of interventions, of between 10% and 30% are required for effective implementation.

sentnum

11

-1

CONCLUSION: In assessing financing requirements, estimates of cost should include the operation, maintenance and replacement of existing coverage as well as new services and programme costs.

sentnum

12

-1

Country-level costing studies are needed to guide sector financing.

null

S0042-96862008000100012

language

EN

section

title

-1

sentnum

0

-1

Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015.

sentnum

1

-1

METHODS: A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle- income countries.

sentnum

2

-1

Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach.

sentnum

3

-1

Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis.

sentnum

4

-1

FINDINGS: The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000.

sentnum

5

-1

By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion.

sentnum

6

-1

Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels.

sentnum

7

-1

In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up.

sentnum

8

-1

CONCLUSION: In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached.

sentnum

9

-1

The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015.

null

S0042-96862008000100014

language

EN

section

title

-1

sentnum

0

-1

How much is not enough?

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool.

sentnum

1

-1

METHODS: We use a model to estimate staffing requirements at primary health care facilities.

sentnum

2

-1

The model integrates several empirically-based assumptions including time and type of health worker required for each type of consultation, amount of management time required, amount of clinical support required and minimum staff requirements per type of facility.

sentnum

3

-1

We also calculate the number of HIV-related consultations per district.

sentnum

4

-1

The model incorporates type of facility, monthly travelling time for mobile clinics, opening hours per week, yearly activity and current staffing and calculates the expected staffing per category of staff per facility and compares it to the actual staffing.

sentnum

5

-1

FINDINGS: Across all the districts there is either an absence of doctors visiting clinics or too few doctors to cover the opening times of community health centres.

sentnum

6

-1

Overall the number of doctors is only 7% of the required amount.

sentnum

7

-1

There is 94% of the required number of professional nurses but with wide variations between districts, with a few districts having excesses while most have shortages.

sentnum

8

-1

The number of enrolled nurses is 60% of what it should be.

sentnum

9

-1

There are 17% too few enrolled nurse assistants.

sentnum

10

-1

Across all districts there is wide variation in staffing levels between facilities leading to inefficient use of professional staff.

sentnum

11

-1

CONCLUSION: The application of an adapted WHO workload tool identified important human resource planning issues.

null

sentnum

1

-1

Human resources requirements for primary health care: a case study from South Africa.

null

S0042-96862008000100016

language

EN

section

title

-1

sentnum

0

-1

Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries.

language

EN

section

abstract

-1

sentnum

0

-1

Ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in new paediatric infections by 2010.

sentnum

1

-1

While these goals are clearly appropriate in their scope, the lack of clarity and consensus around how to monitor the effectiveness of programmes to prevent mother-to-child HIV transmission (PMTCT) makes it difficult for policy-makers to mount a coordinated response.

sentnum

2

-1

In this paper, we develop the case for using population HIV-free child survival as a gold standard metric to measure the effectiveness of PMTCT programmes, and go on to consider multiple study designs and source populations.

sentnum

3

-1

Finally, we propose a novel community survey-based approach that could be implemented widely throughout the developing world with minor modifications to ongoing Demographic and Health Surveys.

null

S0042-96862008000100018

language

EN

section

title

-1

sentnum

0

-1

Increasing tuberculosis case detection: lessons from the Republic of Moldova.

language

EN

section

abstract

-1

sentnum

0

-1

The Republic of Moldova undertook reforms in tuberculosis (TB) control and health care consistent with international recommendations and advanced towards the global target for case detection.

sentnum

1

-1

The number of TB cases notified increased overall by 50% during 2001-2005.

sentnum

2

-1

Expansion of the DOTS strategy and full coverage coincided with a greater role for primary health care (PHC) in TB control and the advent of national insurance for TB diagnosis and treatment.

sentnum

3

-1

These developments and improvements in laboratories, surveillance, medical personnel skills, and public awareness contributed to increased case detection.

sentnum

4

-1

The Republic of Moldova addressed both demand and supply sides in these efforts.

sentnum

5

-1

It increased effective demand for TB services by dispersing diagnostic capability, instituting financing mechanisms and saturating the public with information on symptoms, transmission and treatment.

sentnum

6

-1

It increased the supply of TB services by upgrading the laboratory network, revamping surveillance and training practitioners.

sentnum

7

-1

The Republic of Moldova's experience offers lessons for other countries: TB-PHC integration allowed more suspect cases to be diagnosed at nearby PHC clinics, contributing to more cases being notified.

sentnum

8

-1

Innovative TB communications reached the general public, vulnerable groups, practitioners and the media.

sentnum

9

-1

TB control projects built on each other and national coordination mechanisms served to identify funding for the most pressing needs.

sentnum

10

-1

There are challenges remaining for TB control in the Republic of Moldova, not least the stable treatment success rate, but the country can list valuable lessons and achievements.

null

S0042-96862008000200011

language

EN

section

title

-1

sentnum

0

-1

Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To evaluate the relative cost-effectiveness in different sub-Saharan African settings of presumptive treatment, field-standard microscopy and rapid diagnostic tests (RDTs) to diagnose malaria.

sentnum

1

-1

METHODS: We used a decision tree model and probabilistic sensitivity analysis applied to outpatients presenting at rural health facilities with suspected malaria.

sentnum

2

-1

Costs and effects encompassed those for both patients positive on RDT (assuming artemisinin-based combination therapy) and febrile patients negative on RDT (assuming antibiotic treatment).

sentnum

3

-1

Interventions were defined as cost-effective if they were less costly and more effective or had an incremental cost per disability-adjusted life year averted of less than US$ 150.

sentnum

4

-1

Data were drawn from published and unpublished sources, supplemented with expert opinion.

sentnum

5

-1

FINDINGS: RDTs were cost-effective compared with presumptive treatment up to high prevalences of Plasmodium falciparum parasitaemia.

sentnum

6

-1

Decision-makers can be at least 50% confident of this result below 81% malaria prevalence, and 95% confident below 62% prevalence, a level seldom exceeded in practice.

sentnum

7

-1

RDTs were more than 50% likely to be cost-saving below 58% prevalence.

sentnum

8

-1

Relative to microscopy, RDTs were more than 85% likely to be cost-effective across all prevalence levels, reflecting their expected better accuracy under real-life conditions.

sentnum

9

-1

Results were robust to extensive sensitivity analysis.

sentnum

10

-1

The cost-effectiveness of RDTs mainly reflected improved treatment and health outcomes for non-malarial febrile illness, plus savings in antimalarial drug costs.

sentnum

11

-1

Results were dependent on the assumption that prescribers used test results to guide treatment decisions.

sentnum

12

-1

CONCLUSION: RDTs have the potential to be cost-effective in most parts of sub-Saharan Africa.

null

sentnum

13

-1

Appropriate management of malaria and non-malarial febrile illnesses is required to reap the full benefits of these tests.

null

S0042-96862008000200013

language

EN

section

title

-1

sentnum

0

-1

Comparison of rubella seroepidemiology in 17 countries: progress towards international disease control targets.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To standardize serological surveillance to compare rubella susceptibility in Australia and 16 European countries, and measure progress towards international disease-control targets.

sentnum

1

-1

METHODS: Between 1996 and 2004, representative serum banks were established in 17 countries by collecting residual sera or community sampling.

sentnum

2

-1

Serum banks were tested in each country and assay results were standardized.

sentnum

3

-1

With a questionnaire, we collected information on current and past rubella vaccination programmes in each country.

sentnum

4

-1

The percentage of seronegative (< 4 IU/ml) children (2-14 years of age) was used to evaluate rubella susceptibility, and countries were classified by seronegativity as group I (< 5%), group II (5-10%) or group III (> 10%).

sentnum

5

-1

The proportion of women of childbearing age without rubella protection (< 10 IU/ml) was calculated and compared with WHO targets of < 5%.

sentnum

6

-1

FINDINGS: Only Romania had no rubella immunization programme at the time of the survey; the remaining countries had a two-dose childhood schedule using the measles, mumps and rubella (MMR) vaccine.

sentnum

7

-1

The percentage of susceptible children defined five countries as group I, seven as group II and four as group III.

sentnum

8

-1

Women of childbearing age without rubella protection were < 5% in only five countries.

sentnum

9

-1

CONCLUSION: Despite the low reported incidence in many countries, strengthening the coverage of the routine two-dose of MMR vaccine among children is needed, especially in group III countries.

sentnum

10

-1

Catch-up campaigns in older age groups and selective targeting of older females are needed in many countries to ensure necessary levels of protective immunity among women of childbearing age.

null

S0042-96862008000200015

language

EN

section

title

-1

sentnum

0

-1

Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: We assessed paediatric care in the 13 public hospitals in the north-east of the United Republic of Tanzania to determine if diagnoses and treatments were consistent with current guidelines for care.

sentnum

1

-1

METHODS: Data were collected over a five-day period in each site where paediatric outpatient consultations were observed, and a record of care was extracted from the case notes of children on the paediatric ward.

sentnum

2

-1

Additional data were collected from inspection of ward supplies and hospital reports.

sentnum

3

-1

FINDINGS: Of 1181 outpatient consultations, basic clinical signs were often not checked; e.g. of 895 children with a history of fever, temperature was measured in 57%, and of 657 of children with cough or dyspnoea only 57 (9%) were examined for respiratory rate.

sentnum

4

-1

Among 509 inpatients weight was recorded in the case notes in 250 (49%), respiratory rate in 54 (11%) and mental state in 47 (9%).

sentnum

5

-1

Of 206 malaria diagnoses, 123 (60%) were with a negative or absent slide result, and of these 44 (36%) were treated with quinine only.

sentnum

6

-1

Malnutrition was diagnosed in 1% of children admitted while recalculation of nutritional Z-scores suggested that between 5% and 10% had severe acute malnutrition; appropriate feeds were not present in any of the hospitals.

sentnum

7

-1

A diagnosis of HIV-AIDS was made in only two cases while approximately 5% children admitted were expected to be infected with HIV in this area.

sentnum

8

-1

CONCLUSION: Clinical assessment of children admitted to paediatric wards is disturbingly poor and associated with missed diagnoses and inappropriate treatments.

sentnum

9

-1

Improved assessment and records are essential to initiate change, but achieving this will be a challenging task.

null

S0042-96862008000200017

language

EN

section

title

-1

sentnum

0

-1

Resistance to implementing policy change: the case of Ukraine.

language

EN

section

abstract

-1

sentnum

0

-1

Tuberculosis (TB) is a major public health problem in eastern Europe.

sentnum

1

-1

Since 1990, the incidence rates of TB have continued to increase in Belarus, the Russian Federation, the Ukraine and the central Asian republics of Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan.

sentnum

2

-1

Eastern Europe, and in particular the Russian Federation and the Ukraine, also face the public health challenge of an escalating multidrug-resistant tuberculosis (MDR-TB) epidemic.

sentnum

3

-1

Of the 17 283 global MDR-TB cases reported in 2004, over 60% (10 595) were from the European region and the vast majority of these from eastern Europe, including the Baltic states of Estonia, Latvia and Lithuania.

sentnum

4

-1

Of particular concern is the fact that, along with Africa, treatment success for DOTS in eastern Europe is substantially below average when compared with other regions of the world, and DOTS coverage and smear-positive case detection rate remain the lowest in the world.

sentnum

5

-1

Collectively, along with Africa, these problems in eastern Europe remain the principal obstacle to meeting the Millennium Development Goals for TB in Europe.

sentnum

6

-1

The Ukraine has worsening epidemics of TB, MDR-TB and HIV, against a background of epidemics of sexually transmitted illness (STI) and injecting drug users (IDUs).

sentnum

7

-1

The TB and HIV epidemics are converging.

sentnum

8

-1

In spite of attempts, the Ukraine has failed to implement DOTS policy due to health systems organization, financing and provider payment systems that created disincentives to change while opposition by policy-makers and clinicians to DOTS strategy hindered implementation efforts.

null

S0042-96862008000300009

language

EN

section

title

-1

sentnum

0

-1

Stillbirth in rural Bangladesh: arsenic exposure and other etiological factors: a report from Gonoshasthaya Kendra.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To use data collected by Gonoshasthaya Kendra, a large nongovernmental organization providing health care to some 600 villages, to describe the epidemiological pattern of stillbirth and any additional contribution made by arsenic contamination of hand-pump wells in Bangladesh.

sentnum

1

-1

METHODS: Completed pregnancies and outcomes (n = 30 984) for two calendar years, together with existing data on 26 socioeconomic and health factors were selected for study.

sentnum

2

-1

The health care in these villages was administered from 16 geographical centres; information on the average arsenic concentration in each centre was obtained from the National Hydrochemical Survey.

sentnum

3

-1

After univariate analysis, a multivariate, multilevel, logistic model for stillbirth was developed.

sentnum

4

-1

The additional effect of arsenic was calculated having adjusted for all potential confounders thus identified.

sentnum

5

-1

FINDINGS: The overall stillbirth rate was 3.4% (1056/30 984) and increased with estimated arsenic concentration (2.96% at < 10 Âµg/l; 3.79% at 10 Âµg/l to < 50 Âµg/l; 4.43% at > 50 Âµg/l).

sentnum

6

-1

Having adjusted for 17 socioeconomic and health factors, the odds ratios estimated for arsenic (with < 10 Âµg/l as reference) remained raised: 1.23 (95% confidence interval, CI: 0.87Â1.74) at 10 Âµg/l to < 50 Âµg/l and 1.80 (95% CI: 1.14Â2.86) at 50 Âµg/l or greater.

sentnum

7

-1

CONCLUSION: A increased risk of stillbirth is associated with arsenic contamination.

sentnum

8

-1

This risk, substantial enough to be detected by an ecological approach and not readily attributable to unmeasured confounding, is essentially preventable and all efforts must be made to protect women at high risk.

null

S0042-96862008000300011

language

EN

section

title

-1

sentnum

0

-1

Reconstructing historical changes in the force of infection of dengue fever in Singapore: implications for surveillance and control.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To reconstruct the historical changes in force of dengue infection in Singapore, and to better understand the relationship between control of Aedes mosquitoes and incidence of classic dengue fever.

sentnum

1

-1

METHODS: Seroprevalence data were abstracted from surveys performed in Singapore from 1982 to 2002.

sentnum

2

-1

These data were used to develop two mathematical models of age seroprevalence.

sentnum

3

-1

In the first model, force of infection was allowed to vary independently each year, while in the second it was described by a polynomial function.

sentnum

4

-1

Model-predicted temporal trends were analysed using linear regression.

sentnum

5

-1

Time series techniques were employed to investigate periodicity in predicted forces of infection, dengue fever incidence and mosquito breeding.

sentnum

6

-1

FINDINGS: Force of infection estimates showed a significant downward trend from 1966, when vector control was instigated.

sentnum

7

-1

Force of infection estimates from both models reproduced significant increases in the percentage and average age of the population susceptible to dengue infections.

sentnum

8

-1

Importantly, the year-on-year model independently predicted a five to six year periodicity that was also displayed by clinical incidence but absent from the Aedes household index.

sentnum

9

-1

CONCLUSION: We propose that the rise in disease incidence was due in part to a vector-control-driven reduction in herd immunity in older age groups that are more susceptible to developing clinical dengue.

null

S0042-96862008000300013

language

EN

section

title

-1

sentnum

0

-1

Acute pesticide poisoning: a proposed classification tool.

language

EN

section

abstract

-1

sentnum

0

-1

Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide.

sentnum

1

-1

Developing countries are particularly susceptible due to poorer regulation, lack of surveillance systems, less enforcement, lack of training and inadequate access to information systems.

sentnum

2

-1

Previous research has demonstrated wide variability in incidence rates for APP.

sentnum

3

-1

This is possibly due to inconsistent reporting methodology and exclusion of occupational and non-intentional poisonings.

sentnum

4

-1

The purpose of this document is to create a standard case definition to facilitate the identification and diagnosis of all causes of APP, especially at the field level, rural clinics and primary health-care systems.

sentnum

5

-1

This document is a synthesis of existing literature and case definitions that have been previously proposed by other authors around the world.

sentnum

6

-1

It provides a standardized case definition and classification scheme for APP into categories of probable, possible and unlikely/unknown cases.

sentnum

7

-1

Its use is intended to be applicable worldwide to contribute to identification of the scope of existing problems and thus promote action for improved management and prevention.

sentnum

8

-1

By enabling a field diagnosis for APP, this standardized case definition may facilitate immediate medical management of pesticide poisoning and aid in estimating its incidence.

null

S0042-96862008000300015

language

EN

section

title

-1

sentnum

0

-1

Strategies for implementing the new International Health Regulations in federal countries.

language

EN

section

abstract

-1

sentnum

0

-1

The International Health Regulations (IHR), the principal legal instrument guiding the international management of public health emergencies, have recently undergone an extensive revision process.

sentnum

1

-1

The revised regulations, referred to as the IHR (2005), were unanimously approved in May 2005 by all Member States of the World Health Assembly (WHA) and came into effect on 15 June 2007.

sentnum

2

-1

The IHR (2005) reflect a modernization of the international community's approach to public health and an acknowledgement of the importance of establishing an effective international strategy to manage emergencies that threaten global health security.

sentnum

3

-1

The success of the IHR as a new approach to combating such threats will ultimately be determined by the ability of countries to live up to the obligations they assumed in approving the new international strategy.

sentnum

4

-1

However, doing so may be particularly challenging for decentralized countries, specifically those with federal systems of government.

sentnum

5

-1

Although the IHR (2005) are the product of an agreement among national governments, they cover a wide range of matters, some of which may not fall fully under the constitutional jurisdiction of the national government within many federations.

sentnum

6

-1

This tension between the separation of powers within federal systems of government and the requirements of an evolving global public health governance regime may undermine national efforts towards compliance and could ultimately jeopardize the regime's success.

sentnum

7

-1

We hosted a workshop to examine how federal countries could address some of the challenges they may face in implementing the IHR (2005).

sentnum

8

-1

We present here a series of recommendations, synthesized from the workshop proceedings, on strategies that these countries might pursue to improve their ability to comply with the revised IHR.

null

S0042-96862008000300017

language

EN

section

title

-1

sentnum

0

-1

How can we achieve global equity in provision of renal replacement therapy?.

language

EN

section

abstract

-1

sentnum

0

-1

There is a significant emerging burden of chronic and end-stage kidney disease in low- and middle-income countries, driven by population ageing and the global epidemic of type 2 diabetes.

sentnum

1

-1

Sufferers of end-stage kidney disease require ongoing dialysis or kidney transplantation to survive; however, in many low- and middle-income countries, treatment options are strictly limited or unaffordable.

sentnum

2

-1

Low numbers of maintenance dialysis patients and transplant recipients reflect profound economic and service provision challenges for health-care systems in low- and middle-income countries in sustaining renal replacement therapy programmes.

sentnum

3

-1

Underdeveloped organ donor and transplant programmes, health system and financing issues, ethical regulation of transplantation and the cost of pharmaceuticals commonly pose additional barriers to the delivery of efficient and cost-effective renal replacement therapy.

sentnum

4

-1

Development of locally appropriate transplant programmes, effective use of nongovernmental sources of funding, service planning and cost containment, use of generic drugs and local manufacture of dialysis consumables have the potential to make life-saving renal replacement therapy available to many more in need.

sentnum

5

-1

Select low- and middle-income countries demonstrate more equitable provision of renal replacement therapy is possible outside high-income countries.

sentnum

6

-1

For other low- and middleincome countries, education, the development of good public policy and a supportive international environment are critical.

sentnum

7

-1

Prevention of end-stage kidney disease, ideally as part of an integrated approach to chronic vascular diseases, must also be a key objective.

null

S0042-96862008000400010

language

EN

section

title

-1

sentnum

0

-1

A study of typhoid fever in five asian countries: disease burden and implications for controls.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To inform policy-makers about introduction of preventive interventions against typhoid, including vaccination.

sentnum

1

-1

METHODS: A population-based prospective surveillance design was used.

sentnum

2

-1

Study sites where typhoid was considered a problem by local authorities were established in China, India, Indonesia, Pakistan and Viet Nam.

sentnum

3

-1

Standardized clinical, laboratory, and surveillance methods were used to investigate cases of fever of > 3 days' duration for a one-year period.

sentnum

4

-1

A total of 441 435 persons were under surveillance, 159 856 of whom were aged 5-15 years.

sentnum

5

-1

FINDINGS: A total of 21 874 episodes of fever were detected.

sentnum

6

-1

Salmonella typhi was isolated from 475 (2%) blood cultures, 57% (273/475) of which were from 5-15 year-olds.

sentnum

7

-1

The annual typhoid incidence (per 100 000 person years) among this age group varied from 24.2 and 29.3 in sites in Viet Nam and China, respectively, to 180.3 in the site in Indonesia; and to 412.9 and 493.5 in sites in Pakistan and India, respectively.

sentnum

8

-1

Altogether, 23% (96/413) of isolates were multidrug resistant (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole).

sentnum

9

-1

CONCLUSION: The incidence of typhoid varied substantially between sites, being high in India and Pakistan, intermediate in Indonesia, and low in China and Viet Nam.

sentnum

10

-1

These findings highlight the considerable, but geographically heterogeneous, burden of typhoid fever in endemic areas of Asia, and underscore the importance of evidence on disease burden in making policy decisions about interventions to control this disease.

null

S0042-96862008000400012

language

EN

section

title

-1

sentnum

0

-1

Disease burden and health-care clinic attendances for young children in remote aboriginal communities of northern Australia.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To determine the frequency of presentations and infectious-disease burden at primary health care (PHC) services in young children in two remote Aboriginal communities in tropical northern Australia.

sentnum

1

-1

METHODS: Children born after 1 January 2001, who were resident at 30 September 2005 and for whom consent was obtained, were studied.

sentnum

2

-1

Clinic records were reviewed for all presentations between 1 January 2002 and 30 September 2005.

sentnum

3

-1

Data collected included reason for presentation (if infectious), antibiotic prescription and referral to hospital.

sentnum

4

-1

FINDINGS: There were 7273 clinic presentations for 174 children aged 0-4.75 years, 55% of whom were male.

sentnum

5

-1

The median presentation rate per child per year was 16 (23 in the first year of life).

sentnum

6

-1

Upper-respiratory-tract infections (32%) and skin infections (18%) were the most common infectious reasons for presentation.

sentnum

7

-1

First presentations for scabies and skin sores peaked at the age of 2 months.

sentnum

8

-1

By 1 year of age, 63% and 69% of children had presented with scabies and skin sores, respectively.

sentnum

9

-1

CONCLUSION: These Aboriginal children average about two visits per month to PHC centres during their first year of life.

sentnum

10

-1

This high rate is testament to the disease burden, the willingness of Aboriginal people to use health services and the high workload experienced by these health services.

sentnum

11

-1

Scabies and skin sores remain significant health problems, with this study describing a previously undocumented burden of these conditions commencing within the first few months of life.

sentnum

12

-1

Appropriate prevention and treatment strategies should encompass early infancy to reduce the high burden of infectious diseases in this population.

null

S0042-96862008000400015

language

EN

section

title

-1

sentnum

0

-1

Acceptability of routine HIV counselling and testing, and HIV seroprevalence in Ugandan hospitals.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: Mulago and Mbarara hospitals are large tertiary hospitals in Uganda with a high HIV/AIDS burden.

sentnum

1

-1

Until recently, HIV testing was available only upon request and payment.

sentnum

2

-1

From November 2004, routine free HIV testing and counselling has been offered to improve testing coverage and the clinical management of patients.

sentnum

3

-1

All patients in participating units who had not previously tested HIV-positive were offered HIV testing.

sentnum

4

-1

Family members of patients seen at the hospitals were also offered testing.

sentnum

5

-1

METHODS: Data collected at the 25 participating wards and clinics between 1 November 2004 and 28 February 2006 were analysed to determine the uptake rate of testing and the HIV seroprevalence among patients and their family members.

sentnum

6

-1

FINDINGS: Of the 51 642 patients offered HIV testing, 50 649 (98%) accepted.

sentnum

7

-1

In those who had not previously tested HIV-positive, the overall HIV prevalence was 25%, with 81% being tested for the first time.

sentnum

8

-1

The highest prevalence was found in medical inpatients (35%) and the lowest, in surgical inpatients (12%).

sentnum

9

-1

The prevalence of HIV was 28% in the 39 037 patients who had never been tested before and 9% in those who had previously tested negative.

sentnum

10

-1

Of the 10 439 family members offered testing, 9720 (93%) accepted.

sentnum

11

-1

The prevalence in family members was 20%.

sentnum

12

-1

Among 1213 couples tested, 224 (19%) had a discordant HIV status.

null

sentnum

13

-1

CONCLUSION: In two large Ugandan hospitals, routine HIV testing and counselling was highly acceptable and identified many previously undiagnosed HIV infections and HIV-discordant partnerships among patients and their family members.

null

S0042-96862008000500009

language

EN

section

title

-1

sentnum

0

-1

Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To review individual case histories of children who had died of pneumonia in rural Uganda and to investigate why these children did not survive.

sentnum

1

-1

METHODS: This case-series study was done in the Iganga/Mayuge demographic surveillance site, Uganda, where 67 000 people were visited once every 3 months for population-based data and vital events.

sentnum

2

-1

Children aged 1-59 months from November 2005 to August 2007 were included.

sentnum

3

-1

Verbal and social autopsies were done to determine likely cause of death and care-seeking actions.

sentnum

4

-1

FINDINGS: Cause of death was assigned for 164 children, 27% with pneumonia.

sentnum

5

-1

Of the pneumonia deaths, half occurred in hospital and one-third at home.

sentnum

6

-1

Median duration of pneumonia illness was 7 days, and median time taken to seek care outside the home was 2 days.

sentnum

7

-1

Most first received drugs at home: 52% antimalarials and 27% antibiotics.

sentnum

8

-1

Most were taken for care outside the home, 36% of whom first went to public hospitals.

sentnum

9

-1

One-third of those reaching the district hospital were referred to the regional hospital, and 19% reportedly improved after hospital treatment.

sentnum

10

-1

The median treatment cost for a child with fatal pneumonia was US$ 5.8.

sentnum

11

-1

CONCLUSION: There was mistreatment with antimalarials, delays in seeking care and likely low quality of care for children with fatal pneumonia.

sentnum

12

-1

To improve access to and quality of care, the feasibility and effect on mortality of training community health workers and drug vendors in pneumonia and malaria management with prepacked drugs should be tested.

null

S0042-96862008000500011

language

EN

section

title

-1

sentnum

0

-1

Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi.

language

EN

section

abstract

-1

sentnum

0

-1

PROBLEM: Hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, yet oxygen was not available in most paediatric wards in Malawi.

sentnum

1

-1

APPROACH: The Child Lung Health Programme in Malawi made oxygen available by supplying oxygen concentrators and essential supplies to 22 district and 3 regional hospitals' paediatric wards.

sentnum

2

-1

Five key steps were taken to introduce concentrators: (1) develop a curriculum and training materials; (2) train staff on use and maintenance; (3) retrain electromedical departments on maintenance and repair; (4) conduct training once concentrators arrived in the country; and (5) distribute concentrators once staff had been trained.

sentnum

3

-1

LOCAL SETTING: The paediatric wards in 3 regional and 22 government district hospitals and 3 regional electromedical engineering departments in Malawi.

sentnum

4

-1

RELEVANT CHANGES: Main changes were: (1) provision of a source of oxygen in every paediatric ward in all district hospitals; (2) training of electrical engineering and health personnel in the use, maintenance and repair of oxygen concentrators; and (3) setting-up of high-dependency rooms or areas for severely ill children where oxygen is administered.

sentnum

5

-1

LESSONS LEARNED: It is feasible to implement an oxygen system using concentrators throughout a low-income country.

sentnum

6

-1

Oxygen delivery requires trained staff with necessary equipment and supplies.

sentnum

7

-1

Regular maintenance and supervision are essential to ensure optimal utilization.

null

S0042-96862008000500013

language

EN

section

title

-1

sentnum

0

-1

Acute lower respiratory infections in childhood: opportunities for reducing the global burden through nutritional interventions.

language

EN

section

abstract

-1

sentnum

0

-1

Inadequate nutrition and acute lower respiratory infection (ALRI) are overlapping and interrelated health problems affecting children in developing countries.

sentnum

1

-1

Based on a critical review of randomized trials of the effect of nutritional interventions on ALRI morbidity and mortality, we concluded that: (1) zinc supplementation in zinc-deficient populations prevents about one-quarter of episodes of ALRI, which may translate into a modest reduction in ALRI mortality; (2) breastfeeding promotion reduces ALRI morbidity; (3) iron supplementation alone does not reduce ALRI incidence; and (4) vitamin A supplementation beyond the neonatal period does not reduce ALRI incidence or mortality.

sentnum

2

-1

There was insufficient evidence regarding other potentially beneficial nutritional interventions.

sentnum

3

-1

For strategies with a strong theoretical rationale and probable operational feasibility, rigorous trials with active clinical case-finding and adequate sample sizes should be undertaken.

sentnum

4

-1

At present, a reduction in the burden of ALRI can be expected from the continued promotion of breastfeeding and scale-up of zinc supplementation or fortification strategies in target populations.

null

S0042-96862008000500015

language

EN

section

title

-1

sentnum

0

-1

Safety profile of pneumococcal conjugate vaccines: systematic review of pre- and post-licensure data.

language

EN

section

abstract

-1

sentnum

0

-1

A 7-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV7) was licensed in the United States of America in 2000, but no comprehensive postmarketing review of safety has been carried out.

sentnum

1

-1

We conducted a systematic review of the safety of PCV7 and other pneumococcal conjugate vaccines.

sentnum

2

-1

A total of 42 studies were included in the review.

sentnum

3

-1

Reactogenicity data from some randomized trials suggest that PCV7 may result in more local reactions and fever than certain comparison vaccines.

sentnum

4

-1

However, the reactions were mild and self-limited, and PCV7 did not carry an increased risk of severe injection-site reactions or high fever.

sentnum

5

-1

Some, although not all, of the randomized trials in children found that mild local and systemic reactions associated with PCV7 may increase with the number of doses, at least over the three-dose primary series.

sentnum

6

-1

In addition, PCV7 and other pneumococcal conjugate vaccines were found to have tolerable reactogenicity in Native American and African populations and in medically high-risk groups for which pneumococcal vaccination is recommended.

sentnum

7

-1

Two of the largest studies of PCVs, one involving PCV7 and the other, PCV9, found a statistically significant increased risk of hospitalization for reactive airway disease, including asthma.

sentnum

8

-1

Another large trial of PCV9, however, did not find an increased risk of asthma.

sentnum

9

-1

In conclusion, this review of the evidence did not identify any major safety problems with PCV7 or any other pneumococcal conjugate vaccine, with the possible exception of reactive airway disease, which may bear further scrutiny as additional data become available.

null

S0042-96862008000500017

language

EN

section

title

-1

sentnum

0

-1

Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis.

language

EN

section

abstract

-1

sentnum

0

-1

Reduction of indoor air pollution (IAP) exposure from solid fuel use is a potentially important intervention for childhood pneumonia prevention.

sentnum

1

-1

This review updates a prior meta-analysis and investigates whether risk varies by etiological agent and pneumonia severity among children aged less than 5 years who are exposed to unprocessed solid fuels.

sentnum

2

-1

Searches were made of electronic databases (including Africa, China and Latin America) without language restriction.

sentnum

3

-1

Search terms covered all sources of IAP and wide-ranging descriptions of acute lower respiratory infections, including viral and bacterial agents.

sentnum

4

-1

From 5317 studies in the main electronic databases (plus 307 African and Latin American, and 588 Chinese studies, in separate databases), 25 were included in the review and 24 were suitable for meta-analysis.

sentnum

5

-1

Due to substantial statistical heterogeneity, random effects models were used.

sentnum

6

-1

The overall pooled odds ratio was 1.78 (95% confidence interval, CI: 1.45-2.18), almost unchanged at 1.79 (95% CI: 1.26-2.21) after exclusion of studies with low exposure prevalence (< 15%) and one high outlier.

sentnum

7

-1

There was evidence of publication bias, and the implications for the results are explored.

sentnum

8

-1

Sensitivity subanalyses assessed the impact of control selection, adjustment for confounding, exposure and outcome assessment, and age, but no strong effects were identified.

sentnum

9

-1

Evidence on respiratory syncytial virus was conflicting, while risk for severe or fatal pneumonia was similar to or higher than that for all pneumonia.

sentnum

10

-1

Despite heterogeneity, this analysis demonstrated sufficient consistency to conclude that risk of pneumonia in young children is increased by exposure to unprocessed solid fuels by a factor of 1.8.

sentnum

11

-1

Greater efforts are now required to implement effective interventions.

null

S0042-96862008000500019

language

EN

section

title

-1

sentnum

0

-1

Epidemiology and etiology of childhood pneumonia.

language

EN

section

abstract

-1

sentnum

0

-1

Childhood pneumonia is the leading single cause of mortality in children aged less than 5 years.

sentnum

1

-1

The incidence in this age group is estimated to be 0.29 episodes per child-year in developing and 0.05 episodes per child-year in developed countries.

sentnum

2

-1

This translates into about 156 million new episodes each year worldwide, of which 151 million episodes are in the developing world.

sentnum

3

-1

Most cases occur in India (43 million), China (21 million) and Pakistan (10 million), with additional high numbers in Bangladesh, Indonesia and Nigeria (6 million each).

sentnum

4

-1

Of all community cases, 7-13% are severe enough to be life-threatening and require hospitalization.

sentnum

5

-1

Substantial evidence revealed that the leading risk factors contributing to pneumonia incidence are lack of exclusive breastfeeding, undernutrition, indoor air pollution, low birth weight, crowding and lack of measles immunization.

sentnum

6

-1

Pneumonia is responsible for about 19% of all deaths in children aged less than 5 years, of which more than 70% take place in sub-Saharan Africa and south-east Asia.

sentnum

7

-1

Although based on limited available evidence, recent studies have identified Streptococcus pneumoniae, Haemophilus influenzae and respiratory syncytial virus as the main pathogens associated with childhood pneumonia.

null

S0042-96862008000600011

language

EN

section

title

-1

sentnum

0

-1

Anthropometric and immunological success of antiretroviral therapy and prediction of virological success in west African adults.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step.

sentnum

1

-1

In sub-Saharan Africa, few people have access to plasma viral-load measurement.

sentnum

2

-1

We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART.

sentnum

3

-1

METHODS: In a cohort of 622 adults in Abidjan, Côte d'Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard.

sentnum

4

-1

FINDINGS: After 6 months of ART, the median change in BMI was an increase of 1.0 kg/m² (interquartile range, IQR: 0.0-2.1), the median change in CD4 an increase of 148/ml (IQR: 54-230) and 84% of patients reached viral-load undetectability.

sentnum

5

-1

The distribution of change in BMI was similar among patients who reached undetectability and those who did not (increases of 1.06 kg/m² versus 0.99 kg/m², P = 0.51).

sentnum

6

-1

With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%.

sentnum

7

-1

All results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4.

sentnum

8

-1

CONCLUSION: In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain.

sentnum

9

-1

In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression.

null

S0042-96862008000600013

language

EN

section

title

-1

sentnum

0

-1

Implementing community-based perinatal care: results from a pilot study in rural Pakistan.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: This pilot study investigated the feasibility of delivering a package of community-based interventions for improving perinatal care using lady health workers (LHWs) and traditional birth attendants (Dais) in rural Pakistan.

sentnum

1

-1

METHODS: The intervention was implemented in four of eight village clusters (315 villages, total population 138 600), while four served as a comparison group.

sentnum

2

-1

The LHWs in intervention clusters received additional training focused on essential maternal and newborn care, conducted community education group sessions, and were encouraged to link up with local Dais.

sentnum

3

-1

The intervention was delivered within the regular government LHW programme and was supported by the creation of voluntary community health committees.

sentnum

4

-1

FINDINGS: In intervention villages, there were significant reductions from baseline in stillbirth (from 65.9 to 43.1 per 1000 births, P < 0.001) and neonatal mortality rates (from 57.3 to 41.3 per 1000 live births, P < 0.001).

sentnum

5

-1

The proportion of deliveries conducted by skilled attendants at public sector facilities also increased, from 18% at baseline to 30%, while the proportion of home births decreased from 79% to 65%.

sentnum

6

-1

A household survey indicated a higher frequency of key behaviours (e.g. early and exclusive breastfeeding, delayed bathing and cord care) in intervention villages.

sentnum

7

-1

CONCLUSION: The improved stillbirth and neonatal mortality rates observed indicate that community health workers (i.e. LHWs and Dais) can be effective in implementing a community and outreach package that leads to improved home care practices by families, increased care-seeking behaviour and greater utilization of skilled care providers.

sentnum

8

-1

These preliminary observations require confirmation in an adequately powered trial.

null

S0042-96862008000600015

language

EN

section

title

-1

sentnum

0

-1

Evaluating the WHO Assessment Instrument for Mental Health Systems by comparing mental health policies in four countries.

language

EN

section

abstract

-1

sentnum

0

-1

Mental health is a low priority in most countries around the world.

sentnum

1

-1

Minimal research and resources have been invested in mental health at the national level.

sentnum

2

-1

As a result, WHO has developed the Assessment Instrument for Mental Health Systems (WHO-AIMS) to encourage countries to gather data and to re-evaluate their national mental health policy.

sentnum

3

-1

This paper demonstrates the utility and limitations of WHO-AIMS by applying the model to four countries with different cultures, political histories and public health policies: Iraq, Japan, the Philippines and The former Yugoslav Republic of Macedonia.

sentnum

4

-1

WHO-AIMS provides a useful model for analysing six domains: policy and legislative framework; mental health services; mental health in primary care; human resources; education of the public at large; and monitoring and research.

sentnum

5

-1

This is especially important since most countries do not have experts in mental health policy or resources to design their own evaluation tools for mental health systems.

sentnum

6

-1

Furthermore, WHO-AIMS provides a standardized database for cross-country comparisons.

sentnum

7

-1

However, limitations of the instrument include the neglect of the politics of mental health policy development, underestimation of the role of culture in mental health care utilization, and questionable measurement validity.

null

S0042-96862008000600017

language

EN

section

title

-1

sentnum

0

-1

Global epidemiology of haemoglobin disorders and derived service indicators.

language

EN

section

abstract

-1

sentnum

0

-1

To demonstrate a method for using genetic epidemiological data to assess the needs for equitable and cost-effective services for the treatment and prevention of haemoglobin disorders.

sentnum

1

-1

We obtained data on demographics and prevalence of gene variants responsible for haemoglobin disorders from online databases, reference resources, and published articles.

sentnum

2

-1

A global epidemiological database for haemoglobin disorders by country was established, including five practical service indicators to express the needs for care (indicator 1) and prevention (indicators 2-5).

sentnum

3

-1

Haemoglobin disorders present a significant health problem in 71% of 229 countries, and these 71% of countries include 89% of all births worldwide.

sentnum

4

-1

Over 330 000 affected infants are born annually (83% sickle cell disorders, 17% thalassaemias).

sentnum

5

-1

Haemoglobin disorders account for about 3.4% of deaths in children less than 5 years of age.

sentnum

6

-1

Globally, around 7% of pregnant women carry b or a zero thalassaemia, or haemoglobin S, C, D Punjab or E, and over 1% of couples are at risk.

sentnum

7

-1

Carriers and at-risk couples should be informed of their risk and the options for reducing it.

sentnum

8

-1

Screening for haemoglobin disorders should form part of basic health services in most countries.

null

S0042-96862008000700010

language

EN

section

title

-1

sentnum

0

-1

Lack of active follow-up of cancer patients in Chennai, India: implications for population-based survival estimates.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To measure the bias in absolute cancer survival estimates in the absence of active follow-up of cancer patients in developing countries.

sentnum

1

-1

METHODS: Included in the study were all incident cases of the 10 most common cancers and corresponding subtypes plus all tobacco-related cancers not ranked among the top 10 that were registered in the population-based cancer registry in Chennai, India, during 1990-1999 and followed through 2001.

sentnum

2

-1

Registered incident cases were first matched with those in the all-cause mortality database from the vital statistics division of the Corporation of Chennai.

sentnum

3

-1

Unmatched incident cancer cases were then actively followed up to determine their survival status.

sentnum

4

-1

Absolute survival was estimated by using an actuarial method and applying different assumptions regarding the survival status (alive/dead) of cases under passive and active follow-up.

sentnum

5

-1

FINDINGS: Before active follow-up, matches between cases ranged from 20% to 66%, depending on the site of the primary tumour.

sentnum

6

-1

Active follow-up of unmatched incident cases revealed that 15% to 43% had died by the end of the follow-up period, while the survival status of 4% to 38% remained unknown.

sentnum

7

-1

Before active follow-up of cancer patients, 5-year absolute survival was estimated to be between 22% and 47% higher, than when conventional actuarial assumption methods were applied to cases that were lost to follow-up.

sentnum

8

-1

The smallest survival estimates were obtained when cases lost to follow-up were excluded from the analysis.

sentnum

9

-1

CONCLUSION: Under the conditions that prevail in India and other developing countries, active follow-up of cancer patients yields the most reliable estimates of cancer survival rates.

sentnum

10

-1

Passive case follow-up alone or applying standard methods to estimate survival is likely to result in an upward bias.

null

S0042-96862008000700012

language

EN

section

title

-1

sentnum

0

-1

Funding agencies in low- and middle-income countries: support for knowledge translation.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: The aim was to describe how selected health research funding agencies active in low- and middle-income countries promote the translation of their funded research into policy and practice.

sentnum

1

-1

METHODS: We conducted inductive analysis of semi-structured interviews with key informants from a purposive sample of 23 national and international funding agencies that fund health research in Brazil, Colombia, India, the Philippines, South Africa and Thailand.

sentnum

2

-1

We also surveyed web sites.

sentnum

3

-1

FINDINGS: We found a commitment to knowledge translation in the mandate of 18 of 23 agencies.

sentnum

4

-1

However, there was a lack of common terminology.

sentnum

5

-1

Most of the activities were traditional efforts to disseminate to a broad audience, for example using web sites and publications.

sentnum

6

-1

In addition, more than half (13 of 23) of the agencies encouraged linkage/exchange between researchers and potential users, and 6 of 23 agencies described "pull" activities to generate interest in research from decision-makers.

sentnum

7

-1

One-third (9 of 23) of funding agencies described a mandate to enhance health equity through improving knowledge translation.

sentnum

8

-1

Only 3 of 23 agencies were able to describe evaluation of knowledge translation activities.

sentnum

9

-1

Furthermore, we found national funding agencies made greater knowledge translation efforts when compared to international agencies.

sentnum

10

-1

CONCLUSION: Funding agencies are engaged in a wide range of creative knowledge translation activities.

sentnum

11

-1

They might consider their role as knowledge brokers, with an ability to promote research syntheses and a focus on health equity.

sentnum

12

-1

There is an urgent need to evaluate the knowledge translation activities of funding agencies.

null

S0042-96862008000700014

language

EN

section

title

-1

sentnum

0

-1

Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: Schizophrenia is a highly disabling disease and is costly to treat.

sentnum

1

-1

We set out to establish what are the most cost-effective interventions applicable to developing regions and countries.

sentnum

2

-1

METHODS: Analysis was undertaken at the level of three WHO subregions spanning the Americas, Africa and South-East Asia, and subsequently in three member states (Chile, Nigeria and Sri Lanka).

sentnum

3

-1

A state transition model was used to estimate the population-level health impact of older and newer antipsychotic drugs, alone or in combination with psychosocial intervention.

sentnum

4

-1

Total population-level costs (in international dollars or local currencies) and effectiveness (measured in disability-adjusted life years averted) were combined to form cost-effectiveness ratios.

sentnum

5

-1

FINDINGS: The most cost-effective interventions were those using older antipsychotic drugs combined with psychosocial treatment, delivered via a community-based service model (I$ 2350-7158 per disability-adjusted life year averted across the three subregions, I$ 1670-3400 following country-level contextualisation within each of these subregions).

sentnum

6

-1

The relative cost-effectiveness of interventions making use of newer, "atypical" antipsychotic drugs is estimated to be much less favourable.

sentnum

7

-1

CONCLUSION: By moving to a community-based service model and selecting efficient treatment options, the cost of substantially increasing treatment coverage is not high (less than I$ 1 investment per capita).

sentnum

8

-1

Taken together with other priority-setting criteria such as disease severity, vulnerability and human rights protection, this study suggests that a great deal more could be done for persons and families living under the spectre of this disorder.

null

S0042-96862008000700016

language

EN

section

title

-1

sentnum

0

-1

Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings.

sentnum

1

-1

METHODS: Using data on 5491 adult patients starting ART (median age 35 years, 46% female) in 15 treatment programmes in Africa, Asia and South America with ³ 12 months of follow-up, we investigated risk factors for no follow-up after treatment initiation, and loss to follow-up or death in the first 6 months.

sentnum

2

-1

FINDINGS: Overall, 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first 6 months.

sentnum

3

-1

The probability of no follow-up was higher in 2003-2004 than in 2000 or earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0), as was loss to follow-up (hazard ratio, HR: 7.62; 95% CI: 4.55-12.8) but not recorded death (HR: 1.02; 95% CI: 0.44-2.36).

sentnum

4

-1

Compared with a baseline CD4-cell count ³ 50 cells/µl, a count < 25 cells/µl was associated with a higher probability of no follow-up (OR: 2.49; 95% CI: 1.43-4.33), loss to follow-up (HR: 1.48; 95% CI: 1.23-1.77) and death (HR: 3.34; 95% CI: 2.10-5.30).

sentnum

5

-1

Compared to free treatment, fee-for-service programmes were associated with a higher probability of no follow-up (OR: 3.71; 95% CI: 0.97-16.05) and higher mortality (HR: 4.64; 95% CI: 1.11-19.41).

sentnum

6

-1

CONCLUSION: Early patient losses were increasingly common when programmes were scaled up and were associated with a fee for service and advanced immunodeficiency at baseline.

sentnum

7

-1

Measures to maximize ART programme retention are required in resource-poor countries.

null

S0042-96862008000800010

language

EN

section

title

-1

sentnum

0

-1

Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach.

language

EN

section

abstract

-1

sentnum

0

-1

We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health.

sentnum

1

-1

We describe the different contributions of the international community, women's health advocates and human rights activists.

sentnum

2

-1

We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality.

null

S0042-96862008000800012

language

EN

section

title

-1

sentnum

0

-1

Denaturalizing scarcity: a strategy of enquiry for public- health ethics.

language

EN

section

abstract

-1

sentnum

0

-1

Most scarcities that underpin health disparities within and among countries are not natural; rather, they result from policy choices and the operation of social institutions.

sentnum

1

-1

Using examples from the United States of America: the Chicago heat wave and hurricane Katrina, this paper develops "denaturalizing scarcity" as a strategy for enquiry to inform public-health ethics in an interconnected world.

sentnum

2

-1

It first describes some of the resource scarcities that are of greatest concern from a public-health perspective, and then outlines two (not mutually exclusive) lines of ethical reasoning that demonstrate their importance.

sentnum

3

-1

One of these involves the multiple relationships that link rich and poor across national borders in today's interconnected world.

sentnum

4

-1

The paper then briefly describes ways in which globalization and the associated institutions are linked to health-threatening scarcities.

sentnum

5

-1

The paper concludes that denaturalizing scarcity represents a valuable alternative to mainstream health ethics, directing our attention instead to why some settings are "resource poor" and others are not.

null

S0042-96862008000800014

language

EN

section

title

-1

sentnum

0

-1

Demographic and health surveillance: longitudinal ethical considerations.

language

EN

section

abstract

-1

sentnum

0

-1

Longitudinal data gathered from health surveillance, when combined with detailed demographic information, can provide invaluable insight into disease outcomes.

sentnum

1

-1

Many such surveillance sites exist in the developing world, particularly in Asia and sub-Saharan Africa, and focus on diseases such as HIV/AIDS, cholera, malaria and tuberculosis.

sentnum

2

-1

The indistinct positions of such surveillance systems, often inhabiting an area between research, treatment and population health monitoring, means that the necessity of and responsibility for ethical oversight is unclear.

sentnum

3

-1

This regulatory vacuum is further compounded by a lack of attention to longitudinal surveillance systems in ethics literature.

sentnum

4

-1

In this paper, we explore some key ethical questions that arise during demographic and health surveillance in relation to ethical principles of beneficence, respect for persons and justice: health-care provision, informed consent and study sustainability.

null

S0042-96862008000800016

language

EN

section

title

-1

sentnum

0

-1

A personalist approach to public-health ethics.

language

EN

section

abstract

-1

sentnum

0

-1

First we give an overview of the historical development of public health.

sentnum

1

-1

Then we present some public-health deontology codes and some ethical principles.

sentnum

2

-1

We highlight difficulties in defining ethics for public health, with specific reference to three of them that concern: (i) the adaptability to public health of the classical principles of bioethics; (ii) the duty to respect and safeguard the individual while acting within the community perspective that is typical of public health; and (iii) the application-oriented nature of public health and the general lack of attention towards the ethical implications of collective interventions (compared with research).

sentnum

3

-1

We then mention some proposals drafted from North American bioethics "principles" and utilitarian, liberal and communitarian views.

sentnum

4

-1

Drawing from other approaches, personalism is outlined as being the theory that offers a consistent set of values and alternative principles that are relevant for public health.

null

S0042-96862008000800018

language

EN

section

title

-1

sentnum

0

-1

Health-sector responses to intimate partner violence in low- and middle-income settings: a review of current models, challenges and opportunities.

language

EN

section

abstract

-1

sentnum

0

-1

There is growing recognition of the public-health burden of intimate partner violence (IPV) and the potential for the health sector to identify and support abused women.

sentnum

1

-1

Drawing upon models of health-sector integration, this paper reviews current initiatives to integrate responses to IPV into the health sector in low- and middle-income settings.

sentnum

2

-1

We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives.

sentnum

3

-1

The findings suggest that a few models of integration are being replicated in many settings.

sentnum

4

-1

These often focus on service provision at a secondary or tertiary level through accident and emergency or women's health services, or at a primary level through reproductive or family-planning health services.

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5

-1

Challenges to integration still exist at all levels, from individual service providers' attitudes and lack of knowledge about violence to managerial and health systems' challenges such as insufficient staff training, no clear policies on IPV, and lack of coordination among various actors and departments involved in planning integrated services.

sentnum

6

-1

Furthermore, given the variety of locations where women may present and the range and potential severity of presenting health problems, there is an urgent need for coherent, effective referral within the health sector, and the need for strong local partnership to facilitate effective referral to external, non-health services.

null

S0042-96862008000900011

language

EN

section

title

-1

sentnum

0

-1

Antiretroviral therapy and early mortality in South Africa.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To describe province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme 5 years since inception, and to demonstrate the utility of the WHO monitoring system for ART.

sentnum

1

-1

METHODS: The treatment programme started in 2001 through innovator sites.

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2

-1

Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities.

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3

-1

Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated.

sentnum

4

-1

Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART.

sentnum

5

-1

FINDINGS: By the end of March 2006, 16 234 patients were in care.

sentnum

6

-1

The cohort analysis included 12 587 adults and 1709 children.

sentnum

7

-1

Women accounted for 70% of adults enrolled.

sentnum

8

-1

After 4 and 3 years on ART respectively, 72.0% of adults (95% confidence interval, CI: 68.0-75.6) and 81.5% (95% CI: 75.7-86.1) of children remained in care.

sentnum

9

-1

The percentage of adults starting ART with CD4 counts less than50 cells/µl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at 6 months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at 6 months in 2005).

sentnum

10

-1

Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART.

sentnum

11

-1

CONCLUSION: The location of care in primary-care sites in this programme was associated with good retention in care, while the scaling-up of ART provision was associated with reduced early mortality.

null

S0042-96862008000900013

language

EN

section

title

-1

sentnum

0

-1

Declining HIV prevalence among young pregnant women in Lusaka, Zambia.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: HIV prevention has been ongoing in Lusaka for many years.

sentnum

1

-1

Recent reports suggest a possible decline in HIV sero-incidence in Zambia and some neighbouring countries.

sentnum

2

-1

This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006.

sentnum

3

-1

METHODS: We analysed HIV seroprevalence trends from two Lusaka sources: (i) antenatal data from a city-wide programme to prevent mother-to-child HIV transmission, and (ii) delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005-2006, where specimens from > 97% of public-sector births in each period were obtained and analysed.

sentnum

4

-1

FINDINGS: Between July 2002 and December 2006, the Lusaka district tested 243 302 antenatal women for HIV; 54 853 (22.5%) were HIV infected.

sentnum

5

-1

Over this period, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006 (P < 0.001).

sentnum

6

-1

The cord-blood surveillances were conducted between June and August 2003 and again between October 2005 and January 2006.

sentnum

7

-1

Overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005-2006 (P = 0.001).

sentnum

8

-1

Among women < 17 years of age, seroprevalence declined from 12.1% to 7.7% (P = 0.015).

sentnum

9

-1

CONCLUSION: HIV seroprevalence appears to be declining among antenatal and parturient women in Lusaka.

sentnum

10

-1

The decline is most dramatic among women < " 17 years of age, suggesting a reduction in sero-incidence in this important age group.

null

S0042-96862008000900015

language

EN

section

title

-1

sentnum

0

-1

Estimating child mortality due to diarrhoea in developing countries.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: The major objective of this study is to provide estimates of diarrhoea mortality at country, regional and global level by employing the Child Health Epidemiology Reference Group (CHERG) standard.

sentnum

1

-1

METHODS: A systematic and comprehensive literature review was undertaken of all studies published since 1980 reporting under-5 diarrhoea mortality.

sentnum

2

-1

Information was collected on characteristics of each study and its population.

sentnum

3

-1

A regression model was used to relate these characteristics to proportional mortality from diarrhoea and to predict its distribution in national populations.

sentnum

4

-1

FINDINGS: Global deaths from diarrhoea of children aged less than 5 years were estimated at 1.87 million (95% confidence interval, CI: 1.56-2.19), approximately 19% of total child deaths.

sentnum

5

-1

WHO African and South-East Asia Regions combined contain 78% (1.46 million) of all diarrhoea deaths occurring among children in the developing world; 73% of these deaths are concentrated in just 15 developing countries.

sentnum

6

-1

CONCLUSION: Planning and evaluation of interventions to control diarrhoea deaths and to reduce under-5 mortality is obstructed by the lack of a system that regularly generates cause-of-death information.

sentnum

7

-1

The methods used here provide country-level estimates that constitute alternative information for planning in settings without adequate data.

null

S0042-96862008000900017

language

EN

section

title

-1

sentnum

0

-1

Methods of suicide: international suicide patterns derived from the WHO mortality database.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention.

sentnum

1

-1

Our knowledge of the methods used and their variation across countries and world regions is still limited.

sentnum

2

-1

The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods.

sentnum

3

-1

METHODS: Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database.

sentnum

4

-1

The classification was used to differentiate suicide methods.

sentnum

5

-1

Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data.

sentnum

6

-1

FINDINGS: Poisoning by pesticide was common in many Asian countries and in Latin America; poisoning by drugs was common in both Nordic countries and the United Kingdom.

sentnum

7

-1

Hanging was the preferred method of suicide in eastern Europe, as was firearm suicide in the United States and jumping from a high place in cities and urban societies such as Hong Kong Special Administrative Region, China.

sentnum

8

-1

Correspondence analysis demonstrated a polarization between pesticide suicide and firearm suicide at the expense of traditional methods, such as hanging and jumping from a high place, which lay in between.

sentnum

9

-1

CONCLUSION: This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries.

sentnum

10

-1

The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means.

sentnum

11

-1

The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever.

null

S0042-96862008001000012

language

EN

section

title

-1

sentnum

0

-1

Is mass treatment the appropriate schistosomiasis elimination strategy?.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: In the year 2000, the Philippines' Department of Health adopted mass chemotherapy using praziquantel to eliminate schistosomiasis.

sentnum

1

-1

Mass treatment was offered to an eligible population of 30 187 residents of 50 villages in Western Samar, the Philippines, in 2004 as part of an ongoing epidemiological study, Schistosomiasis Transmission and Ecology in the Philippines (STEP), aimed at measuring the effect of irrigation on infection with schistosomiasis.

sentnum

2

-1

This paper describes the mass-treatment activities and factors associated with participation.

sentnum

3

-1

METHODS: Advocacy, information dissemination and social mobilization activities were conducted before mass chemotherapy.

sentnum

4

-1

Village leaders were primarily responsible for community mobilization.

sentnum

5

-1

Mass treatment was offered in village meeting halls and schools.

sentnum

6

-1

Participation proportions were estimated based on the 2002-2003 census.

sentnum

7

-1

Community involvement was measured using a participation index.

sentnum

8

-1

A Bayesian hierarchical logistic regression model was fitted to estimate the association between sociodemographic factors and residents coming to the treatment site.

sentnum

9

-1

FINDINGS: A village-level average of 53.1% of residents (range: 21.1-85.3) came to the treatment site, leading to a mass-treatment coverage with an average of 48.3% (range: 15.8-80.7).

sentnum

10

-1

At the individual level, participation proportions were higher among males, preschool and school-age children, non-STEP participants and among those who provided a stool sample.

sentnum

11

-1

At the village-level, better community involvement was associated with increased participation whereas a larger census was associated with decreased participation.

sentnum

12

-1

CONCLUSION: The conduct of mass treatment in the 50 villages resulted in far lower participation than expected.

null

sentnum

13

-1

This raises concern for the ongoing mass-treatment initiatives now taking place in developing countries.

null

S0042-96862008001000014

language

EN

section

title

-1

sentnum

0

-1

Two-year impact of single praziquantel treatment on infection in the national control programme on schistosomiasis in Burkina Faso.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To evaluate the impact on schistosomiasis of biennial treatment with praziquantel (PZQ) among school-age children in Burkina Faso, the first country that achieved full national coverage with treatment of more than 90% of the school-age population.

sentnum

1

-1

METHODS: A cohort of 1727 schoolchildren (6-14 years old) was monitored at yearly intervals through a longitudinal survey.

sentnum

2

-1

Additional groups of schoolchildren were monitored in cross-sectional surveys.

sentnum

3

-1

Parasitological examinations for Schistosoma haematobium and Schistosoma mansoni were performed, and prevalence and intensity of infection before and after treatment were analysed.

sentnum

4

-1

FINDINGS: Data from the longitudinal cohort show that a single round of PZQ treatment significantly reduced prevalence of S. haematobium infection by 87% (from 59.6% to 7.7%) and intensity of infection by 92.8% (from 94.2 to 6.8 eggs/10 ml of urine) 2 years post-treatment.

sentnum

5

-1

The impact on infection was also confirmed by a cross-sectional survey 2 years post-treatment.

sentnum

6

-1

Importantly, the proportion of school-age children with heavy S. haematobium infection decreased from around 25% before treatment to around 2-3% 2 years post-treatment.

sentnum

7

-1

Cross-sectional comparison of S. haematobium infection in 7-year-old children in their first year at school, who received treatment through community-based drug delivery, also showed significant reduction in both prevalence (65.9%) and intensity of S. haematobium infection (78.4%) 2 years after single treatment.

sentnum

8

-1

A significant reduction in S. mansoni infection was also achieved.

sentnum

9

-1

CONCLUSION: Significant and sustained reduction in S. haematobium infection was achieved by biennial treatment in school-age children in Burkina Faso.

sentnum

10

-1

This may provide a cost-effective treatment strategy for similar national schistosomiasis control programmes in sub-Saharan Africa.

null

S0042-96862008001000016

language

EN

section

title

-1

sentnum

0

-1

Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme.

sentnum

1

-1

METHODS: Using a quasi-experimental design, we evaluated a programme facilitated by a nongovernmental organization that was implemented by the Indian government within existing infrastructure in two rural districts of Uttar Pradesh, northern India.

sentnum

2

-1

Mothers who had given birth in the 2 years preceding the surveys were interviewed during the baseline (n = 14 952) and endline (n = 13 826) surveys.

sentnum

3

-1

The primary outcome measure was reduction of neonatal mortality.

sentnum

4

-1

FINDINGS: In the intervention district, the frequency of home visits by community-based workers increased during both antenatal (from 16% to 56%) and postnatal (from 3% to 39%) periods, as did frequency of maternal and newborn care practices.

sentnum

5

-1

In the comparison district, no improvement in home visits was observed and the only notable behaviour change was that women had saved money for emergency medical treatment.

sentnum

6

-1

Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received.

sentnum

7

-1

However, neonates who received a postnatal home visit within 28 days of birth had 34% lower neonatal mortality (35.7 deaths per 1000 live births, 95% confidence interval, CI: 29.2-42.1) than those who received no postnatal visit (53.8 deaths per 1000 live births, 95% CI: 48.9-58.8), after adjusting for sociodemographic variables.

sentnum

8

-1

Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth.

sentnum

9

-1

The effect on mortality remained statistically significant when excluding babies who died on the day of birth.

sentnum

10

-1

CONCLUSION: The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level.

sentnum

11

-1

A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.

null

S0042-96862008001100012

language

EN

section

title

-1

sentnum

0

-1

Effects of mutual health organizations on use of priority health-care services in urban and rural Mali: a case-control study.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To examine the effects of a community-based mutual health organization (MHO) on utilization of priority health services, financial protection of its members and inclusion of the poor and other target groups.

sentnum

1

-1

METHODS: Four MHOs were established in two districts in Mali.

sentnum

2

-1

A case-control study was carried out in which household survey data were collected from 817 MHO member households, 787 non-member households in MHO catchment areas, and 676 control households in areas without MHOs.

sentnum

3

-1

We compiled MHO register data by household for a 22-month period.

sentnum

4

-1

Outcome measures included utilization of priority services, health expenditures and out-of-pocket payments.

sentnum

5

-1

Independent variables included individual, household and community demographic, socioeconomic and access characteristics, as determined through a household survey in 2004.

sentnum

6

-1

FINDINGS: MHO members who were up to date on premium payments (controlling for education, distance to the nearest health facility and other factors) were 1.7 times more likely to get treated for fevers in modern facilities; three times more likely to take children with diarrhoea to a health facility and/or treat them with oral rehydration salts at home; twice as likely to make four or more prenatal visits; and twice as likely, if pregnant or younger than 5 years, to sleep under an insecticide-treated net (P < 0.10 or better

sentnum

7

-1

in all cases).

sentnum

8

-1

However, distance was also a significant negative predictor for the utilization of many services, particularly assisted deliveries.

sentnum

9

-1

Household and individual enrolment in an MHO were not significantly associated with socioeconomic status (with the exception of the highest quintile), and MHOs seemed to provide some financial protection for their members.

sentnum

10

-1

CONCLUSIONS: MHOs are one mechanism that countries strengthening the supply of primary care can use to increase financial access to - and equity in - priority health services.

null

S0042-96862008001100014

language

EN

section

title

-1

sentnum

0

-1

Coping with out-of-pocket health payments: empirical evidence from 15 African countries.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To explore factors associated with household coping behaviours in the face of health expenditures in 15 African countries and provide evidence for policy-makers in designing financial health protection mechanisms.

sentnum

1

-1

METHODS: A series of logit regressions were performed to explore factors correlating with a greater likelihood of selling assets, borrowing or both to finance health care.

sentnum

2

-1

The average partial effects for different levels of spending on inpatient care were derived by computing the partial effects for each observation and taking the average across the sample.

sentnum

3

-1

Data used in the analysis were from the 2002-2003 World Health Survey, which asked how households had financed out-of-pocket payments over the previous year.

sentnum

4

-1

Households selling assets or borrowing money were compared to those that financed health care from income or savings.

sentnum

5

-1

Those that used insurance were excluded.

sentnum

6

-1

For the analysis, a value of 1 was assigned to selling assets or borrowing money and a value of 0 to other coping mechanisms.

sentnum

7

-1

FINDINGS: Coping through borrowing and selling assets ranged from 23% of households in Zambia to 68% in Burkina Faso.

sentnum

8

-1

In general, the highest income groups were less likely to borrow and sell assets, but coping mechanisms did not differ strongly among lower income quintiles.

sentnum

9

-1

Households with higher inpatient expenses were significantly more likely to borrow and deplete assets compared to those financing outpatient care or routine medical expenses, except in Burkina Faso, Namibia and Swaziland.

sentnum

10

-1

In eight countries, the coefficient on the highest quintile of inpatient spending had a P-value below 0.01.

sentnum

11

-1

CONCLUSION: In most African countries, the health financing system is too weak to protect households from health shocks.

sentnum

12

-1

Borrowing and selling assets to finance health care are common.

null

sentnum

13

-1

Formal prepayment schemes could benefit many households, and an overall social protection network could help to mitigate the long-term effects of ill health on household well-being and support poverty reduction.

null

S0042-96862008001100016

language

EN

section

title

-1

sentnum

0

-1

Development assistance for health: should policy-makers worry about its macroeconomic impact?.

language

EN

section

abstract

-1

sentnum

0

-1

Many low-income countries need to substantially increase expenditure to meet universal coverage goals for essential health services but, because they have very low-incomes, most will be unable to raise adequate funds exclusively from domestic sources in the short to medium term.

sentnum

1

-1

Increased aid for health will be required.

sentnum

2

-1

However, there has long been a concern that the rapid arrival of large amounts of foreign exchange in a country could lead to an increase in inflation and loss of international competitiveness, with an adverse impact on exports and economic growth, an economic phenomenon termed 'Dutch disease'.

sentnum

3

-1

We review cross-country and country-level empirical studies and propose a simple framework to gauge the extent of macroeconomic risks.

sentnum

4

-1

Of the 15 low-income countries that are increasing aid-financed health spending, 7 have high macroeconomic risks that may constrain the sustained expansion of spending.

sentnum

5

-1

These conditions also apply in one-quarter of the 42 countries not presently increasing spending.

sentnum

6

-1

Health authorities should be aware of the multiple risk factors at play, including factors that are health-sector specific and others that generally are not.

sentnum

7

-1

They should also realize that there are effective means for mitigating the risk of Dutch disease associated with increasing development assistance for health.

sentnum

8

-1

International partners also have an important role to play since more sustainable and predictable flows of donor funding will allow more productivity enhancing investment in physical and human capital, which will also contribute to ensuring there are few harmful macroeconomic effects of increases in aid.

null

S0042-96862008001100018

language

EN

section

title

-1

sentnum

0

-1

Are current debt relief initiatives an option for scaling up health financing in beneficiary countries?.

language

EN

section

abstract

-1

sentnum

0

-1

One central goal of the enhanced Heavily Indebted Poor Countries (HIPC) Initiative and the more recent Multilateral Debt Relief Initiative (MDRI) is to free up additional resources for public spending on poverty reduction.

sentnum

1

-1

The health sector was expected to benefit from a considerable share of these funds.

sentnum

2

-1

The volume of released resources is important enough in certain countries to make a difference for priority programmes that have been underfunded so far.

sentnum

3

-1

However, the relevance of these initiatives in terms of boosting health expenditure depends essentially, at the global level, on the compliance of donors with their aid commitments and, at the domestic level, on the success of health officials in advocating for an adequate share of the additional fiscal space.

sentnum

4

-1

Advocacy efforts are often limited by a state of asymmetric information whereby some ministries are not well aware of the economic consequences of debt relief on public finances and of the management systems in place to deal with savings from debt relief.

sentnum

5

-1

A thorough comprehension of these issues seems essential for health advocates to increase their bargaining power and for a wider public to readjust expectations of what debt relief can realistically achieve and of what can be measured.

sentnum

6

-1

This paper intends to narrow the information gap by classifying debt relief savings management systems observed in practice.

sentnum

7

-1

We illustrate some of the major advantages and stated drawbacks and outline the policy implications for health officials operating in the countries concerned.

sentnum

8

-1

There should be careful monitoring of fungibility (i.e. where untraceable funds risk substitution) and additionality (i.e. the extent to which new inputs add to existing inputs at national and international level).

null

S0042-96862008001100020

language

EN

section

title

-1

sentnum

0

-1

Can countries of the WHO African Region wean themselves off donor funding for health?.

language

EN

section

abstract

-1

sentnum

0

-1

More than 20% of total health expenditure in 48% of the 46 countries in the WHO African Region is provided by external sources.

sentnum

1

-1

Issues surrounding aid effectiveness suggest that these countries ought to implement strategies for weaning off aid dependency.

sentnum

2

-1

This paper broaches the following question: what are some of the strategies that countries of the region can employ to wean off donor funding for health?

sentnum

3

-1

Five strategies are discussed: reduction in economic inefficiencies; reprioritizing public expenditures; raising additional tax revenues; increased private sector involvement in health development; and fighting corruption.

null

S0042-96862008001200010

language

EN

section

title

-1

sentnum

0

-1

Effect of presumptive co-trimoxazole prophylaxis on pneumococcal colonization rates, seroepidemiology and antibiotic resistance in Zambian infants: a longitudinal cohort study.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To ascertain the microbiological consequences of WHO's recommendation for presumptive co-trimoxazole prophylaxis for infants with perinatal HIV exposure.

sentnum

1

-1

METHODS: Using a longitudinal cohort design, we followed HIV-exposed and HIV-unexposed infants trimonthly for up to 18 months per infant.

sentnum

2

-1

HIV-exposed infants received daily co-trimoxazole prophylaxis from 6 weeks to > 12 months of age.

sentnum

3

-1

Using Streptococcus pneumoniae as our sentinel pathogen, we measured how co-trimoxazole altered nasopharyngeal colonization, pneumococcal resistance to antibiotics and serotype distribution as a function of co-trimoxazole exposure.

sentnum

4

-1

FINDINGS: From 260 infants followed for 3096 patient-months, we detected pneumococci in 360/1394 (25.8%) samples.

sentnum

5

-1

HIV-exposed infants were colonized more frequently than HIV-unexposed infants (risk ratio, RR: 1.4; 95% confidence interval, CI: 1.0-1.9, P = 0.04).

sentnum

6

-1

Co-trimoxazole prophylaxis reduced colonization by ca 7% but increased the risk of colonization with co-trimoxazole-resistant pneumococci within 6 weeks of starting prophylaxis (RR: 3.2; 95% CI: 1.3-7.8, P = 0.04).

sentnum

7

-1

Prophylaxis with co-trimoxazole led to a small but statistically significant increase of nasopharyngeal colonization with pneumococci not susceptible to clindamycin (RR: 1.6; 95% CI: 1.0-2.6, P = 0.04) but did not increase the risk of non-susceptibility to penicillin (RR: 1.1; 95% CI: 0.7-1.7), erythromycin (RR: 1.0; 95% CI: 0.6-1.7), tetracycline (RR: 0.9; 95% CI: 0.6-1.5) or chloramphenicol (RR: 0.8; 95% CI: 0.3-2.3).

sentnum

8

-1

Co-trimoxazole prophylaxis did not cause the prevailing pneumococcal serotypes to differ from those that are targeted by the 7-valent conjugate pneumococcal vaccine (RR: 1.0; 95% CI: 0.7-1.6).

sentnum

9

-1

CONCLUSION: Co-trimoxazole prophylaxis modestly suppresses pneumococcal colonization but accelerates infant acquisition of co-trimoxazole- and clindamycin-resistant pneumococci.

sentnum

10

-1

Co-trimoxazole prophylaxis appears unlikely to compromise the future efficacy of conjugate vaccines.

null

S0042-96862008001200012

language

EN

section

title

-1

sentnum

0

-1

Epidemiological impact of a nationwide measles immunization campaign in Viet Nam: a critical review.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To study the impact on measles case incidence of a nationwide measles immunization campaign in Viet Nam, while considering differences in disease surveillance before and after the campaign.

sentnum

1

-1

METHODS: A nationwide mass immunization campaign was conducted in the north and south of Viet Nam in 2002 and 2003, respectively.

sentnum

2

-1

During the campaign, a second vaccination dose was given to children aged 9 months to 9 years, and the reported coverage reached 99% in both zones.

sentnum

3

-1

National measles case-based surveillance data collected during 2001-2006 were reviewed and analysed.

sentnum

4

-1

Surveillance performance was assessed in terms of case investigation and specimen collection rates and reporting sensitivity for febrile rash cases.

sentnum

5

-1

Fisher's exact test was used to test for differences in indicator values before and after the campaign at the national and regional levels; the Wilcoxon signed-rank test was used at the provincial level.

sentnum

6

-1

FINDINGS: Despite significant improvements in disease surveillance, a dramatic reduction in observed measles incidence was noted nationwide after the immunization campaign, with a drop in the national incidence of confirmed measles cases per 100 000 population from 5.44 in 2001 to 0.14 after the campaign (i.e. 2003 in the north and 2004 in the south; P < 0.001).

sentnum

7

-1

Rapid measles resurgence was observed in 2005 and 2006 only in the north-western mountainous region of the country.

sentnum

8

-1

The north did not show a statistically significant age shift for new cases (median age: 9 years in 2001 versus 8 years in 2003; P = 0.113), whereas the south did (median age: 7 years versus 12 years; P < 0.001).

sentnum

9

-1

CONCLUSION: A campaign approach for controlling measles in developing parts of Asia can prove effective.

sentnum

10

-1

The swift re-emergence of disease in the north-western region was probably due to suboptimal coverage by the campaign and by the subsequent routine expanded programme on immunization in the north-western mountainous region.

null

S0042-96862008001200014

language

EN

section

title

-1

sentnum

0

-1

Global campaign against epilepsy: assessment of a demonstration project in rural China.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: The Global Campaign Against Epilepsy demonstration project in rural China aimed: to reduce the treatment gap and morbidity of people with epilepsy by using community-level interventions; to train and educate health professionals; to dispel stigma; to identify potential for prevention and to develop models of integration of epilepsy control into the local health systems.

sentnum

1

-1

We report the overall results of the demonstration project, focusing on the prevalence and the change in the treatment gap of epilepsy after an intervention.

sentnum

2

-1

METHODS: Door-to-door epidemiological surveys were carried out before, and 6 months after the end of, an intervention project for epilepsy in rural settings in five provinces of China.

sentnum

3

-1

The intervention consisted of a treatment programme available to patients without prior appropriate treatment and a public health educational programme about epilepsy.

sentnum

4

-1

The sampled population in the second survey was 51 644 people.

sentnum

5

-1

FINDINGS: In the second survey, epilepsy was confirmed in 320 people, yielding a lifetime prevalence of 6.2/1000 and a prevalence of active epilepsy of 4.5/1000.

sentnum

6

-1

The lifetime prevalence and prevalence of active epilepsy in the first survey were 7.0/1000 and 4.6/1000, respectively.

sentnum

7

-1

The treatment gap of active epilepsy in the second survey was 49.8%, 12.8 percentage points lower than that of the first survey (62.6%).

sentnum

8

-1

CONCLUSION: The results of this study suggest that the intervention measures used were possibly effective and evidently feasible in rural China, contributing to a decrease in the treatment gap of epilepsy.

null

S0042-96862008001200016

language

EN

section

title

-1

sentnum

0

-1

Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986-2002.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the relationships between the observed drop in mean systolic blood pressure (SBP) in Japan in 1986-2002 and the use of antihypertensive treatment and lifestyle factors.

sentnum

1

-1

METHODS: A nationally representative sample of 90 554 men and 101 903 women aged 20 years and over was obtained from pooled data of annual cross-sectional surveys in Japan during 1986-2002.

sentnum

2

-1

Using two-stage least squares with an instrumental variable, we examined the association between SBP and antihypertensive medication and lifestyle factors, including body mass index (BMI), physical activity, alcohol consumption, cigarette smoking and dietary salt intake.

sentnum

3

-1

In the surveys, regular exercise was defined as exercise for more than 30 minutes at a time more than twice a week for over 1 year.

sentnum

4

-1

Current smoking was defined as either daily or occasional cigarette use.

sentnum

5

-1

Current drinking was defined as an intake of more than one standard cup of Japanese sake, one large bottle of regular beer, or one double measure of whisky at a time more than three times a week.

sentnum

6

-1

Changes in mean predicted SBP in each sex and age group between 1986 and 2002 were decomposed into the respective contributions of these explanatory variables.

sentnum

7

-1

FINDINGS: Age-specific means of predicted SBP declined during this period by 1.8 (95% confidence interval, CI: 1.2-2.5) to 3.0 (95% CI: 2.4-3.6) mmHg in men and 3.7 (95% CI: 3.4-4.1) to 5.1 (95% CI: 4.5-5.7) mmHg in women.

sentnum

8

-1

These reductions were partly explained by the increased use of medications across all sex and age groups and decreased mean BMI in women in their 30s and 40s.

sentnum

9

-1

The contributions of treatment effects increased with age.

sentnum

10

-1

Elevated mean BMI in men and elderly women offset part of the decline of their mean SBP.

sentnum

11

-1

CONCLUSION: Declining mean SBP in Japan between 1986 and 2002 was partly attributable to the increased use of antihypertensive medications, especially in the older population, and lowered mean BMI in young women.

sentnum

12

-1

However, a substantial part of the decline was left unexplained and needs to be investigated further.

null

sentnum

13

-1

A still greater decline in SBP would be expected through improvements in body weight management, salt and alcohol intake, and treatment and control of hypertension.

null

S0042-96862009000100010

language

EN

section

title

-1

sentnum

0

-1

Noncommunicable disease mortality and life expectancy in immigrants to Israel from the former Soviet Union: country of origin compared with host country.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the influence of country of origin effects and of adjustment and selection processes by comparing noncommunicable disease mortality and life expectancy among migrants to Israel from the former Soviet Union (FSU) with noncommunicable disease mortality and life expectancy among Israelis and the population of the Russian Federation.

sentnum

1

-1

METHODS: Data from 926 870 FSU-immigrants who migrated to Israel between 1990 and 2003 (study cohort) were analysed.

sentnum

2

-1

Life expectancy was calculated for the study cohort, all Israelis, and the population of the Russian Federation.

sentnum

3

-1

Age-standardized death rates were calculated for grouped causes of death.

sentnum

4

-1

FSU immigrants were additionally compared with other Israelis and with inhabitants of the Russian Federation using cause-specific standardized mortality ratios (SMRs).

sentnum

5

-1

FINDINGS: Life expectancy at age 15 years in 2000-2003 was 61.0 years for male and 67.0 years for female FSU immigrants to Israel.

sentnum

6

-1

Age-standardized death rates for FSU immigrants in Israel were similar to those of other Israelis and much lower than those of inhabitants of the Russian Federation.

sentnum

7

-1

Relative to Israelis, the study cohort had a higher SMR for neoplasms, and particularly for stomach cancer.

sentnum

8

-1

Mortality from brain cancer was higher when immigrants were compared to the Russian Federation (SMR: 1.71, 95% confidence interval, CI: 1.50-1.94 for males; SMR: 1.77, 95% CI: 1.56-2.02 for females), whereas mortality from stomach cancer was lower among immigrants relative to the Russian Federation (SMR: 0.43, 95% CI: 0.40-0.47 for males; SMR: 0.56, 95% CI: 0.52-0.61 for females).

sentnum

9

-1

Mortality from external causes was lower among immigrants relative to the population of the Russian Federation (SMR: 0.20, 95% CI: 0.19-0.21 for males; SMR: 0.35, 95% CI: 0.33-0.37 for females) but significantly higher relative to other Israelis (SMR: 1.41, 95% CI: 1.35-1.47 for males; SMR: 1.08, 95% CI: 1.02-1.15).

sentnum

10

-1

CONCLUSION: Noncommunicable disease mortality among FSU immigrants to Israel is lower than in the population of the Russian Federation.

sentnum

11

-1

Mortality rates in FSU immigrants, particularly from circulatory diseases, have rapidly adjusted and have become similar to those of the destination country.

sentnum

12

-1

However, immigrants from the FSU have considerably higher mortality than other Israelis from external causes and some noncommunicable diseases such as cancer.

null

sentnum

13

-1

Mortality rates in these diaspora migrants show a mixed picture of rapid assimilation together with persistent country of origin effects, as well as the effects of adjustment hardships.

null

S0042-96862009000100012

language

EN

section

title

-1

sentnum

0

-1

Do lifestyle interventions work in developing countries?

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities.

sentnum

1

-1

METHODS: Within the framework of the Isfahan Healthy Heart Program, a community trial was conducted in two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak).

sentnum

2

-1

Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak.

sentnum

3

-1

In each community, a random sample of adults was selected yearly by multi-stage cluster sampling.

sentnum

4

-1

Food consumption, physical exercise and smoking behaviours were quantified and scored as 1 (low-risk) or 0 (other) at baseline (year 2000) and annually for 4 years in the intervention areas and for 3 years in the control area.

sentnum

5

-1

The scores for all behaviours were then added to derive an overall lifestyle score.

sentnum

6

-1

FINDINGS: After 4 years, changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points versus -1.2 points, respectively; P < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% versus -2.0%, respectively; P < 0.001).

sentnum

7

-1

Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant.

sentnum

8

-1

Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women.

sentnum

9

-1

Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (-68 metabolic equivalent task (MET) minutes per week versus -114 MET minutes per week, respectively; P < 0.05).

sentnum

10

-1

Leisure time devoted to physical activities showed an increasing trend in all areas.

sentnum

11

-1

A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score, even after controlling for age, sex and baseline values.

sentnum

12

-1

CONCLUSION: The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting.

sentnum

1

-1

Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran.

null

S0042-96862009000100014

language

EN

section

title

-1

sentnum

0

-1

Provision of abortion by mid-level providers: international policy, practice and perspectives.

language

EN

section

abstract

-1

sentnum

0

-1

Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam.

sentnum

1

-1

It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions.

sentnum

2

-1

Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women.

sentnum

3

-1

The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology.

sentnum

4

-1

Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice.

null

S0042-96862009000200010

language

EN

section

title

-1

sentnum

0

-1

Laboratory confirmation of measles in elimination settings: experience from the Republic of the Marshall Islands, 2003.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To highlight the complications involved in interpreting laboratory tests of measles immunoglobulin M (IgM) for confirmation of infection during a measles outbreak in a highly vaccinated population after conducting a mass immunization campaign as a control measure.

sentnum

1

-1

METHODS: This case study was undertaken in the Republic of the Marshall Islands during a measles outbreak in 2003, when response immunization was conducted.

sentnum

2

-1

A measles case was defined as fever and rash and one or more of cough, coryza or conjunctivitis.

sentnum

3

-1

Between 13 July and 7 November 2003, serum samples were obtained from suspected measles cases for serologic testing and nasopharyngeal swabs were taken for viral isolation by reverse transcriptase polymerase chain reaction (RT-PCR).

sentnum

4

-1

FINDINGS: Specimens were collected from 201 suspected measles cases (19% of total): of the ones that satisfied the clinical case definition, 45% were IgM positive (IgM+) and, of these, 24% had received measles vaccination within the previous 45 days (up to 45 days after vaccination an IgM+ result could be due to either vaccination or wild-type measles infection).

sentnum

5

-1

The proportion of IgM+ results varied with clinical presentation, the timing of specimen collection and vaccination status.

sentnum

6

-1

Positive results on RT-PCR occurred in specimens from eight IgM-negative and four IgM+ individuals who had recently been vaccinated.

sentnum

7

-1

CONCLUSION: During measles outbreaks, limiting IgM testing to individuals who meet the clinical case definition and have not been recently vaccinated allows for measles to be confirmed while conserving resources.

null

S0042-96862009000200012

language

EN

section

title

-1

sentnum

0

-1

Further efforts needed to achieve measles elimination in Germany: results of an outbreak investigation.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To determine morbidity and costs related to a large measles outbreak in Germany and to identify ways to improve the country's national measles elimination strategy.

sentnum

1

-1

METHODS: We investigated a large outbreak of measles in the federal state of North Rhine-Westphalia (NRW) that occurred in 2006 after 2 years of low measles incidence (< 1 case per 100 000).

sentnum

2

-1

WHO's clinical case definition was used, and surveillance data from 2006 and 2001 were compared.

sentnum

3

-1

All cases notified in Duisburg, the most severely affected city, were contacted and interviewed or sent a questionnaire.

sentnum

4

-1

Health-care provider costs were calculated using information on complications, hospitalization and physician consultations.

sentnum

5

-1

FINDINGS: In NRW, 1749 cases were notified over a 48-week period.

sentnum

6

-1

Compared with 2001, the distribution of cases shifted to older age groups (especially the 10-14 year group).

sentnum

7

-1

Most cases (n = 614) occurred in Duisburg.

sentnum

8

-1

Of these, 81% were interviewed; 15% were hospitalized and two died.

sentnum

9

-1

Of the 464 for whom information was available, 80% were reported as unvaccinated.

sentnum

10

-1

Common reasons for non-vaccination were parents either forgetting (36%) or rejecting (28%) vaccination.

sentnum

11

-1

The average cost per measles case was estimated at €373.

sentnum

12

-1

CONCLUSION: An accumulation of non-immune individuals led to this outbreak.

null

sentnum

13

-1

The shift in age distribution has implications for the effectiveness of measles control and the elimination strategy in place.

sentnum

14

-1

Immediate nationwide school-based catch-up vaccination campaigns targeting older age groups are needed to close critical immunity gaps.

sentnum

15

-1

Otherwise, the elimination of measles in Germany and thus in Europe by 2010 will not be feasible.

null

S0042-96862009000200014

language

EN

section

title

-1

sentnum

0

-1

Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To estimate the cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) using sulfadoxine-pyrimethamine (SP).

sentnum

1

-1

METHODS: In two previous IPTi trials in Ifakara (United Republic of Tanzania) and Manhiça (Mozambique), SP was administered three times to infants before 9 months of age through the Expanded Programme on Immunization.

sentnum

2

-1

Based on the efficacy results of the intervention and on malaria incidence in the target population, an estimate was made of the number of clinical malaria episodes prevented.

sentnum

3

-1

This number and an assumed case-fatality rate of 1.57% were used, in turn, to estimate the number of disability-adjusted life years (DALY) averted and the number of deaths averted.

sentnum

4

-1

The cost of the intervention, including start-up and recurrent costs, was then assessed on the basis of these figures.

sentnum

5

-1

FINDINGS: The cost per clinical episode of malaria averted was US$ 1.57 (range: US$ 0.8-4.0) in Ifakara and US$ 4.73 (range: US$ 1.7-30.3) in Manhiça; the cost per DALY averted was US$ 3.7 (range: US$ 1.6-12.2) in Ifakara and US$ 11.2 (range: US$ 3.6-92.0) in Manhiça; and the cost per death averted was US$ 100.2 (range: US$ 43.0-330.9) in Ifakara and US$ 301.1 (range: US$ 95.6-2498.4) in Manhiça.

sentnum

6

-1

CONCLUSION: From the health system and societal perspectives, IPTi with SP is expected to produce health improvements in a cost-effective way.

sentnum

7

-1

From an economic perspective, it offers good value for money for public health programmes.

null

S0042-96862009000200016

language

EN

section

title

-1

sentnum

0

-1

How to establish a successful revolving drug fund: the experience of Khartoum state in the Sudan.

language

EN

section

abstract

-1

sentnum

0

-1

PROBLEM: During the 1990s, the Sudan began several initiatives to establish new medicine-financing mechanisms as part of the health reform process.

sentnum

1

-1

Initial seed stocks were provided to each hospital.

sentnum

2

-1

Unfortunately these facility-based funds did not regenerate and the hospitals were left without funds for medicines.

sentnum

3

-1

The Revolving Drug Fund (RDF) was established in 1989 to facilitate access to medicines in health facilities in Khartoum state.

sentnum

4

-1

APPROACH: This study used quantitative and qualitative research techniques to collect data from health-care providers and users to evaluate the experience of operating an RDF in Khartoum state.

sentnum

5

-1

Data from personal observations and from archival and statistical records were also analysed.

sentnum

6

-1

Seven health facilities were sampled for this research.

sentnum

7

-1

LOCAL SETTING: The Ministry of Health has a policy to expand the RDF to the whole country and has already commenced roll-out to seven more states.

sentnum

8

-1

This policy is based on the experience of the RDF within Khartoum state.

sentnum

9

-1

RELEVANT CHANGES: Khartoum state has a high (97%) level of availability of essential medicines and this is attributed to the RDF.

sentnum

10

-1

The RDF medicines were mostly considered affordable by users and very few (6%) patients failed to obtain the prescribed medicines for financial reasons.

sentnum

11

-1

LESSONS LEARNED: The RDF could be successfully replicated in other states of the Sudan and in low-income countries with similar contexts on condition that they meet success factors, such as gradual implementation, political commitment and availability of hard currency.

null

S0042-96862009000200018

language

EN

section

title

-1

sentnum

0

-1

Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues.

language

EN

section

abstract

-1

sentnum

0

-1

Epidermal parasitic skin diseases (EPSD) are a heterogeneous category of infectious diseases in which parasite-host interactions are confined to the upper layer of the skin.

sentnum

1

-1

The six major EPSD are scabies, pediculosis (capitis, corporis and pubis), tungiasis and hookworm-related cutaneous larva migrans.

sentnum

2

-1

We summarize the current knowledge on EPSD and show that these diseases are widespread, polyparasitism is common, and significant primary and secondary morbidity occurs.

sentnum

3

-1

We show that poverty favours the presence of animal reservoirs, ensures ongoing transmission, facilitates atypical methods of spreading infectious agents and increases the chances of exposure.

sentnum

4

-1

This results in an extraordinarily high prevalence and intensity of infestation of EPSD in resource-poor populations.

sentnum

5

-1

Stigma, lack of access to health care and deficient behaviour in seeking health care are the reasons why EPSD frequently progress untreated and why in resource-poor populations severe morbidity is common.

sentnum

6

-1

The ongoing uncontrolled urbanization in many developing countries makes it likely that EPSD will remain the overriding parasitic diseases for people living in extreme poverty.

sentnum

7

-1

We advocate integrating control of EPSD into intervention measures directed against other neglected diseases such as filariasis and intestinal helminthiases.

null

S0042-96862009000300011

language

EN

section

title

-1

sentnum

0

-1

Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self-poisoning, particularly from pesticides, in a single district.

sentnum

1

-1

METHODS: Data on staff, drug, laboratory and other inputs for each patient admitted for self-poisoning were prospectively collected over a one-month period from one general hospital (2005) and five peripheral hospitals (2006) in the Anuradhapura district.

sentnum

2

-1

Data on transfers to secondary- and tertiary-level facilities were obtained for a 6-month period from 30 peripheral hospitals.

sentnum

3

-1

The cost of the inputs in United States dollars (US$), using 2005 figures, was derived from hospital accounts.

sentnum

4

-1

FINDINGS: The average total cost of treating a self-poisoned patient at the general hospital was US$ 31.83, with ward staff input and drugs being the highest expenditure category and only US$ 0.19 of this sum related to capital and maintenance costs.

sentnum

5

-1

The average total cost of treatment was highest for self-poisoning with pesticides (US$ 49.12).

sentnum

6

-1

The patients placed in the intensive care unit, who comprised 5% of the total, took up 75% of the overall treatment cost for all self-poisoned patients at the general hospital.

sentnum

7

-1

The average total cost of treating self-poisoned patients at peripheral hospitals was US$ 3.33.

sentnum

8

-1

The average patient cost per transfer was US$ 14.03.

sentnum

9

-1

In 2006, the total cost of treating self-poisoned patients in the Anuradhapura district amounted to US$ 76 599, of which US$ 53 834 were comprised of pesticide self-poisonings.

sentnum

10

-1

Based on the total treatment cost per self-poisoned patient estimated in this study, the cost of treating self-poisoned patients in all of Sri Lanka in 2004 was estimated at US$ 866 304.

sentnum

11

-1

CONCLUSION: The cost of treating pesticide self-poisonings may be reduced by promoting the use of less toxic pesticides and possibly by improving case management in primary care hospitals.

sentnum

12

-1

Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services.

null

S0042-96862009000300013

language

EN

section

title

-1

sentnum

0

-1

High incidence of childhood pneumonia at high altitudes in Pakistan: a longitudinal cohort study.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE:To determine the incidence of pneumonia and severe pneumonia among children living at high altitudes in Pakistan.

sentnum

1

-1

METHODS: A longitudinal cohort study was conducted in which 99 female government health workers in Punial and Ishkoman valleys (Ghizer district, Northern Areas of Pakistan) enrolled children at home, conducted home visits every 2 weeks and actively referred sick children to 15 health centres.

sentnum

2

-1

Health centre staff used Integrated Management of Childhood Illness criteria to screen all sick children aged 2-35 months and identify those with pneumonia or severe pneumonia.

sentnum

3

-1

FINDINGS: Community health workers enrolled 5204 eligible children at home and followed them over a 14-month period, ending on 31 December 2002.

sentnum

4

-1

Health centre staff identified 1397 cases of pneumonia and 377 of severe pneumonia in enrolled children aged 2-35 months.

sentnum

5

-1

Among children reported with pneumonia, 28% had multiple episodes.

sentnum

6

-1

Incidence rates per 100 child-years of observation were 29.9 for pneumonia and 8.1 for severe pneumonia.

sentnum

7

-1

Factors associated with a high incidence of pneumonia were younger age, male gender and living at high altitude.

sentnum

8

-1

CONCLUSION: Pneumonia incidence rates in the Northern Areas of Pakistan are much higher than rates reported at lower altitudes in the country and are similar to those in high-altitude settings in other developing countries.

sentnum

9

-1

More studies are needed to determine the causes of pneumonia in these high-mountain communities.

sentnum

10

-1

However, early introduction of the vaccines that are known to prevent pneumonia should be considered.

null

S0042-96862009000300015

language

EN

section

title

-1

sentnum

0

-1

Use of active management of the third stage of labour in seven developing countries.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To document the use of active management of the third stage of labour for preventing postpartum haemorrhage and to explore factors associated with such use in seven developing countries.

sentnum

1

-1

METHODS: Nationally representative samples of facility-based deliveries were selected and observed to determine the use of active management of the third stage of labour and associated factors.

sentnum

2

-1

Policies on active management were assessed through document review and interviews with relevant professionals.

sentnum

3

-1

FINDINGS: Use of a uterotonic during the third or fourth stages of labour was nearly universal.

sentnum

4

-1

Correct use of active management of the third stage of labour was found in only 0.5% to 32% of observed deliveries due to multiple deficiencies in practice.

sentnum

5

-1

In every country except Indonesia, policies regarding active management were conflicting.

sentnum

6

-1

CONCLUSION: Developing countries have not targeted decreasing postpartum haemorrhage as an achievable goal; there is little use of active management of the third stage of labour, and policies regarding such management often conflict.

sentnum

7

-1

Studies are needed to identify the most effective components of active management so that the most efficient package of practices can be promoted.

null

S0042-96862009000300017

language

EN

section

title

-1

sentnum

0

-1

The health worker shortage in Africa: are enough physicians and nurses being trained?.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of pre-service training in the region suffice to address this serious problem, taking into account population increases and attrition of health workers due to premature death, retirement, resignation and dismissal.

sentnum

1

-1

METHODS: Data on the current numbers and types of health workers and outputs from training programmes are from the 2005 WHO health workforce and training institutions' surveys.

sentnum

2

-1

Supplementary information on population estimates and mortality is from the United Nations Population Division and WHO databases, respectively, and information on worker attrition was obtained from the published literature.

sentnum

3

-1

Because of shortages of data in some settings, the study was restricted to 12 countries in sub-Saharan Africa.

sentnum

4

-1

FINDINGS: Our results suggest that the health workforce shortage in Africa is even more critical than previously estimated.

sentnum

5

-1

In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account.

sentnum

6

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Even if attrition were limited to involuntary factors such as premature mortality, with current workforce training patterns it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1000 population for the countries taken as a whole - and some countries would never reach it.

sentnum

7

-1

CONCLUSION: Pre-service training needs to be expanded as well as combined with other measures to increase health worker inflow and reduce the rate of outflow.

null

S0042-96862009000300019

language

EN

section

title

-1

sentnum

0

-1

Limitations of methods for measuring out-of-pocket and catastrophic private health expenditures.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To investigate the effect of survey design, specifically the number of items and recall period, on estimates of household out-of-pocket and catastrophic expenditure on health.

sentnum

1

-1

METHODS: We used results from two surveys - the World Health Survey and the Living Standards Measurement Study - that asked the same respondents about health expenditures in different ways.

sentnum

2

-1

Data from the World Health Survey were used to compare estimates of average annual out-of-pocket spending on health care derived from a single-item and from an eight-item measure.

sentnum

3

-1

This was done by calculating the ratio of the average obtained with the single-item measure to that obtained with the eight-item measure.

sentnum

4

-1

Estimates of catastrophic spending from the two measures were also compared.

sentnum

5

-1

Data from the Living Standards Measurement Study from three countries (Bulgaria, Jamaica and Nepal) with different recall periods and varying numbers of items in different modules were used to compare estimates of average annual out-of-pocket spending derived using various methods.

sentnum

6

-1

FINDINGS: In most countries, a lower level of disaggregation (i.e. fewer items) gave a lower estimate for average health spending, and a shorter recall period yielded a larger estimate.

sentnum

7

-1

However, when the effects of aggregation and recall period are combined, it is difficult to predict which of the two has the greater influence.

sentnum

8

-1

CONCLUSION: The magnitude of both out-of-pocket and catastrophic spending on health is affected by the choice of recall period and the number of items.

sentnum

9

-1

Thus, it is crucial to establish a method to generate valid, reliable and comparable information on private health spending.

null

S0042-96862009000400011

language

EN

section

title

-1

sentnum

0

-1

Emergency triage assessment for hypoxaemia in neonates and young children in a Kenyan hospital: an observational study.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To describe the prevalence of hypoxaemia in children admitted to a hospital in Kenya for the purpose of identifying clinical signs of hypoxaemia for emergency triage assessment, and to test the hypothesis that such signs lead to correct identification of hypoxaemia in children, irrespective of their diagnosis.

sentnum

1

-1

METHODS: From 2002 to 2005 we prospectively collected clinical data and pulse oximetry measurements for all paediatric admissions to Kilifi District Hospital, Kenya, irrespective of diagnosis, and assessed the prevalence of hypoxaemia in relation to the WHO clinical syndromes of "pneumonia" on admission and the final diagnoses made at discharge.

sentnum

2

-1

We used the data collected over the first three years to derive signs predictive of hypoxaemia, and data from the fourth year to validate those signs.

sentnum

3

-1

FINDINGS: Hypoxemia was found in 977 of 15 289 (6.4%) of all admissions (5% to 19% depending on age group) and was strongly associated with inpatient mortality (age-adjusted risk ratio: 4.5; 95% confidence interval, CI: 3.8-5.3).

sentnum

4

-1

Although most hypoxaemic children aged > 60 days met the WHO criteria for a syndrome of "pneumonia" on admission, only 215 of the 693 (31%) such children had a final diagnosis of lower respiratory tract infection (LRTI).

sentnum

5

-1

The most predictive signs for hypoxaemia included shock, a heart rate < 80 beats per minute, irregular breathing, a respiratory rate > 60 breaths per minute and impaired consciousness.

sentnum

6

-1

However, 5-15% of the children who had hypoxaemia on admission were missed, and 18% of the children were incorrectly identified as hypoxaemic.

sentnum

7

-1

CONCLUSION: The syndromes of pneumonia make it possible to identify most hypoxaemic children, including those without LRTI.

sentnum

8

-1

Shock, bradycardia and irregular breathing are important predictive signs, and severe malaria with respiratory distress is a common cause of hypoxaemia.

sentnum

9

-1

Overall, however, clinical signs are poor predictors of hypoxaemia, and using pulse oximetry in resource-poor health facilities to target oxygen therapy is likely to save costs.

null

S0042-96862009000400013

language

EN

section

title

-1

sentnum

0

-1

Financial barriers to HIV treatment in Yaoundé, Cameroon: first results of a national cross-sectional survey.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the extent to which user fees for antiretroviral therapy (ART) represent a financial barrier to access to ART among HIV-positive patients in Yaoundé, Cameroon.

sentnum

1

-1

METHODS: Sociodemographic, economic and clinical data were collected from a random sample of 707 HIV-positive patients followed up in six public hospitals of the capital city (Yaoundé) and its surroundings through face-to-face interviews carried out by trained interviewers independently from medical staff and medical questionnaires filled out by prescribing physicians.

sentnum

2

-1

Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months.

sentnum

3

-1

FINDINGS: Of the 532 patients treated with ART at the time of the survey, 20% reported financial difficulty in purchasing their antiretroviral drugs during the previous 3 months.

sentnum

4

-1

After adjustment for socioeconomic and clinical factors, reports of financial difficulties were significantly associated with lower adherence to ART (odds ratio, OR: 0.24; 95% confidence interval, CI: 0.15-0.40; P < 0.0001) and with lower CD4+ lymphocyte (CD4) counts after 6 months of treatment (OR: 2.14; 95% CI: 1.15-3.96 for CD4 counts < 200 cells/µl; P = 0.04).

sentnum

5

-1

CONCLUSION: Removing a financial barrier to treatment with ART by eliminating user fees at the point of care delivery, as recommended by WHO, could lead to increased adherence to ART and to improved clinical results.

sentnum

6

-1

New health financing mechanisms based on the public resources of national governments and international donors are needed to attain universal access to drugs and treatment for HIV infection.

null

S0042-96862009000400015

language

EN

section

title

-1

sentnum

0

-1

The persistence of tuberculosis in the age of DOTS: reassessing the effect of case detection.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To investigate whether short-term annual declines of 5-10% in the incidence of tuberculosis (TB) can be sustained over the long term by maintaining high case detection rates (CDRs).

sentnum

1

-1

METHODS: We constructed a compartmental difference-equation model of a TB epidemic in a hypothetical population of constant size with a treatment success rate of 85%.

sentnum

2

-1

The impact of CDR on TB incidence was then investigated by generating an equilibrium population with no TB case detection and increasing the smear-positive CDR under two scenarios: (i) rapid expansion by 10% per year to a CDR of 80% after 8 years, and (ii) gradual expansion by 1% per year to a CDR of 90% after 90 years.

sentnum

3

-1

The model was applied in two hypothetical populations: one without HIV and the other with a stable HIV incidence representative of the African Region.

sentnum

4

-1

The CDR for smear-negative TB was assumed to be a constant fraction of the smear-positive CDR. FINDINGS: In the absence of a TB control programme, the projected annual incidence of TB was 513 cases per 100 000 population, with a point prevalence of 1233 per 100 000 and an annual TB-specific mortality rate of 182 per 100 000.

sentnum

5

-1

Immediately increasing the TB CDR from 0% to 70% caused a 74% reduction in TB incidence within 10 years.

sentnum

6

-1

However, once case detection stabilized at any constant level < 80%, projected TB incidence also stabilized.

sentnum

7

-1

Ten years after a CDR of 70% was reached, the annual decline in TB incidence was < 1.5%, regardless of how rapidly case detection was scaled up and despite wide variation of all model parameters.

sentnum

8

-1

CONCLUSION: While improved CDRs have a dramatic short-term effect on TB incidence, maintaining those rates, even at current target levels, may not reduce long-term incidence by more than 1-2% per year.

sentnum

9

-1

TB control programmes and researchers should vigorously pursue improvements in case detection, regardless of current CDRs.

null

S0042-96862009000400017

language

EN

section

title

-1

sentnum

0

-1

Promoting the health of marginalized populations in Ecuador through international collaboration and educational innovations.

language

EN

section

abstract

-1

sentnum

0

-1

This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Escuela Latinoamericana de Medicina in Spanish).

sentnum

1

-1

We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants.

sentnum

2

-1

We highlight some ways we can learn from such training programmes with particular regard to lessons, barriers and opportunities for their sustainability at the local, national and international levels and for pursuing similar initiatives in other countries and contexts.

sentnum

3

-1

We conclude that educational efforts focused on the challenges of marginalization and the determinants of health require explicit attention not only to the knowledge, attitudes and skills of graduates but also on effectively engaging the health settings and systems that will reinforce the establishment and retention of capacity in low- and middle-income settings where this is most needed.

null

S0042-96862009000500010

language

EN

section

title

-1

sentnum

0

-1

Severe physical punishment: risk of mental health problems for poor urban children in Brazil.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To examine the relationship between specific types of child mental health problems and severe physical punishment, in combination with other important known risk factors.

sentnum

1

-1

METHODS: We conducted a cross-sectional study in Embu, São Paulo, Brazil, as the Brazilian component of a multicountry survey on abuse in the family environment.

sentnum

2

-1

From a probabilistic sample of clusters that included all eligible households (women aged 15-49 years with a son or daughter < 18 years of age), we randomly selected one mother-child pair per household (n = 813; attrition rate: 17.6%).

sentnum

3

-1

This study focused on children aged 6-17 years (n = 480).

sentnum

4

-1

Child Behaviour Checklist CBCL/6-18 was used to identify children with internalizing problems only, externalizing problems only, and both internalizing and externalizing problems (comorbidity).

sentnum

5

-1

Severe physical punishment was defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon.

sentnum

6

-1

We examined other potential correlates from four domains: child (gender, age, ever witnessing marital violence); mother (education, unemployment, anxiety or depression, marital violence); father (absence, drunkenness); and family (socioeconomic status).

sentnum

7

-1

The WHO Self-Reporting Questionnaire (SRQ-20) was used to identify maternal anxiety or depression (score > 7).

sentnum

8

-1

Backward logistic regression analysis identified independent correlates and significant interactions.

sentnum

9

-1

FINDINGS: Multivariate modelling showed that severe punishment was an independent correlate of comorbid internalizing and externalizing problems but was not associated with internalizing problems only.

sentnum

10

-1

It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression.

sentnum

11

-1

Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment.

sentnum

12

-1

CONCLUSION: Severe punishment may be related to child mental health problems, with the mechanism depending on the type of problem.

null

sentnum

13

-1

Its influence persists in the presence of family stressors such as the father's absence and maternal anxiety or depression.

null

S0042-96862009000500012

language

EN

section

title

-1

sentnum

0

-1

Child maltreatment prevention: a systematic review of reviews.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence.

sentnum

1

-1

METHODS: A systematic review of reviews was conducted.

sentnum

2

-1

The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures.

sentnum

3

-1

FINDINGS: The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups.

sentnum

4

-1

Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment.

sentnum

5

-1

Three of them - home visiting, parent education and child sexual abuse prevention - appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on.

sentnum

6

-1

An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base.

sentnum

7

-1

CONCLUSION: Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.

null