{ "collection": { "source": "", "date": "", "key": "", "document": [ { "id": "S0004-05922010000100015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Response of broiler chicks to diets with bambaranut (Voandzeia subterranea) as a protein source" } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The effects of raw and toasted bambaranut as a protein source for broiler chicks were investigated using 45 broiler chicks, randomly divided into three groups of 15 birds each." }, { "infon": 1, "offset": -1, "text": "The test diets were formulated such that bambaranut constituted 25% of the diets." }, { "infon": 2, "offset": -1, "text": "Treatment 1 (control) contained no bambaranut, treatment 2 contained raw bambaranut and treatment 3 toasted bambaranut." }, { "infon": 3, "offset": -1, "text": "The study lasted for 6 weeks during which weight gain and feed consumption were measured." }, { "infon": 4, "offset": -1, "text": "The performance of the various groups was evaluated using weight gain, feed conversion ratio and cost per kg weight gain." }, { "infon": 5, "offset": -1, "text": "At slaughter, various internal organs were excised, evaluated for gross lesions and weighed." }, { "infon": 6, "offset": -1, "text": "The results of the study showed that the control group had superior feed conversion ratio and weight gain, while the raw bambaranut group was superior to the toasted bambaranut group." }, { "infon": 7, "offset": -1, "text": "Cost per kg weight gain was higher in the toasted bambaranut groups." }, { "infon": 8, "offset": -1, "text": "There were neither statistically significant differences (p>0.05) in the organ weights nor observable abdominal fat and gross pathology of the internal organs." } ] } ] }, { "id": "S0004-05922011000300039", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Effects of reducing postpartum re-mating timeperiod on reproductive performance of the doe" } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Rabbits being induced ovulators can be rebred within 24 hours after parturition." }, { "infon": 1, "offset": -1, "text": "However, reproductive efficiency and the doe's physiology can be affected by postpartum re-mating interval." }, { "infon": 2, "offset": -1, "text": "This study evaluated the effects of reducing the re-mating interval after parturition on sexual activity, fertility, gestation, parturition and litter characteristics using 90 does." }, { "infon": 3, "offset": -1, "text": "Three groups of crossbred (New Zealand White × Chinchilla) does were used in a randomized complete block design." }, { "infon": 4, "offset": -1, "text": "Does were re-mated 1-9, 10-20 and 21-28 days after parturition in the dry and rainy seasons in Ayetoro, Ogun State, Nigeria." }, { "infon": 5, "offset": -1, "text": "Acceptance of mating decreased with increasing postpartum remating interval." }, { "infon": 6, "offset": -1, "text": "Conception rate was highest in the 21-28 days group (98.8%) and lowest in the 1020 days group (68.4%)." }, { "infon": 7, "offset": -1, "text": "Gestation length was significantly shorter (p<0.05) in the 10-20 days group (30.7 days), than 1-9 days group (31.6 days) and 21-28 days group (31.7 days)." }, { "infon": 8, "offset": -1, "text": "Litter size and weight at birth were not significantly affected." }, { "infon": 9, "offset": -1, "text": "Kit's mortality was lower (p<0.05) in the 21-28 days group (25.6%) compared to 10-20 days group (57.4%) and 1-9 days group (58.8%)." }, { "infon": 10, "offset": -1, "text": "Litter weight (total and alive at birth) was heavier (p<0.05) during the rains (295.9 and 294.9 g) than dry season (250.1 and 243.3 g)." }, { "infon": 11, "offset": -1, "text": "Reducing the re-mating interval after parturition enhanced sexual activity." }, { "infon": 12, "offset": -1, "text": "Fertility was comparable in does re-mated 1-9 and 21-28 days after parturition." } ] } ] }, { "id": "S0004-05922013000200020", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Factors influencing reproduction parameters of ewes Ouled Djellal" } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The study of the reproductive parameters of the ewes Ouled Djellal (n=269), conducted in semiintensive in semi-arid environment, shows a fertility rate of 88 %, a fecundity rate of 95 % and a prolificacy rate was 111 %." }, { "infon": 1, "offset": -1, "text": "The influence of different factors on the reproduction parameters, highlights on fertility, a significant influence (p<0.05) of the physiological state during the mating, an effect very significant of ewes age and a result highly significant (p<0.001) of mode of mating, of month of mating and for the interaction of physiological state during the mating × mode of mating." }, { "infon": 2, "offset": -1, "text": "For fecundity, there is a significant effect (p<0.05) of the ewes age, very significant (p<0.01) of the physiological state during the mating and highly significant (p<0.001) for mode of mating and the month of mating." }, { "infon": 3, "offset": -1, "text": "As for prolificacy, it is significantly influenced by the physiological state during the mating and very significantly by the month of mating." } ] } ] }, { "id": "S0042-96862000000100003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Socioeconomic inequalities in child mortality: comparisons across nine developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper generates and analyses survey data on inequalities in mortality among infants and children aged under five years by consumption in Brazil, Côte d’Ivoire, Ghana, Nepal, Nicaragua, Pakistan, the Philippines, South Africa, and Viet Nam." }, { "infon": 1, "offset": -1, "text": "The data were obtained from the Living Standards Measurement Study and the Cebu Longitudinal Health and Nutrition Survey." }, { "infon": 2, "offset": -1, "text": "Mortality rates were estimated directly where complete fertility histories were available and indirectly otherwise." }, { "infon": 3, "offset": -1, "text": "Mortality distributions were compared between countries by means of concentration curves and concentration indices: dominance checks were carried out for all pairwise intercountry comparisons; standard errors were calculated for the concentration indices; and tests of intercountry differences in inequality were performed." } ] } ] }, { "id": "S0042-96862000000100005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Defining and measuring health inequality: an approach based on the distribution of health expectancy." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper proposes an approach to conceptualizing and operationalizing the measurement of health inequality, defined as differences in health across individuals in the population." }, { "infon": 1, "offset": -1, "text": "We propose that health is an intrinsic component of well-being and thus we should be concerned with inequality in health, whether or not it is correlated with inequality in other dimensions of well-being." }, { "infon": 2, "offset": -1, "text": "In the measurement of health inequality, the complete range of fatal and non-fatal health outcomes should be incorporated." }, { "infon": 3, "offset": -1, "text": "This notion is operationalized through the concept of healthy lifespan." }, { "infon": 4, "offset": -1, "text": "Individual health expectancy is preferable, as a measurement, to individual healthy lifespan, since health expectancy excludes those differences in healthy lifespan that are simply due to chance." }, { "infon": 5, "offset": -1, "text": "In other words, the quantity of interest for studying health inequality is the distribution of health expectancy across individuals in the population." }, { "infon": 6, "offset": -1, "text": "The inequality of the distribution of health expectancy can be summarized by measures of individual/mean differences (differences between the individual and the mean of the population) or inter-individual differences." }, { "infon": 7, "offset": -1, "text": "The exact form of the measure to summarize inequality depends on three normative choices." }, { "infon": 8, "offset": -1, "text": "A firmer understanding of people’s views on these normative choices will provide a basis for deliberating on a standard WHO measure of health inequality." } ] } ] }, { "id": "S0042-96862000000100007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Public spending on health care in Africa: do the poor benefit?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Health care is a basic service essential in any effort to combat poverty, and is often subsidized with public funds to help achieve that aim." }, { "infon": 1, "offset": -1, "text": "This paper examines public spending on curative health care in several African countries and finds that this spending favours mostly the better-off rather than the poor." }, { "infon": 2, "offset": -1, "text": "It concludes that this targeting problem cannot be solved simply by adjusting the subsidy allocations." }, { "infon": 3, "offset": -1, "text": "The constraints that prevent the poor from taking advantage of these services must also be addressed if the public subsidies are to be effective in reaching the poor" } ] } ] }, { "id": "S0042-96862000000100017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Deterioration in the nutritional status of young children and their mothers in Brazzaville, Congo, following the 1994 devaluation of the CFA franc." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The effects of the January 1994 devaluation of the African Financial Community (CFA) franc on the nutritional situation of the populations concerned has been little documented." }, { "infon": 1, "offset": -1, "text": "We report in this article on two nutritional cross-sectional surveys that were conducted before and after this devaluation (1993 and 1996) in two districts of Brazzaville, Congo." }, { "infon": 2, "offset": -1, "text": "The surveys involved a representative sample of 4206 households with a child aged 4-23 months." }, { "infon": 3, "offset": -1, "text": "Complementary feeding practices and the anthropometric indices of the children and their mothers were compared, adjusting for changes in household socioeconomic characteristics." }, { "infon": 4, "offset": -1, "text": "The results show a decline in the quality of the first complementary foods offered to the infants, i.e. less frequent use of special transitional foods and imported complementary flours (of higher nutritional quality), and preparation of less nutritious local gruels." }, { "infon": 5, "offset": -1, "text": "Overall, the nutritional situation had deteriorated, with greater levels of stunting and wasting among children, mothers with lower body mass index, and infants with reduced birth weights." }, { "infon": 6, "offset": -1, "text": "Increased food prices would appear to be the direct cause of the decreased quality in complementary feeding, but factors other than the devaluation have also had an impact on household welfare." }, { "infon": 7, "offset": -1, "text": "The influence of these factors on nutritional status is discussed." } ] } ] }, { "id": "S0042-96862000000100019", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health system reform and the role of field sites based upon demographic and health surveillance." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Field sites for demographic and health surveillance have made well-recognized contributions to the evaluation of new or untested interventions, largely through efficacy trials involving new technologies or the delivery of selected services, e.g. vaccines, oral rehydration therapy and alternative contraceptive methods." }, { "infon": 1, "offset": -1, "text": "Their role in health system reform, whether national or international, has, however, proved considerably more limited." }, { "infon": 2, "offset": -1, "text": "The present article explores the characteristics and defining features of such field sites in low-income and middle-income countries and argues that many currently active sites have a largely untapped potential for contributing substantially to national and subnational health development." }, { "infon": 3, "offset": -1, "text": "Since the populations covered by these sites often correspond with the boundaries of districts or subdistricts, the strategic use of information generated by demographic surveillance can inform the decentralization efforts of national and provincial health authorities." }, { "infon": 4, "offset": -1, "text": "Among the areas of particular importance are the following: making population-based information available and providing an information resource; evaluating programmes and interventions; and developing applications to policy and practice." }, { "infon": 5, "offset": -1, "text": "The question is posed as to whether their potential contribution to health system reform justifies arguing for adaptations to these field sites and expanded investment in them." } ] } ] }, { "id": "S0042-96862000000200003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Safety of immunization injections in Africa: not simply a problem of logistics." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In 1995, the WHO Regional Office for Africa launched a logistics project to address the four main areas of immunization logistics: the cold chain, transport, vaccine supply and quality, and the safety of injections in the countries of the region." }, { "infon": 1, "offset": -1, "text": "The impact of this logistic approach on immunization injection safety was evaluated through surveys of injection procedures and an analysis of the injection materials (e.g. sterilizable or disposable syringes) chosen by the Expanded Programme on Immunization (EPI) and those actually seen to be used." }, { "infon": 2, "offset": -1, "text": "Re-use of injection materials without sterilization, accidental needle-stick injuries among health care workers, and injection-related abscesses in patients were common in countries in the WHO African Region." }, { "infon": 3, "offset": -1, "text": "Few health centres used time-steam saturation-temperature (TST) indicators to check the quality of sterilization and, in many centres, the injection equipment was boiled instead of being steam sterilized." }, { "infon": 4, "offset": -1, "text": "Facilities for the proper disposal of used materials were rarely present." }, { "infon": 5, "offset": -1, "text": "Although the official EPI choice was to use sterilizable equipment, use of a combination of sterilizable and disposable equipment was observed in the field." }, { "infon": 6, "offset": -1, "text": "Unsafe injection practices in these countries were generally due to a failure to integrate nursing practices and public awareness with injection safety issues, and an absence of the influence of EPI managers on health care service delivery." }, { "infon": 7, "offset": -1, "text": "Holistic rather than logistic approaches should be adopted to achieve safe injections in immunization, in the broader context of promoting safe vaccines and safety of all injections." } ] } ] }, { "id": "S0042-96862000000200005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Monitoring signals for vaccine safety: the assessment of individual adverse event reports by an expert advisory committee." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Monitoring vaccine safety is a complex and shared responsibility." }, { "infon": 1, "offset": -1, "text": "It can be carried out in many ways, one of which is the reporting of individual cases of adverse reactions thought to be due to vaccination." }, { "infon": 2, "offset": -1, "text": "The task is difficult because ascribing causality to an individual case report is fraught with challenges." }, { "infon": 3, "offset": -1, "text": "A standardized evaluation instrument - known as the causality assessment form - was therefore developed for use by an expert advisory committee to facilitate the process." }, { "infon": 4, "offset": -1, "text": "By following the several sections in this form, the members of the committee are taken through series of points to establish causality." }, { "infon": 5, "offset": -1, "text": "These points include the basic criteria for causation such as biological plausibility, the time elapsed between the vaccine administration and the onset of the adverse event, and whether other factors (drugs, chemicals or underlying disease) could account for the adverse symptoms." }, { "infon": 6, "offset": -1, "text": "The form concludes with consensus assessment of causality, a commentary about the assessment, and advice for further study or follow-up." }, { "infon": 7, "offset": -1, "text": "This method of assessing the more serious cases of adverse reaction reported to vaccination has proven useful in evaluating ongoing safety of vaccines in Canada." }, { "infon": 8, "offset": -1, "text": "Through analyses such as this, new signals can be identified and investigated further." } ] } ] }, { "id": "S0042-96862000000200007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Simian virus 40, poliovirus vaccines, and human cancer: research progress versus media and public interests." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "From 1955 through early 1963, millions of people were inadvertently exposed to simian virus 40 (SV40) as a contaminant of poliovirus vaccines; the virus had been present in the monkey kidney cultures used to prepare the vaccines and had escaped detection." }, { "infon": 1, "offset": -1, "text": "SV40 was discovered in 1960 and subsequently eliminated from poliovirus vaccines." }, { "infon": 2, "offset": -1, "text": "This article reviews current knowledge about SV40 and considers public responses to reports in the media." }, { "infon": 3, "offset": -1, "text": "SV40 is a potent tumour virus with broad tissue tropism that induces tumours in rodents and transforms cultured cells from many species." }, { "infon": 4, "offset": -1, "text": "It is also an important laboratory model for basic studies of molecular processes in eukaryotic cells and mechanisms of neoplastic transformation." }, { "infon": 5, "offset": -1, "text": "SV40 neutralizing antibodies have been detected in individuals not exposed to contaminated poliovirus vaccines." }, { "infon": 6, "offset": -1, "text": "There have been many reports of detection of SV40 DNA in human tumours, especially mesotheliomas, brain tumours and osteosarcomas; and DNA sequence analyses have ruled out the possibility that the viral DNA in tumours was due to laboratory contamination or that the virus had been misidentified." }, { "infon": 7, "offset": -1, "text": "However, additional studies are necessary to prove that SV40 is the cause of certain human cancers." }, { "infon": 8, "offset": -1, "text": "A recently published review article evaluated the status of the field and received much media attention." }, { "infon": 9, "offset": -1, "text": "The public response emphasized that there is great interest in the possibility of health risks today from vaccinations received in the past." } ] } ] }, { "id": "S0042-96862000000200014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Directly observed treatment, short-course strategy and multidrug-resistant tuberculosis: are any modifications required?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Multidrug-resistant tuberculosis (MDRTB) should be defined as tuberculosis with resistance to at least isoniazid and rifampicin because these drugs are the cornerstone of short-course chemotherapy, and combined isoniazid and rifampicin resistance requires prolonged treatment with second-line agents." }, { "infon": 1, "offset": -1, "text": "Short-course chemotherapy is a key ingredient in the tuberculosis control strategy known as directly observed treatment, short-course (DOTS)." }, { "infon": 2, "offset": -1, "text": "For populations in which multidrug-resistant tuberculosis is endemic, the outcome of the standard short-course chemotherapy regimen remains uncertain." }, { "infon": 3, "offset": -1, "text": "Unacceptable failure rates have been reported and resistance to additional agents may be induced." }, { "infon": 4, "offset": -1, "text": "As a consequence there have been calls for well-functioning DOTS programmes to provide additional services in areas with high rates of multidrug-resistant tuberculosis." }, { "infon": 5, "offset": -1, "text": "These ‘‘DOTS-plus for MDRTB programmes’’ may need to modify all five elements of the DOTS strategy: the treatment may need to be individualized rather than standardized; laboratory services may need to provide facilities for on-site culture and antibiotic susceptibility testing; reliable supplies of a wide range of expensive second-line agents would have to be supplied; operational studies would be required to determine the indications for and format of the expanded programmes; financial and technical support from international organizations and Western governments would be needed in addition to that obtained from local governments." } ] } ] }, { "id": "S0042-96862000000200016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Preventing trachoma through environmental sanitation: a review of the evidence base." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A review of the available evidence for the associations between environmental sanitation and transmission of trachoma was undertaken with a view to identifying preventive interventions." }, { "infon": 1, "offset": -1, "text": "The WHO Global Alliance for the Elimination of Trachoma by the Year 2020 (GET2020) has adopted the ‘‘SAFE’’ strategy, consisting of four components: Surgery, Antibiotic treatment, promotion of Facial cleanliness and initiation of Environmental changes." }, { "infon": 2, "offset": -1, "text": "This review of 19 studies selected from the 39 conducted in different parts of the world shows that there is clear evidence to support the recommendation of facial cleanliness and environmental improvements (i.e. the F and E components of the SAFE strategy) to prevent trachoma." }, { "infon": 3, "offset": -1, "text": "Person-to-person contact and flies appear to constitute the major transmission pathways." }, { "infon": 4, "offset": -1, "text": "Improvement of personal and community hygiene has great potential for a sustainable reduction in trachoma transmission." }, { "infon": 5, "offset": -1, "text": "Controlled clinical trials are needed to estimate the relative contribution of various elements to the risk of transmission of trachoma and the effectiveness of different interventions." }, { "infon": 6, "offset": -1, "text": "These could show the relative attributable risks and effectiveness of interventions to achieve improvement of personal hygiene and fly control by environmental improvements, alone or in combination, and with or without antibiotic treatment." } ] } ] }, { "id": "S0042-96862000000300003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Disease eradication as a public health strategy: a case study of poliomyelitis eradication." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Disease eradication as a public health strategy was discussed at international meetings in 1997 and 1998." }, { "infon": 1, "offset": -1, "text": "In this article, the ongoing poliomyelitis eradication initiative is examined using the criteria for evaluating candidate diseases for eradication proposed at these meetings, which covered costs and benefits, biological determinants of eradicability (technical feasibility) and societal and political considerations (operational feasibility)." }, { "infon": 2, "offset": -1, "text": "The benefits of poliomyelitis eradication are shown to include a substantial investment in health services delivery, the elimination of a major cause of disability, and far-reaching intangible effects, such as establishment of a ‘‘culture of prevention'." }, { "infon": 3, "offset": -1, "text": "The costs are found to be financial and finite, despite some disturbances to the delivery of other health services." }, { "infon": 4, "offset": -1, "text": "The ‘‘technical' feasibility of poliomyelitis eradication is seen in the absence of a non-human reservoir and the presence of both an effective intervention and delivery strategy (oral poliovirus vaccine and national immunization days) and a sensitive and specific diagnostic tool (viral culture of specimens from acute flaccid paralysis cases)." }, { "infon": 5, "offset": -1, "text": "The certification of poliomyelitis eradication in the Americas in 1994 and interruption of endemic transmission in the Western Pacific since March 1997 confirm the operational feasibility of this goal." }, { "infon": 6, "offset": -1, "text": "When the humanitarian, economic and consequent benefits of this initiative are measured against the costs, a strong argument is made for eradication as a valuable disease control strategy." } ] } ] }, { "id": "S0042-96862000000300005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Polio as a platform: using national immunization days to deliver vitamin A supplements." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In 1988 the 41st World Health Assembly committed WHO to the goal of global eradication of poliomyelitis by 2000 \"in ways which strengthen national immunization programmes and health infrastructure\"." }, { "infon": 1, "offset": -1, "text": "The successful use of polio National Immunization Days (NIDs) to deliver vitamin A is an example of how polio eradication can serve as a platform to address other problems of child health." }, { "infon": 2, "offset": -1, "text": "Importantly, this integration is helping to achieve the World Summit for Children goal of eliminating vitamin A deficiency by the year 2000." }, { "infon": 3, "offset": -1, "text": "It is estimated that between 140 million and 250 million preschool children are at risk of subclinical vitamin A deficiency." }, { "infon": 4, "offset": -1, "text": "In 1998 more than 60 million children at risk received vitamin A supplements during polio national immunization days (NIDs)." }, { "infon": 5, "offset": -1, "text": "While food fortification and dietary approaches are fundamental to combating vitamin A deficiency, the administration of vitamin A supplements during NIDs helps raise awareness, enhance technical capacity, improve assessment and establish a reporting system." }, { "infon": 6, "offset": -1, "text": "Moreover, polio NIDs provide an entry point for the sustainable provision of vitamin A supplements with routine immunization services and demonstrate how immunization campaigns can be used for the delivery of other preventive health services." } ] } ] }, { "id": "S0042-96862000000300007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Poliomyelitis surveillance: the model used in India for polio eradication." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases." }, { "infon": 1, "offset": -1, "text": "The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis (AFP)." }, { "infon": 2, "offset": -1, "text": "In October 1997, 59 specially trained Surveillance Medical Officers were deployed throughout the country to establish active AFP surveillance; 11 533 units were created to report weekly on the occurrence of AFP cases at the district, state and national levels; timely case investigation and the collection of stool specimens from AFP cases was undertaken; linkages were made to support the polio laboratory network; and extensive training of government counterparts of the Surveillance Medical Officers was conducted." }, { "infon": 3, "offset": -1, "text": "Data reported at the national level are analysed and distributed weekly." }, { "infon": 4, "offset": -1, "text": "Annualized rates of non-polio AFP increased from 0.22 per 100 000 children aged under 15 years in 1997 to 1.39 per 100 000 in 1999." }, { "infon": 5, "offset": -1, "text": "The proportion of cases with two adequate stools collected within two weeks of the onset of paralysis increased from 34% in 1997 to 68% in 1999." }, { "infon": 6, "offset": -1, "text": "The number of polio cases associated with the isolation of wild poliovirus decreased from 211 in the first quarter of 1998 to 77 in the first quarter of 1999." }, { "infon": 7, "offset": -1, "text": "Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh." }, { "infon": 8, "offset": -1, "text": "In order to achieve polio eradication in India during 2000, extra national immunization days and house-to-house mopping-up rounds should be organized." } ] } ] }, { "id": "S0042-96862000000300010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Stopping poliovirus vaccination after eradication: issues and challenges." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Since 1988 reported polio cases worldwide have declined by about 85% and the number of known or suspected polioendemic countries has decreased from over 120 to less than 50." }, { "infon": 1, "offset": -1, "text": "With eradication of poliomyelitis approaching, issues potentially affecting when and how vaccination against poliovirus can be stopped become extremely important." }, { "infon": 2, "offset": -1, "text": "Because of the potential risks and benefits inherent in such a decision, the best available science, a risk-benefit analysis, contingency plans, a stock pile of poliovirus vaccines, and the endorsement by the global policy-making committees will all be needed before vaccination can be discontinued." }, { "infon": 3, "offset": -1, "text": "The scientific basis for stopping polio immunization has been reviewed by WHO." }, { "infon": 4, "offset": -1, "text": "This Round Table article summarizes the current state of knowledge, provides an update on the processes and timelines for certification, containment, and stopping vaccination, and highlights some of the unanswered scientific questions that will be addressed by further research." }, { "infon": 5, "offset": -1, "text": "These include whether transmission of vaccine-derived poliovirus strains could be sustained so that poliomyelitis could re-emerge in a future unvaccinated population and whether prolonged excretion of vaccine-derived poliovirus from individuals with immune deficiencies could be a mechanism through which this could occur." } ] } ] }, { "id": "S0042-96862000000300014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The role of son preference in reproductive behaviour in Pakistan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The sex of surviving children is an important determinant of reproductive behaviour in South Asia in general and Pakistan in particular." }, { "infon": 1, "offset": -1, "text": "This cohort study evaluates the role of the sex of children on reproductive intentions and subsequent behaviour of women in urban slums of Karachi, Pakistan." }, { "infon": 2, "offset": -1, "text": "The analysis is based on two rounds of surveys conducted in 1990-91 and 1995 of a cohort of married women aged 15-49 years." }, { "infon": 3, "offset": -1, "text": "The results show that pregnancies became increasingly unwanted as the number of surviving sons increased." }, { "infon": 4, "offset": -1, "text": "The sex of surviving children was strongly correlated with subsequent fertility and contraceptive behaviour." }, { "infon": 5, "offset": -1, "text": "However, rather than an exclusive son preference, couples strove for one or more sons and at least one surviving daughter." }, { "infon": 6, "offset": -1, "text": "The policy implications of the link between overt son preference and low status of women are discussed." } ] } ] }, { "id": "S0042-96862000000300016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A proposal to declare neurocysticercosis an international reportable disease." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Neurocysticercosis is an infection of the nervous system caused by Taenia solium." }, { "infon": 1, "offset": -1, "text": "It is the most important human parasitic neurological disease and a common cause of epilepsy in Africa, Asia, and Latin America, representing enormous costs for anticonvulsants, medical resources and lost production." }, { "infon": 2, "offset": -1, "text": "Neurocysticercosis is a human-to-human infection, acquired by the faecal-enteric route from carriers of intestinal T. solium, most often in areas with deficient sanitation." }, { "infon": 3, "offset": -1, "text": "Intestinal tapeworms cause few symptoms, but adult taeniae carried by humans release large numbers of infective eggs and are extremely contagious." }, { "infon": 4, "offset": -1, "text": "Ingestion of poorly cooked pig meat infested with T. solium larvae results in intestinal taeniosis but not neurocysticercosis." }, { "infon": 5, "offset": -1, "text": "With a view to hastening the control of taeniosis and neurocysticercosis we propose that neurocysticercosis be declared an international reportable disease." }, { "infon": 6, "offset": -1, "text": "New cases of neurocysticercosis should be reported by physicians or hospital administrators to their health ministries." }, { "infon": 7, "offset": -1, "text": "An epidemiological intervention could then be launched to interrupt the chain of transmission by: (1) searching for, treating and reporting the sources of contagion, i.e. human carriers of tapeworms; (2) identifying and treating other exposed contacts; (3) providing health education on parasite transmission and improvement of hygiene and sanitary conditions; and (4) enforcing meat inspection policies and limiting the animal reservoir by treatment of pigs." }, { "infon": 8, "offset": -1, "text": "We believe that the first step required to solve the problem of neurocysticercosis is to implement appropriate surveillance mechanisms under the responsibility of ministries of health." }, { "infon": 9, "offset": -1, "text": "Compulsory notification also has the major advantage of providing accurate quantification of the incidence and prevalence of neurocysticercosis at regional level, thus permitting the rational use of resources in eradication campaigns." } ] } ] }, { "id": "S0042-96862000000400004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The burden of mental disorders: a comparison of methods between the Australian burden of disease studies and the Global Burden of Disease study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The national and Victorian burden of disease studies in Australia set out to examine critically the methods used in the Global Burden of Disease study to estimate the burden of mental disorders." }, { "infon": 1, "offset": -1, "text": "The main differences include the use of a different set of disability weights allowing estimates in greater detail by level of severity, adjustments for comorbidity between mental disorders, a greater number of mental disorders measured, and modelling of substance use disorders, anxiety disorders and bipolar disorder as chronic conditions." }, { "infon": 2, "offset": -1, "text": "Uniform age-weighting in the Australian studies produces considerably lower estimates of the burden due to mental disorders in comparison with age-weighted disability-adjusted life years." }, { "infon": 3, "offset": -1, "text": "A lack of follow-up data on people with mental disorders who are identified in cross-sectional surveys poses the greatest challenge in determining the burden of mental disorders more accurately." } ] } ] }, { "id": "S0042-96862000000400006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Why does the burden of disease persist?" }, { "infon": 1, "offset": -1, "text": "Relating the burden of anxiety and depression to effectiveness of treatment." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Why does the burden of mental disorders persist in established market economies?" }, { "infon": 1, "offset": -1, "text": "There are four possibilities: the burden estimates are wrong; there are no effective treatments; people do not receive treatment; or people do not receive effective treatments." }, { "infon": 2, "offset": -1, "text": "Data from the Australian National Survey of Mental Health and Wellbeing about the two commonest mental disorders, generalized anxiety disorder and depression, have been used in examining these issues." }, { "infon": 3, "offset": -1, "text": "The burden of mental disorders in Australia is third in importance after heart disease and cancer, and anxiety and depressive disorders account for more than half of that burden." }, { "infon": 4, "offset": -1, "text": "The efficacy of treatments for both disorders has been established." }, { "infon": 5, "offset": -1, "text": "However, of those surveyed, 40% with current disorders did not seek treatment in the previous year and only 45% were offered a treatment that could have been beneficial." }, { "infon": 6, "offset": -1, "text": "Treatment was not predictive of disorders that remitted during the year." }, { "infon": 7, "offset": -1, "text": "The burden therefore persists for two reasons: too many people do not seek treatment and, when they do, efficacious treatments are not always used effectively." } ] } ] }, { "id": "S0042-96862000000400009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mental health policy development in Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Mental health issues are usually given very low priority in health service policies." }, { "infon": 1, "offset": -1, "text": "Although this is changing, African countries are still confronted with so many problems caused by communicable diseases and malnutrition that they have not woken up to the impact of mental disorders." }, { "infon": 2, "offset": -1, "text": "Every country must formulate a mental health policy based on its own social and cultural realities." }, { "infon": 3, "offset": -1, "text": "Such policies must take into account the scope of mental health problems, provide proven and affordable interventions, safeguard patients' rights, and ensure equity." } ] } ] }, { "id": "S0042-96862000000400011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Towards a global alcohol policy: alcohol, public health and the role of WHO." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In 1983 the World Health Assembly declared alcohol-related problems to be among the world's major health concerns." }, { "infon": 1, "offset": -1, "text": "Since then, alcohol consumption has risen in developing countries, where it takes a heavy toll." }, { "infon": 2, "offset": -1, "text": "Alcohol-related problems are at epidemic levels in the successor states of the Soviet Union and are responsible for 3.5% of disability-adjusted life years (DALYs) lost globally." }, { "infon": 3, "offset": -1, "text": "Substantial evidence exists of the relationship between the levels and patterns of alcohol consumption on the one hand and the incidence of alcohol-related problems on the other." }, { "infon": 4, "offset": -1, "text": "Over the past 20 years, research has demonstrated the effectiveness of public policies involving, for example, taxation and restrictions on alcohol availability, in reducing alcohol-related problems." }, { "infon": 5, "offset": -1, "text": "In the wake of rapid economic globalization, many of these policies at national and subnational levels have been eroded, often with the support of international financial and development organizations." }, { "infon": 6, "offset": -1, "text": "Development agencies and international trade agreements have treated alcohol as a normal commodity, overlooking the adverse consequences of its consumption on productivity and health." }, { "infon": 7, "offset": -1, "text": "WHO is in a strong position to take the lead in developing a global alcohol policy aimed at reducing alcohol-related problems, providing scientific and statistical support, capacity-building, disseminating effective strategies and collaborating with other international organizations." }, { "infon": 8, "offset": -1, "text": "Such leadership can play a significant part in diminishing the health and social problems associated with alcohol use." } ] } ] }, { "id": "S0042-96862000000400017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Nutritional status of breastfed infants in rural Zambia: comparison of the National Center for Health Statistics growth reference versus the WHO 12-month breastfed pooled data set." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Cross-sectional data for breastfed infants in rural Zambia were used to evaluate the effect of applying two different data sets as a reference, i.e. the WHO 12-month breastfed pooled data set and the National Center for Health Statistics (NCHS) growth reference in terms of prevalence of malnutrition (stunting, underweight, and wasting)." }, { "infon": 1, "offset": -1, "text": "A total of 518 infants who were attending mother-and-child health clinics were included." }, { "infon": 2, "offset": -1, "text": "Age, weight and length were recorded." }, { "infon": 3, "offset": -1, "text": "Anthropometric Z-scores were calculated in two ways: by applying the NCHS growth reference and by using the WHO breastfed data set." }, { "infon": 4, "offset": -1, "text": "Anthropometric Z-scores calculated using the breastfed data set were lower during the first 6-7 months of life compared with those calculated by applying the NCHS growth reference." }, { "infon": 5, "offset": -1, "text": "This resulted in a higher proportion of children aged 0-6 months being classified as stunted and underweight using the breastfed data set versus the NCHS growth reference." }, { "infon": 6, "offset": -1, "text": "After the age of 7 months, similar prevalences of stunting or underweight were observed." }, { "infon": 7, "offset": -1, "text": "Relatively few infants were classified as wasted." }, { "infon": 8, "offset": -1, "text": "In order to adequately assess the prevalence of stunting and underweight in breastfed infants, it is recommended that a new growth reference be developed, as has been initiated by WHO." } ] } ] }, { "id": "S0042-96862000000400019", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Global public-private partnerships: part I - a new development in health?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The proliferation of public-private partnerships is rapidly reconfiguring the international health landscape." }, { "infon": 1, "offset": -1, "text": "This article (part I of two on the subject) traces the changing nature of partnership, and discusses the definitional and conceptual ambiguities surrounding the term." }, { "infon": 2, "offset": -1, "text": "After defining global public-private partnerships (GPPPs) for health development, we analyse the factors which have led to the convergence of public and private actors and discuss the consequences of the trend toward partnership between UN agencies (including the World Bank) and commercial entities in the health sector." }, { "infon": 3, "offset": -1, "text": "Generic factors such as globalization and disillusionment with the UN, and factors specific to the health sector, such as market failure in product development for orphan diseases, are examined." }, { "infon": 4, "offset": -1, "text": "Reviewed are the interests, policies, practices and concerns of the UN, the private-for-profit sector, bilateral organizations, and governments of low-income countries with respect to public-private partnership." }, { "infon": 5, "offset": -1, "text": "While GPPPs bring much needed resources to problems of international health, we highlight concerns regarding this new organizational format." }, { "infon": 6, "offset": -1, "text": "Part II, which will be published in the May issue of the Bulletin, presents a conceptual framework for analysing health GPPPs and explores the issues raised." } ] } ] }, { "id": "S0042-96862000000500003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Making abortions safe: a matter of good public health policy and practice." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Globally, abortion mortality accounts for at least 13% of all maternal mortality." }, { "infon": 1, "offset": -1, "text": "Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together." }, { "infon": 2, "offset": -1, "text": "Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives." }, { "infon": 3, "offset": -1, "text": "This article examines the changes in policy and health service provision required to make abortions safe." }, { "infon": 4, "offset": -1, "text": "It is based on a wide-ranging review of published and unpublished sources." }, { "infon": 5, "offset": -1, "text": "In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues." }, { "infon": 6, "offset": -1, "text": "The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers." }, { "infon": 7, "offset": -1, "text": "Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally." } ] } ] }, { "id": "S0042-96862000000500005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Maternal mortality in rural Gambia: levels, causes and contributing factors." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A demographic study carried out in a rural area of the Gambia between January 1993 and December 1998 recorded 74 deaths among women aged 15-49 years." }, { "infon": 1, "offset": -1, "text": "Reported here is an estimation of maternal mortality among these 74 deaths based on a survey of reproductive age mortality, which identified 18 maternal deaths by verbal autopsy." }, { "infon": 2, "offset": -1, "text": "Over the same period there were 4245 live births in the study area, giving a maternal mortality ratio of 424 per 100 000 live births." }, { "infon": 3, "offset": -1, "text": "This maternal mortality estimate is substantially lower than estimates made in the 1980s, which ranged from 1005 to 2362 per 100 000 live births, in the same area." }, { "infon": 4, "offset": -1, "text": "A total of 9 of the 18 deaths had a direct obstetric cause - haemorrhage (6 deaths), early pregnancy (2), and obstructed labour (1)." }, { "infon": 5, "offset": -1, "text": "Indirect causes of obstetric deaths were anaemia (4 deaths), hepatitis (1), and undetermined (4)." }, { "infon": 6, "offset": -1, "text": "Low standards of health care for obstetric referrals, failure to recognize the severity of the problem at the community level, delays in starting the decision-making process to seek health care, lack of transport, and substandard primary health care were identified more than once as probable or possible contributing factors to these maternal deaths." } ] } ] }, { "id": "S0042-96862000000500007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Very few population-based studies of perinatal mortality in developing countries have examined the role of intrapartum risk factors." }, { "infon": 1, "offset": -1, "text": "In the present study, the proportion of perinatal deaths that are attributable to complications during childbirth in Matlab, Bangladesh, was assessed using community-based data from a home-based programme led by professional midwives between 1987 and 1993." }, { "infon": 2, "offset": -1, "text": "Complications during labour and delivery - such as prolonged or obstructed labour, abnormal fetal position, and hypertensive diseases of pregnancy - increased the risk of perinatal mortality fivefold and accounted for 30% of perinatal deaths." }, { "infon": 3, "offset": -1, "text": "Premature labour, which occurred in 20% of pregnancies, accounted for 27% of perinatal mortality." }, { "infon": 4, "offset": -1, "text": "Better care by qualified staff during delivery and improved care of newborns should substantially reduce perinatal mortality in this study population." } ] } ] }, { "id": "S0042-96862000000500009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Measuring reproductive health: review of community-based approaches to assessing morbidity." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This article begins by reviewing selected past approaches to estimating the prevalence of a range of morbidities through the use of household or community-based interview surveys in developed and developing countries." }, { "infon": 1, "offset": -1, "text": "Subsequently, it reviews epidemiological studies that have used a range of methods to estimate the prevalence of reproductive morbidities." }, { "infon": 2, "offset": -1, "text": "A detailed review of recent community or hospital based health interview validation studies that compare self-reported, clinical and laboratory measures is presented." }, { "infon": 3, "offset": -1, "text": "Studies from Bangladesh, Bolivia, China, Egypt, India, Indonesia, Nigeria, Philippines and Turkey provide empirical evidence that self-reported morbidity and observed morbidity measure different phenomena and therefore different aspects of reproductive health and illness." }, { "infon": 4, "offset": -1, "text": "Rather than estimating the prevalence of morbidity, interview-based surveys may provide useful information about the disability or burden associated with reproductive health and illness." } ] } ] }, { "id": "S0042-96862000000500011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care." }, { "infon": 1, "offset": -1, "text": "Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health." }, { "infon": 2, "offset": -1, "text": "The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities." }, { "infon": 3, "offset": -1, "text": "However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right." }, { "infon": 4, "offset": -1, "text": "With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide." } ] } ] }, { "id": "S0042-96862000000500014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Antibody response of patients after postexposure rabies vaccination with small intradermal doses of purified chick embryo cell vaccine or purified Vero cell rabies vaccine." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Although the introduction of tissue culture vaccines for rabies has dramatically improved the immunogenicity and safety of rabies vaccines, they are often prohibitively expensive for developing countries." }, { "infon": 1, "offset": -1, "text": "To examine whether smaller doses of these vaccines could be used, we tested the safety and immunogenicity of purified chick embryo cell vaccine (PCECV) on 211 patients in Thailand with World Health Organization (WHO) category II and III exposures to rabies." }, { "infon": 2, "offset": -1, "text": "The patients presented at two Thai hospitals and were randomized into three groups." }, { "infon": 3, "offset": -1, "text": "Patients in Group 1 received 0.1 ml PCECV intradermally at two sites on days 0, 3, 7, and at one site on days 30 and 90." }, { "infon": 4, "offset": -1, "text": "Group 2 was treated similarly, except that purified Vero cell rabies vaccine (PVRV) was used instead of PCECV." }, { "infon": 5, "offset": -1, "text": "Group 3 received 1.0 ml PCECV intramuscularly on days 0, 3, 7, 14, 30 and 90." }, { "infon": 6, "offset": -1, "text": "After 0, 3, 7, 14, 30 and 90 days serum was collected from the subjects and the geometric mean titres (GMTs) of rabies virus neutralizing antibody determined." }, { "infon": 7, "offset": -1, "text": "After 14 days the GMT of 59 patients vaccinated intradermally with PCECV was equivalent to that of patients who received PVRV." }, { "infon": 8, "offset": -1, "text": "Adverse reactions were more frequent in patients who received vaccines intradermally, indicating the reactions were associated with the route of injection, rather than the vaccine per se." }, { "infon": 9, "offset": -1, "text": "We conclude that PCECV is a safe and highly immunogenic vaccine for postexposure rabies vaccination when administered intradermally in 0.1-ml doses using the two-site method (‘‘2,2,2,0,1,1') recommended by WHO." } ] } ] }, { "id": "S0042-96862000000600004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A framework for assessing the performance of health systems." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals." }, { "infon": 1, "offset": -1, "text": "This paper proposes a framework to advance the understanding of health system performance." }, { "infon": 2, "offset": -1, "text": "A first step is to define the boundaries of the health system, based on the concept of health action." }, { "infon": 3, "offset": -1, "text": "Health action is defined as any set of activities whose primary intent is to improve or maintain health." }, { "infon": 4, "offset": -1, "text": "Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution." }, { "infon": 5, "offset": -1, "text": "Improving health means both increasing the average health status and reducing health inequalities." }, { "infon": 6, "offset": -1, "text": "Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider)." }, { "infon": 7, "offset": -1, "text": "Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all)." }, { "infon": 8, "offset": -1, "text": "This implies that everyone is protected from financial risks due to health care." }, { "infon": 9, "offset": -1, "text": "The measurement of performance relates goal attainment to the resources available." }, { "infon": 10, "offset": -1, "text": "Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge)." }, { "infon": 11, "offset": -1, "text": "By investigating these four functions and how they combine, it is possible not only to understand the proximate determinants of health system performance, but also to contemplate major policy challenges." } ] } ] }, { "id": "S0042-96862000000600006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Benchmarks of fairness for health care reform: a policy tool for developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Teams of collaborators from Colombia, Mexico, Pakistan, and Thailand have adapted a policy tool originally developed for evaluating health insurance reforms in the United States into \"benchmarks of fairness\" for assessing health system reform in developing countries." }, { "infon": 1, "offset": -1, "text": "We describe briefly the history of the benchmark approach, the tool itself, and the uses to which it may be put." }, { "infon": 2, "offset": -1, "text": "Fairness is a wide term that includes exposure to risk factors, access to all forms of care, and to financing." }, { "infon": 3, "offset": -1, "text": "It also includes efficiency of management and resource allocation, accountability, and patient and provider autonomy." }, { "infon": 4, "offset": -1, "text": "The benchmarks standardize the criteria for fairness." }, { "infon": 5, "offset": -1, "text": "Reforms are then evaluated by scoring according to the degree to which they improve the situation, i.e. on a scale of -5 to 5, with zero representing the status quo." }, { "infon": 6, "offset": -1, "text": "The object is to promote discussion about fairness across the disciplinary divisions that keep policy analysts and the public from understanding how trade-offs between different effects of reforms can affect the overall fairness of the reform." }, { "infon": 7, "offset": -1, "text": "The benchmarks can be used at both national and provincial or district levels, and we describe plans for such uses in the collaborating sites." }, { "infon": 8, "offset": -1, "text": "A striking feature of the adaptation process is that there was wide agreement on this ethical framework among the collaborating sites despite their large historical, political and cultural differences." } ] } ] }, { "id": "S0042-96862000000600008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Benchmarks for health expenditures, services and outcomes in Africa during the 1990s." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s." }, { "infon": 1, "offset": -1, "text": "We intend to make statistical information available for national level comparisons." }, { "infon": 2, "offset": -1, "text": "National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews." }, { "infon": 3, "offset": -1, "text": "The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison." }, { "infon": 4, "offset": -1, "text": "There is wide variation in scale and outcome of health care spending between African countries, with poorer countries tending to do worse than wealthier ones." }, { "infon": 5, "offset": -1, "text": "From 1990-96, the median annual per capita government expenditure on health was nearly US$ 6, but averaged US$ 3 in the lowest-income countries, compared to US$ 72 in middle-income countries." }, { "infon": 6, "offset": -1, "text": "Similar trends were found for health services and outcomes." }, { "infon": 7, "offset": -1, "text": "Results from individual countries (particularly Ethiopia, Ghana, Côte d'Ivoire and Gabon) are used to indicate how the data can be used to identify areas of improvement in health system performance." }, { "infon": 8, "offset": -1, "text": "Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management." }, { "infon": 9, "offset": -1, "text": "Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries." } ] } ] }, { "id": "S0042-96862000000600010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Make or buy\" decisions in the production of health care goods and services: new insights from institutional economics and organizational theory." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A central theme of recent health care reforms has been a redefinition of the roles of the state and private providers." }, { "infon": 1, "offset": -1, "text": "With a view to helping governments to arrive at more rational \"make or buy\" decisions on health care goods and services, we propose a conceptual framework in which a combination of institutional economics and organizational theory is used to examine the core production activities in the health sector." }, { "infon": 2, "offset": -1, "text": "Empirical evidence from actual production modalities is also taken into consideration." }, { "infon": 3, "offset": -1, "text": "We conclude that most inputs for the health sector, with the exception of human resources and knowledge, can be efficiently produced by and bought from the private sector." }, { "infon": 4, "offset": -1, "text": "In the health services of low-income countries most dispersed production forms, e.g. ambulatory care, are already provided by the private sector (non-profit and for-profit)." }, { "infon": 5, "offset": -1, "text": "These valuable resources are often ignored by the public sector." }, { "infon": 6, "offset": -1, "text": "The problems of measurability and contestability associated with expensive, complex and concentrated production forms such as hospital care require a stronger regulatory environment and skilled contracting mechanisms before governments can rely on obtaining these services from the private sector." }, { "infon": 7, "offset": -1, "text": "Subsidiary activities within the production process can often be unbundled and outsourced." } ] } ] }, { "id": "S0042-96862000000600012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The role of the hospital in a changing environment." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Hospitals pose many challenges to those undertaking reform of health care systems." }, { "infon": 1, "offset": -1, "text": "This paper examines the evolving role of the hospital within the health care system in industrialized countries and explores the evidence on which policy-makers might base their decisions." }, { "infon": 2, "offset": -1, "text": "It begins by tracing the evolving concept of the hospital, concluding that hospitals must continue to evolve in response to factors such as changing health care needs and emerging technologies." }, { "infon": 3, "offset": -1, "text": "The size and distribution of hospitals are matters for ongoing debate." }, { "infon": 4, "offset": -1, "text": "This paper concludes that evidence in favour of concentrating hospital facilities, whether as a means of enhancing effectiveness or efficiency, is less robust than is often assumed." }, { "infon": 5, "offset": -1, "text": "Noting that care provided in hospitals is often less than satisfactory, this paper summarizes the evidence underlying three reform strategies: (i) behavioural interventions such as quality assurance programmes; (ii) changing organizational culture; and (iii) the use of financial incentives." }, { "infon": 6, "offset": -1, "text": "Isolated behavioural interventions have a limited impact, but are more effective when combined." }, { "infon": 7, "offset": -1, "text": "Financial incentives are blunt instruments that must be monitored." }, { "infon": 8, "offset": -1, "text": "Organizational culture, which has previously received relatively little attention, appears to be an important determinant of quality of care and is threatened by ill-considered policies intended to 're-engineer' hospital services." }, { "infon": 9, "offset": -1, "text": "Overall, evidence on the effectiveness of policies relating to hospitals is limited and this paper indicates where such evidence can be found." } ] } ] }, { "id": "S0042-96862000000600014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient." }, { "infon": 1, "offset": -1, "text": "This is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them." }, { "infon": 2, "offset": -1, "text": "This review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries." } ] } ] }, { "id": "S0042-96862000000700003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Tobacco use by youth: a surveillance report from the Global Youth Tobacco Survey project." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire." }, { "infon": 1, "offset": -1, "text": "The GYTS is school based and employs a two-stage sample design to produce representative data on smoking among students aged 13-15 years." }, { "infon": 2, "offset": -1, "text": "The first stage consists of a probabilistic selection of schools, and the second consists of a random selection of classes from the participating schools." }, { "infon": 3, "offset": -1, "text": "All students in the selected classes are eligible for the survey." }, { "infon": 4, "offset": -1, "text": "In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries." }, { "infon": 5, "offset": -1, "text": "This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland, the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela, and Zimbabwe." }, { "infon": 6, "offset": -1, "text": "The findings show that tobacco use in the surveyed age group ranged from a high of 33% to a low of 10%." }, { "infon": 7, "offset": -1, "text": "While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme." }, { "infon": 8, "offset": -1, "text": "In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare." }, { "infon": 9, "offset": -1, "text": "The majority of young people reported being taught in school about the dangers of smoking." }, { "infon": 10, "offset": -1, "text": "Environmental tobacco smoke exposure was very high in all countries." }, { "infon": 11, "offset": -1, "text": "These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes." } ] } ] }, { "id": "S0042-96862000000700005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Building the evidence base for global tobacco control." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The tobacco control movement needs a global information system permitting routine monitoring of the tobacco trade, tobacco farming, the tobacco industry, the prevalence of tobacco use, associated mortality, and national resources for combating tobacco." }, { "infon": 1, "offset": -1, "text": "The Tobacco Control Country Profiles database, a data collection initiative led by the American Cancer Society in collaboration with WHO and the Centers for Disease Control and Prevention, represents the first step in the development of such a system." }, { "infon": 2, "offset": -1, "text": "Baseline data on several indicators of tobacco use were obtained from 191 Member States of WHO, two Associate Members, Hong Kong Special Administrative Region of China (Hong Kong SAR), China (Province of Taiwan) and the West Bank and Gaza Strip." }, { "infon": 3, "offset": -1, "text": "The methods used to compile the data are described in the present paper." }, { "infon": 4, "offset": -1, "text": "Selected indicators from the database were analysed in order to demonstrate the potential utility and value of data derived from an information system devoted to tobacco control." }, { "infon": 5, "offset": -1, "text": "The analyses covered gender-specific smoking prevalence by WHO Region, per capita cigarette consumption by Human Development Index (HDI) category, and average real annual percentage changes in cigarette prices between 1990 and 1999 for selected countries in each category." }, { "infon": 6, "offset": -1, "text": "In 1998, men were almost four times more likely than women to be smokers." }, { "infon": 7, "offset": -1, "text": "The prevalence of smoking among men was highest in the Western Pacific Region." }, { "infon": 8, "offset": -1, "text": "The differential in gender-specific smoking prevalence was narrowest in the Region of the Americas and the European Region." }, { "infon": 9, "offset": -1, "text": "It was wider in the South-East Asia Region and the Western Pacific Region." }, { "infon": 10, "offset": -1, "text": "The lowest and highest per capita consumption of manufactured cigarettes occurred in the lowest and highest HDI categories respectively." }, { "infon": 11, "offset": -1, "text": "In the medium HDI category, China's growing cigarette consumption after 1975 had a major bearing on the rise in per capita consumption." }, { "infon": 12, "offset": -1, "text": "Cigarette price trends suggest that there is considerable scope for increasing taxes on tobacco products, particularly in low or medium HDI countries." }, { "infon": 13, "offset": -1, "text": "The implications of the findings for future tobacco control efforts are discussed, as are issues surrounding the quality of available data, priorities for future data collection and the need to maintain and improve the information system in order to support such efforts." } ] } ] }, { "id": "S0042-96862000000700007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Tobacco industry tactics for resisting public policy on health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The tactics used by the tobacco industry to resist government regulation of its products include conducting public relations campaigns, buying scientific and other expertise to create controversy about established facts, funding political parties, hiring lobbyists to influence policy, using front groups and allied industries to oppose tobacco control measures, pre-empting strong legislation by pressing for the adoption of voluntary codes or weaker laws, and corrupting public officials." }, { "infon": 1, "offset": -1, "text": "Formerly secret internal tobacco industry documents provide evidence of a 50-year conspiracy to ‘‘resist smoking restrictions, restore smoker confidence and preserve product liability defence'." }, { "infon": 2, "offset": -1, "text": "The documents reveal industry-wide collusion on legal, political and socially important issues to the tobacco industry and clearly demonstrate that the industry is not disposed to act ethically or responsibly." }, { "infon": 3, "offset": -1, "text": "Societal action is therefore required to ensure that the public health takes precedence over corporate profits." }, { "infon": 4, "offset": -1, "text": "Recommendations for reducing the political influence of the tobacco industry include the following." }, { "infon": 5, "offset": -1, "text": "Every tobacco company in every market should publicly disclose what it knew about the addictiveness and harm caused by tobacco, when it obtained this information, and what it did about it." }, { "infon": 6, "offset": -1, "text": "The industry should be required to guarantee internationally recognized basic consumer rights to its customers." }, { "infon": 7, "offset": -1, "text": "Trade associations and other industry groupings established to deceive the public should be disbanded." }, { "infon": 8, "offset": -1, "text": "These recommendations should be incorporated into WHO's Framework Convention on Tobacco Control." } ] } ] }, { "id": "S0042-96862000000700010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "WHO Framework Convention on Tobacco Control: a global ‘‘good' for public health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Although the application of legal instruments to international health issues - relative to other areas of international concern - is still at a rudimentary stage of development, the transnational health impacts of globalization provide a rationale for the codification and implementation of global norms to deal with shared problems." }, { "infon": 1, "offset": -1, "text": "The experience of promulgating international agreements in other areas closely related to international health - the environment, for example - demonstrates how evidence-based international agreements can effectively address a range of problems that cross national boundaries." }, { "infon": 2, "offset": -1, "text": "The framework convention-protocol approach is a legally binding, incremental approach to international law-making that has frequently been employed to deal with environmental threats, and is now being adapted to serve purely public health ends." }, { "infon": 3, "offset": -1, "text": "Experience with the recently initiated WHO Framework Convention on Tobacco Control provides a case study of how transnational public health problems can be addressed by an international legal approach." }, { "infon": 4, "offset": -1, "text": "Scientific evidence in public health and economics has provided the foundation for the elaboration of this evidence-based strategy." }, { "infon": 5, "offset": -1, "text": "The present tobacco epidemic poses a range of transnational challenges that are best addressed through coordinated action." }, { "infon": 6, "offset": -1, "text": "In this article, it is argued that the proposed Convention has the potential to be a global ‘‘good' for public health - i.e. it has the potential to yield important global public health benefits - and that it represents a test case for more active involvement of the public health community in international law-making." } ] } ] }, { "id": "S0042-96862000000800003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Pattern of susceptibility to measles in Italy." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "On the basis of seroprevalence and incidence data we describe the distribution of individuals susceptible and immune to measles in Italy in 1996-97." }, { "infon": 1, "offset": -1, "text": "In regions where vaccination coverage was at least 70%, approximately 10% of 3-year-old children were susceptible to measles, whereas 40% were in this category in regions with lower vaccination coverage." }, { "infon": 2, "offset": -1, "text": "Seroprevalence among children older than 4 years was similar for the two groups of regions; in the age group 20-39 years it was approximately 95%." }, { "infon": 3, "offset": -1, "text": "During 1990-96 in the regions with lower vaccination coverage the incidence was highest among children aged 4-6 years, and the median age of cases was 7 years; in the regions with higher vaccination coverage, however, the incidence remained at around 5% for the age group 4-16 years, and the overall median age was 10 years." }, { "infon": 4, "offset": -1, "text": "These data confirm the partial reduction in measles incidence in Italy, although transmission has still not been interrupted." }, { "infon": 5, "offset": -1, "text": "The size and geographical distribution of the current pool of susceptible individuals can be expected to present an obstacle to measles elimination if appropriate vaccination strategies, such as catch-up campaigns, are not adopted." } ] } ] }, { "id": "S0042-96862000000800005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Low-cost technology for screening uterine cervical cancer." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "We report on an illuminated, low-cost (Rs 1500 (US$ 36)) magnifying device (Magnivisualizer) for detecting precancerous lesions of the uterine cervix." }, { "infon": 1, "offset": -1, "text": "A total of 403 women attending a maternal and child health care clinic who had abnormal vaginal discharge and related symptoms were referred for detailed pelvic examination and visual inspection by means of the device after the application of 5% (v/v) acetic acid." }, { "infon": 2, "offset": -1, "text": "Pap smears were obtained at the same time." }, { "infon": 3, "offset": -1, "text": "The results were compared with those obtained using colposcopy and/or histology." }, { "infon": 4, "offset": -1, "text": "The Magnivisualizer improved the detection rate of early cancerous lesions from 60%, for unaided visual inspection, to 95%." }, { "infon": 5, "offset": -1, "text": "It also permitted detection of 58% of cases of low-grade dysplasia and 83% of cases of high-grade dysplasia; none of these cases were detectable by unaided visual inspection." }, { "infon": 6, "offset": -1, "text": "For low-grade dysplasia the sensitivity of detection by means of the Magnivisualizer was 57.5%, in contrast with 75.3% for cytological examination." }, { "infon": 7, "offset": -1, "text": "However, the two methodologies had similar sensitivities for higher grades of lesions." }, { "infon": 8, "offset": -1, "text": "The specificity of screening with the Magnivisualizer was 94.3%, while that of cytology was 99%." }, { "infon": 9, "offset": -1, "text": "The cost per screening was approximately US$ 0.55 for the Magnivisualizer and US$ 1.10 for cytology." } ] } ] }, { "id": "S0042-96862000000800007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Validation of spot-testing kits to determine iodine content in salt." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Iodine deficiency disorders are a major public health problem, and salt iodization is the most widely practised intervention for their elimination." }, { "infon": 1, "offset": -1, "text": "For the intervention to be successful and sustainable, it is vital to monitor the iodine content of salt regularly." }, { "infon": 2, "offset": -1, "text": "Iodometric titration, the traditional method for measuring iodine content, has problems related to accessibility and cost." }, { "infon": 3, "offset": -1, "text": "The newer spot-testing kits are inexpensive, require minimal training, and provide immediate results." }, { "infon": 4, "offset": -1, "text": "Using data from surveys to assess the availability of iodized salt in two states in India, Madhya Pradesh and the National Capital Territory of Delhi, we tested the suitability of such a kit in field situations." }, { "infon": 5, "offset": -1, "text": "Salt samples from Delhi were collected from 30 schools, chosen using the Expanded Programme on Immunization (EPI) cluster sampling technique." }, { "infon": 6, "offset": -1, "text": "A single observer made the measurement for iodine content using the kit." }, { "infon": 7, "offset": -1, "text": "Salt samples from Madhya Pradesh were from 30 rural and 30 urban clusters, identified by using census data and the EPI cluster sampling technique." }, { "infon": 8, "offset": -1, "text": "In each cluster, salt samples were collected from 10 randomly selected households and all retailers." }, { "infon": 9, "offset": -1, "text": "The 15 investigators performing the survey estimated the iodine content of salt samples in the field using the kit." }, { "infon": 10, "offset": -1, "text": "All the samples were brought to the central laboratory in Delhi, where iodine content was estimated using iodometric titration as a reference method." }, { "infon": 11, "offset": -1, "text": "The agreement between the kit and titration values decreased as the number of observers increased." }, { "infon": 12, "offset": -1, "text": "Although sensitivity was not much affected by the increase in the number of observers (93.3% for a single observer and 93.9% for multiple observers), specificity decreased sharply (90.4% for a single observer and 40.4% for multiple observers)." }, { "infon": 13, "offset": -1, "text": "Due to the low specificity and resulting high numbers of false-positives for the kit when used by multiple observers (‘‘real-life situations'), kits were likely to consistently overestimate the availability of iodized salt." }, { "infon": 14, "offset": -1, "text": "This overestimation could result in complacency." }, { "infon": 15, "offset": -1, "text": "Therefore, we conclude that until a valid alternative is available, the titration method should be used for monitoring the iodine content of salt at all levels, from producer to consumer, to ensure effectiveness of the programme." } ] } ] }, { "id": "S0042-96862000000800009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Why aircraft disinsection?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A serious problem is posed by the inadvertent transport of live mosquitoes aboard aircraft arriving from tropical countries where vector-borne diseases are endemic." }, { "infon": 1, "offset": -1, "text": "Surveys at international airports have found many instances of live insects, particularly mosquitoes, aboard aircraft arriving from countries where malaria and arboviruses are endemic." }, { "infon": 2, "offset": -1, "text": "In some instances mosquito species have been established in countries in which they have not previously been reported." }, { "infon": 3, "offset": -1, "text": "A serious consequence of the transport of infected mosquitoes aboard aircraft has been the numerous cases of ‘‘airport malaria' reported from Europe, North America and elsewhere." }, { "infon": 4, "offset": -1, "text": "There is an important on-going need for the disinsection of aircraft coming from airports in tropical disease endemic areas into nonendemic areas." }, { "infon": 5, "offset": -1, "text": "The methods and materials available for use in aircraft disinsection and the WHO recommendations for their use are described." } ] } ] }, { "id": "S0042-96862000000800011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Community-based services (CBS) have long used checklists to determine eligibility for contraceptive method use, in particular for combined oral contraceptives (COCs) and the 3-month injectable contraceptive depot-medroxyprogesterone acetate (DMPA)." }, { "infon": 1, "offset": -1, "text": "As safety information changes, however, checklists can quickly become outdated." }, { "infon": 2, "offset": -1, "text": "Inconsistent checklists and eligibility criteria often cause uneven access to contraceptives." }, { "infon": 3, "offset": -1, "text": "In 1996, WHO produced updated eligibility criteria for the use of all contraceptive methods." }, { "infon": 4, "offset": -1, "text": "Based on these criteria, new checklists for COCs and DMPA were developed." }, { "infon": 5, "offset": -1, "text": "This article describes the new checklists and their development." }, { "infon": 6, "offset": -1, "text": "Several rounds of expert review produced checklists that were correct, comprehensible and consistent with the eligibility requirements." }, { "infon": 7, "offset": -1, "text": "Nevertheless, field-testing of the checklists revealed that approximately half (48%) of the respondents felt that one or more questions still needed greater comprehensibility." }, { "infon": 8, "offset": -1, "text": "These findings indicated the need for a checklist guide.In March 2000, WHO convened a meeting of experts to review the medical eligibility criteria for contraceptive use." }, { "infon": 9, "offset": -1, "text": "The article reflects also the resulting updated checklist." } ] } ] }, { "id": "S0042-96862000000800013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Antiretroviral interventions to reduce mother-to-child transmission of human immunodeficiency virus: challenges for health systems, communities and society." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper examines the ethical, economic and social issues that should be considered when antiretroviral interventions are being planned to reduce mother-to-child transmission of the human immunodeficiency virus." }, { "infon": 1, "offset": -1, "text": "Interventions aiming to reduce mother-to-child transmission should be concerned with the rights of both the child and the mother." }, { "infon": 2, "offset": -1, "text": "Women should not be seen as vectors of transmission but as people entitled to adequate health care and social services in their own right." }, { "infon": 3, "offset": -1, "text": "For women accepting mother-to-child transmission interventions it is important to consider their medical and emotional needs and to ensure that they are not stigmatized or subjected to abuse or abandonment following voluntary counselling and testing." }, { "infon": 4, "offset": -1, "text": "Seropositive women who do not wish to continue with pregnancy should have access to facilities for safe termination if this is legal in the country concerned." }, { "infon": 5, "offset": -1, "text": "Problems arise in relation to the basic requirements for introducing such interventions via the health services in developing countries." }, { "infon": 6, "offset": -1, "text": "A framework is given for making decisions about implementation of interventions in health care systems with limited resources where there is a relatively high prevalence of human immunodeficiency virus infection among pregnant women." } ] } ] }, { "id": "S0042-96862000000800015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Overlooked opportunities for investing in health research and development." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In 1996, an Ad Hoc Committee on Health Research Relating to Future Intervention Options (formed under the auspices of the World Health Organization) described a model for setting priorities in research funding." }, { "infon": 1, "offset": -1, "text": "This model, however, as presented in the Ad Hoc Committee's report entitled Investing in health research and development, fails in the following important situations: (i) when there is a health problem about which little is known; (ii) when current control measures are unsustainable; (iii) when there are complex risk factors, like ‘‘social factors', which affect many different diseases; and (iv) when the disease burden and resources for control vary greatly from one place to another." }, { "infon": 2, "offset": -1, "text": "In situations of uncertainty or complexity, a method of priority-setting that emphasizes certainty and simplicity may actually mislead." }, { "infon": 3, "offset": -1, "text": "A transparent, matrix-based process - illustrated with an example of priority-setting for malaria - may permit such uncertainty and complexity to be better taken into account in setting health research priorities." } ] } ] }, { "id": "S0042-96862000000900004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Indoor air pollution in developing countries: a major environmental and public health challenge." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy." }, { "infon": 1, "offset": -1, "text": "These materials are typically burnt in simple stoves with very incomplete combustion." }, { "infon": 2, "offset": -1, "text": "Consequently, women and young children are exposed to high levels of indoor air pollution every day." }, { "infon": 3, "offset": -1, "text": "There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries." }, { "infon": 4, "offset": -1, "text": "Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer." }, { "infon": 5, "offset": -1, "text": "Conflicting evidence exists with regard to asthma." }, { "infon": 6, "offset": -1, "text": "All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding." }, { "infon": 7, "offset": -1, "text": "As a result, risk estimates are poorly quantified and may be biased." }, { "infon": 8, "offset": -1, "text": "Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease." }, { "infon": 9, "offset": -1, "text": "Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making." }, { "infon": 10, "offset": -1, "text": "Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections." }, { "infon": 11, "offset": -1, "text": "A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels." } ] } ] }, { "id": "S0042-96862000000900006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Guidelines for the microbiological quality of treated wastewater used in agriculture: recommendations for revising WHO guidelines." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Three different approaches for establishing guidelines for the microbiological quality of treated wastewater that is reused for agriculture are reviewed." }, { "infon": 1, "offset": -1, "text": "These approaches have different objectives as their outcomes: the absence of faecal indicator organisms in the wastewater, the absence of a measurable excess of cases of enteric disease in the exposed population and a model-generated estimated risk below a defined acceptable risk." }, { "infon": 2, "offset": -1, "text": "If the second approach (using empirical epidemiological studies supplemented by microbiological studies of the transmission of pathogens) is used in conjunction with the third approach (using a model-based quantitative risk assessment for selected pathogens) a powerful tool is produced that aids the development of regulations." }, { "infon": 3, "offset": -1, "text": "This combined approach is more cost-effective than the first approach and adequately protects public health." }, { "infon": 4, "offset": -1, "text": "The guideline limit for faecal coliform bacteria in unrestricted irrigation ( < 1000 faecal coliform bacteria/100 ml) is valid, but for restricted irrigation < 105 faecal coliform bacteria/100 ml is recommended when adult farmworkers are exposed to spray irrigation." }, { "infon": 5, "offset": -1, "text": "A limit of < 103 faecal coliform bacteria/100 ml is recommended if flood irrigation is used or children are exposed." }, { "infon": 6, "offset": -1, "text": "The guideline limit for nematode eggs for both types of irrigation is adequate except when conditions favour the survival of nematode eggs and where children are exposed; in these cases it should be reduced from < 1 egg/l to < 0.1 egg/l." } ] } ] }, { "id": "S0042-96862000000900009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Climate change and vector-borne diseases: a regional analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Current evidence suggests that inter-annual and inter-decadal climate variability have a direct influence on the epidemiology of vector-borne diseases." }, { "infon": 1, "offset": -1, "text": "This evidence has been assessed at the continental level in order to determine the possible consequences of the expected future climate change." }, { "infon": 2, "offset": -1, "text": "By 2100 it is estimated that average global temperatures will have risen by 1.0-3.5 °C, increasing the likelihood of many vector-borne diseases in new areas." }, { "infon": 3, "offset": -1, "text": "The greatest effect of climate change on transmission is likely to be observed at the extremes of the range of temperatures at which transmission occurs." }, { "infon": 4, "offset": -1, "text": "For many diseases these lie in the range 14-18 °C at the lower end and about 35-40 °C at the upper end." }, { "infon": 5, "offset": -1, "text": "Malaria and dengue fever are among the most important vector-borne diseases in the tropics and subtropics; Lyme disease is the most common vector-borne disease in the USA and Europe." }, { "infon": 6, "offset": -1, "text": "Encephalitis is also becoming a public health concern." }, { "infon": 7, "offset": -1, "text": "Health risks due to climatic changes will differ between countries that have developed health infrastructures and those that do not." }, { "infon": 8, "offset": -1, "text": "Human settlement patterns in the different regions will influence disease trends." }, { "infon": 9, "offset": -1, "text": "While 70% of the population in South America is urbanized, the proportion in sub-Saharan Africa is less than 45%." }, { "infon": 10, "offset": -1, "text": "Climatic anomalies associated with the El Niño-Southern Oscillation phenomenon and resulting in drought and floods are expected to increase in frequency and intensity." }, { "infon": 11, "offset": -1, "text": "They have been linked to outbreaks of malaria in Africa, Asia and South America." }, { "infon": 12, "offset": -1, "text": "Climate change has far-reaching consequences and touches on all life-support systems." }, { "infon": 13, "offset": -1, "text": "It is therefore a factor that should be placed high among those that affect human health and survival." } ] } ] }, { "id": "S0042-96862000001000004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The decline in child mortality: a reappraisal." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The present paper examines, describes and documents country-specific trends in under-five mortality rates (i.e., mortality among children under five years of age) in the 1990s." }, { "infon": 1, "offset": -1, "text": "Our analysis updates previous studies by UNICEF, the World Bank and the United Nations." }, { "infon": 2, "offset": -1, "text": "It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident." }, { "infon": 3, "offset": -1, "text": "A consistent series of estimates of under-five mortality rate is provided and an indication is given of historical trends during the period 1950-2000 for both developed and developing countries." }, { "infon": 4, "offset": -1, "text": "It is estimated that 10.5 million children aged 0-4 years died in 1999, about 2.2 million or 17.5% fewer than a decade earlier." }, { "infon": 5, "offset": -1, "text": "On average about 15% of newborn children in Africa are expected to die before reaching their fifth birthday." }, { "infon": 6, "offset": -1, "text": "The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%." }, { "infon": 7, "offset": -1, "text": "During the 1990s the decline in child mortality decelerated in all the WHO regions except the Western Pacific but there is no widespread evidence of rising child mortality rates." }, { "infon": 8, "offset": -1, "text": "At the country level there are exceptions in southern Africa where the prevalence of HIV is extremely high and in Asia where a few countries are beset by economic difficulties." }, { "infon": 9, "offset": -1, "text": "The slowdown in the rate of decline is of particular concern in Africa and South-East Asia because it is occurring at relatively high levels of mortality, and in countries experiencing severe economic dislocation." }, { "infon": 10, "offset": -1, "text": "As the HIV/AIDS epidemic continues in Africa, particularly southern Africa, and in parts of Asia, further reductions in child mortality become increasingly unlikely until substantial progress in controlling the spread of HIV is achieved." } ] } ] }, { "id": "S0042-96862000001000006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Trends in under-5 mortality rates and the HIV/AIDS epidemic." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "INTRODUCTION: The prevalence of human immunodeficiency virus (HIV) among adults and mortality rates among under-5-year-olds have increased or stagnated in many countries." }, { "infon": 1, "offset": -1, "text": "The objective of this study was to investigate whether there is a link between under-5 mortality trends and the prevalence of HIV among adults and, if so, to assess the magnitude of the effect of adult HIV prevalence on under-5 mortality rates." }, { "infon": 2, "offset": -1, "text": "METHOD: Data from Demographic and Health Surveys were used to establish the trends in under-5 mortality rates for 25 countries for which there are data for at least two points in time." }, { "infon": 3, "offset": -1, "text": "Countries were ranked according to the most recent adult HIV prevalence data and grouped in three categories: those with very high HIV prevalence ( > 5%); those with moderately high prevalence (1-4.9%); and those with low prevalence (<1%)." }, { "infon": 4, "offset": -1, "text": "A mathematical model was fitted to obtain an estimate of the contribution of HIV/AIDS to the level of under-5 mortality in each country." }, { "infon": 5, "offset": -1, "text": "RESULTS: Under-5 mortality rates showed an increase in most countries with high adult HIV prevalence, but a decrease in almost every country with moderately high or low prevalence." }, { "infon": 6, "offset": -1, "text": "The estimated contribution of adult HIV prevalence to the observed level of under-5 mortality was highest (up to 61%) in Zimbabwe (where HIV prevalence was highest) and tended to decrease with the level of HIV prevalence." }, { "infon": 7, "offset": -1, "text": "DISCUSSION: The contribution of HIV/AIDS to childhood mortality therefore appears to be most noticeable in settings where the epidemic is most severe." } ] } ] }, { "id": "S0042-96862000001000008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Is malnutrition declining?" }, { "infon": 1, "offset": -1, "text": "An analysis of changes in levels of child malnutrition since 1980." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Nutritional status is the best global indicator of well-being in children." }, { "infon": 1, "offset": -1, "text": "Although many surveys of children have been conducted since the 1970s, lack of comparability between them has made it difficult to monitor trends in child malnutrition." }, { "infon": 2, "offset": -1, "text": "Cross-sectional data from 241 nationally representative surveys were analysed in a standard way to produce comparable results of low height-for-age (stunting)." }, { "infon": 3, "offset": -1, "text": "Multilevel modelling was applied to estimate regional and global trends from 1980 to 2005." }, { "infon": 4, "offset": -1, "text": "The prevalence of stunting has fallen in developing countries from 47% in 1980 to 33% in 2000 (i.e. by 40 million), although progress has been uneven according to regions." }, { "infon": 5, "offset": -1, "text": "Stunting has increased in Eastern Africa, but decreased in South-eastern Asia, South-central Asia and South America; Northern Africa and the Caribbean show modest improvement; and Western Africa and Central America present very little progress." }, { "infon": 6, "offset": -1, "text": "Despite an overall decrease of stunting in developing countries, child malnutrition still remains a major public health problem in these countries." }, { "infon": 7, "offset": -1, "text": "In some countries rates of stunting are rising, while in many others they remain disturbingly high." }, { "infon": 8, "offset": -1, "text": "The data we have presented provide a baseline for assessing progress and help identify countries and regions in need of population wide interventions." }, { "infon": 9, "offset": -1, "text": "Approaches to lower child malnutrition should be based on successful nutrition programmes and policies." } ] } ] }, { "id": "S0042-96862000001000011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Factors associated with trends in infant and child mortality in developing countries during the 1990s." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The 1990s have seen a remarkable decrease in mortality among infants and children in most developing countries." }, { "infon": 1, "offset": -1, "text": "In some countries, particularly in sub-Saharan Africa, these declines in mortality among children have slowed and are now increasing again." }, { "infon": 2, "offset": -1, "text": "Internationally comparable data derived from survey programmes, such as the Demographic and Health Survey (DHS) programme, are available both to document the changes that have occurred in mortality and to provide insight into some of the factors that may explain these trends in mortality." }, { "infon": 3, "offset": -1, "text": "The factors found in repeated DHS programmes that explain these trends fall into five categories: fertility behaviour; nutritional status, breastfeeding, and infant feeding; the use of health services by mothers and for children; environmental health conditions; and socioeconomic status." }, { "infon": 4, "offset": -1, "text": "Both simple analyses and multivariate analyses of changes in these factors between surveys indicate that all factors affected the mortality trends." }, { "infon": 5, "offset": -1, "text": "However, to explain trends in mortality, the variables themselves had to have changed over time." }, { "infon": 6, "offset": -1, "text": "During the 1990s fertility behaviour, breastfeeding, and infant feeding have changed less than other factors and so would seem to have played a smaller role in mortality trends." }, { "infon": 7, "offset": -1, "text": "This study confirms that trends in mortality during the 1990s were related to more than just a handful of variables." }, { "infon": 8, "offset": -1, "text": "It would, therefore, be a mistake to concentrate policy actions on one or a few of these while forsaking others." }, { "infon": 9, "offset": -1, "text": "Countries with the largest decreases in mortality have had substantial improvements in most of the factors that might be used to explain these changes." }, { "infon": 10, "offset": -1, "text": "In some countries mortality has risen." }, { "infon": 11, "offset": -1, "text": "In part these increases can be explained by the factors included in this study, such as deterioration in seeking medical care for children with fever." }, { "infon": 12, "offset": -1, "text": "Other factors that were not measured, such as the increasing resistance of malaria to drug treatment and the increased prevalence of parental HIV/AIDS, may be contributing to the increases noted." } ] } ] }, { "id": "S0042-96862000001100004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Associations between socioeconomic status and cardiovascular risk factors in an urban population in China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "INTRODUCTIONS: In developed countries socioeconomic status has been proven to be an important factor in the progression of cardiovascular disease." }, { "infon": 1, "offset": -1, "text": "The present article reports the results of a cross-sectional assessment to investigate the association between socioeconomic status and cardiovascular risk factors in a Chinese urban population." }, { "infon": 2, "offset": -1, "text": "METHODS: In 1996, a behavioural risk factor survey was carried out in Tianjin, the third largest city in China." }, { "infon": 3, "offset": -1, "text": "A sample of 4000 people aged 15-69 years, stratified by sex and 10-year age groups, was drawn randomly from urban areas of the city." }, { "infon": 4, "offset": -1, "text": "The present study covers respondents aged 25-69 years (1615 men and 1592 women)." }, { "infon": 5, "offset": -1, "text": "Four socioeconomic indicators (education, occupation, income, and marital status), blood pressure, body mass index, and cigarette smoking were determined in the survey." }, { "infon": 6, "offset": -1, "text": "RESULTS: Educational level seemed to be the most important measure of the four socioeconomic indicators in relation to the cardiovascular risk factors in the study population." }, { "infon": 7, "offset": -1, "text": "People with lower socioeconomic status had higher levels of cardiovascular risk factors." }, { "infon": 8, "offset": -1, "text": "The association between socioeconomic status and cardiovascular risk factors was more consistent among women than men." }, { "infon": 9, "offset": -1, "text": "DISCUSSION: Our findings do not seem to differ from those observed in developed countries." } ] } ] }, { "id": "S0042-96862000001100006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Association of diarrhoea and upper respiratory infections with weight and height gains in Bangladeshi children aged 5 to 11 years." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "INTRODUCTION: The association between infection and growth delay is not well documented in school-age children in developing countries." }, { "infon": 1, "offset": -1, "text": "We conducted a prospective cohort study to examine the association between infectious disease and weight and height gains among Bangladeshi children." }, { "infon": 2, "offset": -1, "text": "METHODS: A one-year follow-up study was performed to elucidate the determinants and consequences of physical growth of children under five years of age." }, { "infon": 3, "offset": -1, "text": "The study included 135 households randomly selected from four villages in the Matlab area." }, { "infon": 4, "offset": -1, "text": "RESULTS: The most frequent infections were upper respiratory infections (mean = 4 episodes or 27 days per year) followed by non-dysenteric diarrhoea (mean = 2.3 episodes or 15 days per year) and dysentery (mean = 0.2 episodes or 2 days per year)." }, { "infon": 5, "offset": -1, "text": "The number of episodes and their duration decreased significantly with age." }, { "infon": 6, "offset": -1, "text": "Over a 12-month period the mean weight gain was 1.3 kg and the mean increase in height was 2.9 cm. The total number of days when diarrhoea occurred was negatively associated with annual weight gain (regression coefficient b = -7 g per day, P = 0.02), with adjustment for age, sex, energy and protein intake, and household land ownership." }, { "infon": 7, "offset": -1, "text": "The incidence of diarrhoeal disease was significantly associated with weight gain in intermediate models but only marginally associated with it in the final multivariate model (P = 0.08)." }, { "infon": 8, "offset": -1, "text": "Neither the incidence nor the duration of upper respiratory infections was associated with weight gain." }, { "infon": 9, "offset": -1, "text": "Height gain was not significantly associated with the duration or incidence of either category of illness." }, { "infon": 10, "offset": -1, "text": "Diarrhoea was a significant correlate of retarded weight gain among children above preschool age, whereas upper respiratory infections were not." }, { "infon": 11, "offset": -1, "text": "DISCUSSION: Diarrhoeal morbidity slowed growth in children well beyond the weaning age, suggesting that increased attention should be given to the study of the continuous impact of diarrhoea in children aged over 5 years." }, { "infon": 12, "offset": -1, "text": "An understanding of the determinants of growth in school-age children in developing countries would maximize the health and developmental outcomes that are the target of international child survival strategies at younger ages." } ] } ] }, { "id": "S0042-96862000001100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "INTRODUCTION: There is a paucity of published data on the type of conditions that require surgery among children in sub-Saharan Africa." }, { "infon": 1, "offset": -1, "text": "Such information is necessary for assessing the impact of such conditions on child health and for setting priorities to improve paediatric surgical care." }, { "infon": 2, "offset": -1, "text": "METHODS: Described in the article is a 29-month prospective study of all children aged <15 years who were admitted to a government referral hospital in the Gambia from January 1996 to May 1998." }, { "infon": 3, "offset": -1, "text": "RESULTS: A total of 1726 children were admitted with surgical problems." }, { "infon": 4, "offset": -1, "text": "Surgical patients accounted for 11.3% of paediatric admissions and 34 625 total inpatient days." }, { "infon": 5, "offset": -1, "text": "The most common admission diagnoses were injuries (46.9%), congenital anomalies (24.3%), and infections requiring surgery (14.5%)." }, { "infon": 6, "offset": -1, "text": "The diagnoses that accounted for the greatest number of inpatient days were burns (18.8%), osteomyelitis (15.4%), fractures (12.7%), soft tissue injuries (3.9%), and head injuries (3.4%)." }, { "infon": 7, "offset": -1, "text": "Gambian children were rarely admitted for appendicitis and never admitted for hypertrophic pyloric stenosis." }, { "infon": 8, "offset": -1, "text": "The leading causes of surgical deaths were burns, congenital anomalies, and injuries other than burns." }, { "infon": 9, "offset": -1, "text": "DISCUSSION: Prevention of childhood injuries and better trauma management, especially at the primary and secondary health care levels, should be the priorities for improving paediatric surgical care in sub-Saharan Africa." }, { "infon": 10, "offset": -1, "text": "Surgical care of children should be considered an essential component of child health programmes in developing countries." } ] } ] }, { "id": "S0042-96862000001100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Information systems: the key to evidence-based health practice." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making." }, { "infon": 1, "offset": -1, "text": "The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP." }, { "infon": 2, "offset": -1, "text": "The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review." }, { "infon": 3, "offset": -1, "text": "Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication." }, { "infon": 4, "offset": -1, "text": "Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex ‘‘data mining' and rule-driven decision support systems." } ] } ] }, { "id": "S0042-96862000001100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economy." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Globalization has led to an increase in the spread of emerging and re-emerging infectious diseases." }, { "infon": 1, "offset": -1, "text": "International efforts are being launched to control their dissemination through global surveillance, a major hindrance to which is the failure of some countries to report outbreaks." }, { "infon": 2, "offset": -1, "text": "Current guidelines and regulations on emerging and re-emerging infectious diseases do not sufficiently take into account the fact that when developing countries report outbreaks they often derive few benefits and suffer disproportionately heavy social and economic consequences." }, { "infon": 3, "offset": -1, "text": "In order to facilitate full participation in global surveillance by developing countries there should be: better and more affordable diagnostic capabilities to allow for timely and accurate information to be delivered in an open and transparent fashion; accurate, less sensationalist news reporting of outbreaks of diseases; adherence by countries to international regulations, including those of the World Trade Organization and the International Health Regulations; financial support for countries that are economically damaged by the diseases in question." }, { "infon": 4, "offset": -1, "text": "The article presents two cases - plague in India and cholera in Peru - that illuminate some of the limitations of current practices." }, { "infon": 5, "offset": -1, "text": "Recommendations are made on measures that could be taken by WHO and the world community to make global surveillance acceptable." } ] } ] }, { "id": "S0042-96862000001200006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Comparison of house spraying and insecticide-treated nets for malaria control." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The efficacies of using residual house spraying and insecticide-treated nets against malaria vectors are compared, using data from six recent comparisons in Africa, Asia and Melanesia." }, { "infon": 1, "offset": -1, "text": "By all the entomological and malariological criteria recorded, pyrethroid-treated nets were at least as efficacious as house spraying with dichlorodiphenyltrichloroethane (DDT), malathion or a pyrethroid." }, { "infon": 2, "offset": -1, "text": "However, when data from carefully monitored house spraying projects carried out between the 1950s and 1970s at Pare-Taveta and Zanzibar (United Republic of Tanzania), Kisumu (Kenya) and Garki (Nigeria) are compared with recent insecticide-treated net trials with apparently similar vector populations, the results with the insecticide-treated nets were much less impressive." }, { "infon": 3, "offset": -1, "text": "Possible explanations include the longer duration of most of the earlier spraying projects and the use of non-irritant insecticides." }, { "infon": 4, "offset": -1, "text": "Non-irritant insecticides may yield higher mosquito mortalities than pyrethroids, which tend to make insects leave the site of treatment (i.e. are excito-repellent)." }, { "infon": 5, "offset": -1, "text": "Comparative tests with non-irritant insecticides, including their use on nets, are advocated." }, { "infon": 6, "offset": -1, "text": "The relative costs and sustainability of spraying and of insecticide-treated net operations are briefly reviewed for villages in endemic and epidemic situations and in camps for displaced populations." }, { "infon": 7, "offset": -1, "text": "The importance of high population coverage is emphasized, and the advantages of providing treatment free of charge, rather than charging individuals, are pointed out." } ] } ] }, { "id": "S0042-96862000001200008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Molecular entomology and prospects for malaria control." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "During the past decade, the techniques of molecular and cell biology have been embraced by many scientists doing research on anopheline vectors of malaria parasites." }, { "infon": 1, "offset": -1, "text": "Some of the most important research advances in molecular entomology have concerned the development of sophisticated molecular tools for procedures such as genetic and physical mapping and germ line transformation." }, { "infon": 2, "offset": -1, "text": "Major advances have also been made in the study of specific biological processes such as insect defence against pathogens and the manner in which malaria parasites and their anopheline hosts interact during sporogony." }, { "infon": 3, "offset": -1, "text": "One of the most important highlights of this research trend has been the emergence during the past year of a formal international Anopheles gambiae genome project, which at present includes investigators in several laboratories in Europe and the USA." }, { "infon": 4, "offset": -1, "text": "Although much of this molecular research is directed towards the development of malaria control strategies that are probably many years from implementation, there are some important areas of molecular entomology that may have a more near-term impact on malaria control." }, { "infon": 5, "offset": -1, "text": "We highlight developments over the past decade in three such areas that we believe can make important contributions to the development of near-term malaria control strategies." }, { "infon": 6, "offset": -1, "text": "These areas are anopheline species identification, the detection and monitoring of insecticide susceptibility/resistance in wild anopheline populations and the determination of the genetic structure of anopheline populations." } ] } ] }, { "id": "S0042-96862000001200010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Using a geographical information system to plan a malaria control programme in South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "INTRODUCTION: Sustainable control of malaria in sub-Saharan Africa is jeopardized by dwindling public health resources resulting from competing health priorities that include an overwhelming acquired immunodeficiency syndrome (AIDS) epidemic." }, { "infon": 1, "offset": -1, "text": "In Mpumalanga province, South Africa, rational planning has historically been hampered by a case surveillance system for malaria that only provided estimates of risk at the magisterial district level (a subdivision of a province)." }, { "infon": 2, "offset": -1, "text": "METHODS: To better map control programme activities to their geographical location, the malaria notification system was overhauled and a geographical information system implemented." }, { "infon": 3, "offset": -1, "text": "The introduction of a simplified notification form used only for malaria and a carefully monitored notification system provided the good quality data necessary to support an effective geographical information system." }, { "infon": 4, "offset": -1, "text": "RESULTS: The geographical information system displays data on malaria cases at a village or town level and has proved valuable in stratifying malaria risk within those magisterial districts at highest risk, Barberton and Nkomazi." }, { "infon": 5, "offset": -1, "text": "The conspicuous west-to-east gradient, in which the risk rises sharply towards the Mozambican border (relative risk = 4.12, 95% confidence interval = 3.88-4.46 when the malaria risk within 5 km of the border was compared with the remaining areas in these two districts), allowed development of a targeted approach to control." }, { "infon": 6, "offset": -1, "text": "DISCUSSION: The geographical information system for malaria was enormously valuable in enabling malaria risk at town and village level to be shown." }, { "infon": 7, "offset": -1, "text": "Matching malaria control measures to specific strata of endemic malaria has provided the opportunity for more efficient malaria control in Mpumalanga province." } ] } ] }, { "id": "S0042-96862000001200015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Safety of community drinking-water and outbreaks of waterborne enteric disease: Israel, 1976-97." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Waterborne disease remains a major public health problem in many countries." }, { "infon": 1, "offset": -1, "text": "We report findings on nearly three decades of waterborne disease in Israel and the part these diseases play in the total national burden of enteric disease." }, { "infon": 2, "offset": -1, "text": "During the 1970s and 1980s, Israel's community water supplies were frequently of poor quality according to the microbiological standards at that time, and the country experienced many outbreaks of waterborne enteric disease." }, { "infon": 3, "offset": -1, "text": "New regulations raised water quality standards and made chlorination of community water supplies mandatory, as well as imposing more stringent guidelines on maintaining water sources and distribution systems for both surface water and groundwater." }, { "infon": 4, "offset": -1, "text": "This was followed by improved compliance and water quality, and a marked decline in the number of outbreaks of waterborne disease; no outbreaks were detected between 1992 and 1997." }, { "infon": 5, "offset": -1, "text": "The incidence of waterborne salmonellosis, shigellosis, and typhoid declined markedly as proportions of the total burden of these diseases, but peaked during the time in which there were frequent outbreaks of waterborne disease (1980-85)." }, { "infon": 6, "offset": -1, "text": "Long-term trends in the total incidence of reported infectious enteric diseases from all sources, including typhoid, shigellosis, and viral hepatitis (all types) declined, while the total incidence of salmonellosis increased." }, { "infon": 7, "offset": -1, "text": "Mandatory chlorination has had an important impact on improving water quality, in reducing outbreaks of waterborne disease in Israel, and reducing the total burden of enteric disease in the country." } ] } ] }, { "id": "S0042-96862001000100004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Pilot study of the use of community volunteers to distribute azithromycin for trachoma control in Ghana." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the skills of community health volunteers in diagnosing active trachoma and distributing azithromycin in the Northern Region of Ghana." }, { "infon": 1, "offset": -1, "text": "METHODS: Six community health volunteers from Daboya were trained to diagnose trachoma and to treat the disease using azithromycin." }, { "infon": 2, "offset": -1, "text": "They were also informed of the drug's possible side-effects." }, { "infon": 3, "offset": -1, "text": "Under supervision, each volunteer then examined, and if necessary treated, 15 households." }, { "infon": 4, "offset": -1, "text": "The dose of azithromycin was determined by weight; height was also measured." }, { "infon": 5, "offset": -1, "text": "Tablets were given in preference to suspension when possible." }, { "infon": 6, "offset": -1, "text": "RESULTS: The volunteers' diagnostic sensitivity for active trachoma was 63%; their specificity was 96%." }, { "infon": 7, "offset": -1, "text": "At the household level, their ‘‘decision to treat' was correct in 83% of households." }, { "infon": 8, "offset": -1, "text": "In 344 treatment episodes, volunteers planned a dose of azithromycin outside the range 15-30 mg/kg on only seven occasions (2.0% of all planned treatments)." }, { "infon": 9, "offset": -1, "text": "The volunteers' drug management skills were good, the response of the community was excellent, and adverse reactions were infrequent." }, { "infon": 10, "offset": -1, "text": "Diagnosis of active trachoma, record-keeping skills, and knowledge of side-effects were found to need greater emphasis in any future education programme." }, { "infon": 11, "offset": -1, "text": "Most people aged four years or older were able to swallow tablets." }, { "infon": 12, "offset": -1, "text": "For those taking tablets, the correlation between the data gathered for height and weight shows that calculating azithromycin doses by height is a valid alternative to calculating it by weight." }, { "infon": 13, "offset": -1, "text": "CONCLUSION: Trained community health volunteers have a potential role in identifying active trachoma and distributing azithromycin." }, { "infon": 14, "offset": -1, "text": "To simplify training and logistics, it may be better to base dosage schedules on height rather than weight for those taking tablets, which included most people aged four years or more in the population studied." } ] } ] }, { "id": "S0042-96862001000100006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The use of hospital-based nurses for the surveillance of potential disease outbreaks." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To study a novel surveillance system introduced in Mpumalanga Province, a rural area in the north-east of South Africa, in an attempt to address deficiences in the system of notification for infectious conditions that have the potential for causing outbreaks." }, { "infon": 1, "offset": -1, "text": "METHODS: Hospital-based infection control nurses in all of Mpumalanga's 32 public and private hospitals were trained to recognize, report, and respond to nine clinical syndromes that require immediate action." }, { "infon": 2, "offset": -1, "text": "Sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses." }, { "infon": 3, "offset": -1, "text": "The system was evaluated by formal review of hospital records, evidence of the effective containment of a cholera outbreak, and assessment of the speed and appropriateness of responses to other syndromes." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Rapid detection, reporting and response to six imported cholera cases resulted in effective containment, with only 19 proven secondary cholera cases, during the two-year review period." }, { "infon": 5, "offset": -1, "text": "No secondary cases followed detection and prompt response to 14 patients with meningococcal disease." }, { "infon": 6, "offset": -1, "text": "By the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time." }, { "infon": 7, "offset": -1, "text": "Formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: The primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response." }, { "infon": 9, "offset": -1, "text": "Infection control nurses in Mpumalanga hospitals have excelled in timely weekly zero-reporting, participation at monthly training and feedback sessions, detection of priority clinical syndromes, and prompt appropriate response." }, { "infon": 10, "offset": -1, "text": "This review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action." } ] } ] }, { "id": "S0042-96862001000100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery - all of which would provide baseline data for a national prevention programme in Bolivia." }, { "infon": 1, "offset": -1, "text": "METHODS: All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study." }, { "infon": 2, "offset": -1, "text": "FINDINGS: A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery." }, { "infon": 3, "offset": -1, "text": "Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis." }, { "infon": 4, "offset": -1, "text": "While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing." }, { "infon": 5, "offset": -1, "text": "There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples." }, { "infon": 6, "offset": -1, "text": "Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this disease." } ] } ] }, { "id": "S0042-96862001000100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Community-based trials of sexually transmitted disease treatment: repercussions for epidemiology and HIV prevention." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper reviews the scientific basis for trials exploring the relation between sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection in Mwanza in the United Republic of Tanzania and Rakai and Masaka in the Republic of Uganda." }, { "infon": 1, "offset": -1, "text": "The importance of a study's location and explanations for the divergent results of these trials are discussed." }, { "infon": 2, "offset": -1, "text": "The modest effect on STDs seen in the trial of syndromic management in Mwanza, in contrast to the 38% reduction in the incidence of HIV, casts doubt on the underlying hypothesis that treating STDs alone slows the transmission of HIV-1." }, { "infon": 3, "offset": -1, "text": "According to the Piot-Fransen model, the trial in Rakai, which offered treatment of STDs to all subjects irrespective of symptoms (‘‘mass' treatment), should have been more effective both in reducing the prevalence of STDs and the incidence of HIV." }, { "infon": 4, "offset": -1, "text": "However, the Rakai trial was stopped because there was no difference in the incidence of HIV between the intervention and control arms." }, { "infon": 5, "offset": -1, "text": "If Mwanza is seen as the trial that needs explaining, another paradigm becomes relevant." }, { "infon": 6, "offset": -1, "text": "In rural East Africa, where all trials have been conducted, networks of concurrent sexual partnerships are a source of infection with both STDs and HIV." }, { "infon": 7, "offset": -1, "text": "Because of their shorter latency periods, STDs may prompt attendance at a clinic before the early signs of HIV-1 infection appear." }, { "infon": 8, "offset": -1, "text": "Part of the management of STDs is to recommend abstinence or the consistent use of condoms until treatment is completed." }, { "infon": 9, "offset": -1, "text": "This recommendation may cover the earliest period of viraemia during primary HIV-1 infection." }, { "infon": 10, "offset": -1, "text": "This paradigm appears to explain the results from Mwanza and Rakai, emphasizing behavioural aspects of syndromic management." } ] } ] }, { "id": "S0042-96862001000200003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Awareness of eye diseases in an urban population in southern India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the level of awareness of eye diseases in the urban population of Hyderabad in southern India." }, { "infon": 1, "offset": -1, "text": "METHODS: A total of 2522 subjects of all ages, who were representative of the Hyderabad population, participated in the population-based Andhra Pradesh Eye Disease Study." }, { "infon": 2, "offset": -1, "text": "Of these subjects, 1859 aged >15 years responded to a structured questionnaire on cataract, glaucoma, night blindness and diabetic retinopathy to trained field investigators." }, { "infon": 3, "offset": -1, "text": "Having heard of the eye disease in question was defined as ‘‘awareness' and having some understanding of the eye disease was defined as ‘‘knowledge'." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Awareness of cataract (69.8%) and night blindness (60.0%) was moderate but that of diabetic retinopathy (27.0%) was low, while that of glaucoma (2.3%) was very poor." }, { "infon": 5, "offset": -1, "text": "Knowledge of all the eye diseases assessed was poor." }, { "infon": 6, "offset": -1, "text": "Subjects aged > 30 years were significantly more aware of all eye diseases assessed except night blindness." }, { "infon": 7, "offset": -1, "text": "Multivariate analysis revealed that women were significantly less aware of night blindness (odds ratio (OR) = 0.78; 95% confidence interval (CI) = 0.63-0.97)." }, { "infon": 8, "offset": -1, "text": "Education played a significant role in awareness of these eye diseases." }, { "infon": 9, "offset": -1, "text": "Study subjects of upper socioeconomic status were significantly more aware of night blindness (OR = 2.20; 95% CI = 1.29-3.74) and those belonging to upper and middle socioeconomic strata were significantly more aware of diabetic retinopathy (OR = 2.79; 95% CI = 2.19-3.56)." }, { "infon": 10, "offset": -1, "text": "Muslims were significantly more aware of cataract (OR = 2.36; 95% CI = 1.84-3.02) and less aware of night blindness (OR = 0.52; 95% CI = 0.42-0.64)." }, { "infon": 11, "offset": -1, "text": "The major source of awareness of the eye diseases was a family member/friend/relative suffering from that eye disease." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: These data suggest that there is a need for health education in this Indian population to increase their level of awareness and knowledge of common eye diseases." }, { "infon": 13, "offset": -1, "text": "Such awareness and knowledge could lead to better understanding and acceptance of the importance of routine eye examinations for the early detection and treatment of eye diseases, thereby reducing visual impairment in this population." } ] } ] }, { "id": "S0042-96862001000200005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Local problems, local solutions: improving tuberculosis control at the district level in Malawi." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine the causes of a low cure rate at the district level of a tuberculosis (TB) control programme and to formulate, implement, and evaluate an intervention to improve the situation." }, { "infon": 1, "offset": -1, "text": "METHODS: The study setting was Mzuzu (population 60 000), where the annual smear-positive pulmonary TB incidence was 160 per 100 000 and the human immunodeficiency virus (HIV) seroprevalence was 67% among TB patients." }, { "infon": 2, "offset": -1, "text": "There is one TB treatment unit, but several other organizations are involved with TB control." }, { "infon": 3, "offset": -1, "text": "An examination of case-holding activities was carried out, potential areas for improvement were identified, and interventions performed." }, { "infon": 4, "offset": -1, "text": "FINDINGS: In 1990-91, the cure rate was 24% among smear-positive cases (29% among survivors to end of treatment)." }, { "infon": 5, "offset": -1, "text": "Problems identified included a fragmented TB control programme; inadequate training and supervision; suboptimal recording of patients' addresses; and nonadherence to national TB control programme protocols." }, { "infon": 6, "offset": -1, "text": "These problems were addressed, and in 1992-93 the cure rate rose to 68% (relative risk (RR) = 2.85 (95% confidence interval (CI) = 1.63, 4.96)) and to 92% among survivors to the end of treatment (RR = 3.12 (95% CI = 1.84, 5.29))." }, { "infon": 7, "offset": -1, "text": "High cure rates are therefore achievable despite high HIV prevalence." }, { "infon": 8, "offset": -1, "text": "CONCLUSIONS: Simple, inexpensive, local programmatic interventions can dramatically improve TB case holding." }, { "infon": 9, "offset": -1, "text": "This study demonstrates the need for evaluation, training, and supervision at all levels of the programme." } ] } ] }, { "id": "S0042-96862001000200007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Situation analysis for cervical cancer diagnosis and treatment in East, Central and Southern African countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the factors influencing cervical cancer diagnosis and treatment in countries of East, Central and Southern Africa (ECSA)." }, { "infon": 1, "offset": -1, "text": "METHODS: Data were collected from randomly selected primary health care centres, district and provincial hospitals, and tertiary hospitals in each participating country." }, { "infon": 2, "offset": -1, "text": "Health care workers were interviewed, using a questionnaire; the facilities for screening, diagnosing, and treating cervical cancer in each institution were recorded, using a previously designed checklist." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Although 95% of institutions at all health care levels in ECSA countries had the basic infrastructure to carry out cervical cytology screening, only a small percentage of women were actually screened." }, { "infon": 4, "offset": -1, "text": "Lack of policy guidelines, infrequent supply of basic materials, and a lack of suitable qualified staff were the most common reasons reported." }, { "infon": 5, "offset": -1, "text": "CONCLUSIONS: This study demonstrates that there is an urgent need for more investment in the diagnosis and treatment of cervical cancer in ECSA countries." }, { "infon": 6, "offset": -1, "text": "In these, and other countries with low resources, suitable screening programmes should be established." } ] } ] }, { "id": "S0042-96862001000200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Coping with changing conditions: alternative strategies for the delivery of maternal and child health and family planning services in Dhaka, Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The door-to-door distribution of contraceptives and information on maternal and child health and family planning (MCH-FP) services, through bimonthly visits to eligible couples by trained fieldworkers, has been instrumental in increasing the contraceptive prevalence rate and immunization coverage in Bangladesh." }, { "infon": 1, "offset": -1, "text": "The doorstep delivery strategy, however, is labour- intensive and costly." }, { "infon": 2, "offset": -1, "text": "More cost-effective service delivery strategies are needed, not only for family planning services but also for a broader package of reproductive and other essential health services." }, { "infon": 3, "offset": -1, "text": "Against this backdrop, operations research was conducted by the Centre for Health and Population Research at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from January 1996 to May 1997, in collaboration with government agencies and a leading national nongovernmental organization, with a view to developing and field-testing alternative approaches to the delivery of MCH-FP services in urban areas." }, { "infon": 4, "offset": -1, "text": "Two alternative strategies featuring the withdrawal of home-based distribution and the delivery of basic health care from fixed-site facilities were tested in two areas of Dhaka." }, { "infon": 5, "offset": -1, "text": "The clinic-based service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka." }, { "infon": 6, "offset": -1, "text": "It did not adversely affect programme performance and it allowed the needs of clients to be addressed holistically through a package of essential health and family planning services." } ] } ] }, { "id": "S0042-96862001000300005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimates of maternal mortality for 1995." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability." }, { "infon": 1, "offset": -1, "text": "METHODS: For countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used." }, { "infon": 2, "offset": -1, "text": "Estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality." }, { "infon": 3, "offset": -1, "text": "Rather than estimate the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes." }, { "infon": 4, "offset": -1, "text": "Estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age." }, { "infon": 5, "offset": -1, "text": "FINDINGS: On the basis of this exercise, we have obtained a global estimate of 515 000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 100 000 live births." }, { "infon": 6, "offset": -1, "text": "The differences, by region, were very great, with over half (273 000 maternal deaths) occurring in Africa (MMRatio: >1000 per 100 000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 per 100 000)." }, { "infon": 7, "offset": -1, "text": "Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100 000 live births." }, { "infon": 8, "offset": -1, "text": "These uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely." }, { "infon": 10, "offset": -1, "text": "It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes." } ] } ] }, { "id": "S0042-96862001000300007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal." }, { "infon": 1, "offset": -1, "text": "METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma." }, { "infon": 2, "offset": -1, "text": "Resource measures included personnel time required for treatment, transportation, the time that study subjects had to wait to receive treatment, and the quantity of azithromycin used." }, { "infon": 3, "offset": -1, "text": "The costs of the programme were calculated from the perspectives of the public health programme sponsor, the study subjects, and the society as a whole." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Previous studies have indicated no statistically significant differences in effectiveness, and the present work showed no significant differences in total personnel and transportation costs per child aged 1-10 years, the total time that adults spent waiting, or the quantity of azithromycin per child." }, { "infon": 5, "offset": -1, "text": "However, the mass treatment of children was slightly more effective and used less of each resource per child aged 1-10 years than the targeted treatment of households." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: From all perspectives, the mass treatment of children is at least as effective and no more expensive than targeted household treatment, notwithstanding the absence of statistically significant differences." }, { "infon": 7, "offset": -1, "text": "Less expensive targeting methods are required in order to make targeted household treatment more cost-effective." } ] } ] }, { "id": "S0042-96862001000300010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Blindness prevention programmes: past, present, and future." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Blindness and visual impairment have far-reaching implications for society, the more so when it is realized that 80% of visual disability is avoidable." }, { "infon": 1, "offset": -1, "text": "The marked increase in the size of the elderly population, with their greater propensity for visually disabling conditions, presents a further challenge in this respect." }, { "infon": 2, "offset": -1, "text": "However, if available knowledge and skills were made accessible to those communities in greatest need, much of this needless blindness could be alleviated." }, { "infon": 3, "offset": -1, "text": "Since its inception over 50 years ago, and beginning with trachoma control, WHO has spearheaded efforts to assist Member States to meet the challenge of needless blindness." }, { "infon": 4, "offset": -1, "text": "Since the establishment of theWHO Programme for the Prevention of Blindness in 1978, vast strides have been made through various forms of technical support to establish national prevention of blindness programmes." }, { "infon": 5, "offset": -1, "text": "A more recent initiative, ‘‘The Global Initiative for the Elimination of Avoidable Blindness' (referred to as ‘‘VISION 2020 - The Right to Sight'), launched in 1999, is a collaborative effort between WHO and a number of international nongovernmental organizations and other interested partners." }, { "infon": 6, "offset": -1, "text": "This effort is poised to take the steps necessary to achieve the goal of eliminating avoidable blindness worldwide by the year 2020." } ] } ] }, { "id": "S0042-96862001000300012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The SAFE strategy for the elimination of trachoma by 2020: will it work?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "WHO has recently launched a programme (GET 2020) for the elimination of trachoma, the leading cause of preventable blindness." }, { "infon": 1, "offset": -1, "text": "GET 2020 has adopted the SAFE strategy, a comprehensive set of control measures (Surgery for entropion/ trichiasis; Antibiotics for infectious trachoma; Facial cleanliness to reduce transmission; Environmental improvements such as control of disease-spreading flies and access to clean water)." }, { "infon": 2, "offset": -1, "text": "The present article reviews the strengths and weaknesses of each component of the strategy." }, { "infon": 3, "offset": -1, "text": "Although significant hurdles remain to be overcome there is every reason to hope that GET 2020 will be successful." } ] } ] }, { "id": "S0042-96862001000300014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Prevention of blindness and priorities for the future." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The impact of visual loss has profound implications for the person affected and society as a whole." }, { "infon": 1, "offset": -1, "text": "The majority of blind people live in developing countries, and generally, their blindness could have been avoided or cured." }, { "infon": 2, "offset": -1, "text": "Given the current predictions that the number of blind people worldwide will roughly double by the year 2020, it is clear that there is no room for complacency." }, { "infon": 3, "offset": -1, "text": "As the world's population increases and as a greater proportion survives into late adulthood, so the number of people with visual loss will inexorably rise." }, { "infon": 4, "offset": -1, "text": "Given the success of programmes in combating the most common causes of blindness (infectious diseases and malnutrition) which generally affect the young, and the projected demographic shift, age-related eye disease will become increasingly prevalent." }, { "infon": 5, "offset": -1, "text": "Effective preventive measures for these diseases can only be established as more is known about their etiology." }, { "infon": 6, "offset": -1, "text": "As the longevity of the world's population increases, the visual requirements at the workplace are also changing." }, { "infon": 7, "offset": -1, "text": "People with low vision may be at a disadvantage in many common activities, and may face unemployment - particularly in technological societies." }, { "infon": 8, "offset": -1, "text": "The definition of blindness needs to be rethought, to ensure that people with ‘‘economic' blindness are not forgotten." }, { "infon": 9, "offset": -1, "text": "Efforts should be made to recognize and treat those affected at an early stage, for the benefit of the individual and society." } ] } ] }, { "id": "S0042-96862001000400003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: This study was undertaken to assess the ability of a water container with a cover and a spout to prevent household contamination of water in a Malawian refugee camp." }, { "infon": 1, "offset": -1, "text": "METHODS: A randomized trial was conducted in a refugee population that had experienced repeated outbreaks of cholera and diarrhoea and where contamination of water in the home was found to be a significant cause of cholera." }, { "infon": 2, "offset": -1, "text": "Four hundred Mozambican refugee households were systematically identified and followed over a 4-month period, one fourth of the households were randomly assigned to exclusively use the improved container for water collection." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Water flowing from the source wells had little or no microbial contamination although the water collectors quickly contaminated their water, primarily through contact with their hands." }, { "infon": 4, "offset": -1, "text": "Analysis of water samples demonstrated that there was a 69% reduction in the geometric mean of faecal coliform levels in household water and 31% less diarrhoeal disease (P = 0.06) in children under 5 years of age among the group using the improved bucket." }, { "infon": 5, "offset": -1, "text": "Regression models examining diarrhoea among under 5-year-olds confirmed the protective effect of the bucket and found that visible faeces in the family latrine and the presence of animals were significantly associated with an increased diarrhoeal incidence in children." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Household contamination of drinking-water significantly contributed to diarrhoea in this population." }, { "infon": 7, "offset": -1, "text": "Proper chlorination is a less expensive and more effective means of water quality protection in comparison with the improved bucket, but was unpopular and rarely utilized by the camp inhabitants." } ] } ] }, { "id": "S0042-96862001000400005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mass measles vaccination in urban Burkina Faso, 1998." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the impact of the National Immunization Days (NIDs) on measles vaccine coverage in Burkina Faso in 1998." }, { "infon": 1, "offset": -1, "text": "METHODS: During the week after the campaign, in which measles vaccine was offered to children aged 9-59 months in six cities regardless of vaccination history, a cluster survey was conducted in Ouagadougou and Bobo Dioulasso, the country's two largest cities." }, { "infon": 2, "offset": -1, "text": "Interviewers visited the parents of 1267 children aged up to 59 months and examined vaccination cards." }, { "infon": 3, "offset": -1, "text": "We analysed the data using cluster sample methodology for the 1041 children who were aged 9-59 months." }, { "infon": 4, "offset": -1, "text": "FINDINGS: A total of 604 (57%) children had received routine measles vaccination prior to the campaign, and 823 (79%) were vaccinated during the NIDs." }, { "infon": 5, "offset": -1, "text": "Among those who had previously had a routine vaccination, 484 (81%) were revaccinated during the NIDs." }, { "infon": 6, "offset": -1, "text": "Among those not previously vaccinated, 339 (78%) received one dose during the NIDs." }, { "infon": 7, "offset": -1, "text": "After the campaign, 943 (91%) children had received at least one dose of measles vaccine." }, { "infon": 8, "offset": -1, "text": "Better socioeconomic status was associated with a higher chance of having been vaccinated routinely, but it was not associated with NID coverage." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The mass campaign enabled a substantial increase in measles vaccine coverage to be made because it reached a high proportion of children who were difficult to reach through routine methods." } ] } ] }, { "id": "S0042-96862001000400007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Leprosy in China: epidemiological trends between 1949 and 1998." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To report the epidemiological trends of leprosy in China from 1949 to 1998." }, { "infon": 1, "offset": -1, "text": "METHODS: Data for the study were obtained from the computerized database of the National System of Leprosy Surveillance." }, { "infon": 2, "offset": -1, "text": "FINDINGS: A total of 474 774 leprosy patients were detected during this 50-year period." }, { "infon": 3, "offset": -1, "text": "Case detection rates per 100 000 population were highest in the 1950s and 1960s, with peaks appearing in 1957-58, 1963-66, 1969-70, and 1983-84, corresponding to mass surveys or screening surveys carried out in most areas or selected areas of the country." }, { "infon": 4, "offset": -1, "text": "While the duration of the disease at the time of detection fell over the period, the disability rates, which were >50% in the early 1950s, have decreased gradually to 20.8% by 1997-98 but are still too high." }, { "infon": 5, "offset": -1, "text": "More than 50% of cases were found through active methods in the periods 1955-58, 1965-66, and 1969-76, but in recent years cases are mostly detected through dermatological clinics or by voluntary reporting." }, { "infon": 6, "offset": -1, "text": "The peak prevalences of the 1960s (i.e. >2 per 10 000 population) decreased annually from the 1970s onwards." }, { "infon": 7, "offset": -1, "text": "By the end of 1998 the prevalence was 0.05 per 10 000 population." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: This study shows that leprosy was well controlled in China and that the WHO goal of elimination of leprosy as a public health problem has been achieved at the national and subnational levels." }, { "infon": 9, "offset": -1, "text": "However, leprosy is still unevenly distributed in the country." }, { "infon": 10, "offset": -1, "text": "According to the criterion for leprosy elimination in China - defined as a prevalence of <1 per 100 000 in county or city - there are still more than 10% of counties or cities where this target has not yet been reached." }, { "infon": 11, "offset": -1, "text": "Special attention must therefore be given to achieve elimination and final eradication of leprosy in China." } ] } ] }, { "id": "S0042-96862001000400009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Family history: an opportunity for early interventions and improved control of hypertension, obesity and diabetes." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine whether a family history of high-risk groups for major noncommunicable diseases (NCDs) was a significant risk factor for these conditions among family members in a study population in the Gambia, where strong community and family coherence are important determinants that have to be taken into consideration in promoting lifestyle changes." }, { "infon": 1, "offset": -1, "text": "METHODS: We questioned 5389 adults as to any first-degree family history of major noncommunicable diseases (hypertension, obesity, diabetes and stroke), and measured their blood pressure (BP) and body mass index (BMI)." }, { "infon": 2, "offset": -1, "text": "Total blood cholesterol, triglyceride, uric acid, and creatinine concentrations were measured in a stratified subsample, as well as blood glucose (2 hours after ingesting 75 g glucose) in persons aged 35 years." }, { "infon": 3, "offset": -1, "text": "FINDINGS: A significant number of subjects reported a family history of hypertension (8.0%), obesity (5.4%), diabetes (3.3%) and stroke (1.4%), with 14.6% of participants reporting any of these NCDs." }, { "infon": 4, "offset": -1, "text": "Subjects with a family history of hypertension had a higher diastolic BP and BMI, higher cholesterol and uric acid concentrations, and an increased risk of obesity." }, { "infon": 5, "offset": -1, "text": "Those with a family history of obesity had a higher BMI and were at increased risk of obesity." }, { "infon": 6, "offset": -1, "text": "Individuals with a family history of diabetes had a higher BMI and higher concentrations of glucose, cholesterol, triglycerides and uric acid, and their risk of obesity and diabetes was increased." }, { "infon": 7, "offset": -1, "text": "Subjects with a family history of stroke had a higher BMI, as well as higher cholesterol, triglyceride and uric acid concentrations." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: A family history of hypertension, obesity, diabetes, or stroke was a significant risk factor for obesity and hyperlipidaemia." }, { "infon": 9, "offset": -1, "text": "With increase of age, more pathological manifestations can develop in this high-risk group." }, { "infon": 10, "offset": -1, "text": "Health professionals should therefore utilize every opportunity to include direct family members in health education." } ] } ] }, { "id": "S0042-96862001000400011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Safety of the intradermal Copenhagen 1331 BCG vaccine in neonates in Durban, South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate the safety of the intradermal Copenhagen BCG vaccine in neonates at different levels of delivery and neonatal units of the Durban Functional Region and surrounding regions." }, { "infon": 1, "offset": -1, "text": "METHODS: A prospective study was carried out over a two-year period between July 1997 and June 1999." }, { "infon": 2, "offset": -1, "text": "All neonates who had been vaccinated with the intradermal vaccine were evaluated at immunization clinics six weeks after immunization, or earlier if adverse effects occurred." }, { "infon": 3, "offset": -1, "text": "FINDINGS: In total, 9763 neonates were examined: in 95.4% the vaccination scar had healed and 1.5% had no visible scar." }, { "infon": 4, "offset": -1, "text": "Adverse events occurred in 3.1%." }, { "infon": 5, "offset": -1, "text": "The proportion of neonates with no visible vaccination scars decreased over the study period, as did the number with adverse events." }, { "infon": 6, "offset": -1, "text": "The lowest rate of adverse events and the highest rates of healed vaccination scars were seen in the tertiary hospital and regional and district hospitals that were in close proximity to the academic centre involved in this study." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: In the study sites, the transition from the percutaneous to intradermal route of administration of BCG vaccine was successful and took place without incurring unacceptably high rates of adverse events." }, { "infon": 8, "offset": -1, "text": "To minimize adverse events, however, it is essential to continue training health personnel involved in implementing intradermal BCG vaccination programmes." } ] } ] }, { "id": "S0042-96862001000400013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health services under the General Agreement on Trade in Services." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The potential for trade in health services has expanded rapidly in recent decades." }, { "infon": 1, "offset": -1, "text": "More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation." }, { "infon": 2, "offset": -1, "text": "As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS)." }, { "infon": 3, "offset": -1, "text": "It is possible that Members of the World Trade Organization have been discouraged from undertaking access commitments by the novelty of the Agreement, coordination problems between relevant agencies, widespread inexperience in concepts of services trade, a traditionally strong degree of government involvement in the health sector, and concerns about basic quality and social objectives." }, { "infon": 4, "offset": -1, "text": "However, more than five years have passed since GATS entered into force, allowing hesitant administrations to familiarize themselves with its main elements and its operation in practice." }, { "infon": 5, "offset": -1, "text": "The present paper is intended to contribute to this process." }, { "infon": 6, "offset": -1, "text": "It provides an overview of the basic structure of GATS and of the patterns of current commitments in health services and of limitations frequently used in this context." }, { "infon": 7, "offset": -1, "text": "The concluding section discusses possibilities of pursuing basic policy objectives in a more open environment and indicates issues that may have to be dealt with in current negotiations on services." } ] } ] }, { "id": "S0042-96862001000500004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Comparison of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis in Kenya." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare the use of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis (kala-azar)." }, { "infon": 1, "offset": -1, "text": "METHODS: A total of 102 patients with confirmed kala-azar were treated in a mission hospital in West Pokot region, Kenya, with sodium stibogluconate (20 mg/kg/day for 30 days) - either as Pentostam® (PSM) or generic sodium stibogluconate (SSG); 51 patients were allocated alternately to each treatment group." }, { "infon": 2, "offset": -1, "text": "FINDINGS: There were no significant differences in baseline demographic characteristics or disease severity, or in events during treatment." }, { "infon": 3, "offset": -1, "text": "There were 3 deaths in the PSM group and 1 in the SSG group; 2 patients defaulted in each group." }, { "infon": 4, "offset": -1, "text": "Only 1 out of 80 test-of-cure splenic aspirates was positive for Leishmania spp.; this patient was in the SSG group." }, { "infon": 5, "offset": -1, "text": "Follow-up after > 6 months showed that 6 out of 58 patients had relapsed, 5 in the SSG group and 1 in the PSM group." }, { "infon": 6, "offset": -1, "text": "No outcome variable was significantly different between the two groups." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: The availability of cheaper generic sodium stibogluconate, subject to rigid quality controls, now makes it possible for the health authorities in kala-azar endemic areas to provide treatment to many more patients in Africa." } ] } ] }, { "id": "S0042-96862001000500006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimates of the maternal mortality ratio in two districts of the Brong-Ahafo region, Ghana." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the maternal mortality ratio (MMR) by the sisterhood method in two districts of the Brong-Ahafo region of Ghana, and to determine the impact of different assumptions and analytical decisions on these estimates." }, { "infon": 1, "offset": -1, "text": "METHODS: Indirect estimates of the MMR were calculated from data collected in 1995 by Family Health International (FHI) on 5202 women aged 15-49 years, using a household screen of randomly selected areas in the two districts." }, { "infon": 2, "offset": -1, "text": "Other data from the nationally representative 1994 Ghana Infant, Child and Maternal Mortality Survey (ICMMS) and from the 1997 Kassena-Nankana District study were also used for comparison." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Based on the FHI data, the MMR was estimated to be 269 maternal deaths per 100 000 live births for both districts combined, a figure higher than ICMMS estimates." }, { "infon": 4, "offset": -1, "text": "Biases during data collection may account for this difference, including the fact that biases underestimating mortality are more common than those overestimating it." }, { "infon": 5, "offset": -1, "text": "Biases introduced during data analysis were also considered, but only the total fertility rate used to calculate the MMR seemed to affect the estimates significantly." }, { "infon": 6, "offset": -1, "text": "CONCLUSIONS: The results indicate that the sisterhood method is still being refined and the extent and impact of biases have only recently received attention." }, { "infon": 7, "offset": -1, "text": "Users of this method should be aware of limitations when interpreting results." }, { "infon": 8, "offset": -1, "text": "We recommend using confidence limits around estimates, both to dispel false impressions of precision and to reduce overinterpretation of data." } ] } ] }, { "id": "S0042-96862001000500008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Prevalence of vitamin A deficiency in children aged 6-9 years in Wukro, northern Ethiopia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the prevalence of vitamin A deficiency in children aged 6-9 years in northern Ethiopia." }, { "infon": 1, "offset": -1, "text": "METHODS:A cross-sectional study was carried out and the data were analysed for 824 (61.5%) of 1339 eligible children for whom there was complete information on biochemical vitamin A status, dietary vitamin A intake, ocular examination for xerophthalmia, and anthropometry." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The prevalence of xerophthalmia was 5.8%; serum retinol levels were below 0.35 mmol/l and between 0.35 and 0.70 mmol/l in 8.4% and 51.1% of the children respectively." }, { "infon": 3, "offset": -1, "text": "The liver vitamin A reserve (modified relative dose response ratio > 0.06) was low in 41.0% of the children." }, { "infon": 4, "offset": -1, "text": "CONCLUSION: The high prevalence of severe vitamin A deficiency in children aged 6-9 years indicates the need to re-evaluate the practice of targeting vitamin A supplementation programmes on children under 6 years of age in areas where vitamin A deficiency is endemic." } ] } ] }, { "id": "S0042-96862001000500010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The impact of a clinical training unit on integrated child health care in Mexico." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This study had two aims: to describe the activities of a clinical training unit set up for the integrated management of sick children, and to evaluate the impact of the unit after its first four years of operation." }, { "infon": 1, "offset": -1, "text": "The training unit was set up in the outpatient ward of a government hospital and was staffed by a paediatrician, a family medicine physician, two nurses and a nutritionist." }, { "infon": 2, "offset": -1, "text": "The staff kept a computerized database for all patients seen and they were supervised once a month." }, { "infon": 3, "offset": -1, "text": "During the first three years, the demand for first-time medical consultation increased by 477% for acute respiratory infections (ARI) and 134% for acute diarrhoea (AD), with an average annual increase of demand for medical care of 125%." }, { "infon": 4, "offset": -1, "text": "Eighty-nine per cent of mothers who took their child for consultation and 85% of mothers who lived in the catchment area and had a deceased child received training on how to recognize alarming signs in a sick child." }, { "infon": 5, "offset": -1, "text": "Fifty-eight per cent of these mothers were evaluated as being properly trained." }, { "infon": 6, "offset": -1, "text": "Eighty-five per cent of primary care physicians who worked for government institutions (n = 350) and 45% of private physicians (n = 90) were also trained in the recognition and proper management of AD and ARI." }, { "infon": 7, "offset": -1, "text": "ARI mortality in children under 1 year of age in the catchment area (which included about 25 000 children under 5 years of age) decreased by 43.2% in three years, while mortality in children under 5 years of age decreased by 38.8%." }, { "infon": 8, "offset": -1, "text": "The corresponding figures for AD mortality reduction were 36.3% and 33.6%." }, { "infon": 9, "offset": -1, "text": "In this same period, 11 clinical research protocols were written." }, { "infon": 10, "offset": -1, "text": "In summary, we learned that a clinical training unit for integrated child care management was an excellent way to offer in-service training for primary health care physicians." } ] } ] }, { "id": "S0042-96862001000500012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Transmission of Helicobacter pylori: a role for food?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Helicobacter pylori colonizes and grows in human gastric epithelial tissue and mucus." }, { "infon": 1, "offset": -1, "text": "Its presence is associated with gastritis and there is substantial evidence that it causes peptic and duodenal ulcers and chronic gastritis." }, { "infon": 2, "offset": -1, "text": "Since 1994, H. pylori has been classified as carcinogenic to humans." }, { "infon": 3, "offset": -1, "text": "In industrialized countries, as many as 50% of adults are infected with the pathogen, while in the developing world, prevalence values of about 90% have been reported." }, { "infon": 4, "offset": -1, "text": "As little is known about the mode of transmission, a literature search was carried out to determine whether food acts a reservoir or vehicle in the transmission of H. pylori." }, { "infon": 5, "offset": -1, "text": "Although growth of the pathogen should be possible in the gastrointestinal tract of all warm-blooded animals, the human stomach is its only known reservoir." }, { "infon": 6, "offset": -1, "text": "Under conditions where growth is not possible, H. pylori can enter a viable, but nonculturable state." }, { "infon": 7, "offset": -1, "text": "H. pylori has been detected in such states in water, but not in food." }, { "infon": 8, "offset": -1, "text": "Person-to-person contact is thought to be the most likely mode of transmission, and there is no direct evidence that food is involved in the transmission of H. pylori." } ] } ] }, { "id": "S0042-96862001000600003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentre study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate the prevalence, awareness, treatment and control of hypertension among elderly individuals in Bangladesh and India." }, { "infon": 1, "offset": -1, "text": "METHOD: A community-based sample of 1203 elderly individuals (670 women; mean age, 70 years) was selected using a multistage cluster sampling technique from two sites in Bangladesh and three sites in India." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The overall prevalence of hypertension (WHO-International Society for Hypertension criteria) was 65% (95% confidence interval = 62-67%)." }, { "infon": 3, "offset": -1, "text": "The prevalence was higher in urban than rural areas, but did not differ significantly between the sexes." }, { "infon": 4, "offset": -1, "text": "Multiple logistic regression analyses identified a higher body mass index, higher education status and prevalent diabetes mellitus as important correlates of the prevalence of hypertension." }, { "infon": 5, "offset": -1, "text": "Physical activity, rural residence, and current smoking were inversely related to the prevalence of hypertension." }, { "infon": 6, "offset": -1, "text": "Among study subjects who had hypertension, 45% were aware of their condition, 40% were taking anti-hypertensive medications, but only 10% achieved the level established by the US Sixth Joint National Committee on Detection, Evaluation and Treatment of Hypertension (JNC VI)/WHO criteria." }, { "infon": 7, "offset": -1, "text": "A visit to a physician in the previous year, higher educational attainment and being female emerged as important correlates of hypertension awareness." }, { "infon": 8, "offset": -1, "text": "CONCLUSIONS: Our findings emphasize the need to implement effective and low cost management regimens based on absolute levels of cardiovascular risk appropriate for the economic context." }, { "infon": 9, "offset": -1, "text": "From a public health perspective, the only sustainable approach to the high prevalence of hypertension in the Indian subcontinent is through a strategy to reduce the average blood pressure in the population." } ] } ] }, { "id": "S0042-96862001000600005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimating the prevalence of anaemia: a comparison of three methods." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the most effective method for analysing haemoglobin concentrations in large surveys in remote areas, and to compare two methods (indirect cyanmethaemoglobin and HemoCue) with the conventional method (direct cyanmethaemoglobin)." }, { "infon": 1, "offset": -1, "text": "METHODS: Samples of venous and capillary blood from 121 mothers in Indonesia were compared using all three methods." }, { "infon": 2, "offset": -1, "text": "FINDINGS: When the indirect cyanmethaemoglobin method was used the prevalence of anaemia was 31-38%." }, { "infon": 3, "offset": -1, "text": "When the direct cyanmethaemoglobin or HemoCue method was used the prevalence was 14-18%." }, { "infon": 4, "offset": -1, "text": "Indirect measurement of cyanmethaemoglobin had the highest coefficient of variation and the largest standard deviation of the difference between the first and second assessment of the same blood sample (10-12 g/l indirect measurement vs 4 g/l direct measurement)." }, { "infon": 5, "offset": -1, "text": "In comparison with direct cyanmethaemoglobin measurement of venous blood, HemoCue had the highest sensitivity (82.4%) and specificity (94.2%) when used for venous blood." }, { "infon": 6, "offset": -1, "text": "CONCLUSIONS: Where field conditions and local resources allow it, haemoglobin concentration should be assessed with the direct cyanmethaemoglobin method, the gold standard." }, { "infon": 7, "offset": -1, "text": "However, the HemoCue method can be used for surveys involving different laboratories or which are conducted in relatively remote areas." }, { "infon": 8, "offset": -1, "text": "In very hot and humid climates, HemoCue microcuvettes should be discarded if not used within a few days of opening the container containing the cuvettes." } ] } ] }, { "id": "S0042-96862001000600007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Evidence of behaviour change following a hygiene promotion programme in Burkina Faso." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To determine whether a large, 3-year hygiene promotion programme in Bobo-Dioulasso, Burkina Faso, was effective in changing behaviours associated with the spread of diarrhoeal diseases." }, { "infon": 1, "offset": -1, "text": "The programme was tailored to local customs, targeted specific types of behaviour, built on existing motivation for hygiene, and used locally appropriate channels of communication." }, { "infon": 2, "offset": -1, "text": "METHODS: Two population surveys recorded the coverage of the programme among target audiences (mothers of children aged 0-35 months)." }, { "infon": 3, "offset": -1, "text": "Four surveys were carried out: three prior to the programme and one in 1998 (after the programme had been running for 3 years), using structured observation of hygiene behaviours in the participants' homes to document changes in target behaviours." }, { "infon": 4, "offset": -1, "text": "FINDINGS: After the programme had run for 3 years, three-quarters of the mothers targeted had had contact with programme activities." }, { "infon": 5, "offset": -1, "text": "Half could cite the two main messages of the programme correctly." }, { "infon": 6, "offset": -1, "text": "Although the safe disposal of children's stools changed little between 1995 and 1998 (80% pre-intervention, 84% post-intervention), hand-washing with soap after cleaning a child's bottom rose from 13% to 31%." }, { "infon": 7, "offset": -1, "text": "The proportion of mothers who washed their hands with soap after using the latrine increased from 1% to 17%." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Hygiene promotion programmes can change behaviour and are more likely to be effective if they are built on local research and use locally appropriate channels of communication repeatedly and for an extended time." } ] } ] }, { "id": "S0042-96862001000600009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Iodine concentration in household salt in South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the iodine concentration in household salt, the coverage of adequately iodized salt, the use of non-iodized agricultural and producers' salt, and the usefulness of salt as a carrier of iodine, and to relate these observations to socioeconomic status in South Africa." }, { "infon": 1, "offset": -1, "text": "METHOD: The iodometric titration method was used to analyse 2043 household salt samples collected using a national, multistage, stratified, cluster survey." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The national mean and median iodine concentrations of household salt were 27 mg/kg (95% confidence interval (CI): 25-29 mg/kg) and 30 mg/kg (range = 0-155 mg/kg), respectively." }, { "infon": 3, "offset": -1, "text": "There was considerable variation within and between geographical areas." }, { "infon": 4, "offset": -1, "text": "Coverage of adequately iodized household salt, i.e. iodized at >15 mg/kg, was 62.4% of households (95% CI: 58.8-66.0%) two years after the introduction of compulsory iodization at a level of 40-60 mg/kg. A total of 7.3% of households used non-iodized agricultural salt and salt obtained directly from producers." }, { "infon": 5, "offset": -1, "text": "People at the lower end of the socioeconomic spectrum were more likely to suffer the consequences of using under-iodized salt because more of them used agricultural or coarse salt than did people in the higher socioeconomic categories." }, { "infon": 6, "offset": -1, "text": "The iodine concentration in salt was lower in rural areas than in urban and periurban areas." }, { "infon": 7, "offset": -1, "text": "CONCLUSIONS: The consequences of using under-iodized or non-iodized salt were most likely to be experienced in the country's three northern provinces, among people in the low socioeconomic categories, and in rural households." }, { "infon": 8, "offset": -1, "text": "Since 95.4% of households in South Africa use salt regularly and 2.9% use it occasionally, the national iodization programme has the potential to meet the iodine requirements of the population." }, { "infon": 9, "offset": -1, "text": "However, this can only be achieved if the primary reasons for the inadequate iodization of salt are eliminated and if special attention is given to vulnerable groups." } ] } ] }, { "id": "S0042-96862001000600011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals." }, { "infon": 1, "offset": -1, "text": "METHODS: Data were taken from the Maputo City death register and autopsy records for 1994." }, { "infon": 2, "offset": -1, "text": "FINDINGS: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%." }, { "infon": 3, "offset": -1, "text": "Of these, 8114 deaths (92%) were classified by cause." }, { "infon": 4, "offset": -1, "text": "Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961." }, { "infon": 5, "offset": -1, "text": "The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178)." }, { "infon": 6, "offset": -1, "text": "CONCLUSIONS: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register." }, { "infon": 7, "offset": -1, "text": "AIDS-related deaths were underreported." }, { "infon": 8, "offset": -1, "text": "With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City." }, { "infon": 9, "offset": -1, "text": "The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes." } ] } ] }, { "id": "S0042-96862001000600013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Maternal mortality at the end of a decade: signs of progress?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "ABSTRACT: Maternal mortality is an important measure of women's health and indicative of the performance of health care systems." }, { "infon": 1, "offset": -1, "text": "Several international conferences, most recently the Millennium Summit in 2000, have included the goal of reducing maternal mortality." }, { "infon": 2, "offset": -1, "text": "However, monitoring progress towards the goal has proved to be problematic because maternal mortality is difficult to measure, especially in developing countries with weak health information and vital registration systems." }, { "infon": 3, "offset": -1, "text": "This has led to interest in using alternative indicators for monitoring progress." }, { "infon": 4, "offset": -1, "text": "This article examines recent trends in two indicators associated with maternal mortality: the percentage of births assisted by a skilled health care worker and rates of caesarean delivery." }, { "infon": 5, "offset": -1, "text": "Globally, modest improvements in coverage of skilled care at delivery have occurred, with an average annual increase of 1.7% over the period 1989-99." }, { "infon": 6, "offset": -1, "text": "Progress has been greatest in Asia, the Middle East and North Africa, with annual increases of over 2%." }, { "infon": 7, "offset": -1, "text": "In sub-Saharan Africa, on the other hand, coverage has stagnated." }, { "infon": 8, "offset": -1, "text": "In general, caesarean delivery rates were stable over the 1990s." }, { "infon": 9, "offset": -1, "text": "Countries where rates of caesarean deliveries were the lowest - and where the needs were greatest - showed the least change." }, { "infon": 10, "offset": -1, "text": "This analysis leads us to conclude that whereas there may be grounds for optimism regarding trends in maternal mortality in parts of North Africa, Latin America, Asia, and the Middle East, the situation in sub-Saharan Africa remains disquieting." } ] } ] }, { "id": "S0042-96862001000700003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Has oral fluid the potential to replace serum for the evaluation of population immunity levels?: a study of measles, rubella and hepatitis B in rural Ethiopia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the suitability of using oral-fluid samples for determining the prevalence of immunity to vaccine-preventable infections." }, { "infon": 1, "offset": -1, "text": "METHODS: Paired blood and oral-fluid samples were obtained from 853 individuals of all ages from a rural Ethiopian community." }, { "infon": 2, "offset": -1, "text": "Oral fluid around the gums was screened for measles- and rubella-specific antibodies using enhanced IgG antibody capture (GAC) enzyme-linked immunosorbent assays (ELISAs), and for anti-HBc antibodies using a prototype GACELISA." }, { "infon": 3, "offset": -1, "text": "IgG antibodies in serum to measles, rubella and HBc were determined using commercial ELISAs." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Relative to serum, oral fluid assay sensitivity and specificity were as follows: 98% and 87% for measles, 79% and 90% for rubella, and 43% and 87% for anti-HBc." }, { "infon": 5, "offset": -1, "text": "These assay characteristics yielded population prevalence estimates from oral fluid with a precision equal to that of serum for measles (all ages) and rubella (ages <20 years)." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Our results suggest that oral fluid could have the potential to replace serum in IgG antibody prevalence surveys." }, { "infon": 7, "offset": -1, "text": "Further progress requires assessment of variation in assay performance between populations as well as the availability of standardized, easy to use assays." } ] } ] }, { "id": "S0042-96862001000700005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Neonatal mortality of low-birth-weight infants in Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To ascertain the role of low birth weight (LBW) in neonatal mortality in a periurban setting in Bangladesh." }, { "infon": 1, "offset": -1, "text": "METHODS: LBW neonates were recruited prospectively and followed up at one month of age." }, { "infon": 2, "offset": -1, "text": "The cohort of neonates were recruited after delivery in a hospital in Dhaka, Bangladesh, and 776 were successfully followed up either at home or, in the event of early death, in hospital." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The neonatal mortality rate (NMR) for these infants was 133 per 1000 live births (95% confidence interval: 110-159)." }, { "infon": 4, "offset": -1, "text": "The corresponding NMRs (and confidence intervals) for early and late neonates were 112 (91-136) and 21 (12-33) per thousand live births, respectively." }, { "infon": 5, "offset": -1, "text": "The NMR for infants born after fewer than 32 weeks of gestation was 769 (563-910); and was 780 (640-885) for infants whose birth weights were under 1500g." }, { "infon": 6, "offset": -1, "text": "Eighty-four per cent of neonatal deaths occurred in the first seven days; half within 48 hours." }, { "infon": 7, "offset": -1, "text": "Preterm delivery was implicated in three-quarters of neonatal deaths, but was associated with only one-third of LBW neonates." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Policy-relevant findings were: that LBW approximately doubles the NMR in a periurban setting in Bangladesh; that neonatal mortality tends to occur early; and that preterm delivery is the most important contributor to the NMR." }, { "infon": 9, "offset": -1, "text": "The group of infants most likely to benefit from improvements in low-cost essential care for the newborn accounted for almost 61% of neonatal mortalities in the cohort." } ] } ] }, { "id": "S0042-96862001000700007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Efficacy trial of Vi polysaccharide vaccine against typhoid fever in south-western China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To test the efficacy of locally produced Vi vaccine over a time period of longer than one year." }, { "infon": 1, "offset": -1, "text": "METHODS: A double-blinded, randomized field trial was performed in Guangxi Zhuang Autonomous Region in south-western China, using 30 mg doses of locally produced Vi." }, { "infon": 2, "offset": -1, "text": "Enrolled subjects were 3-50 years of age, although the majority (92%) were school-aged children, who have the highest rate of typhoid fever in this setting." }, { "infon": 3, "offset": -1, "text": "A total of 131 271 people were systematically allocated a single dose of 30 mg of Vi polysaccharide or saline placebo." }, { "infon": 4, "offset": -1, "text": "The study population was followed for 19 months, with passive surveillance conducted in the Ministry of Health and the Regional Health and Anti-epidemic Centre (HAEC)." }, { "infon": 5, "offset": -1, "text": "Clinically suspected cases of typhoid fever were confirmed by blood culture, or by serological reaction with O-antigen (Widal tests)." }, { "infon": 6, "offset": -1, "text": "FINDINGS: After 19 months, there were 23 culture-confirmed cases of typhoid fever in the placebo group versus 7 cases in the Vi group (Protective efficacy (PE) = 69%; 95% CI = 28%, 87%)." }, { "infon": 7, "offset": -1, "text": "Most of the isolates were from school-aged children: 22 cases in the placebo group versus 6 in the Vi group (PE = 72%; 95% CI = 32%, 82%)." }, { "infon": 8, "offset": -1, "text": "No serious post-injection reactions were observed." }, { "infon": 9, "offset": -1, "text": "The locally produced Vi polysaccharide vaccine showed levels of protective efficacy similar to those for Vi vaccine produced in industrial countries." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: The slightly higher dose of vaccine did not seem to alter efficacy significantly in China." } ] } ] }, { "id": "S0042-96862001000700009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Operational issues in preventing mother-to-child transmission of HIV-1 in Abidjan, Côte d'Ivoire, 1998-99." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To demonstrate the feasibility, from the public health standpoint, of preventing mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) in Africa." }, { "infon": 1, "offset": -1, "text": "METHODS: Voluntary counselling and HIV serotesting were routinely provided in four health centres in Abidjan, Côte d'Ivoire, for six months in 1998-99." }, { "infon": 2, "offset": -1, "text": "Peripartum treatment with zidovudine and alternatives to breastfeeding were provided free to HIV-infected women." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Of the 4309 pregnant women in the study who attended their first antenatal care visit, 3756 benefited from individual counselling and pretesting (87.2%), and 3452 (80.1%) agreed to undergo HIV serotesting." }, { "infon": 4, "offset": -1, "text": "Overall HIV prevalence was (12.89%) and 5% for women aged under 18 years." }, { "infon": 5, "offset": -1, "text": "Among the 2998 HIV-negative women, 71% returned for their test result, whereas only 60% of the 445 HIV-positive women did so." }, { "infon": 6, "offset": -1, "text": "A total of 124 HIV-positive women were informed of their serostatus and the possibility of preventing mother-to-child transmission of HIV; 100 started treatment and 80 completed zidovudine prophylaxis." }, { "infon": 7, "offset": -1, "text": "At 6 weeks of age, 36 of the 78 liveborn children were being breastfed (46%), two were being mixed-fed and 41 (52%) were being artificially fed." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: In Abidjan, voluntary counselling and HIV testing with a view to preventing mother-to-child transmission was feasible in antenatal care units and was well accepted by pregnant women." }, { "infon": 9, "offset": -1, "text": "An insufficient proportion of women returned to obtain their test results." }, { "infon": 10, "offset": -1, "text": "This was especially so among HIV-positive women, the target group for preventing mother-to-child transmission of HIV." }, { "infon": 11, "offset": -1, "text": "Additional staff were required in order to offer voluntary counselling and HIV testing to the study women." }, { "infon": 12, "offset": -1, "text": "Close supervision and strong commitment of health workers were essential." }, { "infon": 13, "offset": -1, "text": "Alternatives to breastfeeding were effectively proposed to HIV-positive women, with active follow-up of children and clinical, nutritional and social support." } ] } ] }, { "id": "S0042-96862001000700011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Every death counts: measurement of maternal mortality via a census." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Methods for measuring maternal mortality at national and subnational levels in the developing world lag far behind the demand for estimates." }, { "infon": 1, "offset": -1, "text": "We evaluated use of the national population census as a means of measuring maternal mortality by assessing data from five countries (Benin, Islamic Republic of Iran, Lao People's Democratic Republic, Madagascar, and Zimbabwe) which identified maternal deaths in their censuses." }, { "infon": 2, "offset": -1, "text": "Standard demographic methods were used to evaluate the completeness of reporting of adult female deaths and births in the year prior to the census." }, { "infon": 3, "offset": -1, "text": "The results from these exercises were used to adjust the data." }, { "infon": 4, "offset": -1, "text": "In four countries, the numbers of adult female deaths needed to be increased and three countries required upward adjustment of the numbers of recent births." }, { "infon": 5, "offset": -1, "text": "The number of maternal deaths was increased by the same factor as that used for adult female deaths on the assumption that the proportion of adult female deaths due to maternal causes was correct." }, { "infon": 6, "offset": -1, "text": "Age patterns of the various maternal mortality indicators were plausible and consistent with external sources of data for other populations." }, { "infon": 7, "offset": -1, "text": "Our data suggest that under favourable conditions a national census is a feasible and promising approach for the measurement of maternal mortality." }, { "infon": 8, "offset": -1, "text": "Moreover, use of the census circumvents several of the weaknesses of methods currently in use." }, { "infon": 9, "offset": -1, "text": "However, it should also be noted that careful evaluation of the data and adjustment, if necessary, are essential." }, { "infon": 10, "offset": -1, "text": "The public health community is urged to encourage governments to learn from the experience of these five countries and to place maternal mortality estimation in the hands of statistical agencies." } ] } ] }, { "id": "S0042-96862001000700013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reinsurance of health insurance for the informal sector." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness." }, { "infon": 1, "offset": -1, "text": "The role of communities in solving this problem has been recognized, and many initiatives are under way." }, { "infon": 2, "offset": -1, "text": "However, community financing is rarely structured as health insurance." }, { "infon": 3, "offset": -1, "text": "Communities that pool risks (or offer insurance) have been described as micro-insurance units." }, { "infon": 4, "offset": -1, "text": "The sources of their financial instability and the options for stabilization are explained." }, { "infon": 5, "offset": -1, "text": "Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments." }, { "infon": 6, "offset": -1, "text": "The article focuses on risk transfer from micro-insurance units to reinsurance." }, { "infon": 7, "offset": -1, "text": "The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year." }, { "infon": 8, "offset": -1, "text": "The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality." } ] } ] }, { "id": "S0042-96862001000800005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Inherited haemoglobin disorders: an increasing global health problem." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Despite major advances in our understanding of the molecular pathology, pathophysiology, and control and management of the inherited disorders of haemoglobin, thousands of infants and children with these diseases are dying through lack of appropriate medical care." }, { "infon": 1, "offset": -1, "text": "This problem will undoubtedly increase over the next 20 years because, as the result of a reduction in childhood mortality due to infection and malnutrition, more babies with haemoglobin disorders will survive to present for treatment." }, { "infon": 2, "offset": -1, "text": "Although WHO and various voluntary agencies have tried to disseminate information about these diseases, they are rarely mentioned as being sufficiently important to be included in setting health care priorities for the future." }, { "infon": 3, "offset": -1, "text": "It takes considerable time to establish expertise in developing programmes for the control and management of these conditions, and the lessons learned in developed countries will need to be transmitted to those countries in which they occur at a high frequency." } ] } ] }, { "id": "S0042-96862001000800007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Private investment in AIDS vaccine development: obstacles and solutions." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The development of vaccines for the prevention of AIDS, malaria, tuberculosis, and other diseases requires both public and private investment." }, { "infon": 1, "offset": -1, "text": "Private investment, however, has been far lower than might have been hoped, given the massive human toll of these diseases, particularly in the poorest countries." }, { "infon": 2, "offset": -1, "text": "With a view to understanding this situation and exploring potential solutions, the World Bank AIDS Vaccine Task Force commissioned a study on the perspectives of the biotechnology, vaccine, and pharmaceutical industries regarding investment in research and development work on an AIDS vaccine." }, { "infon": 3, "offset": -1, "text": "It was found that different obstacles to the development of an AIDS vaccine arose during the product development cycle." }, { "infon": 4, "offset": -1, "text": "During the earlier phases, before obtaining proof of product, the principal barriers were scientific." }, { "infon": 5, "offset": -1, "text": "The lack of consensus on which approach was likely to be effective increased uncertainty and the risks associated with investing in expensive clinical trials." }, { "infon": 6, "offset": -1, "text": "The later phases, which involved adapting, testing, and scaling up production for different populations, were most influenced by market considerations." }, { "infon": 7, "offset": -1, "text": "In order to raise the levels of private research and development in an AIDS vaccine there will probably have to be a combination of push strategies, which reduce the cost and scientific risk of investment, and pull strategies, which guarantee a market." } ] } ] }, { "id": "S0042-96862001000800009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Perspectives on stimulating industrial research and development for neglected infectious diseases." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper summarizes recent thinking on stimulating industrial research and development (R & D) for neglected infectious diseases and argues that it is critical to enlarge the value of the market for medicines and vaccines through, for example, global purchase funds." }, { "infon": 1, "offset": -1, "text": "The most important economic barriers to R & D are that the commercial markets are small and that individual purchasing power is severely limited, even though the number of patients may be very large." }, { "infon": 2, "offset": -1, "text": "Since R & D costs for all diseases are high, this means that returns will not cover investments." }, { "infon": 3, "offset": -1, "text": "Various mechanisms have been proposed to address this economic imbalance (accepting that other barriers will also need to be considered)." }, { "infon": 4, "offset": -1, "text": "Economic devices which reduce the costs of R & D - push factors - are useful, but our review suggests that high costs do not explain the shortfall in R & D. Economic devices which address the lack of viable markets have been termed pull factors and are designed to create or secure a market, thereby improving the likelihood of a return on investments." }, { "infon": 5, "offset": -1, "text": "One pull mechanism is the commitment in advance to purchase a product that meets specified criteria, if invented." }, { "infon": 6, "offset": -1, "text": "The purchase-precommitment approach has a number of attractive features." }, { "infon": 7, "offset": -1, "text": "For example, it only rewards successful outputs rather than supporting research that may not succeed." }, { "infon": 8, "offset": -1, "text": "Pull programmes effectively mimic the market and lead companies to favour lines of attack that they believe will lead to marketable products." }, { "infon": 9, "offset": -1, "text": "Overall, a combination of push and pull mechanisms is likely to represent an attractive approach." }, { "infon": 10, "offset": -1, "text": "This could combine, for example, increased funding for public laboratories, public-private partnerships in R & D, purchases of underutilized existing products, and a precommitment to purchase new drugs and vaccines when developed." } ] } ] }, { "id": "S0042-96862001000800011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Public-private health partnerships: a strategy for WHO." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Following early success with a number of high-profile partnerships, WHO is increasingly working with the private for-profit sector." }, { "infon": 1, "offset": -1, "text": "In so doing, the organization finds itself in the maelstrom of a vibrant debate on the roles of public, civic, and commercial entities in society and on the appropriate modes of interaction among them." }, { "infon": 2, "offset": -1, "text": "This paper examines WHO's involvement with the commercial sector, particularly in partnerships." }, { "infon": 3, "offset": -1, "text": "WHO's approach to this sector is outlined and the criticisms levelled at public-private partnerships are reviewed." }, { "infon": 4, "offset": -1, "text": "An indication is given of the steps recently taken by WHO to confront the concerns that have been expressed." }, { "infon": 5, "offset": -1, "text": "The paper argues that partnership between WHO and the commercial sector is inevitable and that it presents considerable opportunities, but also significant risks, for the organization and for public health." }, { "infon": 6, "offset": -1, "text": "A strategy is proposed for directing the debate on issues critical to WHO and its role in the promotion and protection of public health." } ] } ] }, { "id": "S0042-96862001000800013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mass psychogenic illness following tetanus-diphtheria toxoid vaccination in Jordan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In September 1998, more than 800 young people in Jordan believed they had suffered from the side- effects of tetanus-diphtheria toxoid vaccine administered at school; 122 of them were admitted to hospital." }, { "infon": 1, "offset": -1, "text": "For the vast majority, their symptoms did not result from the vaccine but arose from mass psychogenic illness." }, { "infon": 2, "offset": -1, "text": "The role played by the media, the children's parents, and the medical profession in the escalation of this mass reaction appeared, at first sight, to be unusual and even unique to the circumstances in Jordan at the time." }, { "infon": 3, "offset": -1, "text": "A review of the literature showed, however, that this mass reaction was similar in many ways to previous outbreaks, even though the underlying causes varied." }, { "infon": 4, "offset": -1, "text": "There are about 200 published accounts of mass responses to situations involving suspected poisoning or other events." }, { "infon": 5, "offset": -1, "text": "Because such mass reactions are relatively rare and the triggers so diverse, individuals faced with responding to them are unlikely to have prior experience in how to handle them and are unlikely to take bold steps to prevent their escalation." }, { "infon": 6, "offset": -1, "text": "Indeed they may be unaware that such events have been recorded before." }, { "infon": 7, "offset": -1, "text": "The lessons learned from this incident in Jordan may help other immunization programme managers to handle crisis situations elsewhere." } ] } ] }, { "id": "S0042-96862001000900005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Comparison of safety and immunogenicity of a Vi polysaccharide typhoid vaccine with a whole-cell killed vaccine in Malaysian Air Force recruits." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To carry out a comparative study of the safety and immunogenicity of Vi polysaccharide vaccine against whole-cell killed (WCK) typhoid vaccine." }, { "infon": 1, "offset": -1, "text": "METHODS: The study was carried out on young adult recruits (aged 18-25 years) of the Malaysian Air Force." }, { "infon": 2, "offset": -1, "text": "A total of 125 subjects received the Vi polyssacharide vaccine and 114 received the WCK vaccine." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The Vi vaccine was significantly less reactogenic than the WCK vaccine with regard to systemic and local reactions." }, { "infon": 4, "offset": -1, "text": "Following administration of the Vi vaccine, seroconversion rates (defined as the percentage of subjects with a 4-fold rise of baseline antibody level) of 75.5% and 67% were observed at 2 weeks and 6 weeks, respectively, after immunization, compared with 25% and 31.3% among recipients of the WCK vaccine." }, { "infon": 5, "offset": -1, "text": "Of the 110 Vi vaccinees with serological data, 21 (19%) had high, seroprotective, pre-immunization levels of anti-Vi antibodies (³1 mg/ml)." }, { "infon": 6, "offset": -1, "text": "The majority of subjects in this group came from a region in Malaysia which is known to have high typhoid endemicity." }, { "infon": 7, "offset": -1, "text": "Interestingly, these antibody levels were boosted considerably following administration of vaccine at a level that was 5- fold higher than in subjects with low pre- immunization levels." }, { "infon": 8, "offset": -1, "text": "In contrast, the seroconversion rates in those receiving the Vi vaccine were higher in subjects with low pre-immunization levels of anti-Vi antibodies (76-84%), compared to those with protective levels of ³1 mg/ml prior to immunization (48-57%)." }, { "infon": 9, "offset": -1, "text": "CONCLUSIONS: The study reaffirms the safety and efficacy of the Vi polysaccharide vaccine and identifies a hitherto unrecognized advantage in its use, i.e. it is a potent immunogen that boosted considerably the protective antibody levels among a significant number of immunologically sensitized individuals living in typhoid-endemic regions." } ] } ] }, { "id": "S0042-96862001000900008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Globalization and health: results and options." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The last two decades have witnessed the emergence and consolidation of an economic paradigm which emphasizes domestic deregulation and the removal of barriers to international trade and finance." }, { "infon": 1, "offset": -1, "text": "If properly managed, such an approach can lead to perceptible gains in health status." }, { "infon": 2, "offset": -1, "text": "Where markets are non-exclusionary, regulatory institutions strong and safety nets in place, globalization enhances the performance of countries with a good human and physical infrastructure but narrow domestic markets." }, { "infon": 3, "offset": -1, "text": "Health gains in China, Costa Rica, the East Asian \"tiger economies\" and Viet Nam can be attributed in part to their growing access to global markets, savings and technology." }, { "infon": 4, "offset": -1, "text": "However, for most of the remaining countries, many of them in Africa, Latin America and Eastern Europe, globalization has not lived up to its promises due to a combination of poor domestic conditions, an unequal distribution of foreign investments and the imposition of new conditions further limiting the access of their exports to the OECD markets." }, { "infon": 5, "offset": -1, "text": "In these developing countries, the last twenty years have brought about a slow, unstable and unequal pattern of growth and stagnation in health indicators." }, { "infon": 6, "offset": -1, "text": "Autarky is not the answer to this situation, but neither is premature, unconditional and unselective globalization." }, { "infon": 7, "offset": -1, "text": "Further unilateral liberalization is unlikely to help them to improve their economic performance and health conditions." }, { "infon": 8, "offset": -1, "text": "For them, a gradual and selective integration into the world economy linked to the removal of asymmetries in global markets and to the creation of democratic institutions of global governance is preferable to instant globalization." } ] } ] }, { "id": "S0042-96862001000900010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Information and communication technologies and health in low income countries: the potential and the constraints." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential." }, { "infon": 1, "offset": -1, "text": "The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services." }, { "infon": 2, "offset": -1, "text": "These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced." }, { "infon": 3, "offset": -1, "text": "Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people." }, { "infon": 4, "offset": -1, "text": "However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them." }, { "infon": 5, "offset": -1, "text": "We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking." }, { "infon": 6, "offset": -1, "text": "Educating health professionals in the possible uses of ICTs, and providing them with access and \"connectivity\", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide." } ] } ] }, { "id": "S0042-96862001000900012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Globalization and occupational health: a perspective from southern Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Increased world trade has generally benefited industrialized or strong economies and marginalized those that are weak." }, { "infon": 1, "offset": -1, "text": "This paper examines the impact of globalization on employment trends and occupational health, drawing on examples from southern Africa." }, { "infon": 2, "offset": -1, "text": "While the share of world trade to the world's poorest countries has decreased, workers in these countries increasingly find themselves in insecure, poor-quality jobs, sometimes involving technologies which are obsolete or banned in industrialized countries." }, { "infon": 3, "offset": -1, "text": "The occupational illness which results is generally less visible and not adequately recognized as a problem in low-income countries." }, { "infon": 4, "offset": -1, "text": "Those outside the workplace can also be affected through, for example, work-related environmental pollution and poor living conditions." }, { "infon": 5, "offset": -1, "text": "In order to reduce the adverse effects of global trade reforms on occupational health, stronger social protection measures must be built into production and trade activities, including improved recognition, prevention, and management of work-related ill-health." }, { "infon": 6, "offset": -1, "text": "Furthermore, the success of production and trade systems should be judged on how well they satisfy both economic growth and population health." } ] } ] }, { "id": "S0042-96862001000900014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Globalization and health: a framework for analysis and action." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Globalization is a key challenge to public health, especially in developing countries, but the linkages between globalization and health are complex." }, { "infon": 1, "offset": -1, "text": "Although a growing amount of literature has appeared on the subject, it is piecemeal, and suffers from a lack of an agreed framework for assessing the direct and indirect health effects of different aspects of globalization." }, { "infon": 2, "offset": -1, "text": "This paper presents a conceptual framework for the linkages between economic globalization and health, with the intention that it will serve as a basis for synthesizing existing relevant literature, identifying gaps in knowledge, and ultimately developing national and international policies more favourable to health." }, { "infon": 3, "offset": -1, "text": "The framework encompasses both the indirect effects on health, operating through the national economy, household economies and health-related sectors such as water, sanitation and education, as well as more direct effects on population-level and individual risk factors for health and on the health care system." }, { "infon": 4, "offset": -1, "text": "Proposed also is a set of broad objectives for a programme of action to optimize the health effects of economic globalization." }, { "infon": 5, "offset": -1, "text": "The paper concludes by identifying priorities for research corresponding with the five linkages identified as critical to the effects of globalization on health." } ] } ] }, { "id": "S0042-96862001001000003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Levels of cardiovascular disease risk factors in Singapore following a national intervention programme." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate the impact of the National Healthy Lifestyle Programme, a noncommunicable disease intervention programme for major cardiovascular disease risk factors in Singapore, implemented in 1992." }, { "infon": 1, "offset": -1, "text": "METHODS: The evaluation was carried out in 1998 by the Singapore National Health Survey (NHS)." }, { "infon": 2, "offset": -1, "text": "The reference population was 2.2 million multiracial Singapore residents, 18¾69 years of age." }, { "infon": 3, "offset": -1, "text": "A population-based survey sample (n = 4723) was selected by disproportionate stratified and systematic sampling." }, { "infon": 4, "offset": -1, "text": "Anthropometric and blood pressure measurements were carried out on all subjects and blood samples were taken for biochemical analysis." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The 1998 results suggest that the National Healthy Lifestyle Programme significantly decreased regular smoking and increased regular exercise over 1992 levels and stabilized the prevalence of obesity and diabetes mellitus." }, { "infon": 6, "offset": -1, "text": "However, the prevalence of high total blood cholesterol and hypertension increased." }, { "infon": 7, "offset": -1, "text": "Ethnic differences in the prevalence of diabetes mellitus, hypertension, and smoking; and in lipid profile and exercise levels were also observed." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: The intervention had mixed results after six years." }, { "infon": 9, "offset": -1, "text": "Successful strategies have been continued and strengthened." } ] } ] }, { "id": "S0042-96862001001000006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Diagnosis of malaria in a remote area of the Philippines: comparison of techniques and their acceptance by health workers and the community." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare the efficacies of remote symptom-based diagnosis of malaria, rapid diagnostic tests and microscopy in an area of low endemicity in the Philippines." }, { "infon": 1, "offset": -1, "text": "METHODS: In Trial I, 350 symptomatic patients were tested within their villages using malaria Plasmodium falciparum (Pf)/Plasmodium vivax (Pv) immunochromatographic tests (ICT tests) and blood films stored and read under local conditions." }, { "infon": 2, "offset": -1, "text": "The slides were later restained and read." }, { "infon": 3, "offset": -1, "text": "In Trial II, unsupervised volunteer barangay health workers prepared ICT tests and slides after brief training." }, { "infon": 4, "offset": -1, "text": "These slides were read at rural health units." }, { "infon": 5, "offset": -1, "text": "Twenty-seven barangay health workers and 72 community members were later questioned about the three diagnostic strategies." }, { "infon": 6, "offset": -1, "text": "FINDINGS: A history of fever alone was sensitive (95.4%) but poorly specific (16.5%) for predicting parasitaemia." }, { "infon": 7, "offset": -1, "text": "The inclusion of other symptoms reduced the sensitivity to below 85%, while specificity remained low." }, { "infon": 8, "offset": -1, "text": "The axillary temperature was poorly predictive." }, { "infon": 9, "offset": -1, "text": "ICT tests achieved high sensitivity (97.9%) but many cases indicated as positive by ICT tests were negative by microscopy." }, { "infon": 10, "offset": -1, "text": "Further analysis of these cases in Trial I indicated that ICT tests were detecting low-level parasitaemias missed by microscopy, and that local microscopy had poor accuracy." }, { "infon": 11, "offset": -1, "text": "ICT tests were well accepted and accurately performed by barangay health workers." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: These tests meet a strong desire in the community for blood-based diagnosis and may increase the compliance and treatment-seeking behaviour of patients." } ] } ] }, { "id": "S0042-96862001001000008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Noncommunicable diseases in sub-Saharan Africa: where do they feature in the health research agenda?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "There is no doubt that communicable diseases will remain the predominant health problem for the populations in sub-Saharan Africa, including adults, for the next 10¾20 years." }, { "infon": 1, "offset": -1, "text": "Concern has been expressed that the available resources to deal with this problem would be reduced by increasing the emphasis on noncommunicable diseases." }, { "infon": 2, "offset": -1, "text": "The latter, however, already present a substantial burden because their overall age-specific rates are currently higher in adults in sub-Saharan Africa than in populations in Established Market Economies." }, { "infon": 3, "offset": -1, "text": "There is also evidence that the prevalence of certain noncommunicable diseases, such as diabetes and hypertension, is increasing rapidly, particularly in the urban areas, and that significant demands are being made on the health services by patients with these diseases." }, { "infon": 4, "offset": -1, "text": "To ignore the noncommunicable diseases would inevitably lead to an increase in their burden; the provision of health services for them would be largely undirected by issues of clinical and cost effectiveness, and their treatment and prevention would be left to the mercy of local and global commercial interests." }, { "infon": 5, "offset": -1, "text": "Improved surveillance of all diseases within sub-Saharan Africa is needed in order to place noncommunicable diseases properly within the context of the overall burden of disease." }, { "infon": 6, "offset": -1, "text": "Research is needed to guide improvements in the clinical and cost effectiveness of resources currently committed to the care of patients with noncommunicable diseases, and to direct and evaluate preventive measures." } ] } ] }, { "id": "S0042-96862001001000010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Community-based noncommunicable disease interventions: lessons from developed countries for developing ones." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Community-based programmes for prevention and control of cardiovascular diseases (CVD) started in Europe and the USA in the early 1970s." }, { "infon": 1, "offset": -1, "text": "High mortality from CVD in Finland led to the start of the North Karelia Project." }, { "infon": 2, "offset": -1, "text": "Since then, a vast amount of scientific literature has accumulated to present results and discuss experience." }, { "infon": 3, "offset": -1, "text": "The results indicate that heart health programmes have a high degree of generalizability, are cost-effective and can influence health policy." }, { "infon": 4, "offset": -1, "text": "In the 1980s the focus of programmes expanded from CVD to noncommunicable diseases (NCD), mainly because of the common risk factors." }, { "infon": 5, "offset": -1, "text": "Attention has now turned to promoting this approach in developing countries, where the prevalence of NCD is growing." }, { "infon": 6, "offset": -1, "text": "Theory and experience show that community-based NCD programmes should be planned, run and evaluated according to clear principles and rules, collaborate with all sectors of the community, and maintain close contact with the national authorities." }, { "infon": 7, "offset": -1, "text": "In view of the burden of disease they represent and of globalization, there is a great need for international collaboration." }, { "infon": 8, "offset": -1, "text": "Practical networks with common guidelines but adaptable to local cultures in a flexible way have proved to be very useful." } ] } ] }, { "id": "S0042-96862001001000012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Can we prevent cardiovascular diseases in low- and middle-income countries?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Ischaemic heart disease, the largest cause of death worldwide, is rapidly becoming a major threat in low- and middle-income countries." }, { "infon": 1, "offset": -1, "text": "Experience in a variety of populations has demonstrated that lowering certain risk factors, such as hypertension and hypercholesterolaemia, reduces illness and deaths from cardiovascular diseases." }, { "infon": 2, "offset": -1, "text": "A dual approach is recommended: screening and intervening in cases of relatively high risk, while fostering population-wide preventive activities." }, { "infon": 3, "offset": -1, "text": "This is both feasible and affordable." }, { "infon": 4, "offset": -1, "text": "Now is the time to make such efforts." } ] } ] }, { "id": "S0042-96862001001100004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Malaria control in Bungoma District, Kenya: a survey of home treatment of children with fever, bednet use and attendance at antenatal clinics." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To lay the basis for planning an improved malaria control programme in Bungoma District, Kenya." }, { "infon": 1, "offset": -1, "text": "METHODS: By means of a cluster sample household survey an investigation was conducted into the home management of febrile children, the use of bednets, and attendance at antenatal clinics." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Female carers provided information on 314 recently febrile children under 5 years of age, of whom 43% received care at a health facility, 47% received an antimalarial drug at home, and 25% received neither." }, { "infon": 3, "offset": -1, "text": "Of the antimalarial treatments given at home, 91% were started by the second day of fever and 92% were with chloroquine, the nationally recommended antimalarial at the time." }, { "infon": 4, "offset": -1, "text": "The recommended dosage of chloroquine to be administered over three days was 25 mg/kg but the median chloroquine tablet or syrup dosage given over the first three days of treatment was 15 mg/kg. The total dosages ranged from 2.5 mg/kg to 82 mg/kg, administered over one to five days." }, { "infon": 5, "offset": -1, "text": "The dosages were lower when syrup was administered than when tablets were used." }, { "infon": 6, "offset": -1, "text": "Only 5% of children under 5 years of age slept under a bednet." }, { "infon": 7, "offset": -1, "text": "No bednets had been treated with insecticide since purchase." }, { "infon": 8, "offset": -1, "text": "At least two antenatal visits were made by 91% of pregnant women." }, { "infon": 9, "offset": -1, "text": "CONCLUSIONS: Carers are major and prompt providers of antimalarial treatment." }, { "infon": 10, "offset": -1, "text": "Home treatment practices should be strengthened and endorsed when prompt treatment at a health facility is impossible." }, { "infon": 11, "offset": -1, "text": "The administration of incorrect dosages, which proved common with chloroquine, may occur less frequently with sulfadoxine-pyrimethamine, as its dosage regimen is simpler." }, { "infon": 12, "offset": -1, "text": "High levels of utilization of antenatal clinics afford the opportunity to achieve good coverage with presumptive intermittent malaria treatments during pregnancy, and to reach the goal of widespread bednet use by pregnant women and children by distributing nets during antenatal clinic visits." } ] } ] }, { "id": "S0042-96862001001100006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "User fees, health staff incentives, and service utilization in Kabarole District, Uganda." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District, western Uganda." }, { "infon": 1, "offset": -1, "text": "METHODS: Of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study." }, { "infon": 2, "offset": -1, "text": "Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began." }, { "infon": 3, "offset": -1, "text": "FINDINGS: After the introduction of cost sharing, overall utilization of general outpatient services, assessed by combining the data from all the participating units, dropped by 21.3%." }, { "infon": 4, "offset": -1, "text": "Utilization increased, however, in facilities located in remote areas, while it decreased in those located in urban or semi-urban areas." }, { "infon": 5, "offset": -1, "text": "The increased utilization in remote facilities was considered to be largely attributable to health workers' incentive payments derived from cost-sharing revenues." }, { "infon": 6, "offset": -1, "text": "CONCLUSIONS: Incentive payments led the health workers to offer improved services." }, { "infon": 7, "offset": -1, "text": "Other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas." } ] } ] }, { "id": "S0042-96862001001100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Prevalence of impairments, disabilities, handicaps and quality of life in the general population: a review of recent literature." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the prevalence rates of morbidity in the general population through bibliographic research." }, { "infon": 1, "offset": -1, "text": "METHODS: Articles relating to impairment, disability, handicap, quality of life and their prevalence in the general population, published between January 1990 and March 1998, were selected on the MEDLINE database." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The 20 articles retained out of 433 used 41 different indicators." }, { "infon": 3, "offset": -1, "text": "Indicators of impairment, disability, handicap and low quality of life showed prevalence rates of 0.1-92%, 3.6-66%, 0.6-56% and 1.8-26% respectively, depending on age and the accuracy of indicators." }, { "infon": 4, "offset": -1, "text": "The heterogeneity of the conceptual framework and insufficient recognition of the importance of indicator accuracy, the age factor and the socioeconomic characteristics of the studied populations impede reliable international comparison." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: Further standardization of indicators is therefore required." }, { "infon": 6, "offset": -1, "text": "The revision of the International Classification of Impairments, Disabilities and Handicaps may make it possible to resolve some of the difficulties encountered." } ] } ] }, { "id": "S0042-96862001001100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Malathion resistance and prevalence of the malathion carboxylesterase mechanism in populations of mosquito vectors of disease in Sri Lanka." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the levels of malathion resistance and prevalence of the malathion carboxylesterase mechanism among mosquitoes in Sri Lanka." }, { "infon": 1, "offset": -1, "text": "METHODS: Bioassays were carried out using WHO-recommended methods on samples of the following Sri Lankan mosquito vectors: Culex quinquefasciatus, C. tritaeniorhynchus, C. gelidus; Anopheles culicifacies B, A. subpictus; Aedes aegypti and A. albopictus." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Malathion-specific carboxylesterase mechanisms were found in A. culicifacies and A. subpictus, both giving high rates of insecticide metabolism." }, { "infon": 3, "offset": -1, "text": "In contrast, malathion resistance in C. quinquefasciatus and C. tritaeniorhynchus is linked to broad-spectrum resistance to organophosphorus compounds due to elevated levels of esterases that sequester malaoxon, but are unable to metabolize malathion." }, { "infon": 4, "offset": -1, "text": "CONCLUSIONS: Resistance among the Anopheles spp. must have occurred as a direct result of antimalarial activities, since malathion use in Sri Lanka is limited to public health treatments." }, { "infon": 5, "offset": -1, "text": "In contrast, resistance among Culex spp. has resulted from large-scale use of the organophosphorus insecticide group as larvicides for filariasis control and on rice paddy, where C. tritaeniorhynchus predominantly breeds, for agricultural purposes." } ] } ] }, { "id": "S0042-96862001001100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The syndromic treatment of gonococcal and chlamydial infections in women seeking primary care in clinics where resources are scarce, as recommended by WHO and implemented in many developing countries, necessitates a balance to be struck between overtreatment and undertreatment." }, { "infon": 1, "offset": -1, "text": "The present paper identifies factors that are relevant to the selection of specific strategies for syndromic treatment in the above circumstances." }, { "infon": 2, "offset": -1, "text": "Among them are the general aspects of decision-making and caveats concerning the rational decision-making approach." }, { "infon": 3, "offset": -1, "text": "The positive and negative implications are outlined of providing or withholding treatment following a specific algorithm with a given accuracy to detect infection, i.e. sensitivity, specificity and predictive values." }, { "infon": 4, "offset": -1, "text": "Other decision-making considerations that are identified are related to implementation and include the stability of risk factors with regard to time, space and the implementer, acceptability by stakeholders, and environmental constraints." }, { "infon": 5, "offset": -1, "text": "There is a need to consider empirically developed treatment algorithms as a basis for policy discourse, to be evaluated together with the evidence, alternatives and arguments by the stakeholders." } ] } ] }, { "id": "S0042-96862001001200005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Diagnosis and management of febrile children using the WHO/UNICEF guidelines for IMCI in Dhaka, Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine whether the fever module in the WHO/UNICEF guidelines for the integrated management of childhood illness (IMCI) identifies children with bacterial infections in an area of low malaria prevalence." }, { "infon": 1, "offset": -1, "text": "METHODS: Physicians assessed a systematic sample of 669 sick children aged 2-59 months who presented to the outpatient department of Dhaka Shishu Hospital, Bangladesh." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Had IMCI guidelines been used to evaluate the children, 78% of those with bacterial infections would have received antibiotics: the majority of children with meningitis (100%), pneumonia (95%), otitis media (95%) and urinary tract infection (83%); and 50% or less of children with bacteraemia (50%), dysentery (48%), and skin infections (30%)." }, { "infon": 3, "offset": -1, "text": "The current fever module identified only one additional case of meningitis." }, { "infon": 4, "offset": -1, "text": "Children with bacteraemia were more likely to be febrile, feel hot, and have a history of fever than those with dysentery and skin infections." }, { "infon": 5, "offset": -1, "text": "Fever combined with parental perception of fast breathing provided a more sensitive fever module for the detection of bacteraemia than the current IMCI module." }, { "infon": 6, "offset": -1, "text": "CONCLUSIONS: In an area of low malaria prevalence, the IMCI guidelines provide antibiotics to the majority of children with bacterial infections, but improvements in the fever module are possible." } ] } ] }, { "id": "S0042-96862001001200007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Fighting HIV/AIDS: is success possible?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The fight against HIV/AIDS poses enormous challenges worldwide, generating fears that success may be too difficult or even impossible to attain." }, { "infon": 1, "offset": -1, "text": "Uganda has demonstrated that an early, consistent and multisectoral control strategy can reduce both the prevalence and the incidence of HIV infection." }, { "infon": 2, "offset": -1, "text": "From only two AIDS cases in 1982, the epidemic in Uganda grew to a cumulative 2 million HIV infections by the end of 2000." }, { "infon": 3, "offset": -1, "text": "The AIDS Control Programme established in 1987 in the Ministry of Health mounted a national response that expanded over time to reach other relevant sectors under the coordinating role of the Uganda AIDS Commission." }, { "infon": 4, "offset": -1, "text": "The national response was to bring in new policies, expanded partnerships, increased institutional capacity for care and research, public health education for behaviour change, strengthened sexually transmitted disease (STD) management, improved blood transfusion services, care and support services for persons with HIV/AIDS, and a surveillance system to monitor the epidemic." }, { "infon": 5, "offset": -1, "text": "After a decade of fighting on these fronts, Uganda became, in October 1996, the first African nation to report declining trends in HIV infection." }, { "infon": 6, "offset": -1, "text": "Further decline in prevalence has since been noted." }, { "infon": 7, "offset": -1, "text": "The Medical Research Council (UK) and the Uganda Virus Research Institute have demonstrated declining HIV incidence rates in the general population in the Kyamulibwa in Masaka Districts." }, { "infon": 8, "offset": -1, "text": "Repeat knowledge, attitudes, behaviour and practice studies have shown positive changes in the priority prevention indicators." }, { "infon": 9, "offset": -1, "text": "The data suggest that a comprehensive national response supported by strong political commitment may be responsible for the observed decline." }, { "infon": 10, "offset": -1, "text": "Other countries in sub-Saharan Africa can achieve similar results by these means." }, { "infon": 11, "offset": -1, "text": "Since success is possible, anything less is unacceptable." } ] } ] }, { "id": "S0042-96862001001200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "An HIV vaccine: how and when?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The best long-term hope for controlling the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic is a safe, effective and affordable preventive vaccine, but its development has encountered unprecedented scientific challenges." }, { "infon": 1, "offset": -1, "text": "The first phase I trial of an HIV vaccine was conducted in 1987." }, { "infon": 2, "offset": -1, "text": "Subsequently, more than 30 candidate vaccines have been tested in over 60 phase I/II trials, involving approximately 10 000 healthy volunteers." }, { "infon": 3, "offset": -1, "text": "Most of these trials have been conducted in the USA and Europe, but several have also been conducted in developing countries." }, { "infon": 4, "offset": -1, "text": "The first phase III trials began in the USA in 1998 and in Thailand in 1999 to assess the efficacy of the first generation of HIV vaccines (based on the HIV envelope protein, gp120); the results will be available within the next 1-2 years." }, { "infon": 5, "offset": -1, "text": "To accelerate the development of an HIV vaccine, additional candidate vaccines must be evaluated in parallel in both industrialized and developing countries." }, { "infon": 6, "offset": -1, "text": "This will require international collaboration and coordination and critical ethical issues will need to be addressed." }, { "infon": 7, "offset": -1, "text": "To ensure that future HIV vaccines contribute to the overall HIV/AIDS prevention effort, we should begin planning now on how best to use them." } ] } ] }, { "id": "S0042-96862001001200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths." }, { "infon": 1, "offset": -1, "text": "In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART)." }, { "infon": 2, "offset": -1, "text": "Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll." }, { "infon": 3, "offset": -1, "text": "Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely." }, { "infon": 4, "offset": -1, "text": "We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control." }, { "infon": 5, "offset": -1, "text": "With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit." }, { "infon": 6, "offset": -1, "text": "The inclusion criteria and preliminary results are presented." }, { "infon": 7, "offset": -1, "text": "We conclude that directly observed therapy (DOT) with HAART, \"DOT-HAART\", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs." } ] } ] }, { "id": "S0042-96862002000100004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Death rate variation in US subpopulations." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To account for variations in death rates in population subgroups of the USA." }, { "infon": 1, "offset": -1, "text": "METHODS: Factors associated with age-adjusted death rates in 366 metropolitan and non- metropolitan areas of the United States were examined for 1990-92." }, { "infon": 2, "offset": -1, "text": "The rates ranged from 690 to 1108 per 100 000 population (mean = 885 ± 78 per 100 000)." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Least squares regression analysis explained 71% of this variance." }, { "infon": 4, "offset": -1, "text": "Factors with the strongest independent positive association were ethnicity (African-American), less than a high school education, high Medicare expenditures, and location in western or southern regions." }, { "infon": 5, "offset": -1, "text": "Factors with the strongest independent negative associations were employment in agriculture and forestry, ethnicity (Hispanic) and per capita income." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Additional research at the individual level is needed to determine if these associations are causal, since some of the factors with the strongest associations, such as education, have long latency periods." } ] } ] }, { "id": "S0042-96862002000100006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Comparison of cohort smoking intensities in Denmark and the Netherlands." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the usefulness of the general framework of the smoking epidemic." }, { "infon": 1, "offset": -1, "text": "METHODS: We use lung cancer mortality as an indicator for smoking intensity and employ an age-cohort model to accommodate the long-lasting and cumulative effects." }, { "infon": 2, "offset": -1, "text": "RESULTS: Dutch males have higher risks than Danish males, but the risks for the younger cohorts have been declining faster in the Netherlands than in Denmark." }, { "infon": 3, "offset": -1, "text": "Danish women have about twice the risk of Dutch women, and in both countries the risks for the younger cohorts are increasing." }, { "infon": 4, "offset": -1, "text": "The smoking epidemic began at about the same time in Denmark and the Netherlands." }, { "infon": 5, "offset": -1, "text": "Dutch males, however, seem to have smoked more but to have given up smoking more quickly than Danish males." }, { "infon": 6, "offset": -1, "text": "Danish females were quicker to take up smoking than Dutch females." }, { "infon": 7, "offset": -1, "text": "CONCLUSIONS: Within the general framework of the smoking epidemic, differences in timing and levels can produce large differences between countries." }, { "infon": 8, "offset": -1, "text": "For the purposes of assessing smoking-related risks, including projections, the smoking epidemic framework therefore has to be tailored to each study population." } ] } ] }, { "id": "S0042-96862002000100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The risk of Ascaris lumbricoides infection in children as an environmental health indicator to guide preventive activities in Caparaó and Alto Caparaó, Brazil." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To develop an environmental health indicator for use as a basis for developing preventive measures against Ascaris lumbricoides infection in children from the rural municipalities of Caparaó and Alto Caparaó, in Minas Gerais, Brazil." }, { "infon": 1, "offset": -1, "text": "METHODS: A cross-sectional survey was conducted between May and September 1998 among 1171 children under 14 years of age living in 588 dwellings selected from 11 communities." }, { "infon": 2, "offset": -1, "text": "Trained interviewers used a questionnaire to identify risk factors for infection (socioeconomic, sanitation and hygiene variables) and collected stool samples from each child for parasitological tests." }, { "infon": 3, "offset": -1, "text": "RESULTS: The overall prevalence of A. lumbricoides infection was 12.2%." }, { "infon": 4, "offset": -1, "text": "The results showed the protective effects of availability of water in the washbasin and better hygiene, sanitation and socioeconomic status; the interactive effect of crowding was five times larger in households without water in the washbasin than in those having water." }, { "infon": 5, "offset": -1, "text": "There was a statistically significant association between infection and children's age." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: The environmental health indicator, which incorporated the most significant biological, environmental and social factors associated with the risk of A. lumbricoides infection in children from these communities, should contribute to the development of surveillance tools and health protection measures in this population." } ] } ] }, { "id": "S0042-96862002000100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The implications of health sector reform for human resources development." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The authors argue that \"health for all\" is not achievable in most countries without health sector reform that incorporates a process of coordinated health and human resources development." }, { "infon": 1, "offset": -1, "text": "They examine the situation in countries in the Eastern Mediterranean Region of the World Health Organization." }, { "infon": 2, "offset": -1, "text": "Though advances have been made, further progress is inhibited by the limited adaptation of traditional health service structures and processes in many of these countries." }, { "infon": 3, "offset": -1, "text": "National reform strategies are needed." }, { "infon": 4, "offset": -1, "text": "These require the active participation of health professional associations and academic training institutions as well as health service managers." }, { "infon": 5, "offset": -1, "text": "The paper indicates some of the initiatives required and suggests that the starting point for many countries should be a rigorous appraisal of the current state of human resources development in health." } ] } ] }, { "id": "S0042-96862002000200004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Poverty and health sector inequalities." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Poverty and ill-health are intertwined." }, { "infon": 1, "offset": -1, "text": "Poor countries tend to have worse health outcomes than better-off countries." }, { "infon": 2, "offset": -1, "text": "Within countries, poor people have worse health outcomes than better-off people." }, { "infon": 3, "offset": -1, "text": "This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor." }, { "infon": 4, "offset": -1, "text": "The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article." }, { "infon": 5, "offset": -1, "text": "An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them." }, { "infon": 6, "offset": -1, "text": "It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities." } ] } ] }, { "id": "S0042-96862002000200006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Ethics in international health research: a perspective from the developing world." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Health research plays a pivotal role in addressing inequities in health and human development, but to achieve these objectives the research must be based on sound scientific and ethical principles." }, { "infon": 1, "offset": -1, "text": "Although it is accepted that ethics play a central role in health research in developing countries, much of the recent debate has focused on controversies surrounding internationally sponsored research and has taken place largely without adequate participation of the developing countries." }, { "infon": 2, "offset": -1, "text": "The relationship between ethical guidelines and regulations, and indigenously sponsored and public health research has not been adequately explored." }, { "infon": 3, "offset": -1, "text": "For example, while the fundamental principles of ethical health research, such as community participation, informed consent, and shared benefits and burdens, remain sacrosanct other issues, such as standards of care and prior agreements, merit greater public debate within developing countries." }, { "infon": 4, "offset": -1, "text": "In particular, the relationship of existing ethical guidelines to epidemiological and public health research merits further exploration." }, { "infon": 5, "offset": -1, "text": "In order to support health research in developing countries that is both relevant and meaningful, the focus must be on developing health research that promotes equity and on developing local capacity in bioethics." }, { "infon": 6, "offset": -1, "text": "Only through such proactive measures can we address the emerging ethical dilemmas and challenges that globalization and the genomics revolution will bring in their wake." } ] } ] }, { "id": "S0042-96862002000200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Basic patterns in national health expenditure." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed." }, { "infon": 1, "offset": -1, "text": "The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability." }, { "infon": 2, "offset": -1, "text": "Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (<US$ 1000 per capita) to typically 8-9% at high incomes (>US$ 7000)." }, { "infon": 3, "offset": -1, "text": "Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US$." }, { "infon": 4, "offset": -1, "text": "Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing." }, { "infon": 5, "offset": -1, "text": "At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows." }, { "infon": 6, "offset": -1, "text": "Absolute out-of-pocket expenditure nonetheless increases with income." }, { "infon": 7, "offset": -1, "text": "Public financing increases faster, and as a share of GDP, and converges at high incomes." }, { "infon": 8, "offset": -1, "text": "Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%." }, { "infon": 9, "offset": -1, "text": "This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services." }, { "infon": 10, "offset": -1, "text": "Within public spending, there is no convergence in the type of finance - general revenue versus social insurance." }, { "infon": 11, "offset": -1, "text": "Private insurance is usually insignificant except in some rich countries." } ] } ] }, { "id": "S0042-96862002000200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Debt relief and public health spending in heavily indebted poor countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Heavily Indebted Poor Countries (HIPC) Initiative, which was launched in 1996, is the first comprehensive effort by the international community to reduce the external debt of the world's poorest countries." }, { "infon": 1, "offset": -1, "text": "The Initiative will generate substantial savings relative to current and past public spending on health and education in these countries." }, { "infon": 2, "offset": -1, "text": "Although there is ample scope for raising public health spending in heavily indebted poor countries, it may not be advisable to spend all the savings resulting from HIPC resources for this purpose." }, { "infon": 3, "offset": -1, "text": "Any comprehensive strategy for tackling poverty should also focus on improving the efficiency of public health outlays and on reallocating funds to programmes that are most beneficial to the poor." }, { "infon": 4, "offset": -1, "text": "In order to ensure that debt relief increases poverty-reducing spending and benefits the poor, all such spending, not just that financed by HIPC resources, should be tracked." }, { "infon": 5, "offset": -1, "text": "This requires that countries improve all aspects of their public expenditure management." }, { "infon": 6, "offset": -1, "text": "In the short run, heavily indebted poor countries can take some pragmatic tracking measures based on existing public expenditure management systems, but in the longer run they should adopt a more comprehensive approach so as to strengthen their budget formulation, execution, and reporting systems." } ] } ] }, { "id": "S0042-96862002000300003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reproductive tract infections: prevalence and risk factors in rural Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the prevalence of and risk factors for reproductive tract infections among men and women in a rural community in Bangladesh." }, { "infon": 1, "offset": -1, "text": "METHODS: In the Matlab area a systematic sample of married non-pregnant women aged 15-50 years was drawn from a comprehensive household registration system for married women." }, { "infon": 2, "offset": -1, "text": "A systematic sample of married and unmarried men in the same age group was drawn from a census-derived demographic surveillance list." }, { "infon": 3, "offset": -1, "text": "Private interviews were conducted with 804 women in a clinic, and cervical, vaginal, urinary and serological samples were collected." }, { "infon": 4, "offset": -1, "text": "Urine and blood specimens were obtained from 969 men who were interviewed at home." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The prevalence of bacterial and viral reproductive tract infections was low to moderate." }, { "infon": 6, "offset": -1, "text": "For example, fewer than 1% of the women had a cervical infection." }, { "infon": 7, "offset": -1, "text": "No cases of human immunodeficiency virus (HIV) infection were found." }, { "infon": 8, "offset": -1, "text": "However, among men there was a high level of reported risk behaviour and a low level of protection against infection." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: A low prevalence of reproductive tract infections, coupled with a high level of reported risk behaviour, indicated a need for primary programmes that would prevent an increase in the incidence of reproductive tract infections, sexually transmitted infections and HIV infection." } ] } ] }, { "id": "S0042-96862002000300005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Structure and performance of infectious disease surveillance and response, United Republic of Tanzania, 1998." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the structure and performance of and support for five infectious disease surveillance systems in the United Republic of Tanzania: Health Management Information System (HMIS); Infectious Disease Week Ending; Tuberculosis/Leprosy; Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome; and Acute Flaccid Paralysis/Poliomyelitis." }, { "infon": 1, "offset": -1, "text": "METHODS: The systems were assessed by analysing the core activities of surveillance and response and support functions (provision of training, supervision, and resources)." }, { "infon": 2, "offset": -1, "text": "Data were collected using questionnaires that involved both interviews and observations at regional, district, and health facility levels in three of the 20 regions in the United Republic of Tanzania." }, { "infon": 3, "offset": -1, "text": "FINDINGS: An HMIS was found at 26 of 32 health facilities (81%) surveyed and at all 14 regional and district medical offices." }, { "infon": 4, "offset": -1, "text": "The four other surveillance systems were found at <20% of health facilities and <75% of medical offices." }, { "infon": 5, "offset": -1, "text": "Standardized case definitions were used for only 3 of 21 infectious diseases." }, { "infon": 6, "offset": -1, "text": "Nineteen (73%) health facilities with HMIS had adequate supplies of forms; 9 (35%) reported on time; and 11 (42%) received supervision or feedback." }, { "infon": 7, "offset": -1, "text": "Four (29%) medical offices with HMIS had population denominators to use for data analyses; 12 (86%) were involved in outbreak investigations; and 11 (79%) had conducted community prevention activities." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: While HMIS could serve as the backbone for IDSR in the United Republic of Tanzania, this will require supervision, standardized case definitions, and improvements in the quality of reporting, analysis, and feedback." } ] } ] }, { "id": "S0042-96862002000300007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Vaccine-associated paralytic poliomyelitis in India during 1999: decreased risk despite massive use of oral polio vaccine." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Vaccine-associated paralytic poliomyelitis (VAPP) is a rare but serious consequence of the administration of oral polio vaccine (OPV)." }, { "infon": 1, "offset": -1, "text": "Intensified OPV administration has reduced wild poliovirus transmission in India but VAPP is becoming a matter of concern." }, { "infon": 2, "offset": -1, "text": "METHODS: We analysed acute flaccid paralysis (AFP) surveillance data in order to estimate the VAPP risk in this country." }, { "infon": 3, "offset": -1, "text": "VAPP was defined as occurring in AFP cases with onset of paralysis in 1999, residual weakness 60 days after onset, and isolation of vaccine-related poliovirus." }, { "infon": 4, "offset": -1, "text": "Recipient VAPP cases were a subset with onset of paralysis between 4 and 40 days after receipt of OPV." }, { "infon": 5, "offset": -1, "text": "FINDINGS: A total of 181 AFP cases met the case definition." }, { "infon": 6, "offset": -1, "text": "The following estimates of VAPP risk were made: overall risk, 1 case per 4.1 to 4.6 million OPV doses administered; recipient risk,1 case per 12.2 million; first-dose recipient risk, 1case per 2.8 million; and subsequent-dose recipient risk, 1 case per 13.9 million." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: On the basis of data from a highly sensitive surveillance system the estimated VAPP risk in India is evidently lower than that in other countries, notwithstanding the administration of multiple OPV doses to children in mass immunization campaigns." } ] } ] }, { "id": "S0042-96862002000300009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A district-based audit of the causes and circumstances of maternal deaths in South Kalimantan, Indonesia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A district-based audit of maternal and perinatal mortality began during 1994 in three provinces of South Kalimantan, Indonesia." }, { "infon": 1, "offset": -1, "text": "Both medical and non-medical factors were documented and an effort was made to progress from merely assessing substandard care to recommending improvements in access to care and the quality of care." }, { "infon": 2, "offset": -1, "text": "Extensive discussions of cases of maternal death were held during regular meetings with providers, policy-makers and community members." }, { "infon": 3, "offset": -1, "text": "The sources of information included verbal autopsies with family members and medical records." }, { "infon": 4, "offset": -1, "text": "Between 1995 and 1999 the audit reviewed 130 maternal deaths." }, { "infon": 5, "offset": -1, "text": "The leading causes of death were haemorrhage (41%) and hypertensive diseases (32%)." }, { "infon": 6, "offset": -1, "text": "Delays in decision-making and poor quality of care in health facilities were seen as contributory factors in 77% and 60% of the deaths, respectively." }, { "infon": 7, "offset": -1, "text": "Economic constraints were believed to have contributed to 37% of the deaths." }, { "infon": 8, "offset": -1, "text": "The distance between a patient's home and a health provider or facility did not appear to have a significant influence, nor did transport problems." }, { "infon": 9, "offset": -1, "text": "The audit led to changes in the quality of obstetric care in the district." }, { "infon": 10, "offset": -1, "text": "Its success was particularly attributable to the process of accountability of both health providers and policy-makers and to improved working relationships between health providers at different levels and between providers and the community." }, { "infon": 11, "offset": -1, "text": "With a view to the continuation and further expansion of the audit it may be necessary to reconsider the role of the provincial team, the need of health providers for confidentiality, the added benefit of facility-based audits, the need to incorporate scientific evidence into the review process, and the possible consideration of severe complications as well as deaths." }, { "infon": 12, "offset": -1, "text": "It may also be necessary to recognize that village midwives are not solely responsible for maternal deaths." } ] } ] }, { "id": "S0042-96862002000400003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Economic analyses of rubella and rubella vaccines: a global review." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate whether the incorporation of rubella vaccine into immunization programmes in developing countries is economically justified." }, { "infon": 1, "offset": -1, "text": "METHODS: A MEDLINE search was conducted for articles published between 1970 and 2000 that dealt with economic analyses of rubella and rubella-containing vaccines." }, { "infon": 2, "offset": -1, "text": "The Eastern Mediterranean, South-East Asia, and Africa regional Index Medicus databases and the LILACS database for Latin America and the Caribbean were also searched." }, { "infon": 3, "offset": -1, "text": "FINDINGS: For developed countries, five cost- benefit analyses of rubella vaccine and five of measles-mumps-rubella vaccine as well as two cost-effectiveness analyses were found." }, { "infon": 4, "offset": -1, "text": "For developing countries, five cost analyses and five cost-benefit analyses were found." }, { "infon": 5, "offset": -1, "text": "All the cost-benefit analyses had a benefit:cost ratio greater than 1 and the cost-effectiveness studies indicated that rubella immunization was a cost-effective means of reducing the impact of congenital rubella syndrome." }, { "infon": 6, "offset": -1, "text": "However, the methodologies were not standardized." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: The data support the inclusion of rubella vaccine in the immunization programmes of both developing and developed countries and indicate economic benefits comparable to those associated with hepatitis B vaccine and Haemophilus influenzae type b vaccine." }, { "infon": 8, "offset": -1, "text": "More studies should be carried out on costs for care and immunization using standardized methodologies and locally obtained information." } ] } ] }, { "id": "S0042-96862002000400005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Universal immunization of infants with low doses of a low-cost, plasma-derived hepatitis B vaccine in South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJETIVE: To evaluate the effectiveness of universal vaccination against viral hepatitis B in South Africa among 18-month-old rural children." }, { "infon": 1, "offset": -1, "text": "METHODS: Children were immunized with a course of low-dose (1.5 mg), plasma-derived hepatitis B vaccine at 6, 10 and 14 weeks of age, and blood samples from the children were tested for three hepatitis B markers: hepatitis B surface antigen (HBsAg), anti-HBs and anti-HBc." }, { "infon": 2, "offset": -1, "text": "FINDINGS: One year after vaccination, a protective anti-HBs antibody titre of at least 10 IU/l was present in 669/769 (87.0%) of blood serum samples tested." }, { "infon": 3, "offset": -1, "text": "Only 3/756 children (0.4%) were HBsAg positive and a fourth child was anti-HBc positive (HBsAg negative)." }, { "infon": 4, "offset": -1, "text": "This is a marked decrease compared to the hepatitis B prevalences reported in previous studies." }, { "infon": 5, "offset": -1, "text": "Among rural migrant mine-workers, for example, HBsAg prevalence was 9.9%, and was 10.1% among children 0-6 years of age in the Eastern Cape Province." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: The low-dose, plasma-derived hepatitis B vaccine, which is affordable to most developing countries, was very successful in controlling endemic hepatitis B infection, where the virus is predominantly spread by horizontal transmission among infants and young children." } ] } ] }, { "id": "S0042-96862002000400007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The contribution of breast milk to toddler diets in western Kenya." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To understand the relative contributions of breast milk and the weaning diet to overall nutrient intake, with a view to designing and implementing appropriate programmes to improve complementary feeding in developing countries." }, { "infon": 1, "offset": -1, "text": "METHODS: Complementary food intake was measured in a sample of 250 toddlers (mean baseline age: 13.9 ± 2.4 months) using 24-h dietary recall interviews administered once every 3 weeks over a 6-month period." }, { "infon": 2, "offset": -1, "text": "Breast-milk intake over a 24-h period was measured using the test-weighing method in a subsample of 50 children." }, { "infon": 3, "offset": -1, "text": "Regression effects of age and sex on observed milk intakes were estimated and imputed to the whole sample to estimate mean intake over the observation period." }, { "infon": 4, "offset": -1, "text": "Total energy and nutrient intakes were evaluated for adequacy with reference to published estimates of toddler requirements." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Total energy intake (1029 kcal/day) was adequate, with breast milk supplying an average of 328 kcal/day (32%), but vitamin A, riboflavin, calcium, iron and zinc intakes were below current estimates of required intakes." }, { "infon": 6, "offset": -1, "text": "Observed limitations in nutrient intake were consistent with the finding that almost half of the toddlers were stunted." }, { "infon": 7, "offset": -1, "text": "The prevalence of wasting was 6% at baseline and 4% at final assessment." }, { "infon": 8, "offset": -1, "text": "Although food consumption increased when breastfeeding stopped, it could not fully compensate for the fat and vitamin A previously supplied by breast milk." }, { "infon": 9, "offset": -1, "text": "CONCLUSIONS: The nutritional role of mother's milk in the second year is inversely related to the adequacy of the complementary diet." }, { "infon": 10, "offset": -1, "text": "In this study, breast milk was an irreplaceable source of fat and vitamin A. When the weaning diet is inadequate for key nutrients because of low intake or poor bioavailability, breast milk assumes greater nutritional significance in the second year of life but does not guarantee adequate nutrient intakes." } ] } ] }, { "id": "S0042-96862002000400009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimating human rabies mortality in the United Republic of Tanzania from dog bite injuries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To make quantitative predictions about the magnitude of underreporting of human rabies deaths in the United Republic of Tanzania." }, { "infon": 1, "offset": -1, "text": "METHODS: Human rabies deaths were estimated by using a series of probability steps to calculate the likelihood of rabies developing after the bite of a suspected rabid dog, incorporating field data on the incidence of animal bite injuries, the accuracy of rabies recognition, the distribution of bite wounds, and post-exposure treatment." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Predicted human rabies mortality was estimated to be (a) 1499 deaths per year (95% confidence interval 891-2238), equivalent to an annual incidence of 4.9 (2.9-7.2) deaths/100 000, when active surveillance data on bite incidence were used, and (b) 193 deaths per year (32-409), corresponding to an annual incidence of 0.62 (0.1-1.32) deaths/100 000, when national bite statistics were used." }, { "infon": 3, "offset": -1, "text": "The annual mean number of rabies deaths officially recorded for the same period was 10.8 (7.7-14.0)." }, { "infon": 4, "offset": -1, "text": "CONCLUSION: In the United Republic of Tanzania, cases of rabies in humans have been greatly underreported." }, { "infon": 5, "offset": -1, "text": "Dog bite injuries are an accessible source of epidemiological data that may be used to estimate the public health burden of rabies and to monitor epidemiological trends in developing countries." } ] } ] }, { "id": "S0042-96862002000400011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Questioning the indicators of need for obstetric care." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The difficulties in measuring maternal mortality have led to a shift in emphasis from indicators of health to indicators of use of health care services." }, { "infon": 1, "offset": -1, "text": "Furthermore, the recognition that some women need specialist obstetric care to prevent maternal death has led to the search for indicators measuring the met need for obstetric care." }, { "infon": 2, "offset": -1, "text": "Although intuitively appealing, the conceptualization and definition of the need for obstetric care is far from straightforward, and there is relatively little experience so far in the use and interpretation of indicators of service use or need for obstetric care." }, { "infon": 3, "offset": -1, "text": "In this paper we review indicators of service use and need for obstetric care, and briefly discuss data collection issues." } ] } ] }, { "id": "S0042-96862002000500003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Early detection and response to meningococcal disease epidemics in sub-Saharan Africa: appraisal of the WHO strategy." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the sensitivity, specificity and predictive value positive of the WHO threshold strategy for detecting meningococcal disease epidemics in sub-Saharan Africa and to estimate the impact of the strategy on an epidemic at district level." }, { "infon": 1, "offset": -1, "text": "METHODS: Data on meningitis cases at the district level were collected weekly from health ministries, WHO country and regional offices, and nongovernmental organizations in countries where there were epidemics of meningococcal disease in 1997." }, { "infon": 2, "offset": -1, "text": "An epidemic was defined as a cumulative district attack rate of at least 100 cases per 100 000 population from January to May, the period of epidemic risk." }, { "infon": 3, "offset": -1, "text": "The sensitivity, specificity and predictive value positive of the WHO threshold rate were calculated, and curves of sensitivity against (1 - specificity) were compared with alternatively defined threshold rates and epidemic sizes." }, { "infon": 4, "offset": -1, "text": "The impact of the WHO strategy on a district epidemic was estimated by comparing the numbers of epidemic cases with cases estimated to have been prevented by vaccination." }, { "infon": 5, "offset": -1, "text": "FINDINGS: An analysis was made of 48 198 cases reported in 174 districts in Benin, Burkina Faso, the Gambia, Ghana, Mali, Niger, and Togo." }, { "infon": 6, "offset": -1, "text": "These cases were 80.3% of those reported from Africa to WHO during the 1997 epidemic period." }, { "infon": 7, "offset": -1, "text": "District populations ranged from 10 298 to 573 908." }, { "infon": 8, "offset": -1, "text": "The threshold rate was crossed during two consecutive weeks in 69 districts (39.7%) and there were epidemics in 66 districts (37.9%)." }, { "infon": 9, "offset": -1, "text": "Overall, the sensitivity of the threshold rate for predicting epidemics was 97%, the specificity was 95%, and the predictive value positive was 93%." }, { "infon": 10, "offset": -1, "text": "Taken together, these values were equivalent or better than the sensitivity, specificity and predictive value positive of alternatively defined threshold rates and epidemics, and remained high regardless of district size." }, { "infon": 11, "offset": -1, "text": "The estimated number of potential epidemic cases decreased by nearly 60% in the age group targeted for vaccination in one district where the guidelines were followed in a timely manner." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: The use of the WHO strategy was sensitive and specific for the early detection of meningococcal disease epidemics in countries of sub-Saharan Africa during 1997 and had a substantial impact on a district epidemic." }, { "infon": 13, "offset": -1, "text": "Nevertheless, the burden of meningococcal disease in these countries remains formidable and additional control measures are needed." } ] } ] }, { "id": "S0042-96862002000500005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Using mortuary statistics in the development of an injury surveillance system in Ghana." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To develop, in a mortuary setting, a pilot programme for improving the accuracy of records of deaths caused by injury." }, { "infon": 1, "offset": -1, "text": "METHODS: The recording of injury-related deaths was upgraded at the mortuary of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, in 1996 through the creation of a prospectively gathered database." }, { "infon": 2, "offset": -1, "text": "FINDINGS: There was an increase in the number of deaths reported annually as attributable to injury from 72 before 1995 to 633 in 1996-99." }, { "infon": 3, "offset": -1, "text": "Injuries accounted for 8.6% of all deaths recorded in the mortuary and for 12% of deaths in the age range 15-59 years; 80% of deaths caused by injury occurred outside the hospital and thus would not have been indicated in hospital statistics; 88% of injury-related deaths were associated with transport, and 50% of these involved injuries to pedestrians." }, { "infon": 4, "offset": -1, "text": "CONCLUSIONS: Injury was a significant cause of mortality in this urban African setting, especially among adults of working age." }, { "infon": 5, "offset": -1, "text": "The reporting of injury-related deaths in a mortuary was made more complete and accurate by means of simple inexpensive methods." }, { "infon": 6, "offset": -1, "text": "This source of data could make a significant contribution to an injury surveillance system, along with hospital records and police accident reports." } ] } ] }, { "id": "S0042-96862002000500008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The treatment gap and primary health care for people with epilepsy in rural Gambia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To study primary-level management for people with epilepsy in rural Gambia by means of community surveys." }, { "infon": 1, "offset": -1, "text": "METHODS: After population screening was carried out, visits were made by a physician who described the epidemiology of epilepsy and its management." }, { "infon": 2, "offset": -1, "text": "Gaps between required management and applied management were investigated by conducting interviews and discussions with people with epilepsy and their communities." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The lifetime prevalence of epilepsy was 4.9/1000 and the continuous treatment rate was less than 10%." }, { "infon": 4, "offset": -1, "text": "The choice of treatment was shaped by beliefs in an external spiritual cause of epilepsy and was commonly expected to be curative but not preventive." }, { "infon": 5, "offset": -1, "text": "Treatment rarely led to the control of seizures, although when control was achieved, the level of community acceptance of people with epilepsy increased." }, { "infon": 6, "offset": -1, "text": "Every person with epilepsy had sought traditional treatment." }, { "infon": 7, "offset": -1, "text": "Of the 69 people with active epilepsy, 42 (61%) said they would like to receive preventive biomedical treatment if it were available in their local community." }, { "infon": 8, "offset": -1, "text": "Key programme factors included the local provision of effective treatment and community information with, in parallel, clarification of the use of preventive treatment and genuine integration with current traditional sources of treatment and advice." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Primary-level management of epilepsy could be integrated into a chronic disease programme covering hypertension, diabetes, asthma and mental health." }, { "infon": 10, "offset": -1, "text": "Initial diagnosis and prescribing could take place away from the periphery but recurrent dispensing would be conducted locally." }, { "infon": 11, "offset": -1, "text": "Probable epilepsy etiologies suggest that there is scope for primary prevention through the strengthening of maternal and child health services." } ] } ] }, { "id": "S0042-96862002000500010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Trends and spatial distribution of deaths of children aged 12-60 months in São Paulo, Brazil, 1980-98." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To describe trends in the mortality of children aged 12-60 months and to perform spatial data analysis of its distribution at the inner city district level in São Paulo from 1980 to 1998." }, { "infon": 1, "offset": -1, "text": "METHODS: Official mortality data were analysed in relation to the underlying causes of death." }, { "infon": 2, "offset": -1, "text": "The population of children aged 12-60 months, disaggregated by sex and age, was estimated for each year." }, { "infon": 3, "offset": -1, "text": "Educational levels, income, employment status, and other socioeconomic indices were also assessed." }, { "infon": 4, "offset": -1, "text": "Statistical Package for Social Sciences software was used for the statistical processing of time series." }, { "infon": 5, "offset": -1, "text": "The Cochrane-Orcutt procedure of generalized least squares regression analysis was used to estimate the regression parameters with control of first-order autocorrelation." }, { "infon": 6, "offset": -1, "text": "Spatial data analysis employed the discrimination of death rates and socioeconomic indices at the inner city district level." }, { "infon": 7, "offset": -1, "text": "For classifying area-level death rates the method of K-means cluster analysis was used." }, { "infon": 8, "offset": -1, "text": "Spatial correlation between variables was analysed by the simultaneous autoregressive regression method." }, { "infon": 9, "offset": -1, "text": "FINDINGS: There was a steady decline in death rates during the 1980s at an average rate of 3.08% per year, followed by a levelling off." }, { "infon": 10, "offset": -1, "text": "Infectious diseases remained the major cause of mortality, accounting for 43.1% of deaths during the last three years of the study." }, { "infon": 11, "offset": -1, "text": "Injuries accounted for 16.5% of deaths." }, { "infon": 12, "offset": -1, "text": "Mortality rates at the area level clearly demonstrated inequity in the city's health profile: there was an increasing difference between the rich and the underprivileged social strata in this respect." }, { "infon": 13, "offset": -1, "text": "CONCLUSION: The overall mortality rate among children aged 12-60 months dropped by almost 30% during the study period." }, { "infon": 14, "offset": -1, "text": "Most of the decline happened during the 1980s." }, { "infon": 15, "offset": -1, "text": "Many people still live in a state of deprivation in underserved areas." }, { "infon": 16, "offset": -1, "text": "Time-series and spatial data analysis provided indications of potential value in the planning of social policies promoting well-being, through the identification of factors affecting child survival and the regions with the worst health profiles, to which programmes and resources should be preferentially directed." } ] } ] }, { "id": "S0042-96862002000500013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Definition and measurement of reproductive health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "ABSTRACT: An internationally agreed conceptual definition of reproductive health is applied to the development and testing of practical indicators for use in the community." }, { "infon": 1, "offset": -1, "text": "Basic criteria are proposed for an interview-based tool to measure reproductive health - as opposed to morbidity or mortality - adapting methods from the health status measurement field." }, { "infon": 2, "offset": -1, "text": "Proposed domains and indicators linked to the definition of reproductive health adopted at the International Conference on Population and Development (ICPD) should be comparable across and within diverse populations." }, { "infon": 3, "offset": -1, "text": "Two sets of domains that describe reproductive health are recommended for further development and testing, seven domains that focus directly on health and six others that assess related areas of well-being." } ] } ] }, { "id": "S0042-96862002000600005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The DOTS strategy in China: results and lessons after 10 years." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy." }, { "infon": 1, "offset": -1, "text": "METHODS: We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991 - 2000)." }, { "infon": 2, "offset": -1, "text": "We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation." }, { "infon": 3, "offset": -1, "text": "FINDINGS: From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties." }, { "infon": 4, "offset": -1, "text": "By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured." }, { "infon": 5, "offset": -1, "text": "During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved." }, { "infon": 6, "offset": -1, "text": "Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces)." }, { "infon": 7, "offset": -1, "text": "CONCLUSIONS: The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale." }, { "infon": 8, "offset": -1, "text": "The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project." }, { "infon": 9, "offset": -1, "text": "However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this." } ] } ] }, { "id": "S0042-96862002000600007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost-effectiveness of community health workers in tuberculosis control in Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare the cost-effectiveness of the tuberculosis (TB) programme run by the Bangladesh Rural Advancement Committee (BRAC), which uses community health workers (CHWs), with that of the government TB programme which does not use CHWs." }, { "infon": 1, "offset": -1, "text": "METHODS: TB control statistics and cost data for July 1996 - June 1997 were collected from both government and BRAC thanas (subdistricts) in rural Bangladesh." }, { "infon": 2, "offset": -1, "text": "To measure the cost per patient cured, total costs were divided by the total number of patients cured." }, { "infon": 3, "offset": -1, "text": "FINDINGS: In the BRAC and government areas, respectively, a total of 186 and 185 TB patients were identified over one year, with cure rates among sputum-positive patients of 84% and 82%." }, { "infon": 4, "offset": -1, "text": "However, the cost per patient cured was US$ 64 in the BRAC area compared to US$ 96 in the government area." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: The government programme was 50% more expensive for similar outcomes." }, { "infon": 6, "offset": -1, "text": "Although both the BRAC and government TB control programmes appeared to achieve satisfactory cure rates using DOTS (a five-point strategy), the involvement of CHWs was found to be more cost-effective in rural Bangladesh." }, { "infon": 7, "offset": -1, "text": "With the same budget, the BRAC programme could cure three TB patients for every two in the government programme." } ] } ] }, { "id": "S0042-96862002000600009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Rapid DOTS expansion in India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Since late 1998 the coverage of the DOTS strategy in India has been expanded rapidly." }, { "infon": 1, "offset": -1, "text": "In both 2000 and 2001 the country probably accounted for more than half the global increase in the number of patients treated under DOTS and by early 2002 more than a million patients were being treated in this way in India." }, { "infon": 2, "offset": -1, "text": "As a result, nearly 200 000 lives were saved." }, { "infon": 3, "offset": -1, "text": "The lessons learnt relate to the importance of the following elements of the programme: (1) getting the science right and ensuring technical excellence; (2) building commitment and ensuring the provision of funds and flexibility in their utilization; (3) maintaining focus and priorities; (4) systematically appraising each area before starting service delivery; (5) ensuring an uninterrupted drug supply; (6) strengthening the established infrastructure and providing support for staff; (7) supporting the infrastructure required in urban areas; (8)" }, { "infon": 4, "offset": -1, "text": "ensuring full-time independent technical support and supervision, particularly during the initial phases of implementation; (9) monitoring intensively and giving timely feedback; and (10) continuous supervision." }, { "infon": 5, "offset": -1, "text": "Tuberculosis (TB) control still faces major challenges in India." }, { "infon": 6, "offset": -1, "text": "To reach its potential, the control programme needs to: continue to expand so as to cover the remaining half of the country, much of which has a weaker health infrastructure than the areas already covered; increase its reach in the areas already covered so that a greater proportion of patients is treated; ensure sustainability; improve the patient-friendliness of services; confront TB associated with human immunodeficiency virus (HIV) infection." }, { "infon": 7, "offset": -1, "text": "It is expected that HIV will increase the number of TB cases by at least 10% and by a considerably higher percentage if HIV becomes much more widespread." }, { "infon": 8, "offset": -1, "text": "India's experience shows that DOTS can achieve high case-detection and cure rates even with imperfect technology and often with an inadequate public health infrastructure." }, { "infon": 9, "offset": -1, "text": "However, this can only happen if the delivery programme is appropriately designed and effectively managed." } ] } ] }, { "id": "S0042-96862002000600012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The development of WHO's DOTS strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation and improvement of operational research in this area." }, { "infon": 1, "offset": -1, "text": "From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multicountry projects that were also concerned with health policy and the needs of health systems." }, { "infon": 2, "offset": -1, "text": "The results are now being put into practice by national TB control programmes." }, { "infon": 3, "offset": -1, "text": "In 1998 an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multidrug resistance." }, { "infon": 4, "offset": -1, "text": "An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article." }, { "infon": 5, "offset": -1, "text": "We discuss the prerequisites for success, the shortcomings of this WHO- supported programme, and future challenges and needs." } ] } ] }, { "id": "S0042-96862002000700003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Preventing tuberculosis among health workers in Malawi." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Following the introduction of guidelines for the control of tuberculosis (TB) infection in all hospitals in Malawi, a study was carried out to determine whether the guidelines were being implemented, the time between admission to hospital and the diagnosis of pulmonary TB had been reduced, and the annual case notification rates among health workers had fallen and were comparable to those of primary-school teachers." }, { "infon": 1, "offset": -1, "text": "METHODS: The study involved 40 district and mission hospitals." }, { "infon": 2, "offset": -1, "text": "Staff and patients were interviewed in order to determine whether the guidelines had been adopted." }, { "infon": 3, "offset": -1, "text": "In four hospitals the diagnostic process in patients with smear-positive pulmonary TB was evaluated before and after the introduction of the guidelines, with the aid of case notes and TB registers." }, { "infon": 4, "offset": -1, "text": "In all hospitals the proportion of health workers registered with TB before and after the guidelines were introduced, in 1996 and 1999, respectively, was determined by conducting interviews and consulting staff lists and TB registers." }, { "infon": 5, "offset": -1, "text": "A similar method was used to determine the proportion of primary- school teachers who were registered with TB in 1999." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The guidelines were not uniformly implemented." }, { "infon": 7, "offset": -1, "text": "Only one hospital introduced voluntary counselling and testing for its staff." }, { "infon": 8, "offset": -1, "text": "Most hospitals stated that they used rapid systems to diagnose pulmonary TB." }, { "infon": 9, "offset": -1, "text": "However, there was no significant change in the interval between admission and diagnosis or between admission and treatment of patients with smear-positive pulmonary TB." }, { "infon": 10, "offset": -1, "text": "The TB case notification rate for 2979 health workers in 1999 was 3.2%; this did not differ significantly from the value of 3.7% for 2697 health workers in 1996 but was significantly higher than that of 1.8% for 4367 primary-school teachers in 1999." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: The introduction of guidelines for the control of TB infection is an important intervention for reducing nosocomial transmission of the disease, but rigorous monitoring and follow-up are needed in order to ensure that they are implemented." } ] } ] }, { "id": "S0042-96862002000700006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Street foods in Accra, Ghana: how safe are they?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate the microbial quality of foods sold on streets of Accra and factors predisposing to their contamination." }, { "infon": 1, "offset": -1, "text": "METHODS: Structured questionnaires were used to collect data from 117 street vendors on their vital statistics, personal hygiene, food hygiene and knowledge of foodborne illness." }, { "infon": 2, "offset": -1, "text": "Standard methods were used for the enumeration, isolation, and identification of bacteria." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Most vendors were educated and exhibited good hygiene behaviour." }, { "infon": 4, "offset": -1, "text": "Diarrhoea was defined as the passage of ³3 stools per day) by 110 vendors (94.0%), but none associated diarrhoea with bloody stools; only 21 (17.9%) associated diarrhoea with germs." }, { "infon": 5, "offset": -1, "text": "The surroundings of the vending sites were clean, but four sites (3.4%) were classified as very dirty." }, { "infon": 6, "offset": -1, "text": "The cooking of food well in advance of consumption, exposure of food to flies, and working with food at ground level and by hand were likely risk factors for contamination." }, { "infon": 7, "offset": -1, "text": "Examinations were made of 511 menu items, classified as breakfast/snack foods, main dishes, soups and sauces, and cold dishes." }, { "infon": 8, "offset": -1, "text": "Mesophilic bacteria were detected in 356 foods (69.7%): 28 contained Bacillus cereus (5.5%), 163 contained Staphylococcus aureus (31.9%) and 172 contained Enterobacteriaceae (33.7%)." }, { "infon": 9, "offset": -1, "text": "The microbial quality of most of the foods was within the acceptable limits but samples of salads, macaroni, fufu, omo tuo and red pepper had unacceptable levels of contamination." }, { "infon": 10, "offset": -1, "text": "Shigella sonnei and enteroaggregative Escherichia coli were isolated from macaroni, rice, and tomato stew, and Salmonella arizonae from light soup." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: Street foods can be sources of enteropathogens." }, { "infon": 12, "offset": -1, "text": "Vendors should therefore receive education in food hygiene." }, { "infon": 13, "offset": -1, "text": "Special attention should be given to the causes of diarrhoea, the transmission of diarrhoeal pathogens, the handling of equipment and cooked food, hand-washing practices and environmental hygiene." } ] } ] }, { "id": "S0042-96862002000700008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "An epidemiological study of RSV infection in the Gambia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To describe the epidemiology of respiratory syncytial virus (RSV) infection in a developing country." }, { "infon": 1, "offset": -1, "text": "METHODS: The work was carried out in three hospitals for primary cases and in the community for secondary cases in the western region of the Gambia, West Africa." }, { "infon": 2, "offset": -1, "text": "RSV infection was diagnosed by immunofluorescence of nasopharyngeal aspirate samples in children younger than two years admitted to hospital with acute lower respiratory infection (ALRI)." }, { "infon": 3, "offset": -1, "text": "Routine records of all children with ALRI were analysed, and the incidence rates of ALRI, severe RSV-associated respiratory illness and hypoxaemic RSV infections were compared." }, { "infon": 4, "offset": -1, "text": "A community-based study was undertaken to identify secondary cases and to obtain information about spread of the virus." }, { "infon": 5, "offset": -1, "text": "FINDINGS: 4799 children with ALRI who were younger than two years and lived in the study area were admitted to the study hospitals: 421 had severe RSV-associated respiratory illness; 55 of these were hypoxaemic." }, { "infon": 6, "offset": -1, "text": "Between 1994 and 1996, the observed incidence rate for ALRI in 100 children younger than one year living close to hospital was 9.6 cases per year; for severe RSV-associated respiratory illness 0.83; and for hypoxaemic RSV-associated respiratory illness 0.089." }, { "infon": 7, "offset": -1, "text": "The proportion of all ALRI admissions due to RSV was 19%." }, { "infon": 8, "offset": -1, "text": "Overall, 41% of children younger than five years in compounds in which cases lived and 42% in control compounds had evidence of RSV infection during the surveillance period." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: RSV is an important cause of ALRI leading to hospital admission in the Gambia." }, { "infon": 10, "offset": -1, "text": "Morbidity is considerable and efforts at prevention are worthwhile." } ] } ] }, { "id": "S0042-96862002000700010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Skill mix in the health care workforce: reviewing the evidence." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper discusses the reasons for skill mix among health workers being important for health systems." }, { "infon": 1, "offset": -1, "text": "It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders." }, { "infon": 2, "offset": -1, "text": "Many published studies are merely descriptive accounts or have methodological weaknesses." }, { "infon": 3, "offset": -1, "text": "With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems." }, { "infon": 4, "offset": -1, "text": "The results from even the most rigorous of studies cannot necessarily be applied to a different setting." }, { "infon": 5, "offset": -1, "text": "This reflects the basis on which skill mix should be examined - identifying the care needs of a specific patient population and using these to determine the required skills of staff." }, { "infon": 6, "offset": -1, "text": "It is therefore not possible to prescribe in detail a \"universal\" ideal mix of health personnel." }, { "infon": 7, "offset": -1, "text": "With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix." }, { "infon": 8, "offset": -1, "text": "For the mix of nursing staff, the evidence suggests that increased use of less qualified staff will not be effective in all situations, although in some cases increased use of care assistants has led to greater organizational effectiveness." }, { "infon": 9, "offset": -1, "text": "Evidence on the doctor-nurse overlap indicates that there is unrealized scope in many systems for extending the use of nursing staff." }, { "infon": 10, "offset": -1, "text": "The effectiveness of different skill mixes across other groups of health workers and professions, and the associated issue of developing new roles remain relatively unexplored." } ] } ] }, { "id": "S0042-96862002000700012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mass measles immunization campaign: experience in the Hong Kong Special Administrative Region of China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "After the 1988 measles outbreak, annual notification rates for measles in Hong Kong SAR between 1989 and 1999 were 0.4-4.9 per 100 000, with peaks in 1992, 1994 and 1997." }, { "infon": 1, "offset": -1, "text": "The first half-year incidence rates per 100 000 were 2.3 in 1997, 0.5 in 1995 and 1.2 in 1996." }, { "infon": 2, "offset": -1, "text": "Monthly notification rates increased from a baseline of <10 cases to 59 in May 1997." }, { "infon": 3, "offset": -1, "text": "Serological surveillance showed only 85.5% of children aged 1-19 years had measles antibodies." }, { "infon": 4, "offset": -1, "text": "An epidemic, mainly because of failure of the first dose to produce immunity, seemed imminent in mid-1997." }, { "infon": 5, "offset": -1, "text": "A mass immunization campaign targeted children aged 1-19 from July to November 1997." }, { "infon": 6, "offset": -1, "text": "The overall coverage was 77%." }, { "infon": 7, "offset": -1, "text": "The rate of adverse events was low." }, { "infon": 8, "offset": -1, "text": "After the campaign, measles notification fell to 0.9 per 100 000 in 1998." }, { "infon": 9, "offset": -1, "text": "A two-dose strategy and supplementary campaigns will maintain measles susceptibility at levels low enough to make measles elimination our goal." } ] } ] }, { "id": "S0042-96862002000800005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The use of models in the estimation of disease epidemiology." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To explore the usefulness of incidence-prevalence-mortality (IPM) models in improving estimates of disease epidemiology." }, { "infon": 1, "offset": -1, "text": "METHODS: Two artificial and four empirical data sets (for breast, prostate, colorectal, and stomach cancer) were employed in IPM models." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The internally consistent artificial data sets could be reproduced virtually identically by the models." }, { "infon": 3, "offset": -1, "text": "Our estimates often differed considerably from the empirical data sets, especially for breast and prostate cancer and for older ages." }, { "infon": 4, "offset": -1, "text": "Only for stomach cancer did the estimates approximate to the data, except at older ages." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: There is evidence that the discrepancies between model estimates and observations are caused both by data inaccuracies and past trends in incidence or mortality." }, { "infon": 6, "offset": -1, "text": "Because IPM models cannot distinguish these effects, their use in improving disease estimates becomes complicated." }, { "infon": 7, "offset": -1, "text": "Expert opinion is indispensable in assessing whether the use of these models improves data quality or, inappropriately, removes the effect of trends." } ] } ] }, { "id": "S0042-96862002000800007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Determining median urinary iodine concentration that indicates adequate iodine intake at population level." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Urinary iodine concentration is the prime indicator of nutritional iodine status and is used to evaluate population-based iodine supplementation." }, { "infon": 1, "offset": -1, "text": "In 1994, WHO, UNICEF and ICCIDD recommended median urinary iodine concentrations for populations of 100- 200 µg/l, assuming the 100 µg/l threshold would limit concentrations <50 µg/l to £20% of people." }, { "infon": 2, "offset": -1, "text": "Some scientists felt this proportion was unacceptably high and wanted to increase the threshold above 100 µg/l." }, { "infon": 3, "offset": -1, "text": "The study was carried out to determine the frequency distribution of urinary iodine in iodine-replete populations (schoolchildren and adults) and the proportion of concentrations <50 µg/l." }, { "infon": 4, "offset": -1, "text": "METHOD: A questionnaire on frequency distribution of urinary iodine in iodine-replete populations was circulated to 29 scientific groups." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Nineteen groups reported data from 48 populations with median urinary iodine concentrations >100 µg/l." }, { "infon": 6, "offset": -1, "text": "The total population was 55 892, including 35 661 (64%) schoolchildren." }, { "infon": 7, "offset": -1, "text": "Median urinary iodine concentrations were 111-540 (median 201) µg/l for all populations, 100-199 µg/l in 23 (48%) populations and ³200 µg/l in 25 (52%)." }, { "infon": 8, "offset": -1, "text": "The frequencies of values <50 µg/l were 0-20.8 (mean 4.8%) overall and 7.2% and 2.5% in populations with medians of 100-199 µg/l and >200 µg/l, respectively." }, { "infon": 9, "offset": -1, "text": "The frequency reached 20% only in two places where iodine had been supplemented for <2 years." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: The frequency of urinary iodine concentrations <50 µg/l in populations with median urinary iodine concentrations ³100 µg/l has been overestimated." }, { "infon": 11, "offset": -1, "text": "The threshold of 100 µg/l does not need to be increased." }, { "infon": 12, "offset": -1, "text": "In populations, median urinary iodine concentrations of 100-200 µg/l indicate adequate iodine intake and optimal iodine nutrition." } ] } ] }, { "id": "S0042-96862002000800009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cross-national comparability of burden of disease estimates: the European Disability Weights Project." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate the sources of cross-national variation in disability-adjusted life-years (DALYs) in the European Disability Weights Project." }, { "infon": 1, "offset": -1, "text": "METHODS: Disability weights for 15 disease stages were derived empirically in five countries by means of a standardized procedure and the cross-national differences in visual analogue scale (VAS) scores were analysed." }, { "infon": 2, "offset": -1, "text": "For each country the burden of dementia in women, used as an illustrative example, was estimated in DALYs." }, { "infon": 3, "offset": -1, "text": "An analysis was performed of the relative effects of cross-national variations in demography, epidemiology and disability weights on DALY estimates." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Cross-national comparison of VAS scores showed almost identical ranking orders." }, { "infon": 5, "offset": -1, "text": "After standardization for population size and age structure of the populations, the DALY rates per 100000 women ranged from 1050 in France to 1404 in the Netherlands." }, { "infon": 6, "offset": -1, "text": "Because of uncertainties in the epidemiological data, the extent to which these differences reflected true variation between countries was difficult to estimate." }, { "infon": 7, "offset": -1, "text": "The use of European rather than country-specific disability weights did not lead to a significant change in the burden of disease estimates for dementia." }, { "infon": 8, "offset": -1, "text": "CONCLUSIONS: Sound epidemiological data are the first requirement for burden of disease estimation and relevant between-countries comparisons." }, { "infon": 9, "offset": -1, "text": "DALY estimates for dementia were relatively insensitive to differences in disability weights between European countries." } ] } ] }, { "id": "S0042-96862002000800011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Control of malaria: a successful experience from Viet Nam." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To follow malaria prospectively in an ethnic minority commune in the south of Viet Nam with high malaria transmission and seasonal fluctuation, during malaria control interventions using insecticide-treated bednets (ITBNs) and early diagnosis and treatment (EDT) of symptomatic patients." }, { "infon": 1, "offset": -1, "text": "METHODS: From 1994 onwards the following interventions were used: distribution of ITBNs to all households with biannual reimpregnation; construction of a health post and appointment of staff trained in microscopic diagnosis and treatment of malaria; regular supply of materials and drugs; annual cross-sectional malaria surveys with treatment of all parasitaemic subjects, and a programme of community involvement and health education." }, { "infon": 2, "offset": -1, "text": "Surveys were held yearly at the end of the rainy season." }, { "infon": 3, "offset": -1, "text": "During the surveys, demographic data were updated." }, { "infon": 4, "offset": -1, "text": "Diagnosis and treatment of malaria were free of charge." }, { "infon": 5, "offset": -1, "text": "Plasmodium falciparum infection was treated with artesunate and P. vivax infection with chloroquine plus primaquine." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The baseline survey in 1994 recorded 716inhabitants." }, { "infon": 7, "offset": -1, "text": "Of the children under 2years of age, 37% were parasitaemic; 56% of children aged 2-10 years, and 35% of the remaining population were parasitaemic." }, { "infon": 8, "offset": -1, "text": "P. falciparum accounted for 73-79% of these infections." }, { "infon": 9, "offset": -1, "text": "The respective splenomegaly rates for the above-mentioned age groups were 20%, 56%, and 32%." }, { "infon": 10, "offset": -1, "text": "In 1999, the proportion of parasitaemic subjects was 4%, 7% and 1%, respectively, of which P.falciparum contributed 56%." }, { "infon": 11, "offset": -1, "text": "The splenomegaly rate was 0%, 5% and 2%, respectively." }, { "infon": 12, "offset": -1, "text": "CONCLUSIONS: A combination of ITBNs and EDT, provided free of charge, complemented by annual diagnosis and treatment during malaria surveys and community involvement with health education successfully brought malaria under control." }, { "infon": 13, "offset": -1, "text": "This approach could be applied to other regions in the south of Viet Nam and provides a sound basis for further studies in other areas with different epidemiological patterns of malaria." } ] } ] }, { "id": "S0042-96862002000800013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Improving equity in the provision of primary health care: lessons from decentralized planning and management in Namibia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team." }, { "infon": 1, "offset": -1, "text": "The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration." }, { "infon": 2, "offset": -1, "text": "A survey of the utilization of government clinics was used to develop a more equitable allocation of primary health care services between localities." }, { "infon": 3, "offset": -1, "text": "The survey revealed disparities between patterns of utilization of the services and the allocation of staff: the poorer localities were relatively underprovided." }, { "infon": 4, "offset": -1, "text": "Decisions made centrally on resource allocation had reinforced the inequities." }, { "infon": 5, "offset": -1, "text": "On the basis of the results of the review, the regional health management team redistributed nursing and medical staff and argued for a shift in the allocation of capital expenditure towards the poorer communities." }, { "infon": 6, "offset": -1, "text": "The review demonstrates the potential for regional and provincial health management teams to make effective assessments of the needs of their populations and to promote the equitable delivery of primary health care services." }, { "infon": 7, "offset": -1, "text": "In order to achieve this they need not only to become effective managers, but also to develop population-based planning skills and the confidence and authority to influence the allocation of resources between and within their regions and provinces." } ] } ] }, { "id": "S0042-96862002000900006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "How to reach clients of female sex workers: a survey \"by surprise\" in brothels in Dakar, Senegal." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To describe the sampling techniques and survey procedures used in identifying male clients who frequent brothels to buy sexual services from female sex workers in Dakar, Senegal, with the aim of measuring the prevalence of human immunodeficiency virus (HIV) infection and investigating related risk behaviours." }, { "infon": 1, "offset": -1, "text": "METHODS:Surveys were conducted in seven brothels in Dakar, Senegal." }, { "infon": 2, "offset": -1, "text": "Clients were identified \"by surprise\" and interviewed and requested to donate saliva for HIV testing." }, { "infon": 3, "offset": -1, "text": "RESULTS:Of the 1450 clients of prostitutes who were solicited to enter the study, 1140 (79.8%) agreed to be interviewed; 1083 (95%) of these clients provided saliva samples for testing." }, { "infon": 4, "offset": -1, "text": "Of the samples tested, 47 were positive for HIV-1 or HIV-2, giving an HIV prevalence of 4.4%." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: The procedures adopted were successful in reaching the target population." }, { "infon": 6, "offset": -1, "text": "Men present in the brothels could not deny being there, and it proved possible to explain the purpose of the study and to gain their confidence." }, { "infon": 7, "offset": -1, "text": "Collection of saliva samples was shown to be an excellent method for performing HIV testing in difficult field conditions where it is hard to gain access to the population under study." }, { "infon": 8, "offset": -1, "text": "The surveying of prostitution sites is recommended as a means of identifying core groups for HIV infection with a view to targeting education programmes more effectively." }, { "infon": 9, "offset": -1, "text": "In countries such as Senegal, where the prevalence of HIV infection is still low, interventions among commercial sex workers and their clients may substantially delay the onset of a larger epidemic in the general population." } ] } ] }, { "id": "S0042-96862002000900008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Rating maternal and neonatal health services in developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries." }, { "infon": 1, "offset": -1, "text": "METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country." }, { "infon": 2, "offset": -1, "text": "The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas." }, { "infon": 4, "offset": -1, "text": "Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding." }, { "infon": 5, "offset": -1, "text": "Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas." }, { "infon": 7, "offset": -1, "text": "Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions." }, { "infon": 8, "offset": -1, "text": "Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion." }, { "infon": 9, "offset": -1, "text": "Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion." }, { "infon": 10, "offset": -1, "text": "Increased financing is only part of the solution." } ] } ] }, { "id": "S0042-96862002000900010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Promotion of well-switching to mitigate the current arsenic crisis in Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To survey tube wells and households in Araihazar upazila, Bangladesh, to set the stage for a long-term epidemiological study of the consequences of chronic arsenic exposure." }, { "infon": 1, "offset": -1, "text": "METHODS: Water samples and household data were collected over a period of 4 months in 2000 from 4997 contiguous tube wells serving a population of 55 000, the position of each well being determined to within ± 30 m using Global Positioning System receivers." }, { "infon": 2, "offset": -1, "text": "Arsenic concentrations were determined by graphite-furnace atomic-absorption spectrometry." }, { "infon": 3, "offset": -1, "text": "In addition, groundwater samples collected every 2 weeks for an entire year from six tube wells were analysed for arsenic by high-resolution inductively coupled plasma-mass spectrometry." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Half of the wells surveyed in Araihazar had been installed in the previous 5 years; 94% were privately owned." }, { "infon": 5, "offset": -1, "text": "Only about 48% of the surveyed wells supplied water with an arsenic content below 50 mg/l, the current Bangladesh standard for drinking-water." }, { "infon": 6, "offset": -1, "text": "Similar to other regions of Bangladesh and West Bengal, India, the distribution of arsenic in Araihazar is spatially highly variable (range: 5-860 mg/l) and therefore difficult to predict." }, { "infon": 7, "offset": -1, "text": "Because of this variability, however, close to 90% of the inhabitants live within 100 m of a safe well." }, { "infon": 8, "offset": -1, "text": "Monitoring of six tube wells currently meeting the 50 mg/l standard showed no indication of a seasonal cycle in arsenic concentrations coupled to the hydrological cycle." }, { "infon": 9, "offset": -1, "text": "This suggests that well-switching is a viable option in Araihazar, at least for the short term." }, { "infon": 10, "offset": -1, "text": "CONCLUSIONS: Well-switching should be more systematically encouraged in Araihazar and many other parts of Bangladesh and West Bengal, India." }, { "infon": 11, "offset": -1, "text": "Social barriers to well-switching need to be better understood and, if possible, overcome." } ] } ] }, { "id": "S0042-96862002000900012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Understanding levels of morbidity and hospitalization in Kerala, India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The prevalence of ailments and hospitalization in Kerala was examined using data from the 52nd National Sample Survey Data on Health Care in Kerala in 1995-6." }, { "infon": 1, "offset": -1, "text": "The survey included 24 401 people from 4928 households." }, { "infon": 2, "offset": -1, "text": "Age and seasonality had considerable effects on the morbidity of individuals." }, { "infon": 3, "offset": -1, "text": "The burden of ill health was higher in rural areas than in urban areas." }, { "infon": 4, "offset": -1, "text": "People who were more likely to have a better lifestyle had a higher level of morbidity and hospitalization." }, { "infon": 5, "offset": -1, "text": "Regional differences were seen, with levels of morbidity and hospitalization higher in the comparatively developed regions of Southern Kerala than in Northern Kerala." }, { "infon": 6, "offset": -1, "text": "Factors like physical accessibility of health care services and capacity to seek health care services could create artificial differences in morbidity and hospitalization among different subgroups of the population in Kerala." } ] } ] }, { "id": "S0042-96862002001000004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Factors associated with elevated blood lead concentrations in children in Karachi, Pakistan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To confirm whether blood lead concentrations in Karachi were as high as reported in 1989 and to identify which types of exposure to lead contribute most to elevated blood lead concentrations in children in Karachi." }, { "infon": 1, "offset": -1, "text": "METHODS: A total of 430 children aged 36-60 months were selected through a geographically stratified design from the city centre, two suburbs, a rural community and an island situated within the harbour at Karachi." }, { "infon": 2, "offset": -1, "text": "Blood samples were collected from children and a pretested questionnaire was administered to assess the effect of various types of exposure." }, { "infon": 3, "offset": -1, "text": "Cooked food, drinking-water and house dust samples were collected from households." }, { "infon": 4, "offset": -1, "text": "FINDINGS: About 80% of children had blood lead concentrations 10 µg/dl, with an overall mean of 15.6 µg/dl." }, { "infon": 5, "offset": -1, "text": "At the 5% level of significance, houses nearer to the main intersection in the city centre, application of surma to children's eyes, father's exposure to lead at workplace, parents' illiteracy and child's habit of hand- to-mouth activity were among variables associated with elevated lead concentrations in blood." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: These findings are of public health concern, as most children in Karachi are likely to suffer some degree of intellectual impairment as a result of environmental lead exposure." }, { "infon": 7, "offset": -1, "text": "We believe that there is enough evidence of the continuing problem of lead in petrol to prompt the petroleum industry to take action." }, { "infon": 8, "offset": -1, "text": "The evidence also shows the need for appropriate interventions in reducing the burden due to other factors associated with this toxic element." } ] } ] }, { "id": "S0042-96862002001000006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Use of remote sensing and a geographical information system in a national helminth control programme in Chad." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To design and implement a rapid and valid epidemiological assessment of helminths among schoolchildren in Chad using ecological zones defined by remote sensing satellite sensor data and to investigate the environmental limits of helminth distribution." }, { "infon": 1, "offset": -1, "text": "METHODS: Remote sensing proxy environmental data were used to define seven ecological zones in Chad." }, { "infon": 2, "offset": -1, "text": "These were combined with population data in a geographical information system (GIS) in order to define a sampling protocol." }, { "infon": 3, "offset": -1, "text": "On this basis, 20 schools were surveyed." }, { "infon": 4, "offset": -1, "text": "Multilevel analysis, by means of generalized estimating equations to account for clustering at the school level, was used to investigate the relationship between infection patterns and key environmental variables." }, { "infon": 5, "offset": -1, "text": "FINDINGS: In a sample of 1023 schoolchildren, 22.5% were infected with Schistosoma haematobium and 32.7% with hookworm." }, { "infon": 6, "offset": -1, "text": "None were infected with Ascaris lumbricoides or Trichuris trichiura." }, { "infon": 7, "offset": -1, "text": "The prevalence of S. haematobium and hookworm showed marked geographical heterogeneity and the observed patterns showed a close association with the defined ecological zones and significant relationships with environmental variables." }, { "infon": 8, "offset": -1, "text": "These results contribute towards defining the thermal limits of geohelminth species." }, { "infon": 9, "offset": -1, "text": "Predictions of infection prevalence were made for each school surveyed with the aid of models previously developed for Cameroon." }, { "infon": 10, "offset": -1, "text": "These models correctly predicted that A. lumbricoides and T. trichiura would not occur in Chad but the predictions for S. haematobium were less reliable at the school level." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: GIS and remote sensing can play an important part in the rapid planning of helminth control programmes where little information on disease burden is available." }, { "infon": 12, "offset": -1, "text": "Remote sensing prediction models can indicate patterns of geohelminth infection but can only identify potential areas of high risk for S. haematobium." } ] } ] }, { "id": "S0042-96862002001000008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Sex- and age- specific relations between economic development, economic inequality and homicide rates in people aged 0-24 years: a cross-sectional analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To test whether relations between economic development, economic inequality, and child and youth homicide rates are sex- and age-specific, and whether a country's wealth modifies the impact of economic inequality on homicide rates." }, { "infon": 1, "offset": -1, "text": "METHODS: Outcome variables were homicide rates around 1994 in males and females in the age ranges 0-4, 5-9, 10-14, 15-19 and 20-24 years from 61 countries." }, { "infon": 2, "offset": -1, "text": "Predictor variables were per capita gross domestic product (GDP), GINI coefficient, percentage change in per capita gross national product (GNP) and female economic activity as a percentage of male economic activity." }, { "infon": 3, "offset": -1, "text": "Relations were analysed by ordinary least squares regression." }, { "infon": 4, "offset": -1, "text": "FINDINGS: All predictors explained significant variances in homicide rates in those aged 15-24." }, { "infon": 5, "offset": -1, "text": "Associations were stronger for males than females and weak for children aged 0-9." }, { "infon": 6, "offset": -1, "text": "Models that included female economic inequality and percentage change in GNP increased the effect in children aged 0-9 and the explained variance in females aged 20-24." }, { "infon": 7, "offset": -1, "text": "For children aged 0-4, country clustering by income increased the explained variance for both sexes." }, { "infon": 8, "offset": -1, "text": "For males aged 15-24, the association with economic inequality was strong in countries with low incomes and weak in those with high incomes." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Relations between economic factors and child and youth homicide rates varied with age and sex." }, { "infon": 10, "offset": -1, "text": "Interventions to target economic factors would have the strongest impact on rates of homicide in young adults and late adolescent males." }, { "infon": 11, "offset": -1, "text": "In societies with high economic inequality, redistributing wealth without increasing per capita GDP would reduce homicide rates less than redistributions linked with overall economic development." } ] } ] }, { "id": "S0042-96862002001000010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Evaluation of the Haemoglobin Colour Scale and comparison with the HemoCue haemoglobin assay." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate the Haemoglobin Colour Scale developed by WHO for estimating haemoglobin concentration and to compare the results obtained using it and the HemoCue assay with those determined using a reference method, the Technicon H3 analyser." }, { "infon": 1, "offset": -1, "text": "METHODS: The Colour Scale and HemoCue assay were used to test 408 blood samples." }, { "infon": 2, "offset": -1, "text": "Subsequently, Bland-Altman plots were determined and the proximity of the test results to those obtained using the reference method was determined." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The mean difference between the Haemoglobin Colour Scale and the reference method was 0.19 g/dl (95% confidence interval: 3.50 g/dl below to 3.11 g/dl above); the corresponding value for the HemoCue assay was 0.50 g/dl (1.16 g/dl below to 0.16 g/dl above)." }, { "infon": 4, "offset": -1, "text": "Only 46.08% of the results obtained by means of the Colour Scale were within 1.0 g/dl of the reference method, whereas 95.34% of the HemoCue results fell within this limit; 22.79% of the Colour Scale results but none of the HemoCue results lay more than 2.0 g/dl from the reference method." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: The Haemoglobin Colour Scale test is too inaccurate for general use, particularly if devices such as the HemoCue are available." } ] } ] }, { "id": "S0042-96862002001000012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The impact of the Global Polio Eradication Initiative on the financing of routine immunization: case studies in Bangladesh, Côte d'Ivoire, and Morocco." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "To determine if the Global Polio Eradication Initiative (PEI) affected financing of routine immunization programmes, we compared sources and uses of funds for routine immunization programmes and PEI activities in Bangladesh, Côte d'Ivoire, and Morocco for the years 1993-98." }, { "infon": 1, "offset": -1, "text": "We also examined funding trends for these years in these countries and assessed the effect of the initiative on the availability of specific resources in national immunization programmes, such as cold-chain equipment and personnel time spent on activities related to national immunization days and surveillance of poliomyelitis and acute flaccid paralysis." }, { "infon": 2, "offset": -1, "text": "We found that all three governments and the majority of donors and international organizations continued to fund routine immunization programmes at levels similar to those before the PEI." }, { "infon": 3, "offset": -1, "text": "Trend analysis also indicated that financing for routine immunization in each of the countries continued to increase after the PEI was introduced." }, { "infon": 4, "offset": -1, "text": "The results show that the PEI did not reduce funding for routine immunizations in these countries." } ] } ] }, { "id": "S0042-96862002001100003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Using the two-source capture-recapture method to estimate the incidence of acute flaccid paralysis in Victoria, Australia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the incidence and the completeness of ascertainment of acute flaccid paralysis (AFP) in Victoria, Australia, in 1998-2000 and to determine its common causes among children aged under 15 years." }, { "infon": 1, "offset": -1, "text": "METHODS:: The two-source capture-recapture method was used to estimate the incidence of cases of AFP and to evaluate case ascertainment in the routine surveillance system." }, { "infon": 2, "offset": -1, "text": "The primary and secondary data sources were notifications from this system and inpatient hospital records, respectively." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The routine surveillance system indicated that there were 14 cases and the hospital record review identified 19 additional cases." }, { "infon": 4, "offset": -1, "text": "According to the two-source capture-recapture method, there would have been 40 cases during this period (95% confidence interval (CI) = 29-51), representing an average annual incidence of 1.4 per 100 000 children aged under 15 years (95% CI = 1.1- 1.7)." }, { "infon": 5, "offset": -1, "text": "Thus case ascertainment based on routine surveillance was estimated to be 35% complete." }, { "infon": 6, "offset": -1, "text": "Guillain-Barré syndrome was the commonest single cause of AFP." }, { "infon": 7, "offset": -1, "text": "CONCLUSIONS: Routine surveillance for AFP in Victoria was insensitive." }, { "infon": 8, "offset": -1, "text": "A literature review indicated that the capture-recapture estimates obtained in this study were plausible." }, { "infon": 9, "offset": -1, "text": "The present results help to define a target notification rate for surveillance in settings where poliomyelitis is not endemic." } ] } ] }, { "id": "S0042-96862002001100005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Model-based estimates of risks of disease transmission and economic costs of seven injection devices in sub-Saharan Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate and compare seven types of injection devices for their risks of iatrogenic transmission of bloodborne pathogens and their economic costs in sub-Saharan Africa." }, { "infon": 1, "offset": -1, "text": "METHODS: Risk assumptions for each device and cost models were constructed to estimate the number of new hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections resulting from patient-to-patient, patient-to-health care worker, and patient-to-community transmission." }, { "infon": 2, "offset": -1, "text": "Costs of device purchase and usage were derived from the literature, while costs of direct medical care and lost productivity from HBV and HIV disease were based on data collected in 1999 in Côte d'Ivoire, Ghana, and Uganda." }, { "infon": 3, "offset": -1, "text": "Multivariate sensitivity analyses using Monte Carlo simulation characterized uncertainties in model parameters." }, { "infon": 4, "offset": -1, "text": "Costs were summed from both the societal and health care system payer's perspectives." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Resterilizable and disposable needles and syringes had the highest overall costs for device purchase, usage, and iatrogenic disease: median US$ 26.77 and US$ 25.29, respectively, per injection from the societal perspective." }, { "infon": 6, "offset": -1, "text": "Disposable-cartridge jet injectors and automatic needle-shielding syringes had the lowest costs, US$ 0.36 and US$ 0.80, respectively." }, { "infon": 7, "offset": -1, "text": "Reusable-nozzle jet injectors and auto-disable needle and syringes were intermediate, at US$ 0.80 and US$ 0.91, respectively, per injection." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Despite their nominal purchase and usage costs, conventional needles and syringes carry a hidden but huge burden of iatrogenic disease." }, { "infon": 9, "offset": -1, "text": "Alternative injection devices for the millions of injections administered annually in sub-Saharan Africa would be of value and should be considered by policy-makers in procurement decisions." } ] } ] }, { "id": "S0042-96862002001100007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mortality patterns in the Russian Federation: indirect technique using widowhood data." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: The Russian mortality crisis of the early 1990s attracted considerable attention, but information on possible covariates of mortality is lacking, and concerns have been raised about the validity of official mortality data." }, { "infon": 1, "offset": -1, "text": "To help elucidate the determinants of mortality, we examined whether indirect demographic techniques could be used to study mortality in countries such as the Russian Federation, where mortality data are inadequate, using input data independent from official vital statistics." }, { "infon": 2, "offset": -1, "text": "METHODS: A national sample of the population was interviewed (n = 1600, response rate = 67%)." }, { "infon": 3, "offset": -1, "text": "Participants who had ever been married (82% of the sample) were asked about the date of birth and vital status of their first spouse." }, { "infon": 4, "offset": -1, "text": "Spousal mortality was then estimated indirectly for the 531 men and 710 women for whom valid data were available." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The estimated risk of death between the ages of 35-69 years was 57% for male spouses and 17% for female spouses." }, { "infon": 6, "offset": -1, "text": "Corresponding figures derived from national data for 1990 were 52% and 25% for the Russian Federation, and 31% and 20% for the United Kingdom." }, { "infon": 7, "offset": -1, "text": "According to spouses' reports, 38% of their husbands died from cardiovascular disease, 22% from cancer, and 14% from injuries and accidents." }, { "infon": 8, "offset": -1, "text": "Mortality of male spouses was inversely related to the education level of their wives, and the age-adjusted hazard ratios for death from all causes, compared to primary education, were 0.77 for secondary education and 0.57 for university education (trend P = 0.03)." }, { "infon": 9, "offset": -1, "text": "Mortality was also inversely related to ownership of household items, but not to size of settlement, pride in Russia, membership in the Soviet Communist Party, nationality or self-assessed social status." }, { "infon": 10, "offset": -1, "text": "CONCLUSIONS: Although the indirect estimates were imprecise (partly owing to the small population size of the study), and mortality in women was probably underestimated (owing to many factors, including poorer reporting by males and high male mortality), our results are nevertheless consistent with the mortality pattern observed in official mortality data." }, { "infon": 11, "offset": -1, "text": "The indirect technique thus appears to be a useful tool to study the determinants of mortality in the Russian Federation and other populations, where reliable or sufficiently extensive data are not available." } ] } ] }, { "id": "S0042-96862002001100009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Risk of death following pregnancy in rural Nepal." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate the length of time following pregnancy during which the risk of mortality was elevated among women in rural Nepal." }, { "infon": 1, "offset": -1, "text": "METHODS: An analysis was performed of prospective data on women participating in the control group of a large, population-based trial." }, { "infon": 2, "offset": -1, "text": "Weekly visits were made for three years to 14 805 women aged 14-45 years." }, { "infon": 3, "offset": -1, "text": "Pregnancy and vital status were assessed." }, { "infon": 4, "offset": -1, "text": "A total of 7325 pregnancies were followed." }, { "infon": 5, "offset": -1, "text": "Mortality during and following pregnancy, expressed on a person-time basis, was compared to referent mortality unrelated to pregnancy (52 weeks after pregnancy) in the same cohort." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The relative risk (RR) of death during pregnancy but before the onset of labour was 0.93 (95% confidence interval (CI): 0.38-2.32)." }, { "infon": 7, "offset": -1, "text": "During the perinatal period, defined as lasting from the onset of labour until seven days after outcome, the RR of death was 37.02 (95% CI: 15.03-90.92)." }, { "infon": 8, "offset": -1, "text": "The RR for 2 to 6 weeks, 7 to 12 weeks, and 13 to 52 weeks after pregnancy were 4.82, 2.59 and 1.01 with 95% CI of 1.77-13.07, 0.81-8.26 and 0.40-2.53, respectively." }, { "infon": 9, "offset": -1, "text": "The RR of death was 2.21 (95% CI." }, { "infon": 10, "offset": -1, "text": "1.03-4.71) during the conventional maternal mortality period (pregnancy until 6 weeks after outcome)." }, { "infon": 11, "offset": -1, "text": "It was 2.26 (95% CI: 1.05-4.90) when the period was extended to 12 weeks after pregnancy outcome." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: The risk of mortality associated with pregnancy should be assessed over the first 12 weeks following outcome instead of over the first 6 weeks." } ] } ] }, { "id": "S0042-96862002001100011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Emergency medical care in developing countries: is it worthwhile?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Prevention is a core value of any health system." }, { "infon": 1, "offset": -1, "text": "Nonetheless, many health problems will continue to occur despite preventive services." }, { "infon": 2, "offset": -1, "text": "A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction." }, { "infon": 3, "offset": -1, "text": "The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries." }, { "infon": 4, "offset": -1, "text": "This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries." }, { "infon": 5, "offset": -1, "text": "An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care." }, { "infon": 6, "offset": -1, "text": "We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities." }, { "infon": 7, "offset": -1, "text": "Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services." }, { "infon": 8, "offset": -1, "text": "A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations." } ] } ] }, { "id": "S0042-96862002001200006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Physical activity during leisure and commuting in Tianjin, China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate physical activity during leisure time and commuting among persons aged 15-69 years in the urban population of Tianjin, China, and to assess its associations with demographic and health-related characteristics." }, { "infon": 1, "offset": -1, "text": "METHODS: In 1996 a cross-sectional survey of 2002 males and 1974 females provided information on physical activity during leisure time and commuting and on demographics and health behaviours." }, { "infon": 2, "offset": -1, "text": "FINDINGS: No leisure-time physical activity was engaged in by 67% of females and 61% of males." }, { "infon": 3, "offset": -1, "text": "However, only 4% of females and 9% of males reported an absence of physical activity during commuting." }, { "infon": 4, "offset": -1, "text": "The mean duration of leisure-time physical activity for the whole population was about 10 min per day." }, { "infon": 5, "offset": -1, "text": "The average commuting time on foot or by bicycle was about 30 min. Leisure-time physical activity was more frequent among highly educated people, people with high incomes, white-collar workers, married people, non-smokers, or people commuting on foot or by bicycle than among other people." }, { "infon": 6, "offset": -1, "text": "Persons with low incomes, male blue-collar workers and married people were more likely than others to engage in 30 min or more per day of physical activity on foot or by bicycle when commuting." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: People in Tianjin engaged in a high level of physical activity when commuting and a low level of leisure-time physical activity." } ] } ] }, { "id": "S0042-96862002001200008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "International law and communicable diseases." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Historically, international law has played a key role in global communicable disease surveillance." }, { "infon": 1, "offset": -1, "text": "Throughout the nineteenth century, international law played a dominant role in harmonizing the inconsistent national quarantine regulations of European nation-states; facilitating the exchange of epidemiological information on infectious diseases; establishing international health organizations; and standardization of surveillance." }, { "infon": 2, "offset": -1, "text": "Today, communicable diseases have continued to re-shape the boundaries of global health governance through legally binding and \"soft-law\" regimes negotiated and adopted within the mandate of multilateral institutions - the World Health Organization, the World Trade Organization, the Food and Agriculture Organization, and the Office International des Epizooties." }, { "infon": 3, "offset": -1, "text": "The globalization of public health has employed international law as an indispensable tool in global health governance aimed at diminishing human vulnerability to the mortality and morbidity burdens of communicable diseases." } ] } ] }, { "id": "S0042-96862002001200010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Biomedicine and international human rights law: in search of a global consensus." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Global challenges raised by biomedical advances require global responses." }, { "infon": 1, "offset": -1, "text": "Some international organizations have made significant efforts over the last few years to establish common standards that can be regarded as the beginning of an international biomedical law." }, { "infon": 2, "offset": -1, "text": "One of the main features of this new legal discipline is the integration of its principles into a human rights framework." }, { "infon": 3, "offset": -1, "text": "This strategy seems the most appropriate, given the role of \"universal ethics\" that human rights play in our world of philosophical pluralism." }, { "infon": 4, "offset": -1, "text": "In addition to the general standards that are gradually being established, a widespread consensus exists on the urgency of preventing two specific procedures: human germ-line interventions and human reproductive cloning." } ] } ] }, { "id": "S0042-96862002001200012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "International environmental law and global public health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The environment continues to be a source of ill-health for many people, particularly in developing countries." }, { "infon": 1, "offset": -1, "text": "International environmental law offers a viable strategy for enhancing public health through the promotion of increased awareness of the linkages between health and environment, mobilization of technical and financial resources, strengthening of research and monitoring, enforcement of health-related standards, and promotion of global cooperation." }, { "infon": 2, "offset": -1, "text": "An enhanced capacity to utilize international environmental law could lead to significant worldwide gains in public health." } ] } ] }, { "id": "S0042-96862003000100003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Compatible poliomyelitis cases in India during 2000." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To describe the characteristics of compatible poliomyelitis cases and to assess the programmatic implications of clusters of such cases in India." }, { "infon": 1, "offset": -1, "text": "METHODS: We described the characteristics of compatible poliomyelitis cases, identified clusters of compatible cases (two or more in the same district or neighbouring districts within two months), and examined their relationship to wild poliovirus cases." }, { "infon": 2, "offset": -1, "text": "FINDINGS: There were 362 compatible cases in 2000." }, { "infon": 3, "offset": -1, "text": "The incidence of compatible cases was higher in districts with laboratory-confirmed poliomyelitis cases than in districts without laboratory-confirmed cases." }, { "infon": 4, "offset": -1, "text": "Of 580 districts, 96 reported one compatible case and 72 reported two or more compatible cases." }, { "infon": 5, "offset": -1, "text": "Among these 168 districts with at least one compatible case, 123 had internal or cross- border clusters of compatible cases." }, { "infon": 6, "offset": -1, "text": "In 27 districts with clusters of compatible cases, no wild poliovirus was isolated either in the same district or in neighbouring districts." }, { "infon": 7, "offset": -1, "text": "Three of these 27 districts presented laboratory-confirmed poliomyelitis cases during 2001." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Most clusters of compatible cases occurred in districts identified as areas with continuing wild poliovirus transmission and where mopping-up vaccination campaigns were carried out." }, { "infon": 9, "offset": -1, "text": "As certification nears, areas with compatible poliomyelitis cases should be investigated and deficiencies in surveillance should be corrected in order to ensure that certification is justified." } ] } ] }, { "id": "S0042-96862003000100006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The cost of diabetes in Latin America and the Caribbean." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJETIVE: To measure the economic burden associated with diabetes mellitus in Latin America and the Caribbean." }, { "infon": 1, "offset": -1, "text": "METHODS: Prevalence estimates of diabetes for the year 2000 were used to calculated direct and indirect costs of diabetes mellitus." }, { "infon": 2, "offset": -1, "text": "Direct costs included costs due to drugs, hospitalizations, consultations and management of complications." }, { "infon": 3, "offset": -1, "text": "The human capital approach was used to calculate indirect costs and included calculations of forgone earnings due to premature mortality and disability attributed to diabetes mellitus." }, { "infon": 4, "offset": -1, "text": "Mortality and disability attributed to causes other than diabetes were subtracted from estimates to consider only the excess burden due to diabetes." }, { "infon": 5, "offset": -1, "text": "A 3% discount rate was used to convert future earnings to current value." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The annual number of deaths in 2000 caused by diabetes mellitus was estimated at 339 035." }, { "infon": 7, "offset": -1, "text": "This represented a loss of 757 096 discounted years of productive life among persons younger than 65 years (US$ 3 billion)." }, { "infon": 8, "offset": -1, "text": "Permanent disability caused a loss of 12 699 087 years and over US$ 50 billion, and temporary disability caused a loss of 136 701 years in the working population and over US$ 763 million." }, { "infon": 9, "offset": -1, "text": "Costs associated with insulin and oral medications were US$ 4720 million, hospitalizations US$ 1012 million, consultations US$ 2508 million and care for complications US$ 2 480 million." }, { "infon": 10, "offset": -1, "text": "The total annual cost associated with diabetes was estimated as US$ 65 216 million (direct US$ 10 721; indirect US$ 54 496)." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: Despite limitations of the data, diabetes imposes a high economic burden to individuals and society in all countries and to Latin American and the Caribbean as whole." } ] } ] }, { "id": "S0042-96862003000100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A comparison of the efficacy of single doses of albendazole, ivermectin, and diethylcarbamazine alone or in combinations against Ascaris and Trichuris spp.." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the efficacy of single doses of albendazole, ivermectin and diethylcarbamazine, and of the combinations albendazole + ivermectin and albendazole + diethylcarbamazine against common intestinal helminthiases caused by Ascaris and Trichuris spp. METHODS: In a randomized, placebo-controlled trial, infected children were randomly assigned to treatment with albendazole + placebo, ivermectin + placebo, diethylcarbamazine + placebo, albendazole + ivermectin, or albendazole + diethylcarbamazine." }, { "infon": 1, "offset": -1, "text": "The Kato-Katz method was used for qualitative and quantitative parasitological diagnosis." }, { "infon": 2, "offset": -1, "text": "The c2 test was used to determine the significance of cure rates, repeated measures analysis of variance for the comparison of mean log egg counts, the Newman-Keuls procedure for multiple comparison tests, and logistic regression for the comparison of infection rates at days 180 and 360 after treatment." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Albendazole, ivermectin and the drug combinations gave significantly higher cure and egg reduction rates for ascariasis than diethylcarbamazine." }, { "infon": 4, "offset": -1, "text": "For trichuriasis, albendazole + ivermectin gave significantly higher cure and egg reduction rates than the other treatments: the infection rates were lower 180 and 360 days after treatment." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: Because of the superiority of albendazole + ivermectin against both lymphatic filariasis and trichuriasis, this combination appears to be a suitable tool for the integrated or combined control of both public health problems." } ] } ] }, { "id": "S0042-96862003000100011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Domestic violence in rural Uganda: evidence from a community-based study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Although domestic violence is an increasing public health concern in developing countries, evidence from representative, community-based studies is limited." }, { "infon": 1, "offset": -1, "text": "In a survey of 5109 women of reproductive age in the Rakai District of Uganda, 30% of women had experienced physical threats or physical abuse from their current partner - 20% during the year before the survey." }, { "infon": 2, "offset": -1, "text": "Three of five women who reported recent physical threats or abuse reported three or more specific acts of violence during the preceding year, and just under a half reported injuries as a result." }, { "infon": 3, "offset": -1, "text": "Analysis of risk factors highlights the pivotal roles of the male partner's alcohol consumption and his perceived human immunodeficiency virus (HIV) risk in increasing the risk of male against female domestic violence." }, { "infon": 4, "offset": -1, "text": "Most respondents - 70% of men and 90% of women - viewed beating of the wife or female partner as justifiable in some circumstances, posing a central challenge to preventing violence in such settings." } ] } ] }, { "id": "S0042-96862003000200003", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Contribution of breastfeeding to vitamin A nutrition of infants: a simulation model." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To provide information on the potential contribution to vitamin A nutrition in infants of strategies for improving maternal vitamin A status and increasing the consumption of breast milk." }, { "infon": 1, "offset": -1, "text": "METHODS: The contribution of breastfeeding to the vitamin A nutrition of children in eight age groups between 0 and 24 months was simulated under four sets of conditions involving two levels of breast milk consumption with or without maternal vitamin A supplementation." }, { "infon": 2, "offset": -1, "text": "FINDINGS: During the first 6 months, optimal breastfeeding on its own (compared with withholding colostrum and then partially breastfeeding after the first week) was as effective as postpartum maternal supplementation alone, retinol intakes being increased by 59 mg per day and 68 mg per day, respectively." }, { "infon": 3, "offset": -1, "text": "Combined in synergy, these strategies increase retinol intake by 144 mg per day, or 36% of the recommended intake." }, { "infon": 4, "offset": -1, "text": "After 6 months, partial breastfeeding continued to provide a significant proportion of the recommended intakes: 42% from 6-12 months and 61% during the second year." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: Maternal supplementation with a high dose of vitamin A at the time of delivery and the promotion of optimal breastfeeding practices are highly effective strategies for improving vitamin A nutrition in infants and should be strengthened as key components of comprehensive child survival programmes." } ] } ] }, { "id": "S0042-96862003000200005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Decentralization and equity of resource allocation: evidence from Colombia and Chile." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate the relation between decentralization and equity of resource allocation in Colombia and Chile." }, { "infon": 1, "offset": -1, "text": "METHODS: The \"decision space\" approach and analysis of expenditures and utilization rates were used to provide a comparative analysis of decentralization of the health systems of Colombia and Chile." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation." }, { "infon": 3, "offset": -1, "text": "In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization - the use of allocation formulae, adequate local funding choices and horizontal equity funds." }, { "infon": 4, "offset": -1, "text": "Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization." }, { "infon": 5, "offset": -1, "text": "This suggests that improved equity of funding over time might reduce inequities of service utilization." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Decentralization can contribute to, or at least maintain, equitable allocation of health resources among municipalities of different incomes." } ] } ] }, { "id": "S0042-96862003000200007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Use of microencapsulated iron(II) fumarate sprinkles to prevent recurrence of anaemia in infants and young children at high risk." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare the effectiveness of microencapsulated iron(II) fumarate sprinkles (with and without vitamin A), iron(II) sulfate drops, and placebo sprinkles in preventing recurrence of anaemia and to determine the long-term haematological outcomes in children at high risk of recurrence of anaemia 12 months after the end of supplementation." }, { "infon": 1, "offset": -1, "text": "METHODS: A prospective, randomized, placebo-controlled design was used to study 437 Ghanaian children aged 8-20 months who were not anaemic (haemoglobin 5100 g/l)." }, { "infon": 2, "offset": -1, "text": "Four groups were given microencapsulated iron(II) fumarate sprinkles, microencapsulated iron(II) fumarate sprinkles with vitamin A, iron(II) sulfate drops or placebo sprinkles daily for six months." }, { "infon": 3, "offset": -1, "text": "Primary outcome measures were change in haemoglobin and anaemic status at baseline and study end." }, { "infon": 4, "offset": -1, "text": "Non-anaemic children at the end of the supplementation period were reassessed 12 months after supplementation ended." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Overall, 324 children completed the supplementation period." }, { "infon": 6, "offset": -1, "text": "Among the four groups, no significant changes were seen in mean haemoglobin, ferritin or serum retinol values from baseline to the end of the supplementation period." }, { "infon": 7, "offset": -1, "text": "During the trial, 82.4% (267/324) of children maintained their non-anaemic status." }, { "infon": 8, "offset": -1, "text": "Sprinkles were well accepted without complications." }, { "infon": 9, "offset": -1, "text": "At 12 months post-supplementation, 77.1% (162/ 210) of children with no intervention remained non-anaemic." }, { "infon": 10, "offset": -1, "text": "This proportion was similar for children among the four groups." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: In most children previously treated for anaemia, further supplementation was not needed to maintain their non-anaemic status." }, { "infon": 12, "offset": -1, "text": "These results may have important implications for community intervention programmes in which initial high-dose treatment is needed because of a high prevalence of anaemia." } ] } ] }, { "id": "S0042-96862003000200010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Shifting the burden: the private sector's response to the AIDS epidemic in Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing." }, { "infon": 1, "offset": -1, "text": "The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector." }, { "infon": 2, "offset": -1, "text": "Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies." }, { "infon": 3, "offset": -1, "text": "Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions." }, { "infon": 4, "offset": -1, "text": "Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS." }, { "infon": 5, "offset": -1, "text": "Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government." }, { "infon": 6, "offset": -1, "text": "Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS." }, { "infon": 7, "offset": -1, "text": "We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed." }, { "infon": 8, "offset": -1, "text": "Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved." } ] } ] }, { "id": "S0042-96862003000300006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate whether the outpatient, syndrome-based approach of the Integrated Management of Childhood Illness (IMCI) protocol could be extended to the inpatient arena to give clear and simple minimum standards of care for poorly resourced facilities." }, { "infon": 1, "offset": -1, "text": "METHODS: A prospective, one-year admission cohort retrospectively compared hypothetical performance of syndrome-based management with paediatrician-defined final diagnosis." }, { "infon": 2, "offset": -1, "text": "Admission syndrome definitions were based on local adaptations to the IMCI protocol that encompassed 20 clinical features, measurement of oxygen saturation, and malaria microscopy." }, { "infon": 3, "offset": -1, "text": "FINDINGS: After 315 children with clinically obvious diagnoses (e.g. sickle cell disease and burns) were excluded, 3705 admission episodes were studied." }, { "infon": 4, "offset": -1, "text": "Of these, 2334 (63%) met criteria for at least one severe syndrome (mortality 8% vs <1% for \"non-severe\" cases), and half of these had features of two or more severe syndromes." }, { "infon": 5, "offset": -1, "text": "No cases of measles were seen." }, { "infon": 6, "offset": -1, "text": "Syndrome-based treatment would have been appropriate (sensitivity >95%) for severe pneumonia, severe malaria, and diarrhoea with severe dehydration, and probably for severe malnutrition (sensitivity 71%)." }, { "infon": 7, "offset": -1, "text": "Syndrome-directed treatment suggested the use of broad-spectrum antibiotics in 75/133 (56% sensitivity) children with bacteraemic and 63/71 (89% sensitivity) children with meningitis." }, { "infon": 8, "offset": -1, "text": "CONCLUSIONS: Twenty clinical features, oxygen saturation measurements, and results of malaria blood slides could be used for inpatient, syndrome-based management of acute paediatric admissions." }, { "infon": 9, "offset": -1, "text": "The addition of microscopy of the cerebrospinal fluid and haemoglobin measurements would improve syndrome-directed treatment considerably." }, { "infon": 10, "offset": -1, "text": "This approach might rationalize admission policy and standardize inpatient paediatric care in resource-poor countries, although the clinical detection of bacteraemia remains a problem." } ] } ] }, { "id": "S0042-96862003000300008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Management of acute respiratory infections by community health volunteers: experience of Bangladesh Rural Advancement Committee (BRAC)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the role of management practices for acute respiratory infections (ARIs) in improving the competency of community health volunteers in diagnosing and treating acute respiratory infections among children." }, { "infon": 1, "offset": -1, "text": "METHODS: Data were collected by a group of research physicians who observed the performance of a sample of 120 health volunteers in 10 sub-districts in Bangladesh in which Bangladesh Rural Advancement Committee (BRAC) had run a community-based ARI control programme since mid-1992." }, { "infon": 2, "offset": -1, "text": "Standardized tests were conducted until the 95% interphysician reliability on the observation of clinical examination was achieved." }, { "infon": 3, "offset": -1, "text": "FINDINGS:The sensitivity, specificity, and overall agreement rates in diagnosing and treating ARIs were significantly higher among the health volunteers who had basic training and were supervised routinely than among those who had not." }, { "infon": 4, "offset": -1, "text": "CONCLUSION: Diagnosis and treatment of ARIs at the household level in developing countries are possible if intensive basic training and the close supervision of service providers are ensured." } ] } ] }, { "id": "S0042-96862003000300010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Current estimates of the global burden of disease for diarrhoea are reported and compared with previous estimates made using data collected in 1954-79 and 1980-89." }, { "infon": 1, "offset": -1, "text": "A structured literature review was used to identify studies that characterized morbidity rates by prospective surveillance of stable populations and studies that characterized mortality attributable to diarrhoea through active surveillance." }, { "infon": 2, "offset": -1, "text": "For children under 5 years of age in developing areas and countries, there was a median of 3.2 episodes of diarrhoea per child-year." }, { "infon": 3, "offset": -1, "text": "This indicated little change from previously described incidences." }, { "infon": 4, "offset": -1, "text": "Estimates of mortality revealed that 4.9 children per 1000 per year in these areas and countries died as a result of diarrhoeal illness in the first 5 years of life, a decline from the previous estimates of 13.6 and 5.6 per 1000 per year." }, { "infon": 5, "offset": -1, "text": "The decrease was most pronounced in children aged under 1 year." }, { "infon": 6, "offset": -1, "text": "Despite improving trends in mortality rates, diarrhoea accounted for a median of 21% of all deaths of children aged under 5 years in these areas and countries, being responsible for 2.5 million deaths per year." }, { "infon": 7, "offset": -1, "text": "There has not been a concurrent decrease in morbidity rates attributable to diarrhoea." }, { "infon": 8, "offset": -1, "text": "As population growth is focused in the poorest areas, the total morbidity component of the disease burden is greater than previously." } ] } ] }, { "id": "S0042-96862003000300012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The Singapore Tuberculosis Elimination Programme: the first five years." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Singapore Tuberculosis Elimination Programme (STEP) was launched in 1997 because the incidence of the disease had remained between 49 and 56 per 100 000 resident population for the preceding 10 years." }, { "infon": 1, "offset": -1, "text": "STEP involves the following key interventions: directly observed therapy (DOT) in public primary health care clinics; monitoring of treatment progress and outcome for all cases by means of a National Treatment Surveillance Registry; and preventive therapy for recently infected close contacts of infectious tuberculosis cases." }, { "infon": 2, "offset": -1, "text": "Among other activities are the revamping of the National Tuberculosis Notification Registry, the discontinuation of BCG revaccination for schoolchildren, the tightening up of defaulter tracing, and the education of the medical community and the public." }, { "infon": 3, "offset": -1, "text": "Future plans include an outreach programme for specific groups of patients who are unable to attend their nearest public primary care clinics for DOT, the detention of infectious recalcitrant defaulters for treatment under the Infectious Diseases Act, the molecular fingerprinting of tuberculosis isolates, and targeted screening of high-risk groups." }, { "infon": 4, "offset": -1, "text": "The incidence of tuberculosis fell from 57 per 100 000 population in 1998 to 48 per 100 000 in 1999 and continued to decline to 44 per 100 000 in 2001." }, { "infon": 5, "offset": -1, "text": "With political will and commitment and the support of the medical community and the public it is hoped that STEP will achieve further progress towards the elimination of tuberculosis in Singapore." } ] } ] }, { "id": "S0042-96862003000400005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality." }, { "infon": 1, "offset": -1, "text": "METHODS: In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India)." }, { "infon": 2, "offset": -1, "text": "Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months." }, { "infon": 3, "offset": -1, "text": "A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles." }, { "infon": 5, "offset": -1, "text": "Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9)." }, { "infon": 6, "offset": -1, "text": "A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population." }, { "infon": 8, "offset": -1, "text": "If true, children in lower castes may reap the greatest gains in survival." }, { "infon": 9, "offset": -1, "text": "The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder." }, { "infon": 10, "offset": -1, "text": "\"All-cause mortality\" is a potentially useful epidemiological endpoint for future vaccine trials." } ] } ] }, { "id": "S0042-96862003000400007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Self-treatment of malaria in rural communities, Butajira, southern Ethiopia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To quantify the use of self-treatment and to determine the actions taken to manage malaria illness." }, { "infon": 1, "offset": -1, "text": "METHODS: A cross-sectional study was undertaken in six peasant associations in Butajira district, southern Ethiopia, between January and September 1999." }, { "infon": 2, "offset": -1, "text": "Simple random sampling was used to select a sample of 630 households with malaria cases within the last six months." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Overall, 616 (>97%) of the study households acted to manage malaria, including the use of antimalarial drugs at home (112, 17.8%), visiting health services after taking medication at home (294, 46.7%), and taking malaria patients to health care facilities without home treatment (210, 33.3%)." }, { "infon": 4, "offset": -1, "text": "Although 406 (64.5%) of the households initiated treatment at home, the use of modern drugs was higher (579, 92%) than that of traditional medicine (51, 8%)." }, { "infon": 5, "offset": -1, "text": "Modern drugs used included chloroquine (457, 73.5%) and sulfadoxine-pyrimethamine (377, 60.6%)." }, { "infon": 6, "offset": -1, "text": "Malaria control programmes were the main sources of antimalarials." }, { "infon": 7, "offset": -1, "text": "In most cases of malaria, treatment was started (322, 52.3%) or health services visited (175, 34.7%) within two days of the onset of symptoms." }, { "infon": 8, "offset": -1, "text": "Cases of malaria in the lowland areas started treatment and visited health services longer after the onset of malaria than those in the midland areas (adjusted odds ratio, 0.44; 95% confidence interval (CI), 0.30-0.64; and adjusted odds ratio, 0.37; 95% CI, 0.25-0.56, respectively)." }, { "infon": 9, "offset": -1, "text": "Similarly, those further than one hour's walk from the nearest health care facility initiated treatment later than those with less than one hour's walk (adjusted odds ratio, 0.62; 95% CI 0.43-0.87)." }, { "infon": 10, "offset": -1, "text": "This might be because of inaccessibility to antimalarial drugs and distant health care facilities in the lowland areas; however, statistically insignificant associations were found for sex, age, and religion." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: Self-treatment at home is the major action taken to manage malaria." }, { "infon": 12, "offset": -1, "text": "Efforts should be made to improve the availability of effective antimalarials to communities in rural areas with malaria, particularly through the use of community health workers, mother coordinators, drug sellers, and shop owners." } ] } ] }, { "id": "S0042-96862003000400009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Poor injection practices transmit potentially life-threatening pathogens." }, { "infon": 1, "offset": -1, "text": "We modelled the cost-effectiveness of policies for the safe and appropriate use of injections in ten epidemiological subregions of the world in terms of cost per disability-adjusted life year (DALY) averted." }, { "infon": 2, "offset": -1, "text": "METHODS: The incidence of injection-associated hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections was modelled for a year 2000 cohort over a 30-year time horizon." }, { "infon": 3, "offset": -1, "text": "The consequences of a \"do nothing\" scenario were compared with a set of hypothetical scenarios that incorporated the health gains of effective interventions." }, { "infon": 4, "offset": -1, "text": "Resources needed to implement effective interventions were costed for each subregion and expressed in international dollars (I$)." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Worldwide, the reuse of injection equipment in the year 2000 accounted for 32%, 40%, and 5% of new HBV, HCV and HIV infections, respectively, leading to a burden of 9.18 million DALYs between 2000 and 2030." }, { "infon": 6, "offset": -1, "text": "Interventions implemented in the year 2000 for the safe (provision of single-use syringes, assumed effectiveness 95%) and appropriate (patients-providers interactional group discussions, assumed effectiveness 30%) use of injections could reduce the burden of injection-associated infections by as much as 96.5% (8.86 million DALYs) for an average yearly cost of I$ 905 million (average cost per DALY averted, 102; range by region, 14-2293)." }, { "infon": 7, "offset": -1, "text": "Attributable fractions and the number of syringes and needles required represented the key sources of uncertainty." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: In all subregions studied, each DALY averted through policies for the safe and appropriate use of injections costs considerably less than one year of average per capita income, which makes such policies a sound investment for health care." } ] } ] }, { "id": "S0042-96862003000400011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A new face for private providers in developing countries: what implications for public health?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate." }, { "infon": 1, "offset": -1, "text": "We review here a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardized primary care services at relatively low cost." }, { "infon": 2, "offset": -1, "text": "The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic." }, { "infon": 3, "offset": -1, "text": "In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics." }, { "infon": 4, "offset": -1, "text": "However, their current role in tackling important public health problems was limited." }, { "infon": 5, "offset": -1, "text": "The implications for public health policy of the emergence of this new model of private provider are discussed." }, { "infon": 6, "offset": -1, "text": "It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government." }, { "infon": 7, "offset": -1, "text": "Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened." }, { "infon": 8, "offset": -1, "text": "However, the constraints to implementing such a system successfully are notable, and these are acknowledged." }, { "infon": 9, "offset": -1, "text": "Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives." } ] } ] }, { "id": "S0042-96862003000500007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost-effectiveness of routine immunization to control Japanese encephalitis in Shanghai, China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Objective: To assess the cost-effectiveness of inactivated and live attenuated Japanese encephalitis (JE) vaccines given to infants and children in Shanghai." }, { "infon": 1, "offset": -1, "text": "Methods: A decision-analytical model was constructed in order to compare costs and outcomes for three hypothetical cohorts of 100 000 children followed from birth in 1997 to the age of 30 years who received either no JE vaccine, inactivated JE vaccine (P3), or live attenuated JE vaccine (SA 14-14-2)." }, { "infon": 2, "offset": -1, "text": "Cumulative incidences of JE from birth to 30 years of age in the pre-immunization era, i.e. before 1968, were used to estimate expected rates of JE in the absence of vaccination." }, { "infon": 3, "offset": -1, "text": "The economic consequences were measured as cost per case, per death, and per disability-adjusted life year (DALY) averted for the two JE immunization programmes." }, { "infon": 4, "offset": -1, "text": "Findings: In comparison with no JE immunization, a programme using the P3 vaccine would prevent 420 JE cases and 105 JE deaths and would save 6456 DALYs per 100 000 persons; the use of the SA 14-14-2 vaccine would prevent 427 cases and 107 deaths and would save 6556 DALYs per 100 000 persons." }, { "infon": 5, "offset": -1, "text": "Both kinds of immunization were cost saving but the SA 14-14-2 vaccine strategy resulted in a saving that was 47% greater (US$ 512 456) than that obtained with the P3 vaccine strategy (US$ 348 246)." }, { "infon": 6, "offset": -1, "text": "Conclusion: Both JE immunization strategies resulted in cost savings in comparison with no JE immunization." }, { "infon": 7, "offset": -1, "text": "This provides a strong economic rationale for vaccinating against JE in Shanghai and suggests that vaccination against JE might be economically justifiable in other parts of China and in certain other developing countries of Asia where the disease is endemic." } ] } ] }, { "id": "S0042-96862003000500009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Treatment of cutaneous leishmaniasis with aminosidine (paromomycin) ointment: double-blind, randomized trial in the Islamic Republic of Iran." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Objective: To compare the parasitological and clinical efficacy of four weeks versus two weeks of treatment with aminosidine (paromomycin) ointment in patients with cutaneous leishmaniasis caused by Leishmania major in the Islamic Republic of Iran." }, { "infon": 1, "offset": -1, "text": "Methods: Double-blind, randomized trial of four weeks of aminosidine ointment (n = 108) vs two weeks of aminosidine ointment and two weeks of placebo (n = 108)." }, { "infon": 2, "offset": -1, "text": "Patients were assessed on days 15, 29, 45, and 105 for clinical cures and clinical and parasitological cures." }, { "infon": 3, "offset": -1, "text": "Findings: Four weeks' treatment gave significantly better cure rates than two weeks' treatment: on day 29, there were 80/108 (74%) vs 64/108 (59%) clinical cures (P = 0.05) and 47 (44%) vs 26 (24%) clinical and parasitological cures (P = 0.005)." }, { "infon": 4, "offset": -1, "text": "By day 45, fewer patients who received four weeks' treatment had required rescue treatment with antimonials than those who received two weeks' treatment: 20 (19%) vs 36 (33%) (P = 0.02)." }, { "infon": 5, "offset": -1, "text": "On day 105, the results still favoured those who had been allocated four weeks of active treatment, but the differences were no longer as clearly significant." }, { "infon": 6, "offset": -1, "text": "No side-effects were observed or reported." }, { "infon": 7, "offset": -1, "text": "Conclusion: Approximately two-thirds of patients given ointment for four weeks were cured clinically." }, { "infon": 8, "offset": -1, "text": "Although about half of those cured might have recovered spontaneously even without treatment, four weeks of aminosidine ointment could become the first-line treatment for uncomplicated cutaneous leishmaniasis due to L. major, with antimonials needed in only the one-third of patients not cured by the end of treatment with aminosidine." }, { "infon": 9, "offset": -1, "text": "This would considerably reduce the costs and side-effects associated with antimonial drugs." } ] } ] }, { "id": "S0042-96862003000500011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Evidence on the use of paracetamol in febrile children." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Antipyretics, including acetaminophen (paracetamol), are prescribed commonly in children with pyrexia, despite minimal evidence of a clinical benefit." }, { "infon": 1, "offset": -1, "text": "A literature review was performed by searching Medline and the Cochrane databases for research papers on the efficacy of paracetamol in febrile illnesses in children and adverse outcomes related to the use of paracetamol." }, { "infon": 2, "offset": -1, "text": "No studies showed any clear benefit for the use of paracetamol in therapeutic doses in febrile children with viral or bacterial infections or with malaria." }, { "infon": 3, "offset": -1, "text": "Some studies suggested that fever may have a beneficial role in infection, although no definitive prospective studies in children have been done to prove this." }, { "infon": 4, "offset": -1, "text": "The use of paracetamol in therapeutic doses generally is safe, although hepatotoxicity has occurred with recommended dosages in children." }, { "infon": 5, "offset": -1, "text": "In developing countries where malnutrition is common, data on the safety of paracetamol are lacking." }, { "infon": 6, "offset": -1, "text": "The cost of paracetamol for poor families is substantial." }, { "infon": 7, "offset": -1, "text": "No evidence shows that it is beneficial to treat febrile children with paracetamol." }, { "infon": 8, "offset": -1, "text": "Treatment should be given only to children who are in obvious discomfort and those with conditions known to be painful." }, { "infon": 9, "offset": -1, "text": "The role of paracetamol in children with severe malaria or sepsis and in malnourished, febrile children needs to be clarified." } ] } ] }, { "id": "S0042-96862003000600007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Including health in transport policy agendas: the role of health impact assessment analyses and procedures in the European experience." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "From the mid-1990s, research began to highlight the importance of a wide range of health impacts of transport policy decisions." }, { "infon": 1, "offset": -1, "text": "The Third Ministerial Conference on Environment and Health adopted a Charter on Transport, Environment and Health based on four main components: bringing awareness of the nature, magnitude and costs of the health impacts of transport into intergovernmental processes; strengthening the arguments for integration of health into transport policies by developing in-depth analysis of the evidence; developing national case studies; and engaging ministries of environment, health and transport as well as intergovernmental and nongovernmental organizations." }, { "infon": 2, "offset": -1, "text": "Negotiation of the Charter was based on two converging processes: the political process involved the interaction of stakeholders in transport, health and environment in Europe, which helped to frame the issues and the approaches to respond to them; the scientific process involved an international group of experts who produced state-of- the-art reviews of the health impacts resulting from transportation activities, identifying gaps in existing knowledge and methodological tools, specifying the policy implications of their findings, and suggesting possible targets for health improvements." }, { "infon": 3, "offset": -1, "text": "Health arguments were used to strengthen environmental ones, clarify costs and benefits, and raise issues of health equity." }, { "infon": 4, "offset": -1, "text": "The European experience shows that HIA can fulfil the need for simple procedures to be systematically applied to decisions regarding transport strategies at national, regional and local levels." }, { "infon": 5, "offset": -1, "text": "Gaps were identified concerning models for quantifying health impacts and capacity building on how to use such tools." } ] } ] }, { "id": "S0042-96862003000600009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Towards health impact assessment of drinking-water privatization: the example of waterborne carcinogens in North Rhine-Westphalia (Germany)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Worldwide there is a tendency towards deregulation in many policy sectors - this, for example, includes liberalization and privatization of drinking-water management." }, { "infon": 1, "offset": -1, "text": "However, concerns about the negative impacts this might have on human health call for prospective health impact assessment (HIA) on the management of drinking-water." }, { "infon": 2, "offset": -1, "text": "On the basis of an established generic 10-step HIA procedure and on risk assessment methodology, this paper aims to produce quantitative estimates concerning health effects from increased exposure to carcinogens in drinking-water." }, { "infon": 3, "offset": -1, "text": "Using data from North Rhine-Westphalia in Germany, probabilistic estimates of excess lifetime cancer risk, as well as estimates of additional cases of cancer from increased carcinogen exposure levels are presented." }, { "infon": 4, "offset": -1, "text": "The results show how exposure to contaminants that are strictly within current limits could increase cancer risks and case-loads substantially." }, { "infon": 5, "offset": -1, "text": "On the basis of the current analysis, we suggest that with uniform increases in pollutant levels, a single chemical (arsenic) is responsible for a large fraction of expected additional risk." }, { "infon": 6, "offset": -1, "text": "The study also illustrates the uncertainty involved in predicting the health impacts of changes in water quality." }, { "infon": 7, "offset": -1, "text": "Future analysis should include additional carcinogens, non-cancer risks including those due to microbial contamination, and the impacts of system failures and of illegal action, which may be increasingly likely to occur under changed management arrangements." }, { "infon": 8, "offset": -1, "text": "If, in spite of concerns, water is privatized, it is particularly important to provide adequate surveillance of water quality." } ] } ] }, { "id": "S0042-96862003000600011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health and equity impacts of a large oil project in Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A system of external reviewers was established by the World Bank Group to promote a thorough environmental and health impact assessment for the US$ 3.5 billion Chad Oil Export Project, based on a loan request from Chad, Cameroon and a consortium of oil companies." }, { "infon": 1, "offset": -1, "text": "The environmental and health assessment process showed evidence of its ability to minimize the number of deaths from malaria, traffic accidents and construction accidents and the occurrence of minor sexually transmitted diseases, diarrhoeal diseases and respiratory diseases; it also probably limited adverse impacts on wildlife and tropical ecology along the pipeline route." }, { "infon": 2, "offset": -1, "text": "However, the system was unable to deal with the larger issues, which included: the intrinsic unsustainability of this kind of extraction project; its eventual contribution to large amounts of greenhouse gases in the atmosphere; the lack of equity in sharing the risks, negative impacts, benefits and decision-making among the various participants in the project; and the possible acceleration of transmission of the AIDS virus into central Africa." }, { "infon": 3, "offset": -1, "text": "Unfortunately, the international panel of experts appointed by the World Bank Group was largely ignored by the project proponents, and had little success in minimizing the most serious impacts or in improving the social equity of the project." } ] } ] }, { "id": "S0042-96862003000600014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health impact assessment needs in south-east Asian countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A situation analysis was undertaken to assess impediments to health impact assessment (HIA) in the South-East Asia Region of WHO (SEARO)." }, { "infon": 1, "offset": -1, "text": "The countries of the region were assessed on the policy framework and procedures for HIA, existing infrastructure required to support HIA, the capacity for undertaking HIA, and the potential for intersectoral collaboration." }, { "infon": 2, "offset": -1, "text": "The findings show that environmental impact assessment (EIA) is being used implicitly as a substitute for HIA, which is not explicitly or routinely conducted in virtually all countries of the Region." }, { "infon": 3, "offset": -1, "text": "Therefore, policy, infrastructure, capacity, and intersectoral collaboration need strengthening for the routine implementation of HIA." } ] } ] }, { "id": "S0042-96862003000700005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Importation and circulation of poliovirus in Bulgaria in 2001." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response." }, { "infon": 1, "offset": -1, "text": "METHODS: Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhanced surveillance for acute flaccid paralysis, and conducted supplemental immunization activities." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The three cases of polio studied had not been vaccinated and lived in socioeconomically deprived areas of two cities." }, { "infon": 3, "offset": -1, "text": "Four Roma children from the Bourgas district had antibody titres to serotype 1 poliovirus only, and wild type 1 virus was isolated from the faeces of two asymptomatic Roma children in the Bourgas and Sofia districts." }, { "infon": 4, "offset": -1, "text": "Poliovirus isolates were related genetically and represented a single evolutionary lineage; genomic sequences were less than 90% identical to poliovirus strains isolated previously in Europe, but 98.3% similar to a strain isolated in India in 2000." }, { "infon": 5, "offset": -1, "text": "No cases or wild virus isolates were found after supplemental immunization activities were launched in May 2001." }, { "infon": 6, "offset": -1, "text": "CONCLUSIONS: In Bulgaria, an imported poliovirus was able to circulate for two to five months among minority populations." }, { "infon": 7, "offset": -1, "text": "Surveillance data strongly suggest that wild poliovirus circulation ceased shortly after supplemental immunization activities with oral poliovirus vaccine were conducted." } ] } ] }, { "id": "S0042-96862003000700007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To draw up evidence-based guidelines to make injections safer." }, { "infon": 1, "offset": -1, "text": "METHODS: A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings." }, { "infon": 2, "offset": -1, "text": "The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Eliminating unnecessary injections is the highest priority in preventing injection-associated infections." }, { "infon": 4, "offset": -1, "text": "However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections." }, { "infon": 6, "offset": -1, "text": "WHO will revise the best practices five years after initial development, i.e. in 2005." } ] } ] }, { "id": "S0042-96862003000700009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost of work-related injuries in insured workplaces in Lebanon." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics." }, { "infon": 1, "offset": -1, "text": "METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed." }, { "infon": 2, "offset": -1, "text": "Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The median cost per injury was US$ 83 (mean, US$ 198; range, US$ 0-16 401)." }, { "infon": 4, "offset": -1, "text": "The overall cost for all 3748 injuries was US$ 742 100 (76% of this was medical costs)." }, { "infon": 5, "offset": -1, "text": "Extrapolated to all injuries within insured workplaces, the overall cost was US$4.5 million a year; this increased to US$ 10 million-13 million when human value cost (pain and suffering) was accounted for." }, { "infon": 6, "offset": -1, "text": "Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the overall costs and hospitalized injuries (245, 6.5%) for 45%." }, { "infon": 7, "offset": -1, "text": "Cost per injury was highest among older workers and for injuries that involved falls and vehicle incidents." }, { "infon": 8, "offset": -1, "text": "Medical, but not compensation, costs were higher among female workers." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The computed costs of work injuries - a fraction of the real burden of occupational injuries in Lebanon - represent a considerable economic loss." }, { "infon": 10, "offset": -1, "text": "This calls for a national policy to prevent work injuries, with a focus on preventing the most serious injuries." }, { "infon": 11, "offset": -1, "text": "Options for intervention and research are discussed." } ] } ] }, { "id": "S0042-96862003000700011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub-Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult." }, { "infon": 1, "offset": -1, "text": "METHODS: In an observational study at first-level health facilities in Uganda, the United Republic of Tanzania, and Niger, over 3-5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines." }, { "infon": 2, "offset": -1, "text": "We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities." }, { "infon": 3, "offset": -1, "text": "FINDINGS: We studied 7195 children aged 2-59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital." }, { "infon": 4, "offset": -1, "text": "Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia." }, { "infon": 5, "offset": -1, "text": "Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral." }, { "infon": 6, "offset": -1, "text": "Legal constraints and a lack of simple equipment (suction pumps, nebulizers, and oxygen concentrators) and supplies (nasogastric tubes and 50% glucose) could prevent health workers from dealing more appropriately with sick children when referral was not possible." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: When referral is difficult or impossible, some additional supplies and equipment, as well as provision of simple guidelines, may improve management of seriously ill infants and children." } ] } ] }, { "id": "S0042-96862003000700013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Poverty, equity, human rights and health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically." }, { "infon": 1, "offset": -1, "text": "Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work." }, { "infon": 2, "offset": -1, "text": "Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments." }, { "infon": 3, "offset": -1, "text": "Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination." }, { "infon": 4, "offset": -1, "text": "Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major" }, { "infon": 5, "offset": -1, "text": "causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector." } ] } ] }, { "id": "S0042-96862003000800005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Labour complications remain the most important risk factors for perinatal mortality in rural Kenya." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV)." }, { "infon": 1, "offset": -1, "text": "METHODS: A cross-sectional study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The perinatal mortality rate was 118 per 1000 births." }, { "infon": 3, "offset": -1, "text": "Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications." }, { "infon": 4, "offset": -1, "text": "Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality." }, { "infon": 5, "offset": -1, "text": "CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting." } ] } ] }, { "id": "S0042-96862003000800007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Annual risk of tuberculous infection in the northern zone of India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the annual risk of infection with tubercle bacilli in the northern zone of India." }, { "infon": 1, "offset": -1, "text": "METHODS: A community-based cross-sectional tuberculin survey was conducted among children aged 1-9 years who lived in a sample of villages and urban blocks of six selected districts in a defined north zone of India." }, { "infon": 2, "offset": -1, "text": "A two-stage cluster sampling method was used to select rural and urban clusters." }, { "infon": 3, "offset": -1, "text": "A total of 48 624 children in 598 clusters were subjected to tuberculin testing with one tuberculin unit (1 TU) of PPD RT23 stabilized with Tween 80." }, { "infon": 4, "offset": -1, "text": "The maximum transverse diameter of induration was measured about 72 hours after the test." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Among the 48 624 test-read children, 22 064 (45.4%) had a bacille Calmette-Guérin (BCG) scar." }, { "infon": 6, "offset": -1, "text": "On the basis of the frequency distribution of tuberculin reaction size among 25 816 children without a BCG scar, the prevalence of infection with tubercle bacilli was estimated as 10.3%." }, { "infon": 7, "offset": -1, "text": "The annual risk of infection was computed as 1.9%." }, { "infon": 8, "offset": -1, "text": "The proportion of infected children was significantly higher in urban than rural areas." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The high rate of tuberculous infection in the north zone of India suggests the need for further intensification of tuberculosis control efforts on a sustained and long-term basis." } ] } ] }, { "id": "S0042-96862003000800009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Injury prevention counselling to improve safety practices by parents in Mexico." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To evaluate the effectiveness of educational counselling programmes aimed at increasing parents' practice of childhood safety in Monterrey, Mexico, and to provide information aimed at helping to improve the effectiveness of future efforts in this field." }, { "infon": 1, "offset": -1, "text": "METHODS: Three different counselling programmes were designed to meet the needs of the upper, middle and lower socioeconomic strata." }, { "infon": 2, "offset": -1, "text": "Evaluation involved the use of baseline questionnaires on parents' existing safety-related practices for intervention and control groups and the administration of corresponding questionnaires after the programmes had been carried out." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Data were obtained on 1124 children before counselling took place and on 625 after it had been given." }, { "infon": 4, "offset": -1, "text": "Overall safety scores (% safe responses) increased from 54% and 65% for the lower and upper socioeconomic strata, respectively, before counselling to 62% and 73% after counselling (P <0.001 for all groups)." }, { "infon": 5, "offset": -1, "text": "Improvements occurred both for activities that required caution and for activities that required the use of safety-related devices (e.g. helmets, car seats)." }, { "infon": 6, "offset": -1, "text": "However, scores for the use of such devices remained suboptimal even after counselling and there were wide discrepancies between the socioeconomic strata." }, { "infon": 7, "offset": -1, "text": "The post-counselling scores for the use of safety-related devices were 55%, 38% and 19% for the upper, middle and lower socioeconomic strata, respectively." }, { "infon": 8, "offset": -1, "text": "CONCLUSIONS: Brief educational interventions targeting parents' practice of childhood safety improved safe behaviours." }, { "infon": 9, "offset": -1, "text": "Increased attention should be given to specific safety-related devices and to the safety of pedestrians." }, { "infon": 10, "offset": -1, "text": "Educational efforts should be combined with other strategies for injury prevention, such as the use of legislation and the improvement of environmental conditions." } ] } ] }, { "id": "S0042-96862003000800011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Poverty and common mental disorders in developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries." }, { "infon": 1, "offset": -1, "text": "Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education." }, { "infon": 2, "offset": -1, "text": "A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels." }, { "infon": 3, "offset": -1, "text": "Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders." }, { "infon": 4, "offset": -1, "text": "The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder." }, { "infon": 5, "offset": -1, "text": "Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors." }, { "infon": 6, "offset": -1, "text": "Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders." }, { "infon": 7, "offset": -1, "text": "Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment." } ] } ] }, { "id": "S0042-96862003000900005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Community wells to mitigate the arsenic crisis in Bangladesh." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To monitor the effectiveness of deep community wells in reducing exposure to elevated levels of arsenic in ground-water pumped from shallower aquifers." }, { "infon": 1, "offset": -1, "text": "METHODS: Six community wells ranging in depth from 60 m to 140 m were installed in villages where very few of the wells already present produced safe water." }, { "infon": 2, "offset": -1, "text": "By means of flow meters and interviews with villagers carrying water from the community wells, a study was made of the extent to which these were used during one year." }, { "infon": 3, "offset": -1, "text": "The results were compared with household and well data obtained during a previous survey in the same area." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The mean arsenic concentration in water pumped from wells already in use in the villages where the community wells, were installed was 180 ± 140 µg/l (n = 956)." }, { "infon": 5, "offset": -1, "text": "Monthly sampling for 4-11 months showed that arsenic levels in groundwater from five of the six newly installed wells were consistently within the WHO guideline value of 10 µg/l for drinking-water." }, { "infon": 6, "offset": -1, "text": "One of these wells met the Bangladesh standard of 50 µg/l arsenic but failed to meet the WHO guideline values for manganese and uranium in drinking-water." }, { "infon": 7, "offset": -1, "text": "The community wells were very popular." }, { "infon": 8, "offset": -1, "text": "Many women walked hundreds of metres each day to fetch water from them." }, { "infon": 9, "offset": -1, "text": "On average, 2200 litres were hand-pumped daily from each community well, regardless of the season." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: A single community well can meet the needs of some 500 people residing within a radius of 150 m of it in a densely populated village." }, { "infon": 11, "offset": -1, "text": "Properly monitored community wells should become more prominent in campaigns to reduce arsenic exposure in Bangladesh." }, { "infon": 12, "offset": -1, "text": "Between 8000 and 10 000 deep community wells are needed to provide safe water for the four to five million people living in the most severely affected parts of the country." } ] } ] }, { "id": "S0042-96862003000900007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Burden of major musculoskeletal conditions." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant." }, { "infon": 1, "offset": -1, "text": "This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010." }, { "infon": 2, "offset": -1, "text": "This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain." }, { "infon": 3, "offset": -1, "text": "Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged >60 years." }, { "infon": 4, "offset": -1, "text": "Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020." }, { "infon": 5, "offset": -1, "text": "Joint replacement surgery, where available, provides effective relief." }, { "infon": 6, "offset": -1, "text": "Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints." }, { "infon": 7, "offset": -1, "text": "It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries." }, { "infon": 8, "offset": -1, "text": "Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs." }, { "infon": 9, "offset": -1, "text": "The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence." }, { "infon": 10, "offset": -1, "text": "Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm." }, { "infon": 11, "offset": -1, "text": "Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function." }, { "infon": 12, "offset": -1, "text": "Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point." }, { "infon": 13, "offset": -1, "text": "Cultural factors greatly influence the prevalence and prognosis of low back pain." } ] } ] }, { "id": "S0042-96862003000900009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Rehabilitation of landmine victims : the ultimate challenge." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Antipersonnel landmines are often used indiscriminately and frequently result in injury or death of non-combatants." }, { "infon": 1, "offset": -1, "text": "In the last 65 years, over 110 million mines have been spread throughout the world into an estimated 70 countries." }, { "infon": 2, "offset": -1, "text": "Landmine victims use a disproportionately high amount of medical resources; the vast majority of incidents occur in regions and countries without a sophisticated medical infrastructure and with limited resources, where rehabilitation is difficult in the best of circumstances." }, { "infon": 3, "offset": -1, "text": "It is suggested that only a quarter of the patients with amputation secondary to landmines receive appropriate care." } ] } ] }, { "id": "S0042-96862003001000004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Dried venous blood samples for the detection and quantification of measles IgG using a commercial enzyme immunoassay." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To determine whether samples of dried venous blood (DVB) were an acceptable alternative to serum for detecting measles-specific IgG in a commercial enzyme immunoassay." }, { "infon": 1, "offset": -1, "text": "METHODS: Paired samples of serum and DVB were collected from 98 suspected cases of measles and 1153 schoolchildren in Victoria, Australia." }, { "infon": 2, "offset": -1, "text": "All samples were tested using the Dade Behring Enzygnost® Anti-Measles-Virus/IgG immunoassay." }, { "infon": 3, "offset": -1, "text": "DVB samples were eluted using either the sample buffer provided with the kit or 5% dry milk powder in phosphate-buffered saline-Tween 20." }, { "infon": 4, "offset": -1, "text": "FINDINGS: DVB samples eluted by sample buffer showed significantly better linear correlation to the serum samples than did DVB samples eluted in 5% dry milk in phosphate-buffered saline-Tween 20." }, { "infon": 5, "offset": -1, "text": "To improve the comparability of serum and DVB samples an adjustment factor of 1.28 was applied to the optical density (OD) values of DVB." }, { "infon": 6, "offset": -1, "text": "This adjustment also enabled quantification of the titre of measles IgG in mIU/ml directly from the OD value using the alpha calculation as specified by the kit protocol." }, { "infon": 7, "offset": -1, "text": "For DVB samples stored for less than six months at 4 °C, the assay showed an overall sensitivity of 98.4% and a specificity of 97.2% compared with the results of serum testing." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: These results illustrate the potential for DVB samples to be widely used with the Dade Behring enzyme immunoassay system for determining the immunity of the individual and the population to the measles virus." } ] } ] }, { "id": "S0042-96862003001000006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Risk factors for early infant mortality in Sarlahi district, Nepal." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries." }, { "infon": 1, "offset": -1, "text": "Identification of risk factors for early infant mortality may help inform the design of intervention strategies." }, { "infon": 2, "offset": -1, "text": "METHODS: Over the period 1994-97, 15 469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth." }, { "infon": 3, "offset": -1, "text": "FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively." }, { "infon": 4, "offset": -1, "text": "Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR =1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR =1.85, 95% CI 1.24-2.75)." }, { "infon": 5, "offset": -1, "text": "A larger maternal mid_upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95)." }, { "infon": 6, "offset": -1, "text": "Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period." }, { "infon": 7, "offset": -1, "text": "Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR =11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks)." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Risk factors for early infant mortality varied with the age of the infant." }, { "infon": 9, "offset": -1, "text": "Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy." } ] } ] }, { "id": "S0042-96862003001000008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Meta-analysis of residential exposure to radon gas and lung cancer." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To investigate the relation between residential exposure to radon and lung cancer." }, { "infon": 1, "offset": -1, "text": "METHODS: A literature search was performed using Medline and other sources." }, { "infon": 2, "offset": -1, "text": "The quality of studies was assessed." }, { "infon": 3, "offset": -1, "text": "Adjusted odds ratios with 95% confidence intervals (CI) for the risk of lung cancer among categories of levels of exposure to radon were extracted." }, { "infon": 4, "offset": -1, "text": "For each study, a weighted log-linear regression analysis of the adjusted odds ratios was performed according to radon concentration." }, { "infon": 5, "offset": -1, "text": "The random effect model was used to combine values from single studies." }, { "infon": 6, "offset": -1, "text": "Separate meta-analyses were performed on results from studies grouped with similar characteristics or with quality scores above or equal to the median." }, { "infon": 7, "offset": -1, "text": "FINDINGS: Seventeen case-control studies were included in the meta-analysis." }, { "infon": 8, "offset": -1, "text": "Quality scoring for individual studies ranged from 0.45 to 0.77 (median, 0.64)." }, { "infon": 9, "offset": -1, "text": "Meta-analysis based on exposure at 150 Bq/m3 gave a pooled odds ratio estimate of 1.24 (95% CI, 1.11-1.38), which indicated a potential effect of residential exposure to radon on the risk of lung cancer." }, { "infon": 10, "offset": -1, "text": "Pooled estimates of fitted odds ratios at several levels of radon exposure were all significantly different from unity - ranging from 1.07 at 50 Bq/m3 to 1.43 at 250 Bq/m3." }, { "infon": 11, "offset": -1, "text": "No remarkable differences from the baseline analysis were found for odds ratios from sensitivity analyses of studies in which >75% of eligible cases were recruited (1.12, 1.00-1.25) and studies that included only women (1.29, 1.04-1.60)." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: Although no definitive conclusions may be drawn, our results suggest a dose-response relation between residential exposure to radon and the risk of lung cancer." }, { "infon": 13, "offset": -1, "text": "They support the need to develop strategies to reduce human exposure to radon." } ] } ] }, { "id": "S0042-96862003001000010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Meningococcal meningitis in sub-Saharan Africa: the case for mass and routine vaccination with available polysaccharide vaccines." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Endemic and epidemic group A meningococcal meningitis remains a major cause of morbidity and mortality in sub-Saharan Africa, despite the availability of the safe and inexpensive group A meningococcal polysaccharide vaccine, which is protective at all ages when administered as directed." }, { "infon": 1, "offset": -1, "text": "Despite optimal therapy, meningococcal meningitis has a 10% fatality rate and at least 15% central nervous system damage." }, { "infon": 2, "offset": -1, "text": "WHO's policy of epidemic containment prevents, at best, about 50% of cases and ignores endemic meningitis, which is estimated at 50 000 cases per year." }, { "infon": 3, "offset": -1, "text": "The effectiveness of group A, C, W135, and Y capsular polysaccharides is the basis for recommending universal vaccination with group A meningococcal polysaccharide twice in infancy, followed by the four-valent vaccine in children aged two and six years." }, { "infon": 4, "offset": -1, "text": "This could eliminate epidemic and endemic disease, prepare for the use of conjugates when they become available, and probably could have prevented the recent epidemics of groups A and W135 meningitis in Burkina Faso." } ] } ] }, { "id": "S0042-96862003001100005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Influence of pesticide regulation on acute poisoning deaths in Sri Lanka." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To assess in a developing Asian country the impact of pesticide regulation on the number of deaths from poisoning." }, { "infon": 1, "offset": -1, "text": "These regulations, which were implemented in Sri Lanka from the 1970s, aimed to reduce the number of deaths - the majority from self-poisoning - by limiting the availability and use of highly toxic pesticides." }, { "infon": 2, "offset": -1, "text": "METHODS: Information on legislative changes was obtained from the Ministry of Agriculture, national and district hospital admission data were obtained from the Sri Lanka Health Statistics Unit, and individual details of deaths by pesticide poisoning were obtained from a manual review of patients' notes and intensive care unit records in Anuradhapura." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Between 1986 and 2000, the total national number of admissions due to poisoning doubled, and admissions due to pesticide poisoning increased by more than 50%." }, { "infon": 4, "offset": -1, "text": "At the same time, the case fatality proportion (CFP) fell for total poisonings and for poisonings due to pesticides." }, { "infon": 5, "offset": -1, "text": "In 1991_92, 72% of pesticide-induced deaths in Anuradhapura were caused by organophosphorus (OP) and carbamate pesticides - in particular, the WHO class I OPs monocrotophos and methamidophos." }, { "infon": 6, "offset": -1, "text": "From 1991, the import of these pesticides was reduced gradually until they were banned for routine use in January 1995, with a corresponding fall in deaths." }, { "infon": 7, "offset": -1, "text": "Unfortunately, their place in agricultural practice was taken by the WHO class II organochlorine endosulfan, which led to a rise in deaths from status epilepticus - from one in 1994 to 50 in 1998." }, { "infon": 8, "offset": -1, "text": "Endosulfan was banned in 1998, and over the following three years the number of endosulfan deaths fell to three." }, { "infon": 9, "offset": -1, "text": "However, at the end of the decade, the number of deaths from pesticides was at a similar level to that of 1991, with WHO class II OPs causing the most deaths." }, { "infon": 10, "offset": -1, "text": "Although these drugs are less toxic than class I OPs, the management of class II OPs remains difficult because they are, nevertheless, still highly toxic, and their toxicity is exacerbated by the paucity of available facilities." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: The fall in CFP amidst a rising incidence of self-poisoning suggests that Sri Lanka's programmes of pesticide regulation were beneficial." }, { "infon": 12, "offset": -1, "text": "However, a closer inspection of pesticide-induced deaths in one hospital revealed switching to other highly toxic pesticides, as one was banned and replaced in agricultural practice by another." }, { "infon": 13, "offset": -1, "text": "Future regulation must predict this switching and bear in mind the ease of treatment of replacement pesticides." }, { "infon": 14, "offset": -1, "text": "Furthermore, such regulations must be implemented alongside other strategies, such as integrated pest management, to reduce the overall pesticide availability for self-harm." } ] } ] }, { "id": "S0042-96862003001100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Knowledge for better health : a conceptual framework and foundation for health research systems." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity." }, { "infon": 1, "offset": -1, "text": "We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions." }, { "infon": 2, "offset": -1, "text": "The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs." }, { "infon": 3, "offset": -1, "text": "The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity." }, { "infon": 4, "offset": -1, "text": "In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity." }, { "infon": 5, "offset": -1, "text": "Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research." }, { "infon": 6, "offset": -1, "text": "The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health." } ] } ] }, { "id": "S0042-96862003001100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Exercise interventions: defusing the world's osteoporosis time bomb." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Osteoporosis is a major public health problem, affecting millions of people worldwide." }, { "infon": 1, "offset": -1, "text": "The associated health care costs are growing in parallel with increases in elderly populations, and it is expected that the number of osteoporotic fractures will double over the next 50 years." }, { "infon": 2, "offset": -1, "text": "The best way to address osteoporosis is prevention." }, { "infon": 3, "offset": -1, "text": "Some interventions to maximize and preserve bone mass have multiple health benefits and are cost-effective." }, { "infon": 4, "offset": -1, "text": "For example, modifications to diet and lifestyle can help to prevent osteoporosis, and could potentially lead to a significant decrease in fracture rates; and exercise is a valuable adjunct to programmes aimed at alleviating the risks and symptoms of osteoporosis." }, { "infon": 5, "offset": -1, "text": "Practising exercise at a young age helps maximize the mineral density of bones while they are still growing and maturing, and continuing to excercise minimizes bone loss later in life." }, { "infon": 6, "offset": -1, "text": "Not only does exercise improve bone health, it also increases muscle strength, coordination, balance, flexibility and leads to better overall health." }, { "infon": 7, "offset": -1, "text": "Walking, aerobic exercise, and t'ai chi are the best forms of exercise to stimulate bone formation and strengthen the muscles that help support bones." }, { "infon": 8, "offset": -1, "text": "Encouraging physical activity at all ages is therefore a top priority to prevent osteoporosis." } ] } ] }, { "id": "S0042-96862003001200005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Human health benefits from livestock vaccination for brucellosis: case study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock." }, { "infon": 1, "offset": -1, "text": "METHODS: Cost-effectiveness and economic benefit for human society and the agricultural sector of mass vaccination against brucellosis was modelled." }, { "infon": 2, "offset": -1, "text": "The intervention consisted of a planned 10-year livestock mass vaccination campaign using Rev-1 livestock vaccine for small ruminants and S19 livestock vaccine for cattle." }, { "infon": 3, "offset": -1, "text": "Cost-effectiveness, expressed as cost per disability-adjusted life year (DALY) averted, was the primary outcome." }, { "infon": 4, "offset": -1, "text": "FINDINGS: In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49 027 DALYs could be averted." }, { "infon": 5, "offset": -1, "text": "Estimated intervention costs were US$ 8.3 million, and the overall benefit was US$ 26.6 million." }, { "infon": 6, "offset": -1, "text": "This results in a net present value of US$ 18.3 million and an average benefit-cost ratio for society of 3.2 (2.27-4.37)." }, { "infon": 7, "offset": -1, "text": "If the costs of the intervention were shared between the sectors in proportion to the benefit to each, the public health sector would contribute 11%, which gives a cost-effectiveness of US$ 19.1 per DALY averted (95% confidence interval 5.3-486.8)." }, { "infon": 8, "offset": -1, "text": "If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the cost-effectiveness would decrease to US$ 71.4 per DALY averted." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors." } ] } ] }, { "id": "S0042-96862003001200007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children." }, { "infon": 1, "offset": -1, "text": "This article reviews the available evidence on private sector utilization and quality of care." }, { "infon": 2, "offset": -1, "text": "It provides a framework for analysing the private sector's influence on child health outcomes." }, { "infon": 3, "offset": -1, "text": "This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs)." }, { "infon": 4, "offset": -1, "text": "Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children." }, { "infon": 5, "offset": -1, "text": "Many governments are experimenting with strategies to engage the private sector to improve child health." }, { "infon": 6, "offset": -1, "text": "The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches." }, { "infon": 7, "offset": -1, "text": "Few experiences are clearly described, monitored, and evaluated." }, { "infon": 8, "offset": -1, "text": "The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively." }, { "infon": 9, "offset": -1, "text": "The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations." } ] } ] }, { "id": "S0042-96862003001200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Progress with new malaria vaccines." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Malaria is a parasitic disease of major global health significance that causes an estimated 2.7 million deaths each year." }, { "infon": 1, "offset": -1, "text": "In this review we describe the burden of malaria and discuss the complicated life cycle of Plasmodium falciparum, the parasite responsible for most of the deaths from the disease, before reviewing the evidence that suggests that a malaria vaccine is an attainable goal." }, { "infon": 2, "offset": -1, "text": "Significant advances have recently been made in vaccine science, and we review new vaccine technologies and the evaluation of candidate malaria vaccines in human and animal studies worldwide." }, { "infon": 3, "offset": -1, "text": "Finally, we discuss the prospects for a malaria vaccine and the need for iterative vaccine development as well as potential hurdles to be overcome." } ] } ] }, { "id": "S0042-96862004000100005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost analysis of post-polio certification immunization policies." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: An analysis was conducted to estimate the costs of different potential post-polio certification immunization policies currently under consideration, with the objective of providing this information to policy-makers." }, { "infon": 1, "offset": -1, "text": "METHODS: We analysed three global policy options: continued use of oral poliovirus vaccine (OPV); OPV cessation with optional inactivated poliovirus vaccine (IPV); and OPV cessation with universal IPV." }, { "infon": 2, "offset": -1, "text": "Assumptions were made on future immunization policy decisions taken by low-, middle-, and high-income countries." }, { "infon": 3, "offset": -1, "text": "We estimated the financial costs of each immunization policy, the number of vaccine-associated paralytic poliomyelitis (VAPP) cases, and the global costs of maintaining an outbreak response capacity." }, { "infon": 4, "offset": -1, "text": "The financial costs of each immunization policy were based on estimates of the cost of polio vaccine, its administration, and coverage projections." }, { "infon": 5, "offset": -1, "text": "The costs of maintaining outbreak response capacity include those associated with developing and maintaining a vaccine stockpile in addition to laboratory and epidemiological surveillance." }, { "infon": 6, "offset": -1, "text": "We used the period 2005-20 as the time frame for the analysis." }, { "infon": 7, "offset": -1, "text": "FINDINGS: OPV cessation with optional IPV, at an estimated cost of US$ 20 412 million, was the least costly option." }, { "infon": 8, "offset": -1, "text": "The global cost of outbreak response capacity was estimated to be US$ 1320 million during 2005-20." }, { "infon": 9, "offset": -1, "text": "The policy option continued use of OPV resulted in the highest number of VAPP cases." }, { "infon": 10, "offset": -1, "text": "OPV cessation with universal IPV had the highest financial costs, but it also had the least number of VAPP cases." }, { "infon": 11, "offset": -1, "text": "Sensitivity analyses showed that global costs were sensitive to assumptions on the cost of the vaccine." }, { "infon": 12, "offset": -1, "text": "Analysis also showed that if the price per dose of IPV was reduced to US$ 0.50 for low-income countries, the cost of OPV cessation with universal IPV would be the same as the costs of continued use of OPV." }, { "infon": 13, "offset": -1, "text": "CONCLUSION: Projections on the vaccine price per dose and future coverage rates were major drivers of the global costs of post-certification polio immunization." }, { "infon": 14, "offset": -1, "text": "The break-even price of switching to IPV compared with continuing with OPV immunizations is US$ 0.50 per dose of IPV." }, { "infon": 15, "offset": -1, "text": "However, this does not account for the cost of vaccine-derived poliovirus cases resulting from the continued use of OPV." }, { "infon": 16, "offset": -1, "text": "In addition to financial costs, risk assessments related to the re-emergence of polio will be major determinants of policy decisions." } ] } ] }, { "id": "S0042-96862004000100007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Certification of polio eradication: process and lessons learned." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, considerable progress has been made towards interrupting the transmission of wild poliovirus globally." }, { "infon": 1, "offset": -1, "text": "A formal process for the certification of polio eradication was established on the basis of experience gained during smallpox eradication." }, { "infon": 2, "offset": -1, "text": "Independent groups of experts were designated at the global, regional, and country levels to conduct the process." }, { "infon": 3, "offset": -1, "text": "The main requirements for the global certification of the eradication of wild poliovirus are the absence of wild poliovirus, isolated from suspect polio cases, healthy individuals, or environmental samples, in all WHO regions for a period of at least three years in the presence of high-quality, certification-standard surveillance and the containment of all wild poliovirus stocks in laboratories." }, { "infon": 4, "offset": -1, "text": "Three WHO regions - the Region of the Americas (1994), Western Pacific Region (2000), and European Region (2002) - have already been certified free of indigenous wild poliovirus." }, { "infon": 5, "offset": -1, "text": "Eradication and certification activities are progressing well in the three endemic regions (African, Eastern Mediterranean, and South-East Asia)." }, { "infon": 6, "offset": -1, "text": "Several challenges remain for the certification of polio eradication: the need for even closer coordination of certification activities between WHO regions, the verification of laboratory containment, the development of an appropriate mechanism to verify the absence of circulating vaccine-derived polioviruses in the future, and the maintenance of polio-free status in certified regions until global certification." } ] } ] }, { "id": "S0042-96862004000100009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Framework for evaluating the risks of paralytic poliomyelitis after global interruption of wild poliovirus transmission." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "With the interruption of wild poliovirus transmission globally, the need for new policies to deal with the post certification era will rapidly arise." }, { "infon": 1, "offset": -1, "text": "New policies will be required in four areas: detection and notification of circulating polioviruses; biocontainment of wild, vaccine-derived and attenuated strains of poliovirus; vaccine stockpiles and response mechanisms; and routine immunization against polioviruses." }, { "infon": 2, "offset": -1, "text": "A common understanding of the potential risks of paralytic poliomyelitis in the post-certification period is essential to the development of these policies." }, { "infon": 3, "offset": -1, "text": "Since 2000, there has been increasing international consensus that the risks of paralytic poliomyelitis in the post-certification era fall into two categories: those due to the continued use of the oral poliovirus vaccine (OPV) and those due to future improper handling of wild polioviruses." }, { "infon": 4, "offset": -1, "text": "The specific risks within both categories have now been defined, and an understanding of the frequency and potential burden of disease associated with each is rapidly improving." }, { "infon": 5, "offset": -1, "text": "This knowledge and clarity have provided a framework that is already proving valuable for identifying research priorities and discussing potential policy options with national authorities." }, { "infon": 6, "offset": -1, "text": "However, this framework must be regarded as a dynamic tool, requiring regular updating as additional information on these risks becomes available through further scientific research, programmatic work, and policy decisions." } ] } ] }, { "id": "S0042-96862004000100011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A developing country perspective on vaccine-associated paralytic poliomyelitis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "When the Expanded Programme on Immunization was established and oral poliovirus vaccine (OPV) was introduced for developing countries to use exclusively, national leaders of public health had no opportunity to make an informed choice between OPV and the inactivated poliovirus vaccine (IPV)." }, { "infon": 1, "offset": -1, "text": "Today, as progress is made towards the goal of global eradication of poliomyelitis attributable to wild polioviruses, all developing countries where OPV is used face the risk of vaccine-associated paralytic poliomyelitis (VAPP)." }, { "infon": 2, "offset": -1, "text": "Until recently, awareness of VAPP has been poor and quantitative risk analysis scanty but it is now well known that the continued use of OPV perpetuates the risk of VAPP." }, { "infon": 3, "offset": -1, "text": "Discontinuation or declining immunization coverage of OPV will increase the risk of emergence of circulating vaccine-derived polioviruses (cVDPV) that re-acquire wild virus-like properties and may cause outbreaks of polio." }, { "infon": 4, "offset": -1, "text": "To eliminate the risk of cVDPV, either very high immunization coverage must be maintained as long as OPV is in use, or IPV should replace OPV." }, { "infon": 5, "offset": -1, "text": "Stopping OPV without first achieving high immunization coverage with IPV is unwise on account of the possibility of emergence of cVDPV." }, { "infon": 6, "offset": -1, "text": "Increasing numbers of developed nations prefer IPV, and manufacturing capacities have not been scaled up, so its price remains prohibitively high and unaffordable by developing countries, where, in addition, large-scale field experience with IPV is lacking." }, { "infon": 7, "offset": -1, "text": "Under these circumstances, a policy shift to increase the use of IPV in national immunization programmes in developing countries is a necessary first step; once IPV coverage reaches high levels (over 85%), the withdrawal of OPV may begin." } ] } ] }, { "id": "S0042-96862004000200004", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Child mortality in a West African population protected with insecticide-treated curtains for a period of up to 6 years." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To determine the impact of insecticide-treated curtains (ITC) on all-cause child mortality (6-59 months) over a period of six years." }, { "infon": 1, "offset": -1, "text": "To determine whether initial reductions in child mortality following the implementation of ITC are sustained over the longer term or whether \"delayed\" mortality occurs." }, { "infon": 2, "offset": -1, "text": "METHODS: A rural population of ca 100 000 living in an area with high, seasonal Plasmodium falciparum transmission was studied in Burkina Faso." }, { "infon": 3, "offset": -1, "text": "Annual censuses were conducted from 1993 to 2000 to measure child mortality." }, { "infon": 4, "offset": -1, "text": "ITC to cover doors, windows, and eaves were provided to half the population in 1994 with the remainder receiving ITC in 1996." }, { "infon": 5, "offset": -1, "text": "Curtains were re-treated or, if necessary, replaced annually." }, { "infon": 6, "offset": -1, "text": "FINDINGS: Over six years of implementation of ITC, no evidence of the shift in child mortality from younger to older children was observed." }, { "infon": 7, "offset": -1, "text": "Estimates of the reduction in child mortality associated with ITC ranged from 19% to 24%." }, { "infon": 8, "offset": -1, "text": "CONCLUSIONS: In our population there was no evidence to suggest that initial reduction in child mortality associated with the introduction of insecticide-treated materials was subsequently compromised by a shift in child mortality to older-aged children." }, { "infon": 9, "offset": -1, "text": "Estimates of the impact of ITC on child mortality in this population range from 19% to 24%." } ] } ] }, { "id": "S0042-96862004000200006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To document and characterize freezing temperatures in the Indonesian vaccine cold chain and to evaluate the feasibility of changes designed to reduce the occurrence of freezing." }, { "infon": 1, "offset": -1, "text": "METHODS: Data loggers were used to measure temperatures of shipments of hepatitis B vaccine from manufacturer to point of use." }, { "infon": 2, "offset": -1, "text": "Baseline conditions and three intervention phases were monitored." }, { "infon": 3, "offset": -1, "text": "During each of the intervention phases, vaccines were removed progressively from the standard 2-8 °C cold chain." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Freezing temperatures were recorded in 75% of baseline shipments." }, { "infon": 5, "offset": -1, "text": "The highest rates of freezing occurred during transport from province to district, storage in district-level ice-lined refrigerators, and storage in refrigerators in health centres." }, { "infon": 6, "offset": -1, "text": "Interventions reduced freezing, without excessive heat exposure." }, { "infon": 7, "offset": -1, "text": "CONCLUSIONS: Inadvertent freezing of freeze-sensitive vaccines is widespread in Indonesia." }, { "infon": 8, "offset": -1, "text": "Simple strategies exist to reduce freezing - for example, selective transport and storage of vaccines at ambient temperatures." }, { "infon": 9, "offset": -1, "text": "The use of vaccine vial monitors reduces the risk associated with heat-damaged vaccines in these scenarios." }, { "infon": 10, "offset": -1, "text": "Policy changes that allow limited storage of freeze-sensitive vaccines at temperatures >2-8 °C would enable flexible vaccine distribution strategies that could reduce vaccine freezing, reduce costs, and increase capacity." } ] } ] }, { "id": "S0042-96862004000200008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Patient advocacy and arthritis: moving forward." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Patient advocacy is based on the premise that people have the right to make their own choices about their health care." }, { "infon": 1, "offset": -1, "text": "Personal advocacy is centred on the experiential expertise of the individual affected by the condition, whereas group advocacy is grounded on patient-centred strategies and actions." }, { "infon": 2, "offset": -1, "text": "The first patient advocacy groups for arthritis were set up over 20 years ago in the USA and have subsequently spread to many other countries." }, { "infon": 3, "offset": -1, "text": "This paper discusses the growth and impact of personal advocacy as well as recent developments in group advocacy in the Asia-Pacific region, Europe, and North America, in terms of arthritis awareness, research, corporate partnerships, and the Bone and Joint Decade global initiative." } ] } ] }, { "id": "S0042-96862004000200010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Regulatory pathways for vaccines for developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Vaccines that are designed for use only in developing countries face regulatory hurdles that may restrict their use." }, { "infon": 1, "offset": -1, "text": "There are two primary reasons for this: most regulatory authorities are set up to address regulation of products for use only within their jurisdictions and regulatory authorities in developing countries traditionally have been considered weak." }, { "infon": 2, "offset": -1, "text": "Some options for regulatory pathways for such products have been identified: licensing in the country of manufacture, file review by the European Medicines Evaluation Agency on behalf of WHO, export to a country with a competent national regulatory authority (NRA) that could handle all regulatory functions for the developing country market, shared manufacturing and licensing in a developing country with competent manufacturing and regulatory capacity, and use of a contracted independent entity for global regulatory approval." }, { "infon": 3, "offset": -1, "text": "These options have been evaluated on the basis of five criteria: assurance of all regulatory functions for the life of the product, appropriateness of epidemiological assessment, applicability to products no longer used in the domestic market of the manufacturing country, reduction of regulatory risk for the manufacturer, and existing rules and regulations for implementation." }, { "infon": 4, "offset": -1, "text": "No one option satisfies all criteria." }, { "infon": 5, "offset": -1, "text": "For all options, national infrastructures (including the underlying regulatory legislative framework, particularly to formulate and implement local evidence-based vaccine policy) must be developed." }, { "infon": 6, "offset": -1, "text": "WHO has led work to develop this capacity with some success." }, { "infon": 7, "offset": -1, "text": "The paper outlines additional areas of action required by the international community to assure development and use of vaccines needed for the developing world." } ] } ] }, { "id": "S0042-96862004000300005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF." }, { "infon": 1, "offset": -1, "text": "The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks." }, { "infon": 2, "offset": -1, "text": "METHODS: Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared." }, { "infon": 3, "offset": -1, "text": "Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months." }, { "infon": 4, "offset": -1, "text": "Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers." }, { "infon": 5, "offset": -1, "text": "Time needed to prepare one feed of replacement milk was simulated." }, { "infon": 6, "offset": -1, "text": "FINDINGS: When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid." }, { "infon": 7, "offset": -1, "text": "PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin." }, { "infon": 8, "offset": -1, "text": "FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8-60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine." }, { "infon": 9, "offset": -1, "text": "Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended a-linolenic acid per 450 ml mixture." }, { "infon": 10, "offset": -1, "text": "It took 21-25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30-35 minutes for the fresh milk preparation." }, { "infon": 11, "offset": -1, "text": "PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months." }, { "infon": 13, "offset": -1, "text": "Commercial infant formula is the only replacement milk that meets all nutritional needs." }, { "infon": 14, "offset": -1, "text": "Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed." }, { "infon": 15, "offset": -1, "text": "If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and a-linolenic acids, and additional vitamins and minerals." } ] } ] }, { "id": "S0042-96862004000300007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Condom use within marriage: a neglected HIV intervention." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the contraceptive effectiveness of condoms versus oral contraceptive pills and estimate the reproductive consequences of a major shift from pill to condom use." }, { "infon": 1, "offset": -1, "text": "METHODS: Secondary analysis was performed on nationally representative cross-sectional surveys of women in 16 developing countries." }, { "infon": 2, "offset": -1, "text": "FINDINGS: In the 16 countries, the median per cent of married couples currently using condoms was 2%, compared with 13% for the pill." }, { "infon": 3, "offset": -1, "text": "Condom users reported a higher 12-month failure and higher method-related discontinuation rates than pill users (9% and 44% vs 6% and 30%, respectively)." }, { "infon": 4, "offset": -1, "text": "Condom users were more likely to report subsequent abortion following failure (21% vs 14%), and also more likely to switch rapidly to another method (76% vs 58%)." }, { "infon": 5, "offset": -1, "text": "The reproductive consequences, in terms of abortion and unwanted births, of a hypothetical reversal of the relative prevalence of condom and pill were estimated to be minor." }, { "infon": 6, "offset": -1, "text": "The main reason for this unexpected result is that the majority of abortions and unwanted births arise from non-use of any contraceptive method." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: A massive shift from the more effective oral contraceptive pills to the less effective condom would not jeopardize policy goals of reducing abortions and unwanted births." }, { "infon": 8, "offset": -1, "text": "However, such a shift would potentially have an added benefit of preventing human immunodeficiency virus (HIV) infections, especially in countries with generalized HIV epidemics." } ] } ] }, { "id": "S0042-96862004000300009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Effectiveness of residual spraying of peridomestic ecotopes with deltamethrin and permethrin on Triatoma infestans in rural western Argentina: a district-wide randomized trial." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare the effectiveness of a single residual spraying of pyrethroids on the occurrence and abundance of Triatoma infestans in peridomestic ecotopes in rural La Rioja." }, { "infon": 1, "offset": -1, "text": "METHODS: A total of 667 (32.8%) peridomestic sites positive for T. infestans in May 1999 were randomly assigned to treatment within each village, sprayed in December 1999, and reinspected in December 2000." }, { "infon": 2, "offset": -1, "text": "Treatments included 2.5% suspension concentrate (SC) deltamethrin in water at 25 mg active ingredient (a.i.)/m2 applied with: (a) manual compression sprayers (standard treatment) or (b) power sprayers; (c) 1.5% emulsifiable concentrate (EC) deltamethrin at 25 mg a.i./m2; and (d) 10% EC cis-permethrin at 170 mg a.i./m2." }, { "infon": 3, "offset": -1, "text": "EC pyrethroids were diluted in soybean oil and applied with power sprayers." }, { "infon": 4, "offset": -1, "text": "All habitations were sprayed with the standard treatment." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The prevalence of T. infestans 1-year post-spraying was significantly lower in sites treated with SC deltamethrin applied with manual (24%) or power sprayers (31%) than in sites treated with EC deltamethrin (40%) or EC permethrin (53%)." }, { "infon": 6, "offset": -1, "text": "The relative odds of infestation and catch of T. infestans 1-year post-spraying significantly increased with the use of EC pyrethroids, the abundance of bugs per site before spraying, total surface, and host numbers." }, { "infon": 7, "offset": -1, "text": "All insecticides had poor residual effects on wooden posts." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Most of the infestations probably originated from triatomines that survived exposure to insecticides at each site." }, { "infon": 9, "offset": -1, "text": "Despite the standard treatment proving to be the most effective, the current tactics and procedures fail to eliminate peridomestic populations of T. infestans in semiarid rural areas and need to be revised." } ] } ] }, { "id": "S0042-96862004000300011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Tobacco smoking and oral clefts: a meta-analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine the association between maternal smoking and non-syndromic orofacial clefts in infants." }, { "infon": 1, "offset": -1, "text": "METHODS: A meta-analysis of the association between maternal smoking during pregnancy was carried out using data from 24 case-control and cohort studies." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Consistent, moderate and statistically significant associations were found between maternal smoking and cleft lip, with or without cleft palate (relative risk 1.34, 95% confidence interval 1.25-1.44) and between maternal smoking and cleft palate (relative risk 1.22, 95% confidence interval 1.10-1.35)." }, { "infon": 3, "offset": -1, "text": "There was evidence of a modest dose-response effect for cleft lip with or without cleft palate." }, { "infon": 4, "offset": -1, "text": "CONCLUSION: The evidence of an association between maternal tobacco smoking and orofacial clefts is strong enough to justify its use in anti-smoking campaigns." } ] } ] }, { "id": "S0042-96862004000400005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Use of medicinal plants and pharmaceuticals by indigenous communities in the Bolivian Andes and Amazon." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate, by means of household surveys, the use of medicinal plants and pharmaceuticals in Apillapampa, a large Andean community of Quechua peasants, and in six small communities of Yuracaré-Trinitario \"slash-and-burn\" cultivators of the National Park Isiboro-Sécure (the NPIS) in the Bolivian Amazon." }, { "infon": 1, "offset": -1, "text": "METHODS: A total of 12% of households in Apillapampa and nearly all households in the NPIS were interviewed about their use of medicinal plants and pharmaceuticals for treating illnesses." }, { "infon": 2, "offset": -1, "text": "Informants were also asked to name any medicinal plants they knew." }, { "infon": 3, "offset": -1, "text": "FINDINGS: In spite of the presence of a primary health care service (PHC) with medical doctor in Apillapampa, an equal number of informants used medicinal plants and pharmaceuticals." }, { "infon": 4, "offset": -1, "text": "In the NPIS, the prevalent use of medicinal plants or pharmaceuticals in any community depended on the distance of the community from the nearest village and from a PHC with medical doctor (r = 0.85 and r = -0.96; both P = 0.05." }, { "infon": 5, "offset": -1, "text": "The NPIS communities' knowledge of plants expressed as the average number of medicinal plants mentioned correlated positively and negatively with distance from the nearest village and use of pharmaceuticals, respectively (r = 0.95, P<0.005 and r = -0.90, P<0.05, respectively)." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: The cultural importance of traditional medicine and the physical isolation of communities, both in general and from PHCs, are factors that influence the use of and knowledge about medicinal plants." } ] } ] }, { "id": "S0042-96862004000400007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Rubella serosurveys at three Aravind Eye Hospitals in Tamil Nadu, India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the susceptibility of female eye hospital staff to rubella infection and the potential risk for hospital-based rubella outbreaks." }, { "infon": 1, "offset": -1, "text": "METHODS: A prospective cohort study on the seroprevalence of rubella IgG antibodies was conducted at three large eye hospitals in Coimbatore, Madurai and Tirunelveli, Tamil Nadu, India, where young children with eye abnormalities attributable to congenital rubella are treated." }, { "infon": 2, "offset": -1, "text": "A total of 1000 female hospital employees aged 18-40 years agreed to participate and gave written informed consent." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The proportions of rubella-seronegative women were: 11.7% at Coimbatore, with a 95% confidence interval (CI) of 8.1-16.5; 15% at Madurai (95% CI = 12.3-18.1), and 20.8 at Tirunelveli (95% CI = 14.7-28.6)." }, { "infon": 4, "offset": -1, "text": "For the entire cohort the proportion seronegative was significantly higher among married women (21.5%) than among single women (14.0%) (P = 0.02)." }, { "infon": 5, "offset": -1, "text": "Rates of seronegativity were highest among physicians and lowest among housekeepers." }, { "infon": 6, "offset": -1, "text": "All 150 seronegative women in the study sample accepted a dose of rubella vaccine." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: These are the first rubella serosurveys to have been reported from eye hospitals in any country." }, { "infon": 8, "offset": -1, "text": "The relatively high rate of susceptibility indicated a risk of a rubella outbreak, and this was reduced by vaccinating all seronegative women." }, { "infon": 9, "offset": -1, "text": "A policy has been established at all three hospitals for the provision of rubella vaccine to new employees." }, { "infon": 10, "offset": -1, "text": "Other hospitals, especially eye hospitals and hospitals in countries without routine rubella immunization, should consider the rubella susceptibility of staff and the risk of hospital-based rubella outbreaks." } ] } ] }, { "id": "S0042-96862004000400009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Do family-planning workers in China support provision of sexual and reproductive health services to unmarried young people?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To ascertain the perspectives of family-planning service providers in eight sites in China on the provision of sexual and reproductive health services to unmarried young people." }, { "infon": 1, "offset": -1, "text": "METHODS: Data were drawn from a survey of 1927 family-planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Family-planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people; however, perceptions about the appropriate age for and content of such education remained conservative." }, { "infon": 3, "offset": -1, "text": "While about 70% of family-planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, only one quarter agreed that the services could be extended to senior high schools." }, { "infon": 4, "offset": -1, "text": "CONCLUSION: Family-planning workers in China are ambivalent about the provision of sexual and reproductive health services to unmarried young people, which potentially poses a significant obstacle to the adoption of safe sex behaviours by young people, as well as to the provision of sexual and reproductive health information and services to young unmarried people in China." }, { "infon": 5, "offset": -1, "text": "Training programmes for family-planning workers are urgently needed to address this issue." } ] } ] }, { "id": "S0042-96862004000400011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reconsidering empirical cotrimoxazole prophylaxis for infants exposed to HIV infection." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Infants with HIV infection are vulnerable to Pneumocystis carinii pneumonia (PCP) during their first year of life." }, { "infon": 1, "offset": -1, "text": "WHO and the Joint United Nations Programme on HIV/AIDS now recommend that all children of HIV-positive mothers receive prophylactic cotrimoxazole against PCP from six weeks of age and continue this therapy until exposure through breast milk ceases and the infant is confirmed to be HIV-negative (rarely before one year of age)." }, { "infon": 2, "offset": -1, "text": "Empirical prophylaxis invokes a trade-off between possible benefit to the infant versus the risk of resistance to antibiotics and antimalarials." }, { "infon": 3, "offset": -1, "text": "From a critical analysis of the literature, we offer a conceptual model demonstrating how, under certain circumstances, a policy of mass cotrimoxazole prophylaxis may be counterproductive." } ] } ] }, { "id": "S0042-96862004000500005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Signs of illness in Kenyan infants aged less than 60 days." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Little data has been published on the presenting symptoms and signs among ill infants aged <60 days from developing countries." }, { "infon": 1, "offset": -1, "text": "We aimed to describe and evaluate the potential of simple clinical features to identify severe illness among young infants who present to rural district hospitals in Kenya." }, { "infon": 2, "offset": -1, "text": "METHODS: Standardized assessment tools were designed to record clinical symptoms and signs." }, { "infon": 3, "offset": -1, "text": "Data were collected prospectively on all infants aged <60 days who weighed >1.5 kg and were admitted over an 18-month period." }, { "infon": 4, "offset": -1, "text": "The same data were collected prospectively from infants recruited to a contemporaneous hospital birth cohort who became ill and were assessed and treated as outpatients at the same hospital." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Data on 467 outpatient consultations and 769 inpatient episodes were available for analysis." }, { "infon": 6, "offset": -1, "text": "These data highlighted the importance of findings in the history, particularly breathing difficulties, abnormal feeding, and abnormal behaviour, as well as clinical signs in the evaluation of young infants." }, { "infon": 7, "offset": -1, "text": "They indicated possible important differences in the panel of signs useful for detecting severe illness in infants aged 0-6 days and those aged 7-59 days." }, { "infon": 8, "offset": -1, "text": "They also showed that some simplification of current guidelines that still preserved the sensitivity and specificity for detecting very severe disease might be possible." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Simple clinical features may allow distinction between severe and non-severe illness to be made with reasonable confidence." }, { "infon": 10, "offset": -1, "text": "Prospective studies on an adequate scale are needed urgently to provide current integrated management of childhood illness guidelines for young infants with an adequate evidence base." } ] } ] }, { "id": "S0042-96862004000500007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost-effectiveness analysis of cataract surgery: a global and regional analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles." }, { "infon": 1, "offset": -1, "text": "METHODS: Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance." }, { "infon": 2, "offset": -1, "text": "A population model was applied to follow the lifelong impact on individuals having cataract surgery." }, { "infon": 3, "offset": -1, "text": "Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review." }, { "infon": 4, "offset": -1, "text": "Costings were estimated for different geographical coverage levels using non-linear cost functions." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness." }, { "infon": 6, "offset": -1, "text": "Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered." }, { "infon": 7, "offset": -1, "text": "Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally." }, { "infon": 8, "offset": -1, "text": "The cost-effectiveness ranges from 57 International dollars (I$) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to I$ 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered." }, { "infon": 10, "offset": -1, "text": "Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters." } ] } ] }, { "id": "S0042-96862004000500010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A simplified screening strategy for thalassaemia and haemoglobin E in rural communities in south-east Asia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate a simple screening strategy for thalassaemia and haemoglobin (Hb) E in a prevention and control programme for thalassaemia in rural communities with limited resources." }, { "infon": 1, "offset": -1, "text": "METHODS: Blood samples from 301 Thai-Khmer participants were screened for thalassaemia and Hb E using a combined modified one-tube osmotic fragility (OF) test and a modified dichlorophenolindophenol (DCIP) precipitation test." }, { "infon": 2, "offset": -1, "text": "Results were evaluated with standard haematological analyses including erythrocyte indices, Hb typing and quantification and polymerase chain reaction (PCR) analysis of a-globin and b-globin genes." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Participants were divided into four groups according to the results of the combined tests." }, { "infon": 4, "offset": -1, "text": "Altogether, 104 of 301 participants (34.6%) had negative results on both tests; 48 (15.9%) were positive on the OF test but not the DCIP test; 40 (13.3%) were negative on the OF test but positive on DCIP test; and 109 (36.2%) were positive on both tests." }, { "infon": 5, "offset": -1, "text": "No carrier of clinically significant forms of thalassaemia (aº-thalassaemia, b-thalassaemia) or Hb E was found among the group that had negative results for both tests." }, { "infon": 6, "offset": -1, "text": "All participants with Hb E had positive DCIP tests." }, { "infon": 7, "offset": -1, "text": "Carriers of a+-thalassaemia or Hb Constant Spring could generate either positive or negative OF test results but they all had negative DCIP tests." }, { "infon": 8, "offset": -1, "text": "Using both tests as a preliminary screening for the three important groups of carriers gave a sensitivity of 100% and a specificity of 69.8%." }, { "infon": 9, "offset": -1, "text": "The positive predictive value of the combined test was 77.2%." }, { "infon": 10, "offset": -1, "text": "The negative predictive value was 100%." }, { "infon": 11, "offset": -1, "text": "Further evaluation of the screening system by local staff at three community hospitals found a sensitivity of 98.1-100% and a specificity of 65.4-88.4% with positive predictive values of 75.0-86.9% and negative predictive values of 98.1-100%." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: A combined test using OF and DCIP could be used as an effective preliminary screening alternative to an electronic blood cell count for identifying carriers with aº-thalassaemia, b-thalassaemia and Hb E. The strategy should prove useful for population screening in prevention and control programmes in rural communities in south-east Asia where laboratory facilities and economic resources are limited." } ] } ] }, { "id": "S0042-96862004000500013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Genomics knowledge and equity: a global public goods perspective of the patent system." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Genomics, the comprehensive examination of an organism's entire set of genes and their interactions, will have a major impact on the way disease is diagnosed, prevented and treated in the new millennium." }, { "infon": 1, "offset": -1, "text": "Despite the tremendous potential it holds for improving global health, genomics challenges policy-makers to ensure that its benefits are harnessed equitably across populations and nations." }, { "infon": 2, "offset": -1, "text": "The classification of genomics as a global public good and the inequity encountered in the development and application of genomics knowledge are outlined in this paper." }, { "infon": 3, "offset": -1, "text": "We examine the effect of the current patent system on the distribution of costs and benefits relating to genomics knowledge between countries of different economic strength." }, { "infon": 4, "offset": -1, "text": "The global public goods concept provides a normative economic rationale for the modification of certain aspects of the current patent system and for the creation of complementary mechanisms to respond to the health needs of low-income and middle-income countries." } ] } ] }, { "id": "S0042-96862004000600005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Maternal and congenital syphilis programmes: case studies in Bolivia, Kenya and South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Preventing congenital syphilis is not technically difficult, however operational difficulties limit the effectiveness of programmes in many settings." }, { "infon": 1, "offset": -1, "text": "This paper reports on programmes in Bolivia, Kenya, and South Africa." }, { "infon": 2, "offset": -1, "text": "All three countries have established antenatal syphilis control programmes." }, { "infon": 3, "offset": -1, "text": "Early antenatal syphilis screening and management of positive cases were difficult to implement since most women presented for their first antenatal clinic visit after 6 months of pregnancy." }, { "infon": 4, "offset": -1, "text": "Most women had rapid plasma reagin (RPR) testing; results were available on the same day in some clinics but took up to 4 weeks in others." }, { "infon": 5, "offset": -1, "text": "No clinic had a system for tracking RPR-reactive women who did not return for their results." }, { "infon": 6, "offset": -1, "text": "There were no guidelines for providers in Kenya and Bolivia." }, { "infon": 7, "offset": -1, "text": "In all countries, supplies, drugs, notification cards, and other consumables were often unavailable." }, { "infon": 8, "offset": -1, "text": "Health-care providers were unmotivated in Kenya and reported an excessive client load." }, { "infon": 9, "offset": -1, "text": "In South Africa and Kenya some clients reported at their exit interview that they had never heard of syphilis nor had they been informed why blood was collected." }, { "infon": 10, "offset": -1, "text": "Several prevention strategies could be implemented at the clinic level." }, { "infon": 11, "offset": -1, "text": "These include encouraging women to attend for antenatal care before the fourth month of pregnancy, providing point-of-care testing so that results are available immediately and women who test positive can be treated, implementing presumptive treatment of sexual partners of women who test positive, adding a second test later in pregnancy so that incident cases can be managed, and improving the quality of syphilis care during pregnancy, delivery, and the neonatal period." } ] } ] }, { "id": "S0042-96862004000600007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The prevention and management of congenital syphilis: an overview and recommendations." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections." }, { "infon": 1, "offset": -1, "text": "More than 1 million infants are born with congenital syphilis each year." }, { "infon": 2, "offset": -1, "text": "Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women." }, { "infon": 3, "offset": -1, "text": "The weak organization of services and the costs of screening are the principal obstacles facing programmes." }, { "infon": 4, "offset": -1, "text": "Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis." }, { "infon": 5, "offset": -1, "text": "Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization." }, { "infon": 6, "offset": -1, "text": "Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific." }, { "infon": 7, "offset": -1, "text": "Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed." }, { "infon": 8, "offset": -1, "text": "Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment." }, { "infon": 9, "offset": -1, "text": "They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early." }, { "infon": 10, "offset": -1, "text": "This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant." } ] } ] }, { "id": "S0042-96862004000600010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Diagnostic tools for preventing and managing maternal and congenital syphilis: an overview." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Syphilis is a major cause of adverse outcomes in pregnancy in developing countries." }, { "infon": 1, "offset": -1, "text": "Fetal death and morbidity due to congenital syphilis are preventable if infected mothers are identified and treated appropriately by the middle of the second trimester." }, { "infon": 2, "offset": -1, "text": "Most pregnant women with syphilis are asymptomatic and can only be identified through serological screening." }, { "infon": 3, "offset": -1, "text": "Non-treponemal tests, such as the rapid plasma reagin (RPR) test, are sensitive, simple to perform, and inexpensive." }, { "infon": 4, "offset": -1, "text": "However, they have often not been available at primary health-care settings because they required cold storage for reagents and electricity to operate a rotator." }, { "infon": 5, "offset": -1, "text": "Additionally, as many as 28% of positive RPR results in pregnant women are biological false positives." }, { "infon": 6, "offset": -1, "text": "Confirmatory assays are usually available only in reference laboratories." }, { "infon": 7, "offset": -1, "text": "Technological advances have resulted in improved serodiagnostic tools for syphilis." }, { "infon": 8, "offset": -1, "text": "New enzyme immunoassays are available for surveillance and for large-scale screening programmes." }, { "infon": 9, "offset": -1, "text": "Decentralized antenatal screening with on-site confirmation is now possible since new RPR reagents that are stable at room temperature have become commercially available, as have solar-powered rotators and simple, rapid point-of-care treponemal tests that use whole blood and do not require electricity or equipment." }, { "infon": 10, "offset": -1, "text": "These will be valuable tools for preventing or eliminating congenital syphilis." }, { "infon": 11, "offset": -1, "text": "The development of a non-invasive rapid treponemal test that distinguishes between active and past infections remains a high priority in areas where syphilis is endemic." } ] } ] }, { "id": "S0042-96862004000600012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Effectiveness of condoms in preventing sexually transmitted infections." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In June 2000, the United States National Institutes of Health (NIH) organized a review of the scientific evidence on the effectiveness of condoms in preventing sexually transmitted infections (STIs)." }, { "infon": 1, "offset": -1, "text": "The review concluded that condoms were effective in protecting against transmission of HIV to women and men and in reducing the risk of men becoming infected with gonorrhoea." }, { "infon": 2, "offset": -1, "text": "Evidence for the effectiveness of condoms in preventing other STIs was considered to be insufficient." }, { "infon": 3, "offset": -1, "text": "We review the findings of prospective studies published after June 2000 that evaluated the effectiveness of condoms in preventing STIs." }, { "infon": 4, "offset": -1, "text": "We searched Medline for publications in English and included other articles, reports, and abstracts of which we were aware." }, { "infon": 5, "offset": -1, "text": "These prospective studies, published since June 2000, show that condom use is associated with statistically significant protection of men and women against several other types of STIs, including chlamydial infection, gonorrhoea, herpes simplex virus type 2, and syphilis." }, { "infon": 6, "offset": -1, "text": "Condoms may also be associated with protecting women against trichomoniasis." }, { "infon": 7, "offset": -1, "text": "While no published prospective study has found protection against genital human papillomavirus (HPV) infection, two studies reported that condom use was associated with higher rates of regression of cervical intraepithelial neoplasia and clearance of cervical HPV infection in women and with regression of HPV-associated penile lesions in men." }, { "infon": 8, "offset": -1, "text": "Research findings available since the NIH review add considerably to the evidence of the effectiveness of condoms against STIs." }, { "infon": 9, "offset": -1, "text": "Although condoms are not 100% effective, partial protection can substantially reduce the spread of STIs within populations." } ] } ] }, { "id": "S0042-96862004000700005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reproductive tract infections in rural women from the highlands, jungle, and coastal regions of Peru." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women." }, { "infon": 1, "offset": -1, "text": "METHODS: During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru." }, { "infon": 2, "offset": -1, "text": "We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively." }, { "infon": 4, "offset": -1, "text": "Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively)." }, { "infon": 5, "offset": -1, "text": "One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%)." }, { "infon": 6, "offset": -1, "text": "Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL." }, { "infon": 7, "offset": -1, "text": "Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs." }, { "infon": 9, "offset": -1, "text": "Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy." } ] } ] }, { "id": "S0042-96862004000700007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Secondary prevention of stroke : results from the Southern Africa Stroke Prevention Initiative (SASPI) study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To describe the prevalence of risk factors and experience of preventive interventions in stroke survivors, and identify barriers to secondary prevention in rural South Africa." }, { "infon": 1, "offset": -1, "text": "METHODS: A clinician visited individuals in the Agincourt field site (in South Africa's rural north east) who were identified in a census as possible stroke victims to confirm the diagnosis of stroke." }, { "infon": 2, "offset": -1, "text": "We explored the impact of stroke on the individual's family, and health-seeking behaviour following stroke by conducting in-depth interviews in the households of 35 stroke survivors." }, { "infon": 3, "offset": -1, "text": "We held two workshops to understand the knowledge, experience, and views of primary care nurses, who provide the bulk of professional health care." }, { "infon": 4, "offset": -1, "text": "FINDINGS: We identified 103 stroke survivors (37 men), 73 (71%) of whom had hypertension, but only 8 (8%) were taking anti-hypertensive treatment." }, { "infon": 5, "offset": -1, "text": "Smoking was uncommon; 8 men and 1 woman smoked a maximum of ten cigarettes daily." }, { "infon": 6, "offset": -1, "text": "94 (91%) stroke survivors had sought help, which involved allopathic health care for most of them (81; 79%)." }, { "infon": 7, "offset": -1, "text": "42 had also sought help from traditional healers and churches, while another 13 people had sought help only from those sources." }, { "infon": 8, "offset": -1, "text": "Of the 35 survivors who were interviewed, 29 reported having been prescribed anti-hypertensive pills after their stroke." }, { "infon": 9, "offset": -1, "text": "Barriers to secondary prevention included cost of treatment, reluctance to use pills, difficulties with access to drugs, and lack of equipment to measure blood pressure." }, { "infon": 10, "offset": -1, "text": "A negative attitude to allopathic care was not an important factor." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: In this rural area hypertension is the most important modifiable risk factor in stroke survivors." }, { "infon": 12, "offset": -1, "text": "Effective secondary prevention may reduce the incidence of recurrent strokes, but there is no system to deliver such care." }, { "infon": 13, "offset": -1, "text": "New strategies for care are needed involving both allopathic and non-allopathic-health care providers." } ] } ] }, { "id": "S0042-96862004000700009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Wheezing conditions in early childhood: prevalence and risk factors in the city of São Paulo, Brazil." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate the prevalence and risk factors for wheezing disorders in early childhood in São Paulo, Brazil, the largest metropolitan area of South America." }, { "infon": 1, "offset": -1, "text": "METHODS: A population-based cross-sectional survey of 1132 children aged 6-59 months was carried out between 1995 and 1996 to obtain information on recent wheezing and on independent variables such as demographic, socioeconomic, environmental, maternal and nutritional variables and immunization status." }, { "infon": 2, "offset": -1, "text": "Intestinal parasitic infections were diagnosed using standard techniques." }, { "infon": 3, "offset": -1, "text": "Multiple unconditional logistic regression was used to describe associations between outcome and independent variables." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The prevalence of recent wheezing (one or more reported episodes in the past 12 months) was 12.5%; 93% of children with wheezing were also reported to have a medical diagnosis of asthma." }, { "infon": 5, "offset": -1, "text": "Recent wheezing was associated with low per capita income, poor quality of housing, day-care attendance, low birth weight and infection with intestinal helminths." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Wheezing in early childhood in São Paulo, although more common than in most developing countries, remains less prevalent than in urban areas of industrialized countries." }, { "infon": 7, "offset": -1, "text": "Low income and conditions associated with poverty (poor housing, low birth weight and parasitic infections) are some of the main risk factors for wheezing disorders among young children in this city." } ] } ] }, { "id": "S0042-96862004000700011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "China's public health-care system: facing the challenges." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies." }, { "infon": 1, "offset": -1, "text": "A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies." }, { "infon": 2, "offset": -1, "text": "The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care." }, { "infon": 3, "offset": -1, "text": "For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas." }, { "infon": 4, "offset": -1, "text": "A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system." }, { "infon": 5, "offset": -1, "text": "China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations." }, { "infon": 6, "offset": -1, "text": "China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care." } ] } ] }, { "id": "S0042-96862004000800005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Selective mass treatment with ivermectin to control intestinal helminthiases and parasitic skin diseases in a severely affected population." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil." }, { "infon": 1, "offset": -1, "text": "METHODS: An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites." }, { "infon": 2, "offset": -1, "text": "The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection." }, { "infon": 3, "offset": -1, "text": "A total of 525 people out of a target population of 576 were treated at baseline." }, { "infon": 4, "offset": -1, "text": "The majority of these were treated with ivermectin (200 µg/kg with a second dose given after 10 days)." }, { "infon": 5, "offset": -1, "text": "If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites." }, { "infon": 6, "offset": -1, "text": "Follow-up examinations were performed at 1 month and 9 months after treatment." }, { "infon": 7, "offset": -1, "text": "FINDINGS: Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively." }, { "infon": 8, "offset": -1, "text": "Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively." }, { "infon": 9, "offset": -1, "text": "Adverse events occurred in 9.4% of treatments." }, { "infon": 10, "offset": -1, "text": "They were all of mild to moderate severity and were transient." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil." }, { "infon": 12, "offset": -1, "text": "The effects of treatment lasted for a prolonged period of time." } ] } ] }, { "id": "S0042-96862004000800007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Public-private mix for DOTS implementation: what makes it work?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare processes and outcomes of four public-private mix (PPM) projects on DOTS implementation for tuberculosis (TB) control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India." }, { "infon": 1, "offset": -1, "text": "METHODS: Cross-project analysis of secondary data from separate project evaluations was used." }, { "infon": 2, "offset": -1, "text": "Differences among PPM project sites in impact on TB control (change in case detection, treatment outcomes and equity in access) were correlated with differences in chosen intervention strategies and structural conditions." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The analysis suggests that an effective intervention package should include the following provider-side components: (1) orienting private providers (PPs) and the staff of the national TB programme (NTP); (2) improving the referral and information system through simple practical tools; (3) the NTP adequately supervising and monitoring PPs; and (4) the NTP providing free anti-TB drugs to patients treated in the private sector." }, { "infon": 4, "offset": -1, "text": "CONCLUSION: Getting such an intervention package to work requires that the NTP be strongly committed to supporting, supervising and evaluating PPM projects." }, { "infon": 5, "offset": -1, "text": "Further, using a local nongovernmental organization or a medical association as an intermediary may facilitate collaboration." }, { "infon": 6, "offset": -1, "text": "Investing time and effort to ensure that sufficient dialogue takes place among all stakeholders is important to help build trust and achieve a high level of agreement." } ] } ] }, { "id": "S0042-96862004000800009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Migration of health-care workers from developing countries: strategic approaches to its management." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active." }, { "infon": 1, "offset": -1, "text": "The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries." }, { "infon": 2, "offset": -1, "text": "Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised." }, { "infon": 3, "offset": -1, "text": "It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing." }, { "infon": 4, "offset": -1, "text": "The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration." } ] } ] }, { "id": "S0042-96862004000800011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Plumbing the brain drain." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Opportunity is the driving force of migration." }, { "infon": 1, "offset": -1, "text": "Unsatisfied demands for higher education and skills, which have been created by the knowledge-based global economy, have generated unprecedented opportunities in knowledge-intensive service industries." }, { "infon": 2, "offset": -1, "text": "These multi-trillion dollar industries include information, communication, finance, business, education and health." }, { "infon": 3, "offset": -1, "text": "The leading industrialized nations are also the focal points of knowledge-intensive service industries and as such constitute centres of research and development activity that proactively draw in talented individuals worldwide through selective immigration policies, employment opportunities and targeted recruitment." }, { "infon": 4, "offset": -1, "text": "Higher education is another major conduit of talent from less-developed countries to the centres of the knowledge-based global economy." }, { "infon": 5, "offset": -1, "text": "Together career and educational opportunities drive \"brain drain and recirculation\"." }, { "infon": 6, "offset": -1, "text": "The departure of a large proportion of the most competent and innovative individuals from developing nations slows the achievement of the critical mass needed to generate the enabling context in which knowledge creation occurs." }, { "infon": 7, "offset": -1, "text": "To favourably modify the asymmetric movement and distribution of global talent, developing countries must implement bold and creative strategies that are backed by national policies to: provide world-class educational opportunities, construct knowledge-based research and development industries, and sustainably finance the required investment for these strategies." }, { "infon": 8, "offset": -1, "text": "Brazil, China and India have moved in this direction, offering world-class education in areas crucial to national development, such as biotechnology and information technology, paralleled by investments in research and development." }, { "infon": 9, "offset": -1, "text": "As a result, only a small proportion of the most highly educated individuals migrate from these countries, and research and development opportunities employ national talent and even attract immigrants." } ] } ] }, { "id": "S0042-96862004000900005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in Pakistan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: This study aimed to estimate the incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in the Loralai district of Pakistan." }, { "infon": 1, "offset": -1, "text": "The supplemental immunization activities were carried out in two phases during 2001-03." }, { "infon": 2, "offset": -1, "text": "METHODS: A state-transition model was used to estimate the effect of routine vaccination with tetanus toxoid as well as vaccination with tetanus toxoid during supplementary immunization activities." }, { "infon": 3, "offset": -1, "text": "The model follows each woman in the target population from birth until the end of her childbearing years, using age-specific fertility data and vaccination history to determine the number of births at risk for neonatal tetanus." }, { "infon": 4, "offset": -1, "text": "Recently published data on the incidence of neonatal tetanus from Loralai was used to determine the number of cases occurring with and without supplementary immunization activities." }, { "infon": 5, "offset": -1, "text": "Data on the costs of the activities were collected from the UNICEF office in Balochistan and from the Provincial Health Department." }, { "infon": 6, "offset": -1, "text": "FINDINGS: Using base-case assumptions we estimated that the supplementary immunization activities would prevent 280 cases of neonatal tetanus and 224 deaths from neonatal tetanus between 2001 and 2034." }, { "infon": 7, "offset": -1, "text": "Implementation of the supplementary activities was relatively inexpensive." }, { "infon": 8, "offset": -1, "text": "The cost per tetanus toxoid dose delivered was US$ 0.40." }, { "infon": 9, "offset": -1, "text": "In the base-case analysis the cost per death averted was US$ 117.00 (95% confidence interval (CI) = US$ 78-205) and the cost per disability-adjusted life year (DALY) averted was US$ 3.61 (95% CI = US$ 2.43-6.39)." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: Compared with similar analyses of other interventions, the cost per DALY averted is a favourable cost-effectiveness ratio." }, { "infon": 11, "offset": -1, "text": "However, if routine diphtheria-tetanus-pertussis vaccination coverage in the Loralai district had been higher (at a coverage rate of about 80%) the cost-effectiveness of the intervention would have been even more favourable, at US$ 2.65 per DALY averted." } ] } ] }, { "id": "S0042-96862004000900007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Improving immunization equity through a public-private partnership in Cambodia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine the effects on immunization equity of the large-scale contracting of primary health-care services in rural areas of Cambodia." }, { "infon": 1, "offset": -1, "text": "METHODS: Data were obtained pre-intervention and post-intervention from a large-scale quasi-experiment in contracting with nongovernmental organizations to provide primary health care in nine rural districts of Cambodia between 1999 and mid-2001." }, { "infon": 2, "offset": -1, "text": "Coverage targets and equity targets for all primary health-care services, including immunization of children, were explicitly included in the contracts awarded in five of nine rural districts which together have a population of over 1.25 million people." }, { "infon": 3, "offset": -1, "text": "The remaining four districts used the traditional government model for providing services and were given identical targets." }, { "infon": 4, "offset": -1, "text": "FINDINGS: After the 2.5 years of the trial, bivariate and multivariate analyses of the results suggested that although there was a substantial increase in the proportion of children who were fully immunized in all districts, children in the poorest 50% of households in the districts served by contractors were more likely to be fully immunized than poor children living in similar circumstances in districts using the government's model, all other things being equal." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: The contracting approach described in this paper suggests a means of moving towards a more equitable distribution of immunization services in developing countries." } ] } ] }, { "id": "S0042-96862004000900009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Variation in the costs of delivering routine immunization services in Peru." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Estimates of vaccination costs usually provide only point estimates at national level with no information on cost variation." }, { "infon": 1, "offset": -1, "text": "In practice, however, such information is necessary for programme managers." }, { "infon": 2, "offset": -1, "text": "This paper presents information on the variations in costs of delivering routine immunization services in three diverse districts of Peru: Ayacucho (a mountainous area), San Martin (a jungle area) and Lima (a coastal area)." }, { "infon": 3, "offset": -1, "text": "METHODS: We consider the impact of variability on predictions of cost and reflect on the likely impact on expected cost-effectiveness ratios, policy decisions and future research practice." }, { "infon": 4, "offset": -1, "text": "All costs are in 2002 prices in US$ and include the costs of providing vaccination services incurred by 19 government health facilities during the January-December 2002 financial year." }, { "infon": 5, "offset": -1, "text": "Vaccine wastage rates have been estimated using stock records." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The cost per fully vaccinated child ranged from US$ 16.63-24.52 in Ayacucho, US$ 21.79-36.69 in San Martin and US$ 9.58-20.31 in Lima." }, { "infon": 7, "offset": -1, "text": "The volume of vaccines administered and wastage rates are determinants of the variation in costs of delivering routine immunization services." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: This study shows there is considerable variation in the costs of providing vaccines across geographical regions and different types of facilities." }, { "infon": 9, "offset": -1, "text": "Information on how costs vary can be used as a basis from which to generalize to other settings and provide more accurate estimates for decision-makers who do not have disaggregated data on local costs." }, { "infon": 10, "offset": -1, "text": "Future studies should include sufficiently large sample sizes and ensure that regions are carefully selected in order to maximize the interpretation of cost variation." } ] } ] }, { "id": "S0042-96862004000900011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The costs, effects and cost-effectiveness of strategies to increase coverage of routine immunizations in low- and middle-income countries: systematic review of the grey literature." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Evidence-based reviews of published literature can be subject to several biases." }, { "infon": 1, "offset": -1, "text": "Grey literature, however, can be of poor quality and expensive to access." }, { "infon": 2, "offset": -1, "text": "Effective search strategies also vary by topic and are rarely known in advance." }, { "infon": 3, "offset": -1, "text": "This paper complements a systematic review of the published literature on the costs and effects of expanding immunization services in developing countries." }, { "infon": 4, "offset": -1, "text": "The quality of data on the effectiveness and cost-effectiveness of strategies to increase immunization coverage is shown to be similar across literatures, but the quality of information on costing is much lower in the grey literature." }, { "infon": 5, "offset": -1, "text": "After excluding poorer quality studies from this review we found the quantity of available evidence almost doubled, particularly for more complex health-system interventions and cost or cost-effectiveness analyses." }, { "infon": 6, "offset": -1, "text": "Interventions in the grey literature are more up to date and cover a different geographical spread." }, { "infon": 7, "offset": -1, "text": "Consequently the conclusions of the published and grey literatures differ, although the number of papers is still too low to account for differences across types of interventions." }, { "infon": 8, "offset": -1, "text": "We recommend that in future researchers consider using non-English keywords in their searches." } ] } ] }, { "id": "S0042-96862004000900013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Does earmarked donor funding make it more or less likely that developing countries will allocate their resources towards programmes that yield the greatest health benefits?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "It should not be assumed that earmarked donor funding automatically increases the allocation of developing-country resources towards programmes that yield the greatest health benefits." }, { "infon": 1, "offset": -1, "text": "Sometimes it does, sometimes it does not - how the funding is designed can influence this." }, { "infon": 2, "offset": -1, "text": "This is true particularly in the longer term, once the earmarked funding has ended." }, { "infon": 3, "offset": -1, "text": "Even in the short term, total funding does not necessarily increase because of fungibility (i.e. recipient governments adjust their spending to offset donor funding preferences)." }, { "infon": 4, "offset": -1, "text": "The author explores six problems with earmarked funding: the multiplicity of earmarked funds confuses the situation for decision-makers; earmarking works against the spirit of the sectorwide approach; from the national perspective, it makes sense not to double-fund activities; local ownership of an activity is often compromised; earmarking can lead governments to accept interventions which they cannot afford in the longer term; and earmarking can distort local resource allocation." } ] } ] }, { "id": "S0042-96862004001000007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimating the economic value to societies of the impact of health research: a critical review." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Estimating the economic value to societies of health research is a complex but essential step in establishing and justifying appropriate levels of investment in research." }, { "infon": 1, "offset": -1, "text": "The practical difficulties encountered include: identifying and valuing the relevant research inputs (when many pieces of research may contribute to a clinical advance); accurately ascribing the impact of the research; and appropriately valuing the attributed economic impact." }, { "infon": 2, "offset": -1, "text": "In this review, relevant studies identified from the literature were grouped into four categories on the basis of the methods used to value the benefits of research." }, { "infon": 3, "offset": -1, "text": "The first category consists of studies that value the direct cost savings that could arise from research leading either to new, less-costly treatments or to developments such as vaccines that reduce the number of patients needing treatment." }, { "infon": 4, "offset": -1, "text": "The second category comprises studies that consider the value to the economy of a healthy workforce." }, { "infon": 5, "offset": -1, "text": "According to this \"human capital\" approach, indirect cost savings arise when better health leads to the avoidance of lost production." }, { "infon": 6, "offset": -1, "text": "The third category includes studies that examine gains to the economy in terms of product development, consequent employment and sales." }, { "infon": 7, "offset": -1, "text": "The studies placed in the fourth category measure the intrinsic value to society of the health gain, by placing a monetary value on a life." }, { "infon": 8, "offset": -1, "text": "The review did not identify any consistency of methodology, but the fourth approach has most promise as a measure of social value." }, { "infon": 9, "offset": -1, "text": "Many of the studies reviewed come from industrialized nations and a proposal is made by the present reviewers for an international initiative, covering developed and developing countries, to undertake further methodological analysis and testing." } ] } ] }, { "id": "S0042-96862004001000009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "From research to practice: the example of antenatal care in Thailand." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention." }, { "infon": 1, "offset": -1, "text": "The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries." }, { "infon": 2, "offset": -1, "text": "However, in developing countries there is wide variation in the proportion of women who receive antenatal care." }, { "infon": 3, "offset": -1, "text": "The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus." }, { "infon": 4, "offset": -1, "text": "This new model of antenatal care is being implemented in Thailand." }, { "infon": 5, "offset": -1, "text": "Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations." }, { "infon": 6, "offset": -1, "text": "The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems." } ] } ] }, { "id": "S0042-96862004001000011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Making research matter: a civil society perspective on health research." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Complex global public health challenges such as the rapidly widening health inequalities, and unprecedented emergencies such as the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) demand a reappraisal of existing priorities in health policies, expenditure and research." }, { "infon": 1, "offset": -1, "text": "Research can assist in mounting an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives." }, { "infon": 2, "offset": -1, "text": "Civil society organizations (CSOs) are already at the forefront of such research." }, { "infon": 3, "offset": -1, "text": "We suggest that there are at least three ways in which the participation of CSOs in research can be increased: namely, influencing commissioning and priority-setting; becoming involved in the review process and in conducting research; and through formal partnerships between communities and universities that link CSOs with academic researchers." } ] } ] }, { "id": "S0042-96862004001000013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Beyond informed consent." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Although a relatively recent phenomenon, the role of informed consent in human research is central to its ethical regulation and conduct." }, { "infon": 1, "offset": -1, "text": "However, guidelines often recommend procedures for obtaining informed consent (usually written consent) that are difficult to implement in developing countries." }, { "infon": 2, "offset": -1, "text": "This paper reviews the guidelines for obtaining informed consent and also discusses prevailing views on current controversies, ambiguities and problems with these guidelines and suggests potential solutions." }, { "infon": 3, "offset": -1, "text": "The emphasis in most externally sponsored research projects in developing countries is on laborious documentation of several mechanical aspects of the research process rather than on assuring true comprehension and voluntary participation." }, { "infon": 4, "offset": -1, "text": "The onus for the oversight of this process is often left to overworked and ill-equipped local ethics review committees." }, { "infon": 5, "offset": -1, "text": "Current guidelines and processes for obtaining informed consent should be reviewed with the specific aim of developing culturally appropriate methods of sharing information about the research project and obtaining and documenting consent that is truly informed." }, { "infon": 6, "offset": -1, "text": "Further research is needed to examine the validity and user friendliness of innovations in information sharing procedures for obtaining consent in different cultural settings." } ] } ] }, { "id": "S0042-96862004001000015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Ownership of knowledge: the role of patents in pharmaceutical R&D." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Both the public and the private sectors contribute to research and development (R&D) in pharmaceuticals." }, { "infon": 1, "offset": -1, "text": "The public sector originates many of the discoveries of new drugs." }, { "infon": 2, "offset": -1, "text": "The private sector, which focuses on development, is heavily reliant on patents." }, { "infon": 3, "offset": -1, "text": "Though patents are presumed to reward genuine inventions, lax rules on patentability and shortcomings in procedures permit protection to be obtained on a myriad of minor developments." }, { "infon": 4, "offset": -1, "text": "These patents, though weak and possibly invalid in many cases, are used to restrain competition and delay the entry of generic competition." }, { "infon": 5, "offset": -1, "text": "Developing countries should design and implement their patent laws so as to prevent strategic patenting and promote competition and access to medicines." } ] } ] }, { "id": "S0042-96862004001100006", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Back to basics: does decentralization improve health system performance?" }, { "infon": 1, "offset": -1, "text": "Evidence from Ceará in north-east Brazil." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine whether decentralization has improved health system performance in the State of Ceará, north-east Brazil." }, { "infon": 1, "offset": -1, "text": "METHODS: Ceará is strongly committed to decentralization." }, { "infon": 2, "offset": -1, "text": "A survey across 45 local (município) health systems collected data on performance and formal organization, including decentralization, informal management and local political culture." }, { "infon": 3, "offset": -1, "text": "The indicators for informal management and local political culture were based on prior ethnographic research." }, { "infon": 4, "offset": -1, "text": "Data were analysed using analysis of variance, Duncan's post-hoc test and multiple regression." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators." }, { "infon": 6, "offset": -1, "text": "Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences." }, { "infon": 7, "offset": -1, "text": "However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Good management practices in the study led to decentralized local health systems rather than vice versa." }, { "infon": 9, "offset": -1, "text": "Any apparent association between decentralization and performance seems to be an artefact of the informal management, and the wider political culture in which a local health system is embedded strongly influences the performance of local health systems." } ] } ] }, { "id": "S0042-96862004001100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Tuberculosis situation among tribal population of Car Nicobar, India, 15 years after intensive tuberculosis control project and implementation of a national tuberculosis programme." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the tuberculosis (TB) situation in the tribal community of Car Nicobar island 15 years after the national TB programme was implemented in this area after an intensive phase of TB control in 1986." }, { "infon": 1, "offset": -1, "text": "METHODS: The entire population of Car Nicobar was enumerated through a house-to-house survey." }, { "infon": 2, "offset": -1, "text": "Children aged <14 years were tuberculin tested and read for reaction sizes." }, { "infon": 3, "offset": -1, "text": "Individuals aged >15 years were asked about the presence of chest symptoms (cough, chest pain, and unexplained fever for two weeks or longer and haemoptysis), and sputum samples were collected from patients with chest symptoms." }, { "infon": 4, "offset": -1, "text": "Sputum samples were examined for presence of acid-fast bacilli." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Among the 4543 children enumerated, 4351 (95.8%) were tuberculin tested and read." }, { "infon": 6, "offset": -1, "text": "Of the 981 children without bacille Calmette-Guérin scars, 161 (16.4%) were infected with TB." }, { "infon": 7, "offset": -1, "text": "A total of 77 cases who were smear-positive for TB were detected from among 10 570 people aged >15 years; the observed smear-positive case prevalence was 728.5 per 100 000." }, { "infon": 8, "offset": -1, "text": "The standardized prevalence of TB infection, annual risk of TB infection, and prevalence of cases smear-positive for TB were 17.0%, 2.5%, and 735.3 per 100 000, respectively." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The prevalence of TB infection and smear-positive cases of TB increased significantly between 1986 and 2002." }, { "infon": 10, "offset": -1, "text": "Such escalation took place despite the implementation of the national TB programme on this island, which was preceded by a set of special anti-TB measures that resulted in sputum conversion in a substantially large proportion of the smear-positive cases prevalent in the community." }, { "infon": 11, "offset": -1, "text": "The most likely reason for the increase seems to be the absence of a district TB programme with enough efficiency to sustain the gains made from the one-time initial phase of special anti-TB measures." }, { "infon": 12, "offset": -1, "text": "High risk of transmission of TB infection currently observed on this island calls for a drastic and sustained improvement in TB control measures." } ] } ] }, { "id": "S0042-96862004001100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The laboratory confirmation of suspected measles cases in settings of low measles transmission: conclusions from the experience in the Americas." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Americas have set a goal of interrupting indigenous transmission of measles using a strategy developed by the Pan American Health Organization (PAHO)." }, { "infon": 1, "offset": -1, "text": "This strategy includes recommendations for vaccination activities to achieve and sustain high immunity in the population and is complemented by sensitive epidemiological surveillance systems developed to monitor illnesses characterized by febrile rash, and to provide effective virological and serological surveillance." }, { "infon": 2, "offset": -1, "text": "A key component in ensuring the success of the programme has been a laboratory network comprising 22 national laboratories including reference centres." }, { "infon": 3, "offset": -1, "text": "Commercially available indirect enzyme immunoassay kits (EIA) for immunoglobulin M (IgM)-class antibodies are currently being used throughout the region." }, { "infon": 4, "offset": -1, "text": "However, because there are few or no true measles cases in the region, the positive predictive value of these diagnostic tests has decreased." }, { "infon": 5, "offset": -1, "text": "False-positive results of IgM tests can also occur as a result of testing suspected measles cases with exanthemata caused by Parvovirus B19, rubella and Human herpesvirus 6, among others." }, { "infon": 6, "offset": -1, "text": "In addition, as countries maintain high levels of vaccination activity and increased surveillance of rash and fever, the notification of febrile rash illness in recently vaccinated people can be anticipated." }, { "infon": 7, "offset": -1, "text": "Thus, managers in the measles elimination programme must be prepared to address the interpretation of a positive result of a laboratory test for measles IgM when clinical and epidemiological data may indicate that the case is not measles." }, { "infon": 8, "offset": -1, "text": "The interpretation of an IgM-positive test under different circumstances and the definition of a vaccine-related rash illness in a setting of greatly reduced, or absent, transmission of measles is discussed." } ] } ] }, { "id": "S0042-96862004001100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health information technology in primary health care in developing countries: a literature review." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper explores the debate and initiatives concerning the use of information technology (IT) in primary health care in developing countries." }, { "infon": 1, "offset": -1, "text": "The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases." }, { "infon": 2, "offset": -1, "text": "The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO)." }, { "infon": 3, "offset": -1, "text": "For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries." }, { "infon": 4, "offset": -1, "text": "These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS)." }, { "infon": 5, "offset": -1, "text": "The main advantages, limitations and perspectives are discussed." } ] } ] }, { "id": "S0042-96862004001200005", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Global estimate of the incidence of clinical pneumonia among children under five years of age." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Clinical pneumonia (defined as respiratory infections associated with clinical signs of pneumonia, principally pneumonia and bronchiolitis) in children under five years of age is still the leading cause of childhood mortality in the world." }, { "infon": 1, "offset": -1, "text": "In this paper we aim to estimate the worldwide incidence of clinical pneumonia in young children." }, { "infon": 2, "offset": -1, "text": "METHODS: Our estimate for the developing world is based on an analysis of published data on the incidence of clinical pneumonia from community based longitudinal studies." }, { "infon": 3, "offset": -1, "text": "Among more than 2000 studies published since 1961, we identified 46 studies that reported the incidence of clinical pneumonia, and 28 of these met pre-defined quality criteria." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The estimate of the median incidence from those studies was 0.28 episodes per child-year (e/cy)." }, { "infon": 5, "offset": -1, "text": "The 25-75% interquartile range was 0.21-0.71." }, { "infon": 6, "offset": -1, "text": "We assessed the plausibility of this estimate using estimates of global mortality from acute respiratory infections and reported case fatality rates for all episodes of clinical pneumonia reported in community-based studies or the case-fatality rate reported only for severe cases and estimates of the proportion of severe cases occurring in a defined population or community." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: The overlap between the ranges of the estimates implies that a plausible incidence estimate of clinical pneumonia for developing countries is 0.29 e/cy." }, { "infon": 8, "offset": -1, "text": "This equates to an annual incidence of 150.7 million new cases, 11-20 million (7-13%) of which are severe enough to require hospital admission." }, { "infon": 9, "offset": -1, "text": "In the developed world no comparable data are available." }, { "infon": 10, "offset": -1, "text": "However, large population-based studies report that the incidence of community-acquired pneumonia among children less than five years old is approximately 0.026 e/cy, suggesting that more than 95% of all episodes of clinical pneumonia in young children worldwide occur in developing countries." } ] } ] }, { "id": "S0042-96862004001200007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Respiratory syncytial virus infection: denominator-based studies in Indonesia, Mozambique, Nigeria and South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the burden of respiratory syncytial virus (RSV)-associated lower respiratory infections (LRI) in children in four developing countries." }, { "infon": 1, "offset": -1, "text": "METHODS: A WHO protocol for prospective population-based surveillance of acute respiratory infections in children aged less than 5 years was used at sites in Indonesia, Mozambique, Nigeria and South Africa." }, { "infon": 2, "offset": -1, "text": "RSV antigen was identified by enzyme-linked immunosorbent assay performed on nasopharyngeal specimens from children meeting clinical case definitions." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Among children aged < 5 years, the incidence of RSV-associated LRI per 1000 child-years was 34 in Indonesia and 94 in Nigeria." }, { "infon": 4, "offset": -1, "text": "The incidence of RSV-associated severe LRI per 1000 child-years was 5 in Mozambique, 10 in Indonesia, and 9 in South Africa." }, { "infon": 5, "offset": -1, "text": "At all study sites, the majority of RSV cases occurred in infants." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: These studies demonstrate that RSV contributes to a substantial but quite variable burden of LRI in children aged < 5 years in four developing countries." }, { "infon": 7, "offset": -1, "text": "The possible explanations for this variation include social factors, such as family size and patterns of seeking health care; the proportion of children infected by human immunodeficiency syndrome (HIV); and differences in clinical definitions used for obtaining samples." }, { "infon": 8, "offset": -1, "text": "The age distribution of cases indicates the need for an RSV vaccine that can protect children early in life." } ] } ] }, { "id": "S0042-96862004001200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The antimicrobial resistance containment and surveillance approach - a public health tool." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Antimicrobial drug resistance (AMR) is widely recognized as a global public health threat because it endangers the effectiveness of treatment of infectious diseases." }, { "infon": 1, "offset": -1, "text": "In 2001 WHO issued the Global Strategy for Containment of Antimicrobial Resistance, but it has proved difficult to translate the recommendations of the Global Strategy into effective public health actions." }, { "infon": 2, "offset": -1, "text": "The purpose of the Antimicrobial Resistance Containment and Surveillance (ARCS) approach is to facilitate the formulation of public health programmes and the mobilization of human and financial resources for the containment of AMR." }, { "infon": 3, "offset": -1, "text": "The ARCS approach highlights the fundamental link between rational drug use and containment of AMR." }, { "infon": 4, "offset": -1, "text": "Clinical management of human and animal infections should be improved through better disease control and prevention, high quality diagnostic testing, appropriate treatment regimens and consumer health education." }, { "infon": 5, "offset": -1, "text": "At the same time, systems for supplying antimicrobial drugs should include appropriate regulations, lists of essential drugs, and functional mechanisms for the approval and delivery of drugs." }, { "infon": 6, "offset": -1, "text": "Containment of AMR is defined in the ARCS approach as the continuous application of this package of core interventions." }, { "infon": 7, "offset": -1, "text": "Surveillance of the extent and trends of antimicrobial resistance as well as the supply, selection and use of antimicrobial drugs should be established to monitor the process and outcome of containment of AMR." }, { "infon": 8, "offset": -1, "text": "The ARCS approach is represented in the ARCS diagram (Fig." }, { "infon": 9, "offset": -1, "text": "2) which provides a simplified, but comprehensive illustration of the complex problem of containment and monitoring of AMR." } ] } ] }, { "id": "S0042-96862004001200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Socioeconomic status and obesity in adult populations of developing countries: a review." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite." }, { "infon": 1, "offset": -1, "text": "The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity." }, { "infon": 2, "offset": -1, "text": "Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1." }, { "infon": 3, "offset": -1, "text": "Obesity in the developing world can no longer be considered solely a disease of groups with higher SES." }, { "infon": 4, "offset": -1, "text": 2 }, { "infon": 5, "offset": -1, "text": "The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases." }, { "infon": 6, "offset": -1, "text": 3 }, { "infon": 7, "offset": -1, "text": "The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men." }, { "infon": 8, "offset": -1, "text": "The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US$ 2500, the mid-point value for lower-middle-income economies." }, { "infon": 9, "offset": -1, "text": "The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all." }, { "infon": 10, "offset": -1, "text": "A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004." } ] } ] }, { "id": "S0042-96862005000100009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy." }, { "infon": 1, "offset": -1, "text": "However, changing to alternative antimicrobial agents, such as amoxicillin, is costly." }, { "infon": 2, "offset": -1, "text": "We compared the clinical efficacy of twice-daily cotrimoxazole in standard versus double dosage for treating non-severe pneumonia in children." }, { "infon": 3, "offset": -1, "text": "METHODS: A randomized controlled multicentre trial was implemented in seven hospital outpatient departments and two community health programmes." }, { "infon": 4, "offset": -1, "text": "A total of 1143 children aged 2-59 months with non-severe pneumonia were randomly allocated to receive 4 mg trimethoprim plus 20 mg sulfamethoxazole/kg of body weight or 8 mg trimethoprim plus 40 mg sulfamethoxazole/kg of body weight orally twice-daily for 5 days Treatment failure occurred when a child required a change of therapy, died or was lost to follow-up." }, { "infon": 5, "offset": -1, "text": "Children required a change of therapy if their condition worsened (they developed chest indrawing or danger signs) or if at 48 hours after enrolment, their clinical condition was the same (defined as having a respiratory rate that was 5 breaths/minute higher or lower than at the time of enrolment)." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The results of 1134 children were analysed: 578 were assigned to the standard dose of cotrimoxazole and 556 to the double dose." }, { "infon": 7, "offset": -1, "text": "Treatment failed in 112 children (19.4%) in the standard group and 118 (21.2%) in the double-dose group (relative risk 1.10; 95% confidence interval = 0.87-1.37)." }, { "infon": 8, "offset": -1, "text": "Using multivariate analysis we found that treatment was more likely to fail in children who were not given the medicine correctly (P = 0.001), in those younger than 12 months (P = 0.004), those who had used antibiotics previously (P = 0.002), those whose respiratory rate was > 20 breaths/minute above the age-specific cut-off point (P = 0.006), and those from urban areas (P = 0.042)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Both standard and double strength cotrimoxazole were equally effective in treating non-severe pneumonia." }, { "infon": 10, "offset": -1, "text": "Close follow-up of patients is essential to prevent worsening of disease." }, { "infon": 11, "offset": -1, "text": "Definitions of clinical failure need to be more specific." }, { "infon": 12, "offset": -1, "text": "Surveillance in both rural and urban areas is essential in the development of treatment policies that are based on clinical outcomes." } ] } ] }, { "id": "S0042-96862005000100011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Helping northern Ethiopian communities reduce childhood mortality: population-based intervention trial." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: More than 10 million children die each year mostly from preventable causes and particularly in developing countries." }, { "infon": 1, "offset": -1, "text": "WHO guidelines for the Integrated Management of Childhood Illness (IMCI) are intended to reduce childhood mortality and are being implemented in Ethiopia." }, { "infon": 2, "offset": -1, "text": "As well as specific clinical interventions, the role of the community in understanding and acting on childhood sickness is an important factor in improving survival." }, { "infon": 3, "offset": -1, "text": "This trial sought to assess the effect on survival of community-based health promotion activities." }, { "infon": 4, "offset": -1, "text": "METHODS: Two districts in northern Ethiopia were studied, each with a random sample of more than 4000 children less than 5 years old." }, { "infon": 5, "offset": -1, "text": "Regular six-monthly visits were made to document deaths among children." }, { "infon": 6, "offset": -1, "text": "After the first year, communities in one district were educated about issues of good childcare and caring for sick children while the other district received this information only after the trial ended." }, { "infon": 7, "offset": -1, "text": "FINDINGS: Although overall mortality was higher in the post-intervention period, most of the increase was seen in the control area." }, { "infon": 8, "offset": -1, "text": "A Cox proportional hazards model gave an adjusted hazard ratio of 0.66 (95% confidence interval = 0.46-0.95) for the intervention area compared with the control area in the post-intervention period, with no significant pre-intervention difference." }, { "infon": 9, "offset": -1, "text": "Significant survival advantages were found for females, children of younger fathers, those with married parents, those living in larger households, and those whose nearest health facility was a health centre." }, { "infon": 10, "offset": -1, "text": "For all of the children who died, only 44% of parents or caregivers had sought health care before the child's death." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: This non-specific community-based public health intervention, as an addition to IMCI strategies in local health facilities, appears to have significantly reduced childhood mortality in these communities." }, { "infon": 12, "offset": -1, "text": "The possibility that such interventions may not effectively reach certain social groups (for example single parents) is an important consideration for implementation of similar strategies in future." }, { "infon": 13, "offset": -1, "text": "The synergy between community awareness and the availability of effective peripheral health services is also an issue that needs further exploration." } ] } ] }, { "id": "S0042-96862005000100013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Schistosomiasis control in China: the impact of a 10-year World Bank Loan Project (1992-2001)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "China has been carrying out large-scale schistosomiasis control since the mid-1950s, but in the early 1990s, schistosomiasis was still endemic in eight provinces." }, { "infon": 1, "offset": -1, "text": "A World Bank Loan Project enabled further significant progress to be made during the period 1992-2001." }, { "infon": 2, "offset": -1, "text": "The control strategy was focused on the large-scale use of chemotherapy - primarily to reinforce morbidity control - while at the same time acting on transmission with the ultimate goal of interrupting it." }, { "infon": 3, "offset": -1, "text": "Chemotherapy was complemented by health education, chemical control of snails and environmental modification where appropriate." }, { "infon": 4, "offset": -1, "text": "A final evaluation in 2002 showed that infection rates in humans and livestock had decreased by 55% and 50%, respectively." }, { "infon": 5, "offset": -1, "text": "The number of acute infections and of individuals with advanced disease had also significantly decreased." }, { "infon": 6, "offset": -1, "text": "Although snail infection rates continued to fluctuate at a low level, the densities of infected snails had decreased by more than 75% in all endemic areas." }, { "infon": 7, "offset": -1, "text": "The original objectives of the China World Bank Loan Project for schistosomiasis control had all been met." }, { "infon": 8, "offset": -1, "text": "One province, Zhejiang, had already fulfilled the criteria for elimination of schistosomiasis by 1995." }, { "infon": 9, "offset": -1, "text": "The project was therefore a success and has provided China with a sound basis for further control." } ] } ] }, { "id": "S0042-96862005000100015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Participation in health impact assessment: objectives, methods and core values." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Health impact assessment (HIA) is a multidisciplinary aid to decision-making that assesses the impact of policy on public health and on health inequalities." }, { "infon": 1, "offset": -1, "text": "Its purpose is to assist decision-makers to maximize health gains and to reduce inequalities." }, { "infon": 2, "offset": -1, "text": "The 1999 Gothenburg Consensus Paper (GCP) provides researchers with a rationale for establishing community participation as a core value of HIA." }, { "infon": 3, "offset": -1, "text": "According to the GCP, participation in HIA empowers people within the decision-making process and redresses the democratic deficit between government and society." }, { "infon": 4, "offset": -1, "text": "Participation in HIA generates a sense that health and decision-making is community-owned, and the personal experiences of citizens become integral to the formulation of policy." }, { "infon": 5, "offset": -1, "text": "However, the participatory and empowering dimensions of HIA may prove difficult to operationalize." }, { "infon": 6, "offset": -1, "text": "In this review of the participation strategies adopted in key applications of HIA in the United Kingdom, we found that HIA's aim of influencing decision-making creates tension between its participatory and knowledge-gathering dimensions." }, { "infon": 7, "offset": -1, "text": "Accordingly, researchers have decreased the participatory dimension of HIA by reducing the importance attached to the community's experience of empowerment, ownership and democracy, while enlarging its knowledge-gathering dimension by giving pre-eminence to \"expert\" and \"research-generated\" evidence." }, { "infon": 8, "offset": -1, "text": "Recent applications of HIA offer a serviceable rationale for participation as a means of information gathering and it is no longer tenable to uphold HIA as a means of empowering communities and advancing the aims of participatory democracy." } ] } ] }, { "id": "S0042-96862005000100017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mental and social health during and after acute emergencies: emerging consensus?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial." }, { "infon": 1, "offset": -1, "text": "There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services." }, { "infon": 2, "offset": -1, "text": "A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion." }, { "infon": 3, "offset": -1, "text": "Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health." }, { "infon": 4, "offset": -1, "text": "In terms of early interventions, this agreement is exemplified by the recent inclusion of a \"mental and social aspects of health\" standard in the Sphere handbook's revision on minimal standards in disaster response." }, { "infon": 5, "offset": -1, "text": "This affirmation of emerging agreement is important and should give clear messages to health planners." } ] } ] }, { "id": "S0042-96862005000200010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: We estimated the global burden of disease attributable to low consumption of fruit and vegetables, an increasingly recognized risk factor for cardiovascular disease and cancer, and compared its impact with that of other major risk factors for disease." }, { "infon": 1, "offset": -1, "text": "METHODS: The burden of disease attributable to suboptimal intake of fruit and vegetables was estimated using information on fruit and vegetable consumption in the population, and on its association with six health outcomes (ischaemic heart disease, stroke, stomach, oesophageal, colorectal and lung cancer)." }, { "infon": 2, "offset": -1, "text": "Data from both sources were stratified by sex, age and by 14 geographical regions." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The total worldwide mortality currently attributable to inadequate consumption of fruit and vegetables is estimated to be up to 2.635 million deaths per year." }, { "infon": 4, "offset": -1, "text": "Increasing individual fruit and vegetable consumption to up to 600 g per day (the baseline of choice) could reduce the total worldwide burden of disease by 1.8%, and reduce the burden of ischaemic heart disease and ischaemic stroke by 31% and 19% respectively." }, { "infon": 5, "offset": -1, "text": "For stomach, oesophageal, lung and colorectal cancer, the potential reductions were 19%, 20%, 12% and 2%, respectively." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: This study shows the potentially large impact that increasing fruit and vegetable intake could have in reducing many noncommunicable diseases." }, { "infon": 7, "offset": -1, "text": "It highlights the need for much greater emphasis on dietary risk factors in public health policy in order to tackle the rise in noncommunicable diseases worldwide, and suggests that the proposed intersectoral WHO/FAO fruit and vegetable promotion initiative is a crucial component in any global diet strategy." } ] } ] }, { "id": "S0042-96862005000200012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The global distribution of risk factors by poverty level." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the individual-level association of income poverty with being underweight, using tobacco, drinking alcohol, having access only to unsafe water and sanitation, being exposed to indoor air pollution and being obese." }, { "infon": 1, "offset": -1, "text": "METHODS: Using survey data for as many countries as possible, we estimated the relative risk association between income or assets and risk factors at the individual level within 11 medium- and low-income subregions of WHO." }, { "infon": 2, "offset": -1, "text": "WHO and The World Bank data on the prevalence of risk factors and income poverty (defined as living on < US$ 1.00 per day, US$ 1-2.00 per day and > US$ 2.00 per day) were analysed to impute the association between poverty and risk factors for each subregion." }, { "infon": 3, "offset": -1, "text": "The possible effect of poverty reduction on the prevalence of risk factors was estimated using population-attributable risk percentages." }, { "infon": 4, "offset": -1, "text": "FINDINGS: There were strong associations between poverty and malnutrition among children, having access only to unsafe water and sanitation, and being exposed to indoor air pollution within each subregion (relative risks were twofold to threefold greater for those living on < US$ 1.00 per day compared with those living on > US$ 2.00 per day)." }, { "infon": 5, "offset": -1, "text": "Associations between poverty and obesity, tobacco use and alcohol use varied across subregions." }, { "infon": 6, "offset": -1, "text": "If everyone living on < US$ 2.00 per day had the risk factor profile of those living on > US$ 2.00 per day, 51% of exposures to unimproved water and sanitation could be avoided as could 37% of malnutrition among children and 38% of exposure to indoor air pollution." }, { "infon": 7, "offset": -1, "text": "The more realistic, but still challenging, Millennium Development Goal of halving the number of people living on < US$ 1.00 per day would achieve much smaller reductions." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: To achieve large gains in global health requires both poverty eradication and public health action." }, { "infon": 9, "offset": -1, "text": "The methods used in this study may be useful for monitoring pro-equity progress towards Millennium Development Goals." } ] } ] }, { "id": "S0042-96862005000200014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Prevention and treatment of human immunodeficiency virus/acquired immunodeficiency syndrome in resource-limited settings." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Strategies for confronting the epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have included a range of different approaches that focus on prevention and treatment." }, { "infon": 1, "offset": -1, "text": "However, debate persists over what levels of emphasis are appropriate for the different components of the global response." }, { "infon": 2, "offset": -1, "text": "This paper presents an overview of this debate and briefly summarizes the evidence on a range of interventions designed to prevent the spread of HIV infection, paying particular attention to voluntary counselling and testing, treatment for sexually transmitted infections and prevention of mother-to-child transmission." }, { "infon": 3, "offset": -1, "text": "We also review the experience with antiretroviral therapy to date in terms of response rates and survival rates, adherence, drug resistance, behavioural change and epidemiological impact." }, { "infon": 4, "offset": -1, "text": "Although various studies have identified strategies with proven effectiveness in reducing the risks of HIV infection and AIDS mortality, considerable uncertainties remain." }, { "infon": 5, "offset": -1, "text": "Successful integration of treatment and prevention of HIV/AIDS will require a balanced approach and rigorous monitoring of the impact of programmes in terms of both individual and population outcomes." } ] } ] }, { "id": "S0042-96862005000300010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Monitoring low birth weight: an evaluation of international estimates and an updated estimation procedure." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To critically examine the data used to produce estimates of the proportion of infants with low birth weight in developing countries and to describe biases in these data." }, { "infon": 1, "offset": -1, "text": "To assess the effect of adjustment procedures on the estimates and propose a modified estimation procedure for international reporting purposes." }, { "infon": 2, "offset": -1, "text": "METHODS: Mothers' reports about their recent births in 62 nationally representative Demographic and Health Surveys (DHS) conducted between 1990 and 2000 were analysed." }, { "infon": 3, "offset": -1, "text": "The proportion of infants weighed at birth, characteristics of those weighed, extent of misreporting, and mothers' subjective assessments of their children's size at birth were examined." }, { "infon": 4, "offset": -1, "text": "FINDINGS: In many developing countries the majority of infants were not weighed at birth." }, { "infon": 5, "offset": -1, "text": "Those who were weighed were more likely to have mothers who live in urban areas and are educated, and to be born in a medical facility with assistance from medically trained personnel." }, { "infon": 6, "offset": -1, "text": "Birth weights reported by mothers are \"heaped\" on multiples of 500 grams." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Current survey-based estimates of the prevalence of low birth weight are biased substantially downwards." }, { "infon": 8, "offset": -1, "text": "Two adjustments to reported data are recommended: a weighting procedure that combines reported birth weights with mothers' assessment of the child's size at birth, and categorization of one-quarter of the infants reported to have a birth weight of exactly 2500 grams as having low birth weight." }, { "infon": 9, "offset": -1, "text": "Averaged over all surveys, these procedures increased the proportion classified as having low birth weight by 25%." }, { "infon": 10, "offset": -1, "text": "We also recommend that the proportion of infants not weighed at birth be routinely reported." }, { "infon": 11, "offset": -1, "text": "Efforts are needed to increase the weighing of newborns and the recording of their weights." } ] } ] }, { "id": "S0042-96862005000300012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign." }, { "infon": 1, "offset": -1, "text": "METHODS: In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months-15 years." }, { "infon": 2, "offset": -1, "text": "Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet." }, { "infon": 3, "offset": -1, "text": "The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign." }, { "infon": 4, "offset": -1, "text": "Volunteers visited homes to inform caregivers about the campaign and encourage them to participate." }, { "infon": 5, "offset": -1, "text": "We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites." }, { "infon": 6, "offset": -1, "text": "Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use." }, { "infon": 7, "offset": -1, "text": "Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory." }, { "infon": 8, "offset": -1, "text": "FINDINGS: At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet." }, { "infon": 9, "offset": -1, "text": "Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed." }, { "infon": 10, "offset": -1, "text": "Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign." }, { "infon": 11, "offset": -1, "text": "For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%))." }, { "infon": 12, "offset": -1, "text": "The marginal operational cost was US$ 0.32 per insecticide-treated bednet delivered." }, { "infon": 13, "offset": -1, "text": "CONCLUSION: These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets." } ] } ] }, { "id": "S0042-96862005000300014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Poverty, child undernutrition and morbidity: new evidence from India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Undernutrition continues to be a primary cause of ill-health and premature mortality among children in developing countries." }, { "infon": 1, "offset": -1, "text": "This paper examines how the prevalence of undernutrition in children is measured and argues that the standard indices of stunting, wasting and underweight may each be underestimating the scale of the problem." }, { "infon": 2, "offset": -1, "text": "This has important implications for policy-makers, planners and organizations seeking to meet international development targets." }, { "infon": 3, "offset": -1, "text": "Using anthropometric data on 24 396 children in India, we constructed an alternative composite index of anthropometric failure (CIAF) and compared it with conventional indices." }, { "infon": 4, "offset": -1, "text": "The CIAF examines the relationship between distinct subgroups of anthropometric failure, poverty and morbidity, showing that children with multiple anthropometric failures are at a greater risk of morbidity and are more likely to come from poorer households." }, { "infon": 5, "offset": -1, "text": "While recognizing that stunting, wasting and underweight reflect distinct biological processes of clear importance, the CIAF is the only measure that provides a single, aggregated figure of the number of undernourished children in a population." } ] } ] }, { "id": "S0042-96862005000300016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Should nevirapine be used to prevent mother-to-child transmission of HIV among women of unknown serostatus?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "At present, HIV testing and counselling during pregnancy represent the key entry point for women to learn their serostatus and for them to access, if they are HIV-positive, specific interventions to reduce mother-to-child transmission (MTCT) of HIV." }, { "infon": 1, "offset": -1, "text": "However, the provision and uptake of testing and counselling services are inadequate, and many pregnant women in countries most affected by the HIV/AIDS epidemic remain unaware of their HIV status." }, { "infon": 2, "offset": -1, "text": "The offer of single-dose nevirapine prophylaxis to women whose HIV status is unknown at the time of delivery has been proposed to circumvent these problems in high-prevalence settings." }, { "infon": 3, "offset": -1, "text": "The potential advantages and disadvantages of three different programme approaches are considered: targeted programmes in which antiretroviral drugs are offered only to women who are known to be HIV-positive; combined programmes in which nevirapine prophylaxis is offered to women whose serostatus remains unknown at the time of delivery despite targeted programme inputs; and universal nevirapine prophylaxis programmes in which HIV testing and counselling are not available and all pregnant women, regardless of their serostatus, are offered nevirapine prophylaxis." } ] } ] }, { "id": "S0042-96862005000400008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Staff training and ambulatory tuberculosis treatment outcomes: a cluster randomized controlled trial in South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatment in primary care clinics with treatment success rates below 70%." }, { "infon": 1, "offset": -1, "text": "METHODS: A cluster randomized controlled trial was conducted from July 1996 to July 2000 in nurse-managed ambulatory primary care clinics in Cape Town, South Africa." }, { "infon": 2, "offset": -1, "text": "Clinics with successful TB treatment completion rates of less than 70% and annual adult pulmonary TB loads of more than 40 patients per year were randomly assigned to either the intervention (n = 12) or control (n = 12) groups." }, { "infon": 3, "offset": -1, "text": "All clinics completed follow-up." }, { "infon": 4, "offset": -1, "text": "Treatment outcomes were measured in cohorts of adult, pulmonary TB patients before the intervention (n = 1200) and 9 months following the training (n = 1177)." }, { "infon": 5, "offset": -1, "text": "The intervention comprised an 18-hour experiential, participatory in-service training programme for clinic staff delivered by nurse facilitators and focusing on patient centredness, critical reflection on practice, and quality improvement." }, { "infon": 6, "offset": -1, "text": "The main outcome measure was successful treatment, defined as patients who were cured and those who had completed tuberculosis treatment." }, { "infon": 7, "offset": -1, "text": "FINDINGS: The estimated effect of the intervention was an increase in successful treatment rates of 4.8% (95% confidence interval (CI): -5.5% to 15.2%) and in bacteriological cure rates of 10.4% (CI: -1.2% to 22%)." }, { "infon": 8, "offset": -1, "text": "A treatment effect of 10% was envisaged, based on the views of policy-makers on the minimum effect size for large-scale implementation." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: This is the first evidence from a randomized controlled trial on the effects of experiential, participatory training on TB outcomes in primary care facilities in a developing country." }, { "infon": 10, "offset": -1, "text": "Such training did not appear to improve TB outcomes." }, { "infon": 11, "offset": -1, "text": "However, the results were inconclusive and further studies are required." } ] } ] }, { "id": "S0042-96862005000400010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Polio eradication: mobilizing and managing the human resources." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Between 1988 and 2004, the Global Polio Eradication Initiative grew to become the largest international health effort in history, operating in every country of the world." }, { "infon": 1, "offset": -1, "text": "An estimated 10 million health workers and volunteers have been engaged in implementing the necessary polio supplementary immunization activities (SIAs) on a recurring basis, and at least 35 000 well-trained workers have been conducting polio surveillance." }, { "infon": 2, "offset": -1, "text": "A combination of task simplification, technological innovations and adaptation of strategies to fit local circumstances has allowed the Initiative to use a wide range of workers and volunteers, from both inside and outside the health sector, to deliver the polio vaccine during SIAs and to monitor progress in virtually every area of every country, regardless of the health infrastructure, conflict, geography and/or culture." }, { "infon": 3, "offset": -1, "text": "This approach has required sustained political advocacy and mass community mobilization, together with strong management and supervisory processes." }, { "infon": 4, "offset": -1, "text": "Non-monetary incentives, reimbursement of costs and substantial technical assistance have been essential." }, { "infon": 5, "offset": -1, "text": "Given the unique features of eradication programmes in general, and polio eradication in particular, the implications of this approach for the broader health system must continue to be studied if it is to be replicated for the delivery and monitoring of other interventions." } ] } ] }, { "id": "S0042-96862005000400012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Ethical issues in health workforce development." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas." }, { "infon": 1, "offset": -1, "text": "The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described." }, { "infon": 2, "offset": -1, "text": "These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers." }, { "infon": 3, "offset": -1, "text": "The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed." } ] } ] }, { "id": "S0042-96862005000400014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Human resources for the control of road traffic injury." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems." }, { "infon": 1, "offset": -1, "text": "We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care." }, { "infon": 2, "offset": -1, "text": "Many low-cost strategies to improve these functions in low- or middle-income countries can be identified." }, { "infon": 3, "offset": -1, "text": "For all these strategies, there is need for adequate institutional capacity, including funding, legal authority, and human resources." }, { "infon": 4, "offset": -1, "text": "Several categories of human resources need to be developed: epidemiologists who can handle injury data, design surveillance systems, and undertake research; engineers and planners versed in safety aspects of road design, traffic flow, urban planning, and vehicle design; police and lawyers who understand the health impact of traffic law; clinicians who can develop cost-effective improvements in the entire system of trauma treatment; media experts to undertake effective behaviour change and social marketing; and economists to assist with cost-effectiveness evaluations." }, { "infon": 5, "offset": -1, "text": "RTI control can be strengthened by enhancing such training in these disciplines, as well as encouraging retention of those who have the needed skills." }, { "infon": 6, "offset": -1, "text": "Mechanisms to enhance collaboration between these different fields need to be promoted." }, { "infon": 7, "offset": -1, "text": "Finally, the burden of RTI is borne disproportionately by the poor; in addition to technical issues, more profound equity issues must be addressed." }, { "infon": 8, "offset": -1, "text": "This mandates that people from all professional backgrounds who work for RTI control should develop skills in advocacy and politics." } ] } ] }, { "id": "S0042-96862005000400016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Understanding dengue pathogenesis: implications for vaccine design." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In the second half of the twentieth century dengue spread throughout the tropics, threatening the health of a third of the world's population." }, { "infon": 1, "offset": -1, "text": "Dengue viruses cause 50 -100 million cases of acute febrile disease every year, including more than 500 000 reported cases of the severe forms of the disease - dengue haemorrhagic fever and dengue shock syndrome." }, { "infon": 2, "offset": -1, "text": "Attempts to create conventional vaccines have been hampered by the lack of suitable experimental models, the need to provide protection against all four serotypes simultaneously and the possible involvement of virus-specific immune responses in severe disease." }, { "infon": 3, "offset": -1, "text": "The current understanding of dengue pathogenesis is outlined in this review, with special emphasis on the role of the immune response." }, { "infon": 4, "offset": -1, "text": "The suspected involvement of the immune system in increased disease severity and vascular damage has raised concerns about every vaccine design strategy proposed so far." }, { "infon": 5, "offset": -1, "text": "Clearly more research is needed on understanding the correlates of protection and mechanisms of pathogenesis." }, { "infon": 6, "offset": -1, "text": "There is, however, an urgent need to provide a solution to the escalating global public health problems caused by dengue infections." }, { "infon": 7, "offset": -1, "text": "Better disease management, vector control and improved public health measures will help reduce the current disease burden, but a safe and effective vaccine is probably the only long-term solution." }, { "infon": 8, "offset": -1, "text": "Although concerns have been raised about the possible safety and efficacy of both conventional and novel vaccine technologies, the situation is now so acute that it is not possible to wait for the perfect vaccine." }, { "infon": 9, "offset": -1, "text": "Consequently the careful and thorough evaluation of several of the current candidate vaccines may be the best approach to halting the spread of disease." } ] } ] }, { "id": "S0042-96862005000500009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Modelling the effectiveness of financing policies to address underutilization of children's health services in Nepal." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the price responsiveness of utilization of formal children's health-care services in Nepal and to use this information to model the impact on utilization of subsidies or increases in user fees." }, { "infon": 1, "offset": -1, "text": "METHODS: A total of 8112 individual observations (of children aged < 15 years) from 2847 households in 274 communities were obtained from the 1996 Nepal Living Standards Survey." }, { "infon": 2, "offset": -1, "text": "A logit model was applied to determine the net impact of price on a parent or caregiver's decision to seek care for a given instance of illness." }, { "infon": 3, "offset": -1, "text": "The model's coefficients were used to calculate the price responsiveness of utilization decisions." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Parents or caregivers reported that 9.7% of children (788/8112) had been ill or injured in the previous month." }, { "infon": 5, "offset": -1, "text": "Parents reported that they had sought care in 566 (71.8%) of these cases; care was most frequently sought from public providers." }, { "infon": 6, "offset": -1, "text": "The price elasticity of demand for children's health-care services in the formal sector was estimated at -0.16." }, { "infon": 7, "offset": -1, "text": "As prices rise, the demand curve exhibits continuous and declining price elasticity." }, { "infon": 8, "offset": -1, "text": "Overall, a 100% subsidy of user fees would increase current utilization rates by 56%, while a 100% increase in fees would lead to a drop in utilization of only 12%." }, { "infon": 9, "offset": -1, "text": "The differential in utilization across income groups was substantial after changes in fees were implemented." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: While the effect of price on the utilization of children's health-care services in Nepal is statistically significant, the size of the impact is modest." }, { "infon": 11, "offset": -1, "text": "Policies to subsidize fees could increase utilization substantially, while fee increases would lead to modest declines in utilization and generate increased revenue." } ] } ] }, { "id": "S0042-96862005000500011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "BACKGROUND: Although radiological pneumonia is used as an outcome measure in epidemiological studies, there is considerable variability in the interpretation of chest radiographs." }, { "infon": 1, "offset": -1, "text": "A standardized method for identifying radiological pneumonia would facilitate comparison of the results of vaccine trials and epidemiological studies of pneumonia." }, { "infon": 2, "offset": -1, "text": "METHODS: A WHO working group developed definitions for radiological pneumonia." }, { "infon": 3, "offset": -1, "text": "Inter-observer variability in categorizing a set of 222 chest radiographic images was measured by comparing the readings made by 20 radiologists and clinicians with a reference reading." }, { "infon": 4, "offset": -1, "text": "Intra-observer variability was measured by comparing the initial readings of a randomly chosen subset of 100 radiographs with repeat readings made 8-30 days later." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Of the 222 images, 208 were considered interpretable." }, { "infon": 6, "offset": -1, "text": "The reference reading categorized 43% of these images as showing alveolar consolidation or pleural effusion (primary end-point pneumonia); the proportion thus categorized by each of the 20 readers ranged from 8% to 61%." }, { "infon": 7, "offset": -1, "text": "Using the reference reading as the gold standard, 14 of the 20 readers had sensitivity and specificity of > 0.70 in identifying primary end-point pneumonia; 13 out of 20 readers had a kappa index of > 0.6 compared with the reference reading." }, { "infon": 8, "offset": -1, "text": "For the 92 radiographs deemed to be interpretable among the 100 images used for intra-observer variability, 19 out of 20 readers had a kappa index of > 0.6." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Using standardized definitions and training, it is possible to achieve agreement in identifying radiological pneumonia, thus facilitating the comparison of results of epidemiological studies that use radiological pneumonia as an outcome." } ] } ] }, { "id": "S0042-96862005000500013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Does the Integrated Management of Childhood Illness cost more than routine care?" }, { "infon": 1, "offset": -1, "text": "Results from the United Republic of Tanzania." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually." }, { "infon": 1, "offset": -1, "text": "Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care." }, { "infon": 2, "offset": -1, "text": "Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania." }, { "infon": 3, "offset": -1, "text": "METHODS: Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level." }, { "infon": 4, "offset": -1, "text": "We also included administrative and support costs incurred by national and district administrations." }, { "infon": 5, "offset": -1, "text": "The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The annual cost per child of caring for children less than five years old in districts with IMCI was US$ 11.19, 44% lower than the cost in the districts without IMCI (US$ 16.09)." }, { "infon": 7, "offset": -1, "text": "Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI." }, { "infon": 8, "offset": -1, "text": "Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts." }, { "infon": 9, "offset": -1, "text": "CONCLUSION:IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania." }, { "infon": 10, "offset": -1, "text": "Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI." } ] } ] }, { "id": "S0042-96862005000500016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Monitoring equity in immunization coverage." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper analyses trends in coverage of three doses of diphtheria-pertussis-tetanus vaccine (DPT3) by wealth groups in selected countries." }, { "infon": 1, "offset": -1, "text": "It discusses the depth of disparities in coverage by wealth and changes during the 1990s." }, { "infon": 2, "offset": -1, "text": "Complete assessment of equity in income and its trends have been discussed in other papers, however issues related to children's well-being have often been brushed aside because the comparable data needed to fully understand and rectify inequalities is lacking." }, { "infon": 3, "offset": -1, "text": "A focal point of this paper pertains to gathering any and all information recorded about the immunization of children and then transcribing these data so that it is applicable to all countries." }, { "infon": 4, "offset": -1, "text": "We analyse the technical difficulties and methodological solutions that would enable comparisons to be made between various measures of inequity taken from different surveys at two or three points in time among a variety of subpopulations in order to obtain disaggregated data." }, { "infon": 5, "offset": -1, "text": "This paper argues for a simultaneous analysis of changes in averages and disparities in immunization coverage along variables of interest, such as wealth, gender and place of residence in order to achieve a better understanding of trends." }, { "infon": 6, "offset": -1, "text": "We also focus on measurement issues and describe trends in immunization by wealth." }, { "infon": 7, "offset": -1, "text": "We conclude with a brief discussion of issues related to monitoring equitable outcomes and offer suggestions for further research." }, { "infon": 8, "offset": -1, "text": "In addition, the paper presents some lessons that can be drawn about monitoring and policies." }, { "infon": 9, "offset": -1, "text": "We hope that this analysis of patterns of disparities will help policy-makers in devising, proposing and executing efficient policies and interventions." } ] } ] }, { "id": "S0042-96862005000600009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the association of different feeding patterns for infants (exclusive breastfeeding, predominant breastfeeding, partial breastfeeding and no breastfeeding) with mortality and hospital admissions during the first half of infancy." }, { "infon": 1, "offset": -1, "text": "METHODS: This paper is based on a secondary analysis of data from a multicentre randomized controlled trial on immunization-linked vitamin A supplementation." }, { "infon": 2, "offset": -1, "text": "Altogether, 9424 infants and their mothers (2919 in Ghana, 4000 in India and 2505 in Peru) were enrolled when infants were 18-42 days old in two urban slums in New Delhi, India, a periurban shanty town in Lima, Peru, and 37 villages in the Kintampo district of Ghana." }, { "infon": 3, "offset": -1, "text": "Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru." }, { "infon": 4, "offset": -1, "text": "At each visit, mothers were queried about what they had offered their infant to eat or drink during the past week." }, { "infon": 5, "offset": -1, "text": "Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months." }, { "infon": 6, "offset": -1, "text": "The main outcome measures were all-cause mortality, diarrhoea-specific mortality, mortality caused by acute lower respiratory infections, and hospital admissions." }, { "infon": 7, "offset": -1, "text": "FINDINGS: There was no significant difference in the risk of death between children who were exclusively breastfed and those who were predominantly breastfed (adjusted hazard ratio (HR) = 1.46; 95% confidence interval (CI) = 0.75-2.86)." }, { "infon": 8, "offset": -1, "text": "Non-breastfed infants had a higher risk of dying when compared with those who had been predominantly breastfed (HR = 10.5; 95% CI = 5.0-22.0; P < 0.001) as did partially breastfed infants (HR = 2.46; 95% CI = 1.44-4.18; P = 0.001)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: There are two major implications of these findings." }, { "infon": 10, "offset": -1, "text": "First, the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants." }, { "infon": 11, "offset": -1, "text": "Second, our finding that the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding." } ] } ] }, { "id": "S0042-96862005000600011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Operational and economic evaluation of an NGO-led sexually transmitted infections intervention: north-western Cambodia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Sexually transmitted infection (STI) services were offered by the nongovernmental organization Médecins Sans Frontières-Holland in Banteay Meanchey province, Cambodia, between 1997 and 1999." }, { "infon": 1, "offset": -1, "text": "These services targeted female sex workers but were available to the general population." }, { "infon": 2, "offset": -1, "text": "We conducted an evaluation of the operational performance and costs of this real-life project." }, { "infon": 3, "offset": -1, "text": "METHODS: Effectiveness outcomes (syndromic cure rates of STIs) were obtained by retrospectively analysing patients' records." }, { "infon": 4, "offset": -1, "text": "Annual financial and economic costs were estimated from the provider's perspective." }, { "infon": 5, "offset": -1, "text": "Unit costs for the cost-effectiveness analysis included the cost per visit, per partner treated, and per syndrome treated and cured." }, { "infon": 6, "offset": -1, "text": "FINDINGS: Over 30 months, 11 330 patients attended the clinics; of these, 7776 (69%) were STI index patients and only 1012 (13%) were female sex workers." }, { "infon": 7, "offset": -1, "text": "A total of 15 269 disease episodes and 30 488 visits were recorded." }, { "infon": 8, "offset": -1, "text": "Syndromic cure rates ranged from 39% among female sex workers with genital ulcers to 74% among men with genital discharge; there were variations over time." }, { "infon": 9, "offset": -1, "text": "Combined rates of syndromes classified as cured or improved were around 84-95% for all syndromes." }, { "infon": 10, "offset": -1, "text": "The total economic costs of the project were US$ 766 046." }, { "infon": 11, "offset": -1, "text": "The average cost per visit over 30 months was US$ 25.12 and the cost per partner treated for an STI was US$ 50.79." }, { "infon": 12, "offset": -1, "text": "The average cost per STI syndrome treated was US$ 48.43, of which US$ 4.92 was for drug treatment." }, { "infon": 13, "offset": -1, "text": "The costs per syndrome cured or improved ranged from US$ 46.95-153.00 for men with genital ulcers to US$ 57.85-251.98 for female sex workers with genital discharge." }, { "infon": 14, "offset": -1, "text": "CONCLUSION: This programme was only partly successful in reaching its intended target population of sex workers and their male partners." }, { "infon": 15, "offset": -1, "text": "Decreasing cure rates among sex workers led to relatively poor cost-effectiveness outcomes overall despite decreasing unit costs." } ] } ] }, { "id": "S0042-96862005000600013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reliability of data on caesarean sections in developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine the reliability of reported rates of caesarean sections from developing countries and make recommendations on how data collection for surveys and health facility-based studies could be improved." }, { "infon": 1, "offset": -1, "text": "METHODS: Population-based rates for caesarean section obtained from two sources: Demographic and Health Surveys (DHS) and health facility-based records of caesarean sections from the Unmet Obstetric Need Network, together with estimates of the number of live births, were compared for six developing countries." }, { "infon": 2, "offset": -1, "text": "Sensitivity analyses were conducted using several different definitions of the caesarean section rate, and the rates obtained from the two data sources were compared." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The DHS rates for caesarean section were consistently higher than the facility-based rates." }, { "infon": 4, "offset": -1, "text": "However, in three quarters of the cases, the facility-based rates for caesarean sections fell within the 95% confidence intervals for the DHS estimate." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: The importance of the differences between these two series of rates depends on the analyst's perspective." }, { "infon": 6, "offset": -1, "text": "For national and global monitoring, DHS data on caesarean sections would suffice, although the imprecision of the rates would make the monitoring of trends difficult." }, { "infon": 7, "offset": -1, "text": "However, the imprecision of DHS data on caesarean sections precludes their use for the purposes of programme evaluation at the regional level." } ] } ] }, { "id": "S0042-96862005000600015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "National maternal mortality ratio in Egypt halved between 1992-93 and 2000." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms." }, { "infon": 1, "offset": -1, "text": "The numbers of maternal deaths were determined and interviews conducted." }, { "infon": 2, "offset": -1, "text": "The medical causes of death and avoidable factors were determined." }, { "infon": 3, "offset": -1, "text": "Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100 000 live births)." }, { "infon": 4, "offset": -1, "text": "The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt." }, { "infon": 5, "offset": -1, "text": "In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000." }, { "infon": 6, "offset": -1, "text": "Consideration of the intermediate and outcome indicators suggests that the greatest effect of maternal health interventions was on the death-related avoidable factors \"substandard care by health providers\" and \"delays in recognizing problems or seeking medical care\"." }, { "infon": 7, "offset": -1, "text": "The enormous improvements in these areas are certainly due in part to extensive training, revised curricula, the publication of medical protocols and services standards, the upgrading of facilities, and successful community outreach programmes and media campaigns." }, { "infon": 8, "offset": -1, "text": "The impact on the utilization of antenatal care (ANC) has been less successful." }, { "infon": 9, "offset": -1, "text": "Other areas that remain problematic are inadequate supplies of blood, drugs and equipment." }, { "infon": 10, "offset": -1, "text": "Although the number of maternal deaths linked to haemorrhage has been drastically reduced, it remains the primary cause." }, { "infon": 11, "offset": -1, "text": "The drop in maternal mortality in the 1990s in response to Safe Motherhood programmes was impressive and the ability to tailor interventions based on the data from the NMMS of 1992-93 and 2000 was clearly demonstrated." }, { "infon": 12, "offset": -1, "text": "To ensure the continuing availability of information to guide and evaluate programmes for reducing maternal mortality, an Egyptian national maternal mortality surveillance system is being developed." } ] } ] }, { "id": "S0042-96862005000700008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: The aim of this study was to estimate the field efficacy of the first routine programme for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) initiated in South Africa, in the subdistrict of Khayelitsha." }, { "infon": 1, "offset": -1, "text": "METHODS: A consecutive sample of 658 mother-infant pairs, identified from the PMTCT register from 1 March to 30 November 2003, were identified for enrolment in this study." }, { "infon": 2, "offset": -1, "text": "Details of the regimen received were established and HIV status of the infants at between 6 and 10 weeks of age was determined by qualitative DNA polymerase chain reaction." }, { "infon": 3, "offset": -1, "text": "Zidovudine (AZT) was provided antenatally from week 34 of gestation and during labour." }, { "infon": 4, "offset": -1, "text": "Infant formula milk was offered to mothers who chose not to breastfeed." }, { "infon": 5, "offset": -1, "text": "The protocol was amended in July 2003 such that women who had received < 2 weeks of treatment with AZT were given a single dose of nevirapine (NVP) at the onset of labour, and the infant received a weight-adjusted dose of NVP within 72 h of delivery." }, { "infon": 6, "offset": -1, "text": "RESULTS: Of the 535 mother-infant pairs (81%) eventually included in the study, 410 (77%) received an effective PMTCT intervention according to the protocol." }, { "infon": 7, "offset": -1, "text": "The rate of transmission of HIV from mother to child was 8.8% (95% confidence interval (CI), 6.2-10.9)." }, { "infon": 8, "offset": -1, "text": "A maternal age of > 25 years was the only significant independent risk factor for transmission (odds ratio, 2.12; 95% CI, 1.14-4.07)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The results of this study demonstrate the feasibility and effectiveness of a large-scale PMTCT programme in an urban public-sector setting." } ] } ] }, { "id": "S0042-96862005000700010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization." }, { "infon": 1, "offset": -1, "text": "METHODS: The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanus-pertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts." }, { "infon": 2, "offset": -1, "text": "The quality of monitoring systems was measured using quality indices for different components of the monitoring systems." }, { "infon": 3, "offset": -1, "text": "These indices were applied to each level of the health service (health unit, district and national)." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The proportion of verified DTP-3 doses was lower than 85% in 16 countries." }, { "infon": 5, "offset": -1, "text": "Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units." }, { "infon": 6, "offset": -1, "text": "All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes." }, { "infon": 8, "offset": -1, "text": "Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities." }, { "infon": 9, "offset": -1, "text": "The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements." }, { "infon": 10, "offset": -1, "text": "It provides a useful example for other global health initiatives." } ] } ] }, { "id": "S0042-96862005000700012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Current global iodine status and progress over the last decade towards the elimination of iodine deficiency." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate worldwide iodine nutrition and monitor country progress towards sustained elimination of iodine deficiency disorders." }, { "infon": 1, "offset": -1, "text": "METHODS: Cross-sectional data on urinary iodine (UI) and total goitre prevalence (TGP) in school-age children from 1993-2003 compiled in the WHO Global Database on Iodine Deficiency were analysed." }, { "infon": 2, "offset": -1, "text": "The median UI was used to classify countries according to the public health significance of their iodine nutrition status." }, { "infon": 3, "offset": -1, "text": "Estimates of the global and regional populations with insufficient iodine intake were based on the proportion of each country's population with UI below 100 µg/l." }, { "infon": 4, "offset": -1, "text": "TGP was computed for trend analysis over 10 years." }, { "infon": 5, "offset": -1, "text": "FINDINGS: UI data were available for 92.1% of the world's school-age children." }, { "infon": 6, "offset": -1, "text": "Iodine deficiency is still a public health problem in 54 countries." }, { "infon": 7, "offset": -1, "text": "A total of 36.5% (285 million) school-age children were estimated to have an insufficient iodine intake, ranging from 10.1% in the WHO Region of the Americas to 59.9% in the European Region." }, { "infon": 8, "offset": -1, "text": "Extrapolating this prevalence to the general population generated an estimate of nearly two billion individuals with insufficient iodine intake." }, { "infon": 9, "offset": -1, "text": "Iodine intake was more than adequate, or excessive, in 29 countries." }, { "infon": 10, "offset": -1, "text": "Global TGP in the general population was 15.8%." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: Forty-three countries have reached optimal iodine nutrition." }, { "infon": 12, "offset": -1, "text": "Strengthened UI monitoring is required to ensure that salt iodization is having the desired impact, to identify at-risk populations and to ensure sustainable prevention and control of iodine deficiency." }, { "infon": 13, "offset": -1, "text": "Efforts to eliminate iodine deficiency should be maintained and expanded." } ] } ] }, { "id": "S0042-96862005000700014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "An evidence-based approach to benchmarking the fairness of health-sector reform in developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Benchmarks of Fairness instrument is an evidence-based policy tool developed in generic form in 2000 for evaluating the effects of health-system reforms on equity, efficiency and accountability." }, { "infon": 1, "offset": -1, "text": "By integrating measures of these effects on the central goal of fairness, the approach fills a gap that has hampered reform efforts for more than two decades." }, { "infon": 2, "offset": -1, "text": "Over the past three years, projects in developing countries on three continents have adapted the generic version of these benchmarks for use at both national and subnational levels." }, { "infon": 3, "offset": -1, "text": "Interdisciplinary teams of managers, providers, academics and advocates agree on the relevant criteria for assessing components of fairness and, depending on which aspects of reform they wish to evaluate, select appropriate indicators that rely on accessible information; they also agree on scoring rules for evaluating the diverse changes in the indicators." }, { "infon": 4, "offset": -1, "text": "In contrast to a comprehensive index that aggregates all measured changes into a single evaluation or rank, the pattern of changes revealed by the benchmarks is used to inform policy deliberation about which aspects of the reforms have been successfully implemented, and it also allows for improvements to be made in the reforms." }, { "infon": 5, "offset": -1, "text": "This approach permits useful evidence about reform to be gathered in settings where existing information is underused and where there is a weak information infrastructure." }, { "infon": 6, "offset": -1, "text": "Brief descriptions of early results from Cameroon, Ecuador, Guatemala, Thailand and Zambia demonstrate that the method can produce results that are useful for policy and reveal the variety of purposes to which the approach can be put." }, { "infon": 7, "offset": -1, "text": "Collaboration across sites can yield a catalogue of indicators that will facilitate further work." } ] } ] }, { "id": "S0042-96862005000700016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The public health implications of asthma." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions." }, { "infon": 1, "offset": -1, "text": "Both morbidity and mortality from asthma are significant." }, { "infon": 2, "offset": -1, "text": "The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia." }, { "infon": 3, "offset": -1, "text": "Asthma management plans have, however, reduced mortality and severity in countries where they have been applied." }, { "infon": 4, "offset": -1, "text": "Several barriers reduce the availability, affordability, dissemination and efficacy of optimal asthma management plans in both developed and developing countries." }, { "infon": 5, "offset": -1, "text": "The workplace environment contributes significantly to the general burden of asthma." }, { "infon": 6, "offset": -1, "text": "Patients with occupational asthma have higher rates of hospitalization and mortality than healthy workers." }, { "infon": 7, "offset": -1, "text": "The surveillance of asthma as part of a global WHO programme is essential." }, { "infon": 8, "offset": -1, "text": "The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and the cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death)." }, { "infon": 9, "offset": -1, "text": "Direct costs are significant in most countries." }, { "infon": 10, "offset": -1, "text": "In order to reduce costs and improve quality of care, employers and health plans are exploring more precisely targeted ways of controlling rapidly rising health costs." }, { "infon": 11, "offset": -1, "text": "Poor control of asthma symptoms is a major issue that can result in adverse clinical and economic outcomes." }, { "infon": 12, "offset": -1, "text": "A model of asthma costs is needed to aid attempts to reduce them while permitting optimal management of the disease." }, { "infon": 13, "offset": -1, "text": "This paper presents a discussion of the burden of asthma and its socioeconomic implications and proposes a model to predict the costs incurred by the disease." } ] } ] }, { "id": "S0042-96862005000800010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health information systems: the foundations of public health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Public health decision-making is critically dependent on the timely availability of sound data." }, { "infon": 1, "offset": -1, "text": "The role of health information systems is to generate, analyse and disseminate such data." }, { "infon": 2, "offset": -1, "text": "In practice, health information systems rarely function systematically." }, { "infon": 3, "offset": -1, "text": "The products of historical, social and economic forces, they are complex, fragmented and unresponsive to needs." }, { "infon": 4, "offset": -1, "text": "International donors in health are largely responsible for the problem, having prioritized urgent needs for data over longer-term country capacity-building." }, { "infon": 5, "offset": -1, "text": "The result is painfully apparent in the inability of most countries to generate the data needed to monitor progress towards the Millennium Development Goals." }, { "infon": 6, "offset": -1, "text": "Solutions to the problem must be comprehensive; money alone is likely to be insufficient unless accompanied by sustained support to country systems development coupled with greater donor accountability and allocation of responsibilities." }, { "infon": 7, "offset": -1, "text": "The Health Metrics Network, a global collaboration in the making, is intended to help bring such solutions to the countries most in need." } ] } ] }, { "id": "S0042-96862005000800012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Harmonizing health information systems with information systems in other social and economic sectors." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Efforts to strengthen health information systems in low- and middle-income countries should include forging links with systems in other social and economic sectors." }, { "infon": 1, "offset": -1, "text": "Governments are seeking comprehensive socioeconomic data on the basis of which to implement strategies for poverty reduction and to monitor achievement of the Millennium Development Goals." }, { "infon": 2, "offset": -1, "text": "The health sector is looking to take action on the social factors that determine health outcomes." }, { "infon": 3, "offset": -1, "text": "But there are duplications and inconsistencies between sectors in the collection, reporting, storage and analysis of socioeconomic data." }, { "infon": 4, "offset": -1, "text": "National offices of statistics give higher priority to collection and analysis of economic than to social statistics." }, { "infon": 5, "offset": -1, "text": "The Report of the Commission for Africa has estimated that an additional US$ 60 million a year is needed to improve systems to collect and analyse statistics in Africa." }, { "infon": 6, "offset": -1, "text": "Some donors recognize that such systems have been weakened by numerous international demands for indicators, and have pledged support for national initiatives to strengthen statistical systems, as well as sectoral information systems such as those in health and education." }, { "infon": 7, "offset": -1, "text": "Many governments are working to coordinate information systems to monitor and evaluate poverty reduction strategies." }, { "infon": 8, "offset": -1, "text": "There is therefore an opportunity for the health sector to collaborate with other sectors to lever international resources to rationalize definition and measurement of indicators common to several sectors; streamline the content, frequency and timing of household surveys; and harmonize national and subnational databases that store socioeconomic data." }, { "infon": 9, "offset": -1, "text": "Without long-term commitment to improve training and build career structures for statisticians and information technicians working in the health and other sectors, improvements in information and statistical systems cannot be sustained." } ] } ] }, { "id": "S0042-96862005000800014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The use of a computerized database to monitor vaccine safety in Viet Nam." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Health information systems to monitor vaccine safety are used in industrialized countries to detect adverse medical events related to vaccinations or to prove the safety of vaccines." }, { "infon": 1, "offset": -1, "text": "There are no such information systems in the developing world, but they are urgently needed." }, { "infon": 2, "offset": -1, "text": "A large linked database for the monitoring of vaccine-related adverse events has been established in Khanh Hoa province, Viet Nam." }, { "infon": 3, "offset": -1, "text": "Data collected during the first 2 years of surveillance, a period which included a mass measles vaccination campaign, were used to evaluate the system." }, { "infon": 4, "offset": -1, "text": "For this purpose the discharge diagnoses of individuals admitted to polyclinics and hospitals were coded according to the International Classification of Diseases (ICD)-10 guidelines and linked in a dynamic population database with vaccination histories." }, { "infon": 5, "offset": -1, "text": "A case-series analysis was applied to the cohort of children vaccinated during the mass measles vaccination campaign." }, { "infon": 6, "offset": -1, "text": "The study recorded 107 022 immunizations in a catchment area with a population of 357 458 and confirmed vaccine coverage of 87% or higher for completed routine childhood vaccinations." }, { "infon": 7, "offset": -1, "text": "The measles vaccination campaign immunized at least 86% of the targeted children aged 9 months to 10 years." }, { "infon": 8, "offset": -1, "text": "No medical event was detected significantly more frequently during the 14 days after measles vaccination than before it." }, { "infon": 9, "offset": -1, "text": "The experience in Viet Nam confirmed the safety of a measles vaccination campaign and shows that it is feasible to establish health information systems such as a large linked database which can provide reliable data in a developing country for a modest increase in use of resources." } ] } ] }, { "id": "S0042-96862005000800016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Evaluating national cause-of-death statistics: principles and application to the case of China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Mortality statistics systems provide basic information on the levels and causes of mortality in populations." }, { "infon": 1, "offset": -1, "text": "Only a third of the world's countries have complete civil registration systems that yield adequate cause-specific mortality data for health policy-making and monitoring." }, { "infon": 2, "offset": -1, "text": "This paper describes the development of a set of criteria for evaluating the quality of national mortality statistics and applies them to China as an example." }, { "infon": 3, "offset": -1, "text": "The criteria cover a range of structural, statistical and technical aspects of national mortality data." }, { "infon": 4, "offset": -1, "text": "Little is known about cause-of-death data in China, which is home to roughly one-fifth of the world's population." }, { "infon": 5, "offset": -1, "text": "These criteria were used to evaluate the utility of data from two mortality statistics systems in use in China, namely the Ministry of Health-Vital Registration (MOH-VR) system and the Disease Surveillance Point (DSP) system." }, { "infon": 6, "offset": -1, "text": "We concluded that mortality registration was incomplete in both." }, { "infon": 7, "offset": -1, "text": "No statistics were available for geographical subdivisions of the country to inform resource allocation or for the monitoring of health programmes." }, { "infon": 8, "offset": -1, "text": "Compilation and publication of statistics is irregular in the case of the DSP, and they are not made publicly available at all by the MOH-VR." }, { "infon": 9, "offset": -1, "text": "More research is required to measure the content validity of cause-of-death attribution in the two systems, especially due to the use of verbal autopsy methods in rural areas." }, { "infon": 10, "offset": -1, "text": "This framework of criteria-based evaluation is recommended for the evaluation of national mortality data in developing countries to determine their utility and to guide efforts to improve their value for guiding policy." } ] } ] }, { "id": "S0042-96862005000800018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health information system reform in South Africa: developing an essential data set." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Health services are increasingly under pressure to develop information systems that are responsive to changing health needs and appropriate to service objectives." }, { "infon": 1, "offset": -1, "text": "Developing an essential data set provides managers with a clearly defined set of indicators for monitoring and evaluating services." }, { "infon": 2, "offset": -1, "text": "This article describes a process that resulted in the creation of an essential data set at district level." }, { "infon": 3, "offset": -1, "text": "This had a significant impact on neighbouring districts and resulted in the development of a regional essential data set, which in turn helped to influence the creation of a provincial and then national essential data set." }, { "infon": 4, "offset": -1, "text": "Four key lessons may be drawn from the process." }, { "infon": 5, "offset": -1, "text": "The development of an essential data set both requires and can contribute to a process that allows the reporting requirements to be adjusted over time in response to changing circumstances." }, { "infon": 6, "offset": -1, "text": "In addition, it contributes to (and requires) the integration of programme reporting requirements into a coherent information system." }, { "infon": 7, "offset": -1, "text": "While the case study describes a bottom-up approach, a top-down consultative process is advocated because it establishes a framework within which information needs can be reviewed." }, { "infon": 8, "offset": -1, "text": "Lastly, the use of surveys can aid efforts to keep the essential elements to a minimum." }, { "infon": 9, "offset": -1, "text": "In conclusion, the development of an essential data set contributes to strengthening health services because it necessitates dialogue between programme managers and defines indicators to be monitored by them." } ] } ] }, { "id": "S0042-96862005000900010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Areca (betel) nut chewing habit among high-school children in the Commonwealth of the Northern Mariana Islands (Micronesia)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate the prevalence of its use by high-school children in Saipan in Micronesia." }, { "infon": 1, "offset": -1, "text": "Usage of the areca nut is indigenous to south Asia and the western and south Pacific." }, { "infon": 2, "offset": -1, "text": "Some serious health effects of areca nut chewing are recognized and the International Agency for Research on Cancer has recently classified regular use of areca nut as being carcinogenic to humans." }, { "infon": 3, "offset": -1, "text": "Information on usage by young people, however, is scarce." }, { "infon": 4, "offset": -1, "text": "METHODS: Data on consumption of areca nut were obtained by a self-administered questionnaire." }, { "infon": 5, "offset": -1, "text": "Following an oral mucosal examination using WHO criteria any detectable oral mucosal diseases were recorded." }, { "infon": 6, "offset": -1, "text": "FINDINGS: Of 309 schoolchildren surveyed (mean age 16.3 ± 1.5 years), 63.4% claimed regular use, the highest level recorded in any school population survey." }, { "infon": 7, "offset": -1, "text": "Significant oral diseases detected were oral leukoplakia in 13% and oral submucous fibrosis in 8.8% of children." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: These findings from Saipan suggest that areca nut chewing starts at a young age in Micronesia." }, { "infon": 9, "offset": -1, "text": "As many users develop dependency this raises important concerns regarding its consequences for oral health." } ] } ] }, { "id": "S0042-96862005000900012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The effective use of fluorides in public health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Dental caries remain a public health problem for many developing countries and for underprivileged populations in developed countries." }, { "infon": 1, "offset": -1, "text": "This paper outlines the historical development of public health approaches to the use of fluoride and comments on their effectiveness." }, { "infon": 2, "offset": -1, "text": "Early research and development was concerned with waterborne fluorides, both naturally occurring and added, and their effects on the prevalence and incidence of dental caries and dental fluorosis." }, { "infon": 3, "offset": -1, "text": "In the latter half of the 20th century, the focus of research was on fluoride toothpastes and mouth rinses." }, { "infon": 4, "offset": -1, "text": "More recently, systematic reviews summarizing these extensive databases have indicated that water fluoridation and fluoride toothpastes both substantially reduce the prevalence and incidence of dental caries." }, { "infon": 5, "offset": -1, "text": "We present four case studies that illustrate the use of fluoride in modern public health practice, focusing on: recent water fluoridation schemes in California, USA; salt fluoridation in Jamaica; milk fluoridation in Chile; and the development of \"affordable\" fluoride toothpastes in Indonesia." }, { "infon": 6, "offset": -1, "text": "Common themes are the concern to reduce demands for compliance with fluoride regimes that rely upon action by individuals and their families, and the issue of cost." }, { "infon": 7, "offset": -1, "text": "We recommend that a community should use no more than one systemic fluoride (i.e. water or salt or milk fluoridation) combined with the use of fluoride toothpastes, and that the prevalence of dental fluorosis should be monitored in order to detect increases in or higher-than-acceptable levels." } ] } ] }, { "id": "S0042-96862005000900014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Oral health information systems - towards measuring progress in oral health promotion and disease prevention." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels." }, { "infon": 1, "offset": -1, "text": "Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health." }, { "infon": 2, "offset": -1, "text": "Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion." }, { "infon": 3, "offset": -1, "text": "The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public." }, { "infon": 4, "offset": -1, "text": "WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems." }, { "infon": 5, "offset": -1, "text": "Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research." }, { "infon": 6, "offset": -1, "text": "Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide." } ] } ] }, { "id": "S0042-96862005000900016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Oral lesions in infection with human immunodeficiency virus." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper discusses the importance of oral lesions as indicators of infection with human immunodeficiency virus (HIV) and as predictors of progression of HIV disease to acquired immunodeficiency syndrome (AIDS)." }, { "infon": 1, "offset": -1, "text": "Oral manifestations are among the earliest and most important indicators of infection with HIV." }, { "infon": 2, "offset": -1, "text": "Seven cardinal lesions, oral candidiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and non-Hodgkin lymphoma, which are strongly associated with HIV infection, have been identified and internationally calibrated, and are seen in both developed and developing countries." }, { "infon": 3, "offset": -1, "text": "They may provide a strong indication of HIV infection and be present in the majority of HIV-infected people." }, { "infon": 4, "offset": -1, "text": "Antiretroviral therapy may affect the prevalence of HIV-related lesions." }, { "infon": 5, "offset": -1, "text": "The presence of oral lesions can have a significant impact on health-related quality of life." }, { "infon": 6, "offset": -1, "text": "Oral health is strongly associated with physical and mental health and there are significant increases in oral health needs in people with HIV infection, especially in children, and in adults particularly in relation to periodontal diseases." }, { "infon": 7, "offset": -1, "text": "International collaboration is needed to ensure that oral aspects of HIV disease are taken into account in medical programmes and to integrate oral health care with the general care of the patient." }, { "infon": 8, "offset": -1, "text": "It is important that all health care workers receive education and training on the relevance of oral health needs and the use of oral lesions as surrogate markers in HIV infection." } ] } ] }, { "id": "S0042-96862005000900018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Strategies and approaches in oral disease prevention and health promotion." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Oral health is an important element of general health and well-being." }, { "infon": 1, "offset": -1, "text": "Although largely preventable, many people across the world still suffer unnecessarily from the pain and discomfort associated with oral diseases." }, { "infon": 2, "offset": -1, "text": "In addition, the costs of dental treatment are high, both to the individual and to society." }, { "infon": 3, "offset": -1, "text": "Effective evidence-based preventive approaches are needed to address this major public health problem." }, { "infon": 4, "offset": -1, "text": "The aim of this paper is to outline public health strategies to promote oral health and reduce inequalities." }, { "infon": 5, "offset": -1, "text": "An extensive collection of public health policy documents produced by WHO are reviewed to guide the development of oral health strategies." }, { "infon": 6, "offset": -1, "text": "In addition a range of Cochrane and other systematic reviews assessing the evidence base for oral health interventions are summarized." }, { "infon": 7, "offset": -1, "text": "Public health strategies should tackle the underlying social determinants of oral health through the adoption of a common risk approach." }, { "infon": 8, "offset": -1, "text": "Isolated interventions which merely focus on changing oral health behaviours will not achieve sustainable improvements in oral health." }, { "infon": 9, "offset": -1, "text": "Radical public health action on the conditions which determine unhealthy behaviours across the population is needed rather than relying solely on the high-risk approach." }, { "infon": 10, "offset": -1, "text": "Based upon the Ottawa Charter, a range of complementary strategies can be implemented in partnership with relevant local, national and international agencies." }, { "infon": 11, "offset": -1, "text": "At the core of this public health approach is the need to empower local communities to become actively involved in efforts to promote their oral health." } ] } ] }, { "id": "S0042-96862005001000010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimating the burden of shigellosis in Thailand: 36-month population-based surveillance study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate incidence of shigellosis in the Kaengkhoi district, Saraburi Province, Thailand." }, { "infon": 1, "offset": -1, "text": "METHODS: Population-based surveillance of shigellosis based in treatment centres." }, { "infon": 2, "offset": -1, "text": "The detected rates of treated shigellosis were corrected for the number of cases missed due to the low sensitivity of microbiological culture methods and participants' use of health-care providers not participating in the study." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The overall uncorrected incidence of shigellosis was 0.6/1000 population per year (95% confidence interval (CI) = 0.5-0.8)." }, { "infon": 4, "offset": -1, "text": "The unadjusted incidence of treated shigellosis was highest among children less than 5 years old (4/1000 children per year; 95% CI = 3-6) and significantly lower among people aged > 5 years (0.3/1000 population per year; 95% CI = 0.2-0.5; P < 0.001)." }, { "infon": 5, "offset": -1, "text": "Adjusting for cases likely to be missed as a result of culture and surveillance methods increased estimates approximately five times." }, { "infon": 6, "offset": -1, "text": "The majority of Shigella isolates (122/146; 84%) were S. sonnei; the rest were S. flexneri." }, { "infon": 7, "offset": -1, "text": "Of the 22 S. flexneri isolates, the three most frequently encountered serotypes were 2a (36%), 1b (23%) and 3b (28%)." }, { "infon": 8, "offset": -1, "text": "A total of 90-95% of S. sonnei and S. flexneri isolates were resistant to tetracycline and co-trimoxazole." }, { "infon": 9, "offset": -1, "text": "In contrast to S. sonnei isolates, more than 90% of the S. flexneri isolates were also resistant to ampicillin and chloramphenicol (P < 0.0001)." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: Estimates of incidence of Shigella infection in the community are 10-fold to 100-fold greater than those found from routine government surveillance." }, { "infon": 11, "offset": -1, "text": "The high prevalence of Shigella strains resistant to multiple antibiotics adds urgency to the development of a vaccine to protect against shigellosis in this region of Thailand." } ] } ] }, { "id": "S0042-96862005001000012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Using lot quality-assurance sampling and area sampling to identify priority areas for trachoma control: Viet Nam." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To report on the use of lot quality-assurance sampling (LQAS) surveys undertaken within an area-sampling framework to identify priority areas for intervention with trachoma control activities in Viet Nam." }, { "infon": 1, "offset": -1, "text": "METHODS: The LQAS survey method for the rapid assessment of the prevalence of active trachoma was adapted for use in Viet Nam with the aim of classifying individual communes by the prevalence of active trachoma among children in primary school." }, { "infon": 2, "offset": -1, "text": "Schoolbased sampling was used; school sites to be sampled were selected using an area-sampling approach." }, { "infon": 3, "offset": -1, "text": "A total of 719 communes in 41 districts in 18 provinces were surveyed." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Survey staff found the LQAS survey method both simple and rapid to use after initial problems with area-sampling methods were identified and remedied." }, { "infon": 5, "offset": -1, "text": "The method yielded a finer spatial resolution of prevalence than had been previously achieved in Viet Nam using semiquantitative rapid assessment surveys and multistage cluster-sampled surveys." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: When used with area-sampling techniques, the LQAS survey method has the potential to form the basis of survey instruments that can be used to efficiently target resources for interventions against active trachoma." }, { "infon": 7, "offset": -1, "text": "With additional work, such methods could provide a generally applicable tool for effective programme planning and for the certification of the elimination of trachoma as a blinding disease." } ] } ] }, { "id": "S0042-96862005001000014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings." }, { "infon": 1, "offset": -1, "text": "Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption." }, { "infon": 2, "offset": -1, "text": "It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity." }, { "infon": 3, "offset": -1, "text": "This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings." }, { "infon": 4, "offset": -1, "text": "The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses." }, { "infon": 5, "offset": -1, "text": "Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources." }, { "infon": 6, "offset": -1, "text": "This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation." }, { "infon": 7, "offset": -1, "text": "In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date." } ] } ] }, { "id": "S0042-96862005001100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Alcohol consumption and increased mortality in Russian men and women: a cohort study based on the mortality of relatives." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine the relations between frequency of alcohol consumption and of binge drinking and adult mortality in Russian men and women." }, { "infon": 1, "offset": -1, "text": "METHODS: Using modified indirect demographic techniques, a convenience cohort was constructed based on survey respondents' information about their close relatives." }, { "infon": 2, "offset": -1, "text": "A random sample general population of the Russian Federation of 7172 respondents (response rate 61%) provided information on 10 475 male and 3129 female relatives, including age, vital status, and frequency of alcohol consumption and binge drinking." }, { "infon": 3, "offset": -1, "text": "These relatives formed the cohort analysed in this report." }, { "infon": 4, "offset": -1, "text": "The outcome measure was all-cause mortality after the age of 30 years." }, { "infon": 5, "offset": -1, "text": "FINDINGS: There was a strong linear relation between frequency of drinking and of binge drinking and all-cause mortality in men; after controlling for smoking and calendar period of birth, the relative risk of death in daily drinkers compared to occasional drinkers was 1.52 (95% confidence interval (CI) 1.33-1.75)." }, { "infon": 6, "offset": -1, "text": "Male binge drinkers had higher mortality than drinkers who did not binge, which persisted after adjustment for drinking frequency (adjusted relative risk 1.09, 95% CI 1.00-1.19)." }, { "infon": 7, "offset": -1, "text": "In women, the increased mortality was confined to a small group of those who binged at least once a month (adjusted relative risk 2.68, 95% CI 1.54-4.66)." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: The results suggest a positive association between alcohol and mortality in the Russian Federation." }, { "infon": 9, "offset": -1, "text": "There was no evidence for the protective effect of drinking seen in western populations." }, { "infon": 10, "offset": -1, "text": "Alcohol appears to have contributed to the high long-term mortality rates in Russian men, but it is unlikely to be a major cause of female mortality." } ] } ] }, { "id": "S0042-96862005001100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Role of socioeconomic markers and state prohibition policy in predicting alcohol consumption among men and women in India: a multilevel statistical analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To investigate the independent contribution of individual socioeconomic markers and state prohibition policy on alcohol consumption among men and women in India." }, { "infon": 1, "offset": -1, "text": "METHODS: The study used a multilevel cross-sectional analysis of alcohol consumption from the 1998-1999 Indian national family health survey of 301 984 adult individuals in 92 447 households in 3215 villages in 440 districts in 26 states, stratified by sex." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Men with no education were more likely to consume alcohol that those with a post graduate education (OR, 2.28; 95% CI, 2.08-2.50)." }, { "infon": 3, "offset": -1, "text": "Unlike men, women showed a U-shaped association between education and alcohol consumption." }, { "infon": 4, "offset": -1, "text": "Men and women living in households at the lowest standard-of-living quintile were more likely to consume alcohol (OR, 1.92; 95% CI, 1.81-2.03, and OR, 2.72, 95% CI, 2.18-3.39), respectively, than those classified as living in the top quintile." }, { "infon": 5, "offset": -1, "text": "Members of scheduled tribes and castes and other backward classes were more likely to consume alcohol than members of other caste groups." }, { "infon": 6, "offset": -1, "text": "There was no difference in alcohol consumption between men from states that were not under prohibition (OR, 1.36; 95% CI 0.69-2.03) and those that were." }, { "infon": 7, "offset": -1, "text": "By contrast, states not under prohibition has higher alcohol use by women (OR, 3.04, 95% CI, 1.59-4.48) than those under partial or complete prohibition." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Caste, education and standard of living independently influence alcohol use in India." }, { "infon": 9, "offset": -1, "text": "Prohibition policies appear to have little effect on alcohol use by men, but may reduce the proportion of women who consume alcohol." }, { "infon": 10, "offset": -1, "text": "The socioeconomic patterning of health behaviours is likely to feed substantially into inequalities in health outcomes." }, { "infon": 11, "offset": -1, "text": "Further investigation is required to understand how social and cultural factors in more localized contexts (e.g. districts) influence alcohol consumption." } ] } ] }, { "id": "S0042-96862005001100014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Differences in willingness to pay for artemisinin-based combinations or monotherapy: experiences from the United Republic of Tanzania." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: The cost of combination treatment is thought to be one of the greatest barriers to their deployment, but this has not been tested directly." }, { "infon": 1, "offset": -1, "text": "Estimates of willingness to pay were compared across four drug combinations used to treat Tanzanian children with uncomplicated malaria." }, { "infon": 2, "offset": -1, "text": "The reasons behind respondents' valuations and the effect of socioeconomic status on willingness to pay were explored." }, { "infon": 3, "offset": -1, "text": "METHODS: One hundred and eighty mothers whose children had been recruited into a recently completed randomized effectiveness trial of amodiaquine + artesunate (AQ+AS), amodiaquine + sulfadoxine-pyrimethamine (AQ+SP), artemether-lumefantrine (coartemether) and amodiaquine monotherapy (AQ) were interviewed about their willingness to pay for these drugs two weeks after treatment." }, { "infon": 4, "offset": -1, "text": "Estimates of willingness to pay were elicited with the bidding game technique." }, { "infon": 5, "offset": -1, "text": "FINDINGS: A significant difference was detected in the mean amounts respondents were willing to pay, with those who received AQ+AS willing to pay the most, followed by co-artemether, AQ+SP and finally AQ." }, { "infon": 6, "offset": -1, "text": "The amounts patients' mothers were willing to pay for the artemisinin-based combinations, however, fell well short of the market costs." }, { "infon": 7, "offset": -1, "text": "Socioeconomic status was not found to have a statistically significant effect on mean willingness to pay scores for any treatment group." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: This study shows that families who live in an area in which drug resistance to monotherapy is very high are willing to pay more for more effective artemisinin-based combination therapies." }, { "infon": 9, "offset": -1, "text": "These amounts, however, are nowhere near the real costs of delivering the new drugs." }, { "infon": 10, "offset": -1, "text": "Only with subsidies will artemisinin-based combination therapies realistically have any impact." } ] } ] }, { "id": "S0042-96862005001100016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Treatment of tuberculosis: present status and future prospects." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Over recent years, tuberculosis (TB) and disease caused by human immunodeficiency virus (HIV) have merged in a synergistic pandemic." }, { "infon": 1, "offset": -1, "text": "The number of new cases of TB is stabilizing and declining, except in countries with a high prevalence of HIV infection." }, { "infon": 2, "offset": -1, "text": "In these countries, where HIV is driving an increase in the TB burden, the capacity of the current tools and strategies to reduce the burden has been exceeded." }, { "infon": 3, "offset": -1, "text": "This paper summarizes the current status of TB management and describes recent thinking and strategy adjustments required for the control of TB in settings of high HIV prevalence." }, { "infon": 4, "offset": -1, "text": "We review the information on anti-TB drugs that is available in the public domain and highlight the need for continued and concerted efforts (including financial, human and infrastructural investments) for the development of new strategies and anti-TB agents." } ] } ] }, { "id": "S0042-96862005001200012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The epidemiology of trachoma in Eastern Equatoria and Upper Nile States, southern Sudan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Limited surveys and anecdotal data indicate that trachoma is endemic in the states of Eastern Equatoria and Upper Nile in southern Sudan." }, { "infon": 1, "offset": -1, "text": "However, its magnitude and geographical distribution are largely unknown." }, { "infon": 2, "offset": -1, "text": "We conducted surveys to ascertain the prevalence and geographical distribution of trachoma, and to identify targets for control interventions." }, { "infon": 3, "offset": -1, "text": "METHODS: Population-based cross-sectional surveys were conducted in nine sites in southern Sudan between September 2001 and June 2004." }, { "infon": 4, "offset": -1, "text": "Two-stage random cluster sampling with probability proportional to size was used to select the sample." }, { "infon": 5, "offset": -1, "text": "Trachoma grading was done using the WHO simplified grading system." }, { "infon": 6, "offset": -1, "text": "FINDINGS: A total of 17 016 persons were examined, a response rate of 86.1% of the enumerated population." }, { "infon": 7, "offset": -1, "text": "Prevalence of signs of active trachoma in children aged 1-9 years was: TF = 53.7% (95% confidence interval (CI) = 52.1-55.3); TI = 42.7% (95% CI = 41.2-44.2); TF and/or TI = 64.1% (95% CI = 62.5-65.5)." }, { "infon": 8, "offset": -1, "text": "Prevalence of trichiasis (TT) in children aged less than 15 years was 1.2% (95% CI = 0.9-1.4), while TT prevalence in persons aged 15 years and above was 9.2% (95% CI = 8.6-9.9)." }, { "infon": 9, "offset": -1, "text": "Women were more likely to have trichiasis compared to men (odds ratio (OR) = 1.57; 95% CI = 1.34-1.84)." }, { "infon": 10, "offset": -1, "text": "Tentative extrapolation to the states of Eastern Equatoria and Upper Nile estimates that there is a backlog of 178 250 (lower and upper bounds = 156 027-205 995) persons requiring surgery and the entire population, estimated to be over 3.9 million, is in need of the SAFE strategy to control blinding trachoma." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: Trachoma is a public health problem in all nine of the study sites surveyed." }, { "infon": 12, "offset": -1, "text": "The unusually high prevalence of active trachoma and TT in children points to the severity of the problem." }, { "infon": 13, "offset": -1, "text": "There is urgent need to implement trachoma control interventions in trachoma endemic regions of southern Sudan." } ] } ] }, { "id": "S0042-96862005001200014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Development assistance for health in central and eastern European Region." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: We aimed to quantify development assistance for health to countries of central and eastern Europe and the Commonwealth of Independent States (CEE-CIS)." }, { "infon": 1, "offset": -1, "text": "METHODS: We used the International Development Statistics database of the Organisation for Economic Co-operation and Development and the database on development assistance for health compiled for the Commission on Macroeconomics and Health to quantify health development assistance to the region, compared to global and overall development assistance." }, { "infon": 2, "offset": -1, "text": "We based our analysis on standard health indicators, including child mortality, life expectancy at birth and health expenditures." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Although total development assistance per capita to CEE-CIS was higher than that for most other regions of the world, development assistance for health was very low compared to other countries with similar levels of child mortality, life expectancy at birth and national expenditures on health." }, { "infon": 4, "offset": -1, "text": "CONCLUSION: The allocation of development assistance for health on a global scale seems to be related far more to child mortality rather than adult mortality." }, { "infon": 5, "offset": -1, "text": "Countries of CEE-CIS have a high burden of adult morbidity and mortality from non-communicable diseases, which does not appear to attract proportionate development assistance." }, { "infon": 6, "offset": -1, "text": "Levels of development assistance for health should be determined in consideration of the region's particular burden of disease." } ] } ] }, { "id": "S0042-96862005001200016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Integration of basic dermatological care into primary health care services in Mali." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases - a neglected component of primary health care in such regions." }, { "infon": 1, "offset": -1, "text": "METHODS: We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area." }, { "infon": 2, "offset": -1, "text": "We evaluated their knowledge and practice before and after training." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Before training, knowledge about skin diseases often was poor and practice inadequate." }, { "infon": 4, "offset": -1, "text": "We found a marked improvement in both parameters after training." }, { "infon": 5, "offset": -1, "text": "We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs." }, { "infon": 6, "offset": -1, "text": "Improved levels of knowledge and practice persisted for up to 18 months after training." }, { "infon": 7, "offset": -1, "text": "CONCLUSIONS: The training programme markedly improved the basic dermatological abilities of the health care workers targeted." }, { "infon": 8, "offset": -1, "text": "Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries." } ] } ] }, { "id": "S0042-96862005001200018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Priorities for research to take forward the health equity policy agenda." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening." }, { "infon": 1, "offset": -1, "text": "Our recommendations regarding research priorities for health equity are based on an assessment of what information is required to gain an understanding of how to make substantial reductions in health inequities." }, { "infon": 2, "offset": -1, "text": "We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people's chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care" }, { "infon": 3, "offset": -1, "text": "system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas." } ] } ] }, { "id": "S0042-96862006000100011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine the effect of a new point-of-use treatment for drinking-water, a commercially developed flocculant-disinfectant, on the prevalence of diarrhoea in children." }, { "infon": 1, "offset": -1, "text": "METHODS: We conducted a randomized controlled trial among 514 rural Guatemalan households, divided into 42 neighbourhood clusters, for 13 weeks, from 4 November 2002 through 31 January 2003." }, { "infon": 2, "offset": -1, "text": "Clusters assigned to water treatment with the flocculant-disinfectant were compared with those using their usual water-handling practices." }, { "infon": 3, "offset": -1, "text": "The longitudinal prevalence of diarrhoea was calculated as the proportion of total days with diarrhoea divided by the total number of days of observation." }, { "infon": 4, "offset": -1, "text": "The prevalence of diarrhoea was compared using the Wilcoxon rank-sum test." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The 1702 people in households receiving the disinfectant had a prevalence of diarrhoea that was 40% lower than that among the 1699 people using standard water-handling practices (0.9% versus 1.5%; P = 0.001)." }, { "infon": 6, "offset": -1, "text": "In households using the flocculant-disinfectant, children < 1 year of age had a 39% lower prevalence of diarrhoea than those in households using their standard practices (3.7% versus 6.0%; P = 0.005)." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: In settings where families rarely treat drinking-water, we introduced a novel flocculant-disinfectant that reduced the longitudinal prevalence of diarrhoea, especially among children aged < 1 year, among whom diarrhoea has been strongly associated with mortality." }, { "infon": 8, "offset": -1, "text": "Successful introduction and use of this product could contribute to preventing diarrhoeal disease globally." } ] } ] }, { "id": "S0042-96862006000100013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health-systems efficiency in the Russian Federation: tuberculosis control." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To conduct a comprehensive assessment of the case-mix of patients admitted to tuberculosis hospitals and the reasons for their admission in four Russian regions: Ivanovo, Orel, Samara and Vladimir." }, { "infon": 1, "offset": -1, "text": "We also sought to quantify the extent to which efficiency could be improved by reducing hospitalization rates and re-profiling hospital beds available in the tuberculosis-control system." }, { "infon": 2, "offset": -1, "text": "METHODS: We used a standard questionnaire to determine how beds were being used and who was using the beds in tuberculosis facilities in four Russian regions." }, { "infon": 3, "offset": -1, "text": "Data were collected to determine how 4306 tuberculosis beds were utilized as well as on the socioeconomic and demographic indicators, clinical parameters and reasons for hospitalization for 3352 patients." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Of the 3352 patients surveyed about 70% were male; the average age was 40; and rates of unemployment, disability and alcohol misuse were high." }, { "infon": 5, "offset": -1, "text": "About one-third of beds were occupied by smear-positive or culture-positive tuberculosis patients; 20% were occupied by tuberculosis patients who were smear-negative and/or culture-negative; 20% were occupied by patients who no longer had tuberculosis; and 20% were unoccupied." }, { "infon": 6, "offset": -1, "text": "If clinical and public health admission criteria were applied then < 50% of admissions would be justified and < 50% of the current number of beds would be required." }, { "infon": 7, "offset": -1, "text": "Up to 85% of admissions and beds were deemed to be necessary when social problems and poor access to outpatient care were considered along with clinical and public health admission criteria." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Much of the Russian Federation's large tuberculosis hospital infrastructure is unnecessary when clinical and public health criteria are used, but the large hospital infrastructure within the tuberculosis-control system has an important social support function." }, { "infon": 9, "offset": -1, "text": "Improving the efficiency of the system will require the reform of health-system norms and regulations as they relate to resource allocation and clinical care and implementation of lower-cost approaches to case management for patients with social problems." }, { "infon": 10, "offset": -1, "text": "Additionally, closer attention will need to be paid to the management of staff numbers in the tuberculosis system." } ] } ] }, { "id": "S0042-96862006000100015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Child health in complex emergencies." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Coordinated and effective interventions are critical for relief efforts to be successful in addressing the health needs of children in situations of armed conflict, population displacement, and/or food insecurity." }, { "infon": 1, "offset": -1, "text": "We reviewed published literature and surveyed international relief organizations engaged in child health activities in complex emergencies." }, { "infon": 2, "offset": -1, "text": "Our aim was to identify research needs and improve guidelines for the care of children." }, { "infon": 3, "offset": -1, "text": "Much of the literature details the burden of disease and the causes of morbidity and mortality; few interventional studies have been published." }, { "infon": 4, "offset": -1, "text": "Surveys of international relief organizations showed that most use World Health Organization (WHO), United Nations Children's Fund (UNICEF), and ministry of health guidelines designed for use in stable situations." }, { "infon": 5, "offset": -1, "text": "Organizations were least likely to have formal guidelines on the management of asphyxia, prematurity, and infection in neonates; diagnosis and management of children with human immunodeficiency virus (HIV) infection; active case-finding and treatment of tuberculosis; paediatric trauma; and the diagnosis and management of mental-health problems in children." }, { "infon": 6, "offset": -1, "text": "Guidelines often are not adapted to the different types of health-care workers who provide care in complex emergencies." }, { "infon": 7, "offset": -1, "text": "Evidence-based, locally adapted guidelines for the care of children in complex emergencies should be adopted by ministries of health, supported by WHO and UNICEF, and disseminated to international relief organizations to ensure appropriate, effective, and uniform care." } ] } ] }, { "id": "S0042-96862006000100017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: experience from a vaccine trial." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "INTRODUCTION: In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical." }, { "infon": 1, "offset": -1, "text": "In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest." }, { "infon": 2, "offset": -1, "text": "This, however, poses enormous challenges in practice." }, { "infon": 3, "offset": -1, "text": "The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described." }, { "infon": 4, "offset": -1, "text": "METHODS: The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan." }, { "infon": 5, "offset": -1, "text": "At the suggestion of private practitioners, a phlebotomy team was formed to provide support for disease surveillance." }, { "infon": 6, "offset": -1, "text": "Children who had a reported history of fever for more than three days were enrolled for a diagnosis." }, { "infon": 7, "offset": -1, "text": "RESULTS: Between May 2003 and April 2004, 5540 children younger than 16 years with fever for three days or more were enrolled in the study." }, { "infon": 8, "offset": -1, "text": "Of the children, 1312 (24%) were seen first by private practitioners; the remainder presented directly to study centres." }, { "infon": 9, "offset": -1, "text": "In total, 5329 blood samples were obtained for microbiology." }, { "infon": 10, "offset": -1, "text": "The annual incidence of Salmonella typhi diagnosed by blood culture was 407 (95% confidence interval (95% CI), 368-448) per 100 000/year and for Salmonella paratyphi A was 198 (95% CI, 171-227) per 100 000/year." }, { "infon": 11, "offset": -1, "text": "Without the contribution of private practitioners, the rates would have been 240 per 100 000/year (95% CI, 211-271) for S. typhi and 114 (95% CI, 94-136) per 100 000/year for S. paratyphi A. CONCLUSION: The private sector plays a major health-care role in Pakistan." }, { "infon": 12, "offset": -1, "text": "Our experience from a surveillance and burden estimation study in Pakistan indicates that this objective is possible to achieve but requires considerable effort and confidence building." }, { "infon": 13, "offset": -1, "text": "Nonetheless, it is essential to include private health care providers when attempting to accurately estimate the burden of disease in such settings." } ] } ] }, { "id": "S0042-96862006000200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Comparison of the diagnostic accuracy of a rapid immunochromatographic test and the rapid plasma reagin test for antenatal syphilis screening in Mozambique." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Programmes to control syphilis in developing countries are hampered by a lack of laboratory services, delayed diagnosis, and doubts about current screening methods." }, { "infon": 1, "offset": -1, "text": "We aimed to compare the diagnostic accuracy of an immunochromatographic strip (ICS) test and the rapid plasma reagin (RPR) test with the combined gold standard (RPR, Treponema pallidum haemagglutination assay and direct immunofluorescence stain done at a reference laboratory) for the detection of syphilis in pregnancy." }, { "infon": 2, "offset": -1, "text": "METHODS: We included test results from 4789 women attending their first antenatal visit at one of six health facilities in Sofala Province, central Mozambique." }, { "infon": 3, "offset": -1, "text": "We compared diagnostic accuracy (sensitivity, specificity, and positive and negative predictive values) of ICS and RPR done at the health facilities and ICS performed at the reference laboratory." }, { "infon": 4, "offset": -1, "text": "We also made subgroup comparisons by human immunodeficiency virus (HIV) and malaria status." }, { "infon": 5, "offset": -1, "text": "FINDINGS: For active syphilis, the sensitivity of the ICS was 95.3% at the reference laboratory, and 84.1% at the health facility." }, { "infon": 6, "offset": -1, "text": "The sensitivity of the RPR at the health facility was 70.7%." }, { "infon": 7, "offset": -1, "text": "Specificity and positive and negative predictive values showed a similar pattern." }, { "infon": 8, "offset": -1, "text": "The ICS outperformed RPR in all comparisons (P<0.001)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The diagnostic accuracy of the ICS compared favourably with that of the gold standard." }, { "infon": 10, "offset": -1, "text": "The use of the ICS in Mozambique and similar settings may improve the diagnosis of syphilis in health facilities, both with and without laboratories." } ] } ] }, { "id": "S0042-96862006000200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate, symptom duration, and treatment outcome of smear-positive tuberculosis (TB)." }, { "infon": 1, "offset": -1, "text": "METHODS: We randomly allocated 32 rural communities to intervention or control groups." }, { "infon": 2, "offset": -1, "text": "In intervention communities, health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum samples for sputum microscopy from symptomatic TB suspects." }, { "infon": 3, "offset": -1, "text": "In addition, trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings." }, { "infon": 4, "offset": -1, "text": "Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility." }, { "infon": 5, "offset": -1, "text": "In control communities, cases were detected through passive case-finding among symptomatic suspects reporting to health facilities." }, { "infon": 6, "offset": -1, "text": "Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospectively enrolled." }, { "infon": 7, "offset": -1, "text": "FINDINGS: In the 1-year study period, 159 and 221 cases of smear-positive TB were detected in the intervention and control groups, respectively." }, { "infon": 8, "offset": -1, "text": "Case-notification rates in all age groups were 124.6/105 and 98.1/105 person-years, respectively (P = 0.12)." }, { "infon": 9, "offset": -1, "text": "The corresponding rates in adults older than 14 years were 207/105 and 158/105 person-years, respectively (P = 0.09)." }, { "infon": 10, "offset": -1, "text": "The proportion of patients with >3 months' symptom duration was 41% in the intervention group compared with 63% in the control group (P<0.001)." }, { "infon": 11, "offset": -1, "text": "Pre-treatment symptom duration in the intervention group fell by 55-60% compared with 3-20% in the control group." }, { "infon": 12, "offset": -1, "text": "In the intervention and control groups, 81% and 75%, respectively of patients successfully completed treatment (P = 0.12)." }, { "infon": 13, "offset": -1, "text": "CONCLUSION: The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting." }, { "infon": 14, "offset": -1, "text": "Both groups had comparable treatment outcomes." } ] } ] }, { "id": "S0042-96862006000200013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries." }, { "infon": 1, "offset": -1, "text": "While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database." }, { "infon": 2, "offset": -1, "text": "We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic." }, { "infon": 3, "offset": -1, "text": "Our novel data capture approach collects \"key\" data for tracking patient and programme outcomes." }, { "infon": 4, "offset": -1, "text": "It saves physician time and does not detract from clinical care." } ] } ] }, { "id": "S0042-96862006000200015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Re-emerging schistosomiasis in hilly and mountainous areas of Sichuan, China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Despite great strides in schistosomiasis control over the past several decades in Sichuan Province, China the disease has re-emerged in areas where it was previously controlled." }, { "infon": 1, "offset": -1, "text": "We reviewed historical records and found that schistosomiasis had reemerged in eight counties by the end of 2004 - seven of 21 counties with transmission control and one of 25 with transmission interruption as reported in 2001 were confirmed to have local disease transmission." }, { "infon": 2, "offset": -1, "text": "The average \"return time\" (from control to re-emergence) was about eight years." }, { "infon": 3, "offset": -1, "text": "The onset of re-emergence was commonly signalled by the occurrence of acute infections." }, { "infon": 4, "offset": -1, "text": "Our survey results suggest that environmental and sociopolitical factors play an important role in re-emergence." }, { "infon": 5, "offset": -1, "text": "The main challenge would be to consolidate and maintain effective control in the longer term until \"real\" eradication is achieved." }, { "infon": 6, "offset": -1, "text": "This would be possible only by the formulation of a sustainable surveillance and control system." } ] } ] }, { "id": "S0042-96862006000300011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "How should we measure maternal mortality in the developing world?" }, { "infon": 1, "offset": -1, "text": "A comparison of household deaths and sibling history approaches." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: A reduction in the maternal mortality ratio (MMR) is one of six health-related Millennium Development Goals (MDGs)." }, { "infon": 1, "offset": -1, "text": "However, there is no consensus about how to measure MMR in the many countries that do not have complete registration of deaths and accurate ascertainment of cause of death." }, { "infon": 2, "offset": -1, "text": "In this study, we compared estimates of pregnancy-related deaths and maternal mortality in a developing country from three different household survey measurement approaches: a module collecting information on deaths of respondents' sisters; collection of information about recent household deaths with a time-of-death definition of maternal deaths; and a verbal autopsy instrument to identify maternal deaths." }, { "infon": 3, "offset": -1, "text": "METHODS: We used data from a very large nationally-representative household sample survey conducted in Bangladesh in 2001." }, { "infon": 4, "offset": -1, "text": "A total of 104 323 households were selected for participation, and 99 202 households (95.1% of selected households, 98.8% of contacted households) were successfully interviewed." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The sisterhood and household death approaches gave very similar estimates of all-cause and pregnancy-related mortality; verbal autopsy gave an estimate of maternal deaths that was about 15% lower than the pregnancy-related deaths." }, { "infon": 6, "offset": -1, "text": "Even with a very large sample size, however, confidence intervals around mortality estimates were similar for all approaches and exceeded ±15%." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Our findings suggest that with improved training for survey data collectors, both the sisterhood and household deaths methods are viable approaches for measuring pregnancy-related mortality." }, { "infon": 8, "offset": -1, "text": "However, wide confidence intervals around the estimates indicate that routine sample surveys cannot provide the information needed to monitor progress towards the MDG target." }, { "infon": 9, "offset": -1, "text": "Other approaches, such as inclusion of questions about household deaths in population censuses, should be considered." } ] } ] }, { "id": "S0042-96862006000300013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Assessing adult mortality in HIV-1-afflicted Zimbabwe (1998 -2003)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare alternative methods to vital registration systems for estimating adult mortality, and describe patterns of mortality in Manicaland, Zimbabwe, which has been severely affected by HIV." }, { "infon": 1, "offset": -1, "text": "METHODS: We compared estimates of adult mortality from (1) a single question on household mortality, (2) repeated household censuses, and (3) an adult cohort study with linked HIV testing from Manicaland, with a mathematical model fitted to local age-specific HIV prevalence (1998 -2000)." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The crude death rate from the single question (29 per 1000 person-years) was roughly consistent with that from the mathematical model (22 -25 per 1000 person-years), but much higher than that from the household censuses (12 per 1000 person-years)." }, { "infon": 3, "offset": -1, "text": "Adult mortality in the household censuses (males 0.65; females 0.51) was lower than in the cohort study (males 0.77; females 0.57), while mathematical models gave a much higher estimate, especially for females (males 0.80 -0.83; females 0.75 -0.80)." }, { "infon": 4, "offset": -1, "text": "The population attributable fraction of adult deaths due to HIV was 0.61 for men and 0.70 for women, with life expectancy estimated to be 34.3 years for males and 38.2 years for females." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: Each method for estimating adult mortality had limitations in terms of loss to follow-up (cohort study), under-ascertainment (household censuses), transparency of underlying processes (single question), and sensitivity to parameterization (mathematical model)." }, { "infon": 6, "offset": -1, "text": "However, these analyses make clear the advantages of longitudinal cohort data, which provide more complete ascertainment than household censuses, highlight possible inaccuracies in model assumptions, and allow direct quantification of the impact of HIV." } ] } ] }, { "id": "S0042-96862006000300015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Verbal autopsy (VA)- the interviewing of family members or caregivers about the circumstances of a death after the event- is an established tool in areas where routine death registration is non-existent or inadequate." }, { "infon": 1, "offset": -1, "text": "We assessed the performance of a probabilistic model (InterVA) for interpreting community-based VA interviews, in order to investigate patterns of cause-specific mortality in a rural Ethiopian community." }, { "infon": 2, "offset": -1, "text": "We compared results with those obtained after review of the VA by local physicians, with a view to validating the model as a community-based tool." }, { "infon": 3, "offset": -1, "text": "METHODS: Two-hundred and eighty-nine VA interviews were successfully completed; these included most deaths occurring in a defined community over a 1-year period." }, { "infon": 4, "offset": -1, "text": "The VA interviews were interpreted by physicians and by the model, and cause-specific mortality fractions were derived for the whole community and for particular age groups using both approaches." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The results of the two approaches to interpretation correlated well in this example from Ethiopia." }, { "infon": 6, "offset": -1, "text": "Four major cause groups accounted for over 60% of all mortality, and patterns within specific age groups were consistent with expectations for an underdeveloped high-mortality community in sub-Saharan Africa." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Compared with interpretation by physicians, the InterVA model is much less labour intensive and offers 100% consistency." }, { "infon": 8, "offset": -1, "text": "It is a valuable new tool for characterizing patterns of cause-specific mortality in communities without death registration and for comparing patterns of mortality in different populations." } ] } ] }, { "id": "S0042-96862006000300017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Facility-based maternal death reviews: effects on maternal mortality in a district hospital in Senegal." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: The improvement of obstetric services is one of the key components of the Safe Motherhood Programme." }, { "infon": 1, "offset": -1, "text": "Reviewing maternal deaths and complications is one method that may make pregnancy safer, but there is no evidence about the effectiveness of this strategy." }, { "infon": 2, "offset": -1, "text": "The objective of our before and after study is to assess the effect of facility-based maternal deaths reviews (MDR) on maternal mortality rates in a district hospital in Senegal that provides primary and referral maternity services." }, { "infon": 3, "offset": -1, "text": "METHODS: We included all women who were admitted to the maternity unit for childbirth, or within 24 hours of delivery." }, { "infon": 4, "offset": -1, "text": "We recorded maternal mortality during a 1-year baseline period from January to December 1997, and during a 3-year period from January 1998 to December 2000 after MDR had been implemented." }, { "infon": 5, "offset": -1, "text": "Effects of MDR on organization of care were qualitatively evaluated." }, { "infon": 6, "offset": -1, "text": "FINDINGS: The MDR strategy led to changes in organizational structure that improved life-saving interventions with a relatively large financial contribution from the community." }, { "infon": 7, "offset": -1, "text": "Overall mortality significantly decreased from 0.83 (95% CI (confidence interval) = 0.60 -1.06) in baseline period to 0.41 (95% CI = 0.25 -0.56) per 100 women 3 years later." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: MDR had a marked effect on resources, management and maternal outcomes in this facility." }, { "infon": 9, "offset": -1, "text": "However, given the design of our study and the local specific context, further research is needed to confirm the feasibility of MDR in other settings and to confirm the benefits of this approach for maternal health in developing countries." } ] } ] }, { "id": "S0042-96862006000300019", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A critical assessment of mortality statistics in Thailand: potential for improvements." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This study evaluates the collection and flow of mortality and cause-of-death (COD) data in Thailand, identifying areas of weakness and presenting potential approaches to improve these statistics." }, { "infon": 1, "offset": -1, "text": "Methods include systems analysis, literature review, and the application of the Health Metrics Network (HMN) self-assessment tool by key stakeholders." }, { "infon": 2, "offset": -1, "text": "We identified two weaknesses underlying incompleteness of death registration and inaccuracy of COD attribution: problems in recording events or certifying deaths, and problems in transferring information from death certificates to death registers." }, { "infon": 3, "offset": -1, "text": "Deaths occurring outside health facilities, representing 65% of all deaths in Thailand, contribute to the inaccuracy of cause-of-death data because they must be certified by village heads with limited knowledge and expertise in cause-of-death attribution." }, { "infon": 4, "offset": -1, "text": "However, problems also exist with in-hospital cause-of-death certification by physicians." }, { "infon": 5, "offset": -1, "text": "Priority should be given to training medical personnel in death certification, review of medical records by health personnel in district hospitals, and use of verbal autopsy techniques for assessing internal consistency." }, { "infon": 6, "offset": -1, "text": "This should be coupled with stronger collaboration with district registrars for the 65% of deaths that occur outside hospitals." }, { "infon": 7, "offset": -1, "text": "Training of physicians and data coders and harmonization of death certificates and registries would improve COD data for the 35% of deaths that take place in hospital." }, { "infon": 8, "offset": -1, "text": "Public awareness of the importance of registering all deaths and the application of registration requirements prior to funerals would also improve coverage, though enforcement would be difficult." } ] } ] }, { "id": "S0042-96862006000400010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Failure of standard antimicrobial therapy in children aged 3-59 months with mild or asymptomatic HIV infection and severe pneumonia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine whether children aged 3-59 months with mild or non-symptomatic human immunodeficiency virus (HIV) infection and WHO-defined severe pneumonia have a higher failure rate than do HIV-uninfected children when treated with the standard WHO treatment of parenteral penicillin or oral amoxicillin." }, { "infon": 1, "offset": -1, "text": "METHODS: This study was a planned sub-analysis of a randomized trial of 3-59-month-old children presenting with WHO-defined severe pneumonia (the APPIS study)." }, { "infon": 2, "offset": -1, "text": "We included two sites with high HIV prevalence in Durban, South Africa and Ndola, Zambia." }, { "infon": 3, "offset": -1, "text": "Primary outcome measures were clinical treatment failure at day 2 and day 14." }, { "infon": 4, "offset": -1, "text": "CLINICALTRIALS.GOV IDENTIFIER: CT00227331http://www.clinicaltrialsgov/show/NCT00227331)." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Of the 523 children enrolled, HIV status was known for 464 participants; 106 (23%) of these were infected with HIV." }, { "infon": 6, "offset": -1, "text": "By day 2, 57 (12.3%) children had failed treatment and 110 (23.7%) failed by day 14." }, { "infon": 7, "offset": -1, "text": "Twenty (18.9%) HIV-infected children failed by day 2 compared with 37 (10.3%) uninfected children (adjusted odds ratio (OR) 2.07; 95% confidence interval (CI): 1.07-4.00)." }, { "infon": 8, "offset": -1, "text": "Thirty-four (32.1%) HIV-infected children failed treatment by day 14 compared with 76 (21.2%) uninfected children (adjusted OR 1.88; 95% CI: 1.11-3.17)." }, { "infon": 9, "offset": -1, "text": "Analysis stratified by age showed that the greatest differential in treatment failure at day 2 and day 14 occurred in the children aged 3-5 months." }, { "infon": 10, "offset": -1, "text": "CONCLUSIONS: HIV-infected children with severe pneumonia fail WHO-standard treatment with parenteral penicillin or amoxicillin at day 2 and day 14 more often than do HIV-uninfected children, especially young infants." }, { "infon": 11, "offset": -1, "text": "Standard case management of acute respiratory infection (ARI) using WHO treatment guidelines is inadequate in areas of high HIV prevalence and reappraisal of empiric antimicrobial therapy is urgently needed for severe pneumonia associated with HIV-1." } ] } ] }, { "id": "S0042-96862006000400012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Maternal mortality in St. Petersburg, Russian Federation." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To study the levels and causes of maternal mortality in St. Petersburg, Russian Federation." }, { "infon": 1, "offset": -1, "text": "METHODS: We collected data about all pregnancy-related deaths in St. Petersburg over the period 1992-2003 using several sources of information." }, { "infon": 2, "offset": -1, "text": "An independent research group reviewed and classified all cases according to ICD-10 and the Confidential Enquiries into Maternal Deaths in the United Kingdom." }, { "infon": 3, "offset": -1, "text": "We tested trends of overall and cause specific ratios (deaths per 100 000 births) for four 3-year intervals using the c² test." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The maternal mortality ratio for the study period was 43 per 100 000 live births." }, { "infon": 5, "offset": -1, "text": "A sharp decline of direct obstetric deaths was observed from the first to fourth 3-year interval (49.8 for 1992-94 versus 18.5 for 2001-03)." }, { "infon": 6, "offset": -1, "text": "Sepsis and haemorrhage were the main causes of direct obstetric deaths." }, { "infon": 7, "offset": -1, "text": "Among the total deaths from sepsis, 63.8% were due to abortion." }, { "infon": 8, "offset": -1, "text": "Death ratios from sepsis declined significantly from the first to second study interval." }, { "infon": 9, "offset": -1, "text": "In the last study interval (2001-03), 50% of deaths due to haemorrhage were secondary to ectopic pregnancies." }, { "infon": 10, "offset": -1, "text": "The death ratio from thromboembolism remained low (2.9%) and stable throughout the study period." }, { "infon": 11, "offset": -1, "text": "Among indirect obstetric deaths a non-significant decrease was observed for deaths from cardiac disease." }, { "infon": 12, "offset": -1, "text": "Death ratios from infectious causes and suicides increased over the study period." }, { "infon": 13, "offset": -1, "text": "CONCLUSIONS: Maternal mortality levels in St. Petersburg still exceed European levels by a factor of five." }, { "infon": 14, "offset": -1, "text": "Improved management of abortion, emergency care for sepsis and haemorrhage, and better identification and control of infectious diseases in pregnancy, are needed." } ] } ] }, { "id": "S0042-96862006000400014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A method for deriving leading causes of death." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: A standard list for ranking leading causes of death worldwide does not exist." }, { "infon": 1, "offset": -1, "text": "WHO headquarters, regional offices and Member States all use different lists that have varying levels of detail." }, { "infon": 2, "offset": -1, "text": "We sought to derive a standard list to enable countries to identify their leading causes of death and to permit comparison between countries." }, { "infon": 3, "offset": -1, "text": "Our aim is to share the criteria and methodology we used to bring some order to the construction of such a list, to provide a consistent procedure that can be used by others, and to give researchers and data owners an opportunity to utilize the list at national and subnational levels." }, { "infon": 4, "offset": -1, "text": "METHODS: Results were primarily data-driven." }, { "infon": 5, "offset": -1, "text": "Data from individual countries representing different regions of the world were extracted from the WHO Mortality Database." }, { "infon": 6, "offset": -1, "text": "Supplementary information from WHO estimates on mortality was used for regions where data were scarce." }, { "infon": 7, "offset": -1, "text": "In addition, a set of criteria was used to group the candidate causes and to determine other causes that should be included on the list." }, { "infon": 8, "offset": -1, "text": "FINDINGS: A ranking list of the leading causes of death that contains broad cause groupings (such as \"all cancers\", \"all heart diseases\" or \"all accidents\") is not effective and does not identify the leading individual causes within these broad groupings; thus it does not allow policy-makers to generate appropriate health advocacy and cost-effective interventions." }, { "infon": 9, "offset": -1, "text": "Similarly, defining candidate causal groups too narrowly or including diseases that have a low frequency does not meet these objectives." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: For international comparisons, we recommend that countries use this list; it is based on extensive evidence and the application of public health disease-prevention criteria." }, { "infon": 11, "offset": -1, "text": "It is not driven by political or financial motives." }, { "infon": 12, "offset": -1, "text": "This list may be adapted for national statistical purposes." } ] } ] }, { "id": "S0042-96862006000400016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes." }, { "infon": 1, "offset": -1, "text": "Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated." }, { "infon": 2, "offset": -1, "text": "APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies." }, { "infon": 3, "offset": -1, "text": "The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate." }, { "infon": 4, "offset": -1, "text": "We assessed the deficiencies and sought resources to improve services." }, { "infon": 5, "offset": -1, "text": "LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi." }, { "infon": 6, "offset": -1, "text": "RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services." }, { "infon": 7, "offset": -1, "text": "Training coincided with a restructuring of the physical layout of the department." }, { "infon": 8, "offset": -1, "text": "The changes were put in place when the department reopened in January 2001." }, { "infon": 9, "offset": -1, "text": "LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice." }, { "infon": 10, "offset": -1, "text": "Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after." } ] } ] }, { "id": "S0042-96862006000400018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Translating words into actions: are governments acting on the advice of the World health report?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Every year, WHO produces the World health report: the 2005 report concentrated on maternal, neonatal and child health." }, { "infon": 1, "offset": -1, "text": "But what is the value of these reports?" }, { "infon": 2, "offset": -1, "text": "Are they ritualistic publications designed to promote WHO, or are they worthy of proper discussion and debate?" }, { "infon": 3, "offset": -1, "text": "One would think that given the current crises in global health, the annual report of the UN's primary agency for health would be important." }, { "infon": 4, "offset": -1, "text": "However, unless there is evidence that these reports are taken seriously, discussed and debated, and shown to have an effect, a conclusion might be drawn that they are largely insignificant." }, { "infon": 5, "offset": -1, "text": "And that would consign WHO to a level of insignificance that it does not warrant." }, { "infon": 6, "offset": -1, "text": "In this discussion of the 2005 report, I aim to provoke a response from both WHO and the international health community to demonstrate that the annual World health reports are meaningful." }, { "infon": 7, "offset": -1, "text": "Furthermore, I suggest here that WHO shows its commitment to the recommendations of the 2005 report by monitoring how well recommendations have been taken forward." } ] } ] }, { "id": "S0042-96862006000500014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Managing the effect of TRIPS on availability of priority vaccines." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The stated purpose of intellectual property protection is to stimulate innovation." }, { "infon": 1, "offset": -1, "text": "The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires all Members of the World Trade Organization (WTO) to enact national laws conferring minimum standards of intellectual property protection by certain deadlines." }, { "infon": 2, "offset": -1, "text": "Critics of the Agreement fear that such action is inconsistent with ensuring access to medicines in the developing world." }, { "infon": 3, "offset": -1, "text": "A WHO convened meeting on intellectual property rights and vaccines in developing countries, on which this paper is based, found no evidence that TRIPS has stimulated innovation in developing market vaccine development (where markets are weak) or that protection of intellectual property rights has had a negative effect on access to vaccines." }, { "infon": 4, "offset": -1, "text": "However, access to future vaccines in the developing world could be threatened by compliance with TRIPS." }, { "infon": 5, "offset": -1, "text": "The management of such threats requires adherence of all countries to the Doha Declaration on TRIPS, and the protections guaranteed by the Agreement itself, vigilance on TRIPS-plus elements of free trade agreements, developing frameworks for licensing and technology transfer, and promoting innovative vaccine development in developing countries." }, { "infon": 6, "offset": -1, "text": "The role of international organizations in defining best practices, dissemination of information, and monitoring TRIPS impact will be crucial to ensuring optimal access to priority new vaccines for the developing world." } ] } ] }, { "id": "S0042-96862006000500016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Essential medicines and human rights: what can they learn from each other?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Most countries have acceded to at least one global or regional covenant or treaty confirming the right to health." }, { "infon": 1, "offset": -1, "text": "After years of international discussions on human rights, many governments are now moving towards practical implementation of their commitments." }, { "infon": 2, "offset": -1, "text": "A practical example may be of help to those governments who aim to translate their international treaty obligations into practice." }, { "infon": 3, "offset": -1, "text": "WHO's Essential Medicines Programme is an example of how this transition from legal principles to practical implementation may be achieved." }, { "infon": 4, "offset": -1, "text": "This programme has been consistent with human rights principles since its inception in the early 1980s, through its focus on equitable access to essential medicines." }, { "infon": 5, "offset": -1, "text": "This paper provides a brief overview of what the international human rights instruments mention about access to essential medicines, and proposes five assessment questions and practical recommendations for governments." }, { "infon": 6, "offset": -1, "text": "These recommendations cover the selection of essential medicines, participation in programme development, mechanisms for transparency and accountability, equitable access by vulnerable groups, and redress mechanisms." } ] } ] }, { "id": "S0042-96862006000500018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Data sharing and intellectual property in a genomic epidemiology network: policies for large-scale research collaboration." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Genomic epidemiology is a field of research that seeks to improve the prevention and management of common diseases through an understanding of their molecular origins." }, { "infon": 1, "offset": -1, "text": "It involves studying thousands of individuals, often from different populations, with exacting techniques." }, { "infon": 2, "offset": -1, "text": "The scale and complexity of such research has required the formation of research consortia." }, { "infon": 3, "offset": -1, "text": "Members of these consortia need to agree on policies for managing shared resources and handling genetic data." }, { "infon": 4, "offset": -1, "text": "Here we consider data-sharing and intellectual property policies for an international research consortium working on the genomic epidemiology of malaria." }, { "infon": 5, "offset": -1, "text": "We outline specific guidelines governing how samples and data are transferred among its members; how results are released into the public domain; when to seek protection for intellectual property; and how intellectual property should be managed." }, { "infon": 6, "offset": -1, "text": "We outline some pragmatic solutions founded on the basic principles of promoting innovation and access." } ] } ] }, { "id": "S0042-96862006000500021", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Implications of bilateral free trade agreements on access to medicines." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The TRIPS Agreement of the World Trade Organization (WTO) mandated the introduction of protection of intellectual property rights, notably patents, for pharmaceutical products." }, { "infon": 1, "offset": -1, "text": "While the implications for the access to medicines contained in the terms of this Agreement raised significant concerns, a recent new wave of free trade agreements, negotiated outside the WTO, requires even higher levels of intellectual property protection for medicines than those mandated by that Agreement." }, { "infon": 2, "offset": -1, "text": "The measures involved include the extension of the patent term beyond 20 years; prohibition of use of test data on drug efficacy and safety for certain periods for the approval of generic products; the linkage between drug registration and patent protection; in some cases, limitations to the grounds for granting compulsory licences." }, { "infon": 3, "offset": -1, "text": "This article reviews some of these measures that further limit the competition of generic products and discusses their possible implication for access to medicines." } ] } ] }, { "id": "S0042-96862006000600012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) ontrol in India." }, { "infon": 1, "offset": -1, "text": "METHODS: We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews." }, { "infon": 2, "offset": -1, "text": "The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector." }, { "infon": 3, "offset": -1, "text": "Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants." }, { "infon": 4, "offset": -1, "text": "Effectiveness was measured as the number of cases successfully treated." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector." }, { "infon": 6, "offset": -1, "text": "From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63)." }, { "infon": 7, "offset": -1, "text": "DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS)." }, { "infon": 8, "offset": -1, "text": "The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment." }, { "infon": 9, "offset": -1, "text": "Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients." } ] } ] }, { "id": "S0042-96862006000600014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Multicentre study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVES: To study the risk of non-fatal injury at low levels and moderate levels of alcohol consumption as well as the differences in risk across modes of injury and differences among alcoholics." }, { "infon": 1, "offset": -1, "text": "METHODS: Data are from patients aged 18 years and older collected in 2001-02 by the WHO collaborative study on alcohol and injuries from 10 emergency departments around the world (n = 4320)." }, { "infon": 2, "offset": -1, "text": "We used a case-crossover method to compare the use of alcohol during the 6 hours prior to the injury with the use of alcohol during same day of the week in the previous week." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The risk of injury increased with consumption of a single drink (odds ratio (OR) = 3.3; 95% confidence interval = 1.9-5.7), and there was a 10-fold increase for participants who had consumed six or more drinks during the previous 6 hours." }, { "infon": 4, "offset": -1, "text": "Participants who had sustained intentional injuries were at a higher risk than participants who had sustained unintentional injuries." }, { "infon": 5, "offset": -1, "text": "Patients who had no symptoms of alcohol dependence had a higher OR." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Since low levels of drinking were associated with an increased risk of sustaining a non-fatal injury, and patients who are not dependent on alcohol may be at higher risk of becoming injured, comprehensive strategies for reducing harm should be implemented for all drinkers seen in emergency departments." } ] } ] }, { "id": "S0042-96862006000600016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health transitions in sub-Saharan Africa: overview of mortality trends in children under 5 years old (1950-2000)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To reconstruct and analyse mortality trends in children younger than 5 years in sub-Saharan Africa between 1950 and 2000." }, { "infon": 1, "offset": -1, "text": "METHODS: We selected 66 Demographic and Health Surveys and World Fertility Surveys from 32 African countries for analysis." }, { "infon": 2, "offset": -1, "text": "Death rates were calculated by yearly periods for each survey." }, { "infon": 3, "offset": -1, "text": "When several surveys were available for the same country, overlapping years were combined." }, { "infon": 4, "offset": -1, "text": "Country-specific time series were analysed to identify periods of monotonic trends, whether declining, steady or increasing." }, { "infon": 5, "offset": -1, "text": "We tested changes in trends using a linear logistic model." }, { "infon": 6, "offset": -1, "text": "FINDINGS: A quarter of the countries studied had monotonic declining mortality trends: i.e. a smooth health transition." }, { "infon": 7, "offset": -1, "text": "Another quarter had long-term declines with some minor rises over short periods of time." }, { "infon": 8, "offset": -1, "text": "Eight countries had periods of major increases in mortality due to political or economic crises, and in seven countries mortality stopped declining for several years." }, { "infon": 9, "offset": -1, "text": "In eight other countries mortality has risen in recent years as a result of paediatric AIDS." }, { "infon": 10, "offset": -1, "text": "Reconstructed levels and trends were compared with other estimates made by international organizations, usually based on indirect methods." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: Overall, major progress in child survival was achieved in sub-Saharan Africa during the second half of the twentieth century." }, { "infon": 12, "offset": -1, "text": "However, transition has occurred more slowly than expected, with an average decline of 1.8% per year." }, { "infon": 13, "offset": -1, "text": "Additionally, transition was chaotic in many countries." }, { "infon": 14, "offset": -1, "text": "The main causes of mortality increase were political instability, serious economic downturns, and emerging diseases." } ] } ] }, { "id": "S0042-96862006000600018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Is the current public health message on UV exposure correct?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Current sun safety messages stress the importance of sun protection in avoiding the consequences of excessive exposure to ultraviolet radiation (UVR), such as skin cancers, cataracts and other eye diseases, and viral infections caused by UV-induced immunosuppression." }, { "infon": 1, "offset": -1, "text": "However, adequate exposure to UVR has an important role in human health, primarily through UV-induced production of vitamin D, a hormone essential to bone health." }, { "infon": 2, "offset": -1, "text": "Vitamin D insufficiency may be associated with increased risks of some cancers, autoimmune diseases and mental health disorders such as schizophrenia." }, { "infon": 3, "offset": -1, "text": "Here, we review the evolution of current sun exposure practices and sun-safe messages and consider not only the benefits, but also the detrimental effects that such messages may have." }, { "infon": 4, "offset": -1, "text": "UVR-induced vitamin D production can be inhibited by factors such as deep skin pigmentation, indoor lifestyles, older age, sun avoidance behaviours and clothing habits that limit skin exposure, with deleterious consequences for health." }, { "infon": 5, "offset": -1, "text": "There is some early evidence that sun-safe messages are beginning to cause a decrease in skin cancer rates in young people." }, { "infon": 6, "offset": -1, "text": "After the widespread promotion of sun safety, it may now be appropriate to refine public health messages to take better account of variations between groups and their susceptibility to the dangers and benefits of sun exposure." } ] } ] }, { "id": "S0042-96862006000700014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Costs of measures to control tuberculosis/HIV in public primary care facilities in Cape Town, South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To measure the costs and estimate the cost-effectiveness of the ProTEST package of tuberculosis/human immunodeficiency virus (TB/HIV) interventions in primary health care facilities in Cape Town, South Africa." }, { "infon": 1, "offset": -1, "text": "METHODS: We collected annual cost data retrospectively using ingredients-based costing in three primary care facilities and estimated the cost per HIV infection averted and the cost per TB case prevented." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The range of costs per person for the ProTEST interventions in the three facilities were: US$ 7-11 for voluntary counselling and testing (VCT), US$ 81-166 for detecting a TB case, US$ 92-183 for completing isoniazid preventive therapy (IPT) and US$ 20-44 for completing six months of cotrimoxazole preventive therapy." }, { "infon": 3, "offset": -1, "text": "The estimated cost per HIV infection averted by VCT was US$ 67-112." }, { "infon": 4, "offset": -1, "text": "The cost per TB case prevented by VCT (through preventing HIV) was US$ 129-215, by intensified case finding was US$ 323-664 and by IPT was US$ 486-962." }, { "infon": 5, "offset": -1, "text": "Sensitivity analysis showed that the use of chest X-rays for IPT screening decreases the cost-effectiveness of IPT in preventing TB cases by 36%." }, { "infon": 6, "offset": -1, "text": "IPT screening with or without tuberculin purified protein derivative screening was almost equally cost-effective." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: We conclude that the ProTEST package is cost saving." }, { "infon": 8, "offset": -1, "text": "Despite moderate adherence, linking prevention and care interventions for TB and HIV resulted in the estimated costs of preventing TB being less than previous estimates of costs of treating it." }, { "infon": 9, "offset": -1, "text": "VCT was less expensive than previously reported in Africa." } ] } ] }, { "id": "S0042-96862006000700016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: We assessed the impact of breastfeeding by women infected with human immunodeficiency virus (HIV)-1 on their morbidity and risk of mortality and on the mortality of their children." }, { "infon": 1, "offset": -1, "text": "METHODS: We analysed longitudinal data from two previous randomized clinical trials of mother-to-child transmission of HIV conducted between April 2000 and March 2003 in the Republic of Malawi, Africa." }, { "infon": 2, "offset": -1, "text": "Mothers infected with HIV, and their newborns, were enrolled at the time of their child's birth; they then returned for follow-up visits when the child was aged 1 week, 6-8 weeks and then 3, 6, 9, 15, 18, 21 and 24 months." }, { "infon": 3, "offset": -1, "text": "Patterns of breastfeeding (classified as exclusive, mixed or no breastfeeding), maternal morbidity and mortality, and mortality among their children were assessed at each visit." }, { "infon": 4, "offset": -1, "text": "Descriptive and multivariate analyses were performed to determine the association between breastfeeding and maternal and infant outcomes." }, { "infon": 5, "offset": -1, "text": "FINDINGS: A total of 2000 women infected with HIV were enrolled in the original studies." }, { "infon": 6, "offset": -1, "text": "During the 2 years after birth, 44 (2.2%) mothers and 310 (15.5%) children died." }, { "infon": 7, "offset": -1, "text": "(Multiple births were excluded.)" }, { "infon": 8, "offset": -1, "text": "The median duration of breastfeeding was 18 months (interquartile range (IQR) = 9.0-22.5), exclusive breastfeeding 2 months (IQR = 2-3) and mixed feeding 12 months (IQR = 6-18)." }, { "infon": 9, "offset": -1, "text": "Breastfeeding patterns were not significantly associated with maternal mortality or morbidity after adjusting for maternal viral load and other covariates." }, { "infon": 10, "offset": -1, "text": "Breastfeeding was associated with reduced mortality among infants and children: the adjusted hazard ratio for overall breastfeeding was 0.44 (95% confidence interval (CI) = 0.28-0.70), for mixed feeding 0.45 (95% CI = 0.28-0.71) and for exclusive breastfeeding 0.40 (95% CI = 0.22-0.72)." }, { "infon": 11, "offset": -1, "text": "These protective effects were seen both in infants who were infected with HIV and those who were not." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: Breastfeeding by women infected with HIV was not associated with mortality or morbidity; it was associated with highly significant reductions in mortality among their children." } ] } ] }, { "id": "S0042-96862006000700018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Trend and disease burden of bacillary dysentery in China (1991-2000)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: We aimed to determine the burden of bacillary dysentery in China, its cross-regional variations, trends in morbidity and mortality, the causative bacterial species and antimicrobial resistance patterns." }, { "infon": 1, "offset": -1, "text": "METHODS: We extracted and integrated governmental statistics and relevant medical literature published from 1991 to 2000." }, { "infon": 2, "offset": -1, "text": "Data were also collected from one general hospital each for the six provinces and Jin-an district, Shanghai, representative of six geographical regions and a modern city." }, { "infon": 3, "offset": -1, "text": "FINDINGS: In 2000, 0.8-1.7 million episodes of bacillary dysentery occurred of which 0.5 to 0.7 million were treated at health-care facilities and 0.15-0.20 million patients were hospitalized." }, { "infon": 4, "offset": -1, "text": "The highest morbidity and mortality rates were among the youngest and oldest age groups." }, { "infon": 5, "offset": -1, "text": "Bacillary dysentery peaked during the summer months." }, { "infon": 6, "offset": -1, "text": "The major causative species was Shigella flexneri (86%) and the predominant S. flexneri serotype was 2a (80%)." }, { "infon": 7, "offset": -1, "text": "About 74-80% of Shigella isolates remained susceptible to fluorinated quinolones." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: We conclude that while morbidity and mortality due to bacillary dysentery has decreased considerably in China in the past decade due to increasing access to affordable health care and antibiotics, a considerable burden exists among the youngest and oldest age groups and in regions with low economic development." }, { "infon": 9, "offset": -1, "text": "We suggest that while a vaccine would be effective for short- and medium-term control of bacillary dysentery, improved water supply, sanitation, and hygiene are likely to be required for long-term control." } ] } ] }, { "id": "S0042-96862006000700020", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The Global Fund Secretariat's suspension of funding to Uganda: how could this have been avoided?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In August 2005, the Global Fund to fight AIDS, Tuberculosis and Malaria (the Global Fund) Secretariat suspended its five grants to Uganda following a PricewaterhouseCoopers audit report that exposed gross mismanagement in the Project Management Unit." }, { "infon": 1, "offset": -1, "text": "How could this have been avoided?" }, { "infon": 2, "offset": -1, "text": "How can other countries avoid a similar pitfall?" }, { "infon": 3, "offset": -1, "text": "We argue that if a legitimate and fair decision-making process were used, the suspension of funding to Uganda could have been avoided, and that this lesson should be applied to other countries." }, { "infon": 4, "offset": -1, "text": "The \"accountability for reasonableness\" framework of relevance, publicity, revisions and enforcement would help in implementing legitimate and fair decision-making processes, which would improve effectiveness, accountability and transparency in the implementation of Global Fund programmes, preventing future suspension of funding to any Global Fund projects." } ] } ] }, { "id": "S0042-96862006000800009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The knowledge-value chain: a conceptual framework for knowledge translation in health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This article briefly discusses knowledge translation and lists the problems associated with it." }, { "infon": 1, "offset": -1, "text": "Then it uses knowledge-management literature to develop and propose a knowledge-value chain framework in order to provide an integrated conceptual model of knowledge management and application in public health organizations." }, { "infon": 2, "offset": -1, "text": "The knowledge-value chain is a non-linear concept and is based on the management of five dyadic capabilities: mapping and acquisition, creation and destruction, integration and sharing/transfer, replication and protection, and performance and innovation." } ] } ] }, { "id": "S0042-96862006000800011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Using knowledge brokering to promote evidence-based policy-making: the need for support structures." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Knowledge brokering is a promising strategy to close the \"know-do gap\" and foster greater use of research findings and evidence in policy-making." }, { "infon": 1, "offset": -1, "text": "It focuses on organizing the interactive process between the producers and users of knowledge so that they can co-produce feasible and research-informed policy options." }, { "infon": 2, "offset": -1, "text": "We describe a recent successful experience with this novel approach in the Netherlands and discuss the requirements for effective institutionalization of knowledge brokering." }, { "infon": 3, "offset": -1, "text": "We also discuss the potential of this approach to assist health policy development in low-income countries based on the experience of developing the Regional East-African Health (REACH)-Policy Initiative." }, { "infon": 4, "offset": -1, "text": "We believe that intermediary organizations, such as regional networks, dedicated institutional mechanisms and funding agencies, can play key roles in supporting knowledge brokering." }, { "infon": 5, "offset": -1, "text": "We recommend the need to support and learn from the brokerage approach to strengthen the relationship between the research and policy communities and hence move towards a stronger culture of evidence-based policy and policy-relevant research." } ] } ] }, { "id": "S0042-96862006000800013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Assessing country-level efforts to link research to action." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "We developed a framework for assessing country-level efforts to link research to action." }, { "infon": 1, "offset": -1, "text": "The framework has four elements." }, { "infon": 2, "offset": -1, "text": "The first element assesses the general climate (how those who fund research, universities, researchers and users of research support or place value on efforts to link research to action)." }, { "infon": 3, "offset": -1, "text": "The second element addresses the production of research (how priority setting ensures that users' needs are identified and how scoping reviews, systematic reviews and single studies are undertaken to address these needs)." }, { "infon": 4, "offset": -1, "text": "The third element addresses the mix of four clusters of activities used to link research to action." }, { "infon": 5, "offset": -1, "text": "These include push efforts (how strategies are used to support action based on the messages arising from research), efforts to facilitate \"user pull\" (how \"one-stop shopping\" is provided for optimally packaged high-quality reviews either alone or as part of a national electronic library for health, how these reviews are profiled during \"teachable moments\" such as intense media coverage, and how rapid-response units meet users' needs for the best research), \"user pull\" efforts undertaken by those who use research (how users assess their" }, { "infon": 6, "offset": -1, "text": "capacity to use research and how structures and processes are changed to support the use of research) and exchange efforts (how meaningful partnerships between researchers and users help them to jointly ask and answer relevant questions)." }, { "infon": 7, "offset": -1, "text": "The fourth element addresses approaches to evaluation (how support is provided for rigorous evaluations of efforts to link research to action)." } ] } ] }, { "id": "S0042-96862006000800015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Knowledge mapping as a technique to support knowledge translation." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper explores the possibility of integrating knowledge mapping into a conceptual framework that could serve as a tool for understanding the many complex processes, resources and people involved in a health system, and for identifying potential gaps within knowledge translation processes in order to address them." }, { "infon": 1, "offset": -1, "text": "After defining knowledge mapping, this paper presents various examples of the application of this process in health, before looking at the steps that need to be taken to identify potential gaps, to determine to what extent these gaps affect the knowledge translation process and to establish their cause." }, { "infon": 2, "offset": -1, "text": "This is followed by proposals for interventions aimed at strengthening the overall process." }, { "infon": 3, "offset": -1, "text": "Finally, potential limitations on the application of this framework at the country level are addressed." } ] } ] }, { "id": "S0042-96862006000800017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "An interactive integrative approach to translating knowledge and building a \"learning organization\" in health services management." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "This paper proposes a basic approach to ensuring that knowledge from research studies is translated for use in health services management with a view towards building a \"learning organization\". (" }, { "infon": 1, "offset": -1, "text": "(A learning organization is one in which the environment is structured in such a way as to facilitate learning as well as the sharing of knowledge among members or employees.)" }, { "infon": 2, "offset": -1, "text": "This paper highlights various dimensions that determine the complexity of knowledge translation, using the problem-solving cycle as the backbone for gaining a better understanding of how different types of knowledge interact in health services management." }, { "infon": 3, "offset": -1, "text": "It is essential to use an integrated and interactive approach to ensure that knowledge from research is translated in a way that allows a learning organization to be built and that knowledge is not used merely to influence a single decision in isolation from the overall services and management of an organization." } ] } ] }, { "id": "S0042-96862006000800020", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "From research evidence to policy: mental health care in Viet Nam." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: The use of evidence-based policy is gaining attention in developing countries." }, { "infon": 1, "offset": -1, "text": "Frameworks to analyse the process of developing policy and to assess whether evidence is likely to influence policy-makers are now available." }, { "infon": 2, "offset": -1, "text": "However, the use of evidence in policies on caring for people with mental illness in developing countries has rarely been analysed." }, { "infon": 3, "offset": -1, "text": "APPROACH: This case study from Viet Nam illustrates how evidence can be used to influence policy." }, { "infon": 4, "offset": -1, "text": "We summarize evidence on the burden of mental illness in Viet Nam and describe attempts to influence policy-makers." }, { "infon": 5, "offset": -1, "text": "We also interviewed key stakeholders to ascertain their views on how policy could be affected." }, { "infon": 6, "offset": -1, "text": "We then applied an analytical framework to the case study; this framework included an assessment of the political context in which the policy was developed, the links between organizations needed to influence policy, external influences on policy-makers and the nature of evidence required to influence policy-makers." }, { "infon": 7, "offset": -1, "text": "LOCAL SETTING: The burden of mental illness among various population groups was large but there were few policies aimed at providing care for people with mental illness, apart from policies for providing hospital-based care for people with severe mental illness." }, { "infon": 8, "offset": -1, "text": "RELEVANT CHANGES: The national plan proposes to incorporate screening for mental illness among women and children in order to implement early detection and treatment." }, { "infon": 9, "offset": -1, "text": "LESSONS LEARNED: Evidence on the burden of mental ill-health in Viet Nam is patchy and research in this area is still relatively undeveloped." }, { "infon": 10, "offset": -1, "text": "Nonetheless the policy process was influenced by the evidence from research because key links between organizations and policy-makers were established at an early stage, the evidence was regarded as rigorous and the timing was opportune." } ] } ] }, { "id": "S0042-96862006000800022", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Integration of mass drug administration programmes in Nigeria: the challenge of schistosomiasis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: Annual mass drug administration (MDA) with safe oral anthelminthic drugs (praziquantel, ivermectin and albendazole) is the strategy for control of onchocerciasis, lymphatic filariasis (LF) and schistosomiasis." }, { "infon": 1, "offset": -1, "text": "District health officers seek to integrate treatment activities in areas of overlapping disease endemicity, but they are faced with having to merge different programmatic guidelines." }, { "infon": 2, "offset": -1, "text": "APPROACH: We proceeded through the three stages of integrated MDA implementation: mapping the distribution of the three diseases at district level; tailoring district training and logistics based on the results of the mapping exercises; and implementing community-based annual health education and mass treatment where appropriate." }, { "infon": 3, "offset": -1, "text": "During the process we identified the \"know-do\" gaps in the MDA guidelines for each disease that prevented successful integration of these programmes." }, { "infon": 4, "offset": -1, "text": "LOCAL SETTING: An integrated programme launched in 1999 in Plateau and Nasarawa States in central Nigeria, where all three diseases were known to occur." }, { "infon": 5, "offset": -1, "text": "RELEVANT CHANGES: Current guidelines allowed onchocerciasis and LF activities to be integrated, resulting in rapid mapping throughout the two states, and states-wide provision of over 9.3 million combined ivermectin-albendazole treatments for the two diseases between 2000 and 2004." }, { "infon": 6, "offset": -1, "text": "In contrast, schistosomiasis activities could not be effectively integrated because of the more restrictive guidelines, resulting in less than half of the two states being mapped, and delivery of only 701 419 praziquantel treatments for schistosomiasis since 1999." }, { "infon": 7, "offset": -1, "text": "LESSONS LEARNED: Integration of schistosomiasis into other MDA programmes would be helped by amended guidelines leading to simpler mapping, more liberal use of praziquantel and the ability to administer praziquantel simultaneously with ivermectin and albendazole." } ] } ] }, { "id": "S0042-96862006000900012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To report stillbirth and early neonatal mortality and to quantify the relative importance of different primary obstetric causes of perinatal mortality in 171 perinatal deaths from 7993 pregnancies that ended after 28 weeks in nulliparous women." }, { "infon": 1, "offset": -1, "text": "METHODS: A review of all stillbirths and early newborn deaths reported in the WHO calcium supplementation trial for the prevention of pre-eclampsia conducted at seven WHO collaborating centres in Argentina, Egypt, India, Peru, South Africa and Viet Nam." }, { "infon": 2, "offset": -1, "text": "We used the Baird-Pattinson system to assign primary obstetric causes of death and classified causes of early neonatal death using the International classification of diseases and related health problems, Tenth revision (ICD-10)." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Stillbirth rate was 12.5 per 1000 births and early neonatal mortality rate was 9.0 per 1000 live births." }, { "infon": 4, "offset": -1, "text": "Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively)." }, { "infon": 5, "offset": -1, "text": "Prematurity was the main cause of early neonatal deaths (62%)." }, { "infon": 6, "offset": -1, "text": "CONCLUSIONS: Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries." } ] } ] }, { "id": "S0042-96862006000900014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Community surveys and risk factor analysis of human alveolar and cystic echinococcosis in Ningxia Hui autonomous region, China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the true community prevalence of human cystic (CE) and alveolar (AE) echinococcosis (hydatid disease) in a highly endemic region in Ningxia Hui, China, by detecting asymptomatic cases." }, { "infon": 1, "offset": -1, "text": "METHODS: Using hospital records and \"AE-risk\" landscape patterns we selected study communities predicted to be at risk of human echinococcosis in Guyuan, Longde and Xiji counties." }, { "infon": 2, "offset": -1, "text": "We conducted community surveys of 4773 individuals from 26 villages in 2002 and 2003 using questionnaire analysis, ultrasound examination and serology." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Ultrasound and serology showed a range of prevalences for AE (0-8.1%; mean 2%) and CE (0-7.4%; mean 1.6%), with the highest prevalence in Xiji (2% for CE, 2.5% for AE)." }, { "infon": 4, "offset": -1, "text": "There were significant differences in the prevalence of CE, AE and total echinococcosis between the three counties and villages (with multiple degrees of freedom)." }, { "infon": 5, "offset": -1, "text": "While hospital records showed 96% of echinococcosis cases attributable to CE, our survey showed a higher prevalence of human AE (56%) compared to CE (44%)." }, { "infon": 6, "offset": -1, "text": "Questionnaire analysis revealed that key risk factors for infection were age and dog ownership for both CE and AE, and Hui ethnicity and being female for AE. Drinking well-water decreased the risk for both AE and CE." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Echinococcosis continues to be a severe public health problem in this part of China because of unhygienic practices/habits and poor knowledge among the communities regarding this disease." } ] } ] }, { "id": "S0042-96862006000900016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The syndromic management of vaginal discharge using singledose treatments: a randomized controlled trial in West Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To evaluate whether single-dose treatments are as effective as standard therapy in the syndromic management of vaginal discharge." }, { "infon": 1, "offset": -1, "text": "METHODS: A randomized controlled effectiveness trial compared single-dose tinidazole plus fluconazole (TF) with treatment for 7 days with metronidazole plus 3 days of treatment with vaginal clotrimazole (MC) among 1570 women presenting with vaginal discharge at primary health care institutions in Ghana, Guinea, Mali and Togo." }, { "infon": 2, "offset": -1, "text": "Participants were randomly allocated to one of the two treatments by research nurses or physicians using precoded envelopes." }, { "infon": 3, "offset": -1, "text": "Effectiveness was assessed by symptomatic response on day 14." }, { "infon": 4, "offset": -1, "text": "CLINICAL IDENTIFIER ClinicalTrials.gov NCT00313131." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The two treatment regimens had similar effectiveness: complete resolution was seen in 66% (TF) and 64% (MC) and partial resolution in 33% (TF) and 34% (MC) of participants (P = 0.26)." }, { "infon": 6, "offset": -1, "text": "Effectiveness was similar among subgroups with vulvovaginal candidiasis, Trichomonas vaginalis vaginitis or bacterial vaginosis." }, { "infon": 7, "offset": -1, "text": "The two treatment regimens had a similar effectiveness among human immunodeficiency virus (HIV)-infected (TF: n = 76, 71% complete resolution, 28% partial; MC: n = 83, 72% complete resolution, 25% partial, P = 0.76) and HIV-uninfected women (TF: n = 517, 68% complete, 32% partial; MC: n = 466, 65% complete, 33% partial, P = 0.20)." }, { "infon": 8, "offset": -1, "text": "Cervical infections with Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium were uncommon among women not involved in sex work, were associated with bacterial vaginosis or T. vaginalis vaginitis, and did not alter response to treatment with agents active against vaginal infections." }, { "infon": 9, "offset": -1, "text": "Four-fifths of women not relieved by a single dose of TF had a favourable response when MC was administered as second-line treatment." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: Single-dose TF is as effective as multiple-dose MC in the syndromic management of vaginal discharge, even among women with HIV-infection." }, { "infon": 11, "offset": -1, "text": "Given its low price and easier adherence, TF should be considered as a first-line treatment for vaginal discharge syndrome." } ] } ] }, { "id": "S0042-96862006000900018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Rare essentials: drugs for rare diseases as essential medicines." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Since 1977, the WHO Model List of Essential Medicines (EML), published by WHO, has provided advice for Member States that struggle to decide which pharmaceutical technologies should be provided to patients within their public health systems." }, { "infon": 1, "offset": -1, "text": "Originating from outside WHO, an incentive system has been put in place by various governments for the development of medicines for rare diseases (\"orphan drugs\")." }, { "infon": 2, "offset": -1, "text": "With progress in pharmaceutical research (e.g. drugs targeted for narrower indications), these medicines will feature more often on future public health agendas." }, { "infon": 3, "offset": -1, "text": "However, when current definitions for selecting essential medicines are applied strictly, orphan drugs cannot be part of the WHO Essential Medicines Programme, creating the risk that WHO may lose touch with this field." }, { "infon": 4, "offset": -1, "text": "In our opinion WHO should explicitly include orphan drugs in its policy sphere by composing a complementary Orphan Medicines Model List as an addition to the EML." }, { "infon": 5, "offset": -1, "text": "This complementary list of \"rare essentials\" could aid policy-makers and patients in, for example, emerging countries to improve access to these drugs and stimulate relevant policies." }, { "infon": 6, "offset": -1, "text": "Furthermore, inconsistencies in the current EML with regard to medicines for rare diseases can be resolved." }, { "infon": 7, "offset": -1, "text": "In this paper we propose selection criteria for an Orphan Medicines Model List that could form a departure point for future work towards an extensive WHO Orphan Medicines Programme." } ] } ] }, { "id": "S0042-96862006001000011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Treatment outcomes and risk factors for relapse in patients with early-stage human African trypanosomiasis (HAT) in the Republic of the Congo." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: In 2002-03, the Republic of the Congo increased the threshold separating stage 1 and 2 cases of human African trypanosomiasis (HAT) from a cerebrospinal fluid (CSF) white cell count of 5 cells/mm3 to 10 cells/mm3." }, { "infon": 1, "offset": -1, "text": "We aimed to assess whether the increased threshold of 10 cells/mm3 is a safe indicator of stage 2 disease." }, { "infon": 2, "offset": -1, "text": "METHODS: We assessed patients treated for stage 1 HAT caused by Trypanosoma brucei gambiense in the Republic of the Congo between April 2001 and April 2005." }, { "infon": 3, "offset": -1, "text": "Patients with 0-10 cells/mm3 in CSF were classed as stage 1 and treated with pentamidine." }, { "infon": 4, "offset": -1, "text": "Patients with CSF of > 10 cells/mm3 were classed as stage 2 and treated with either melarsoprol or eflornithine." }, { "infon": 5, "offset": -1, "text": "We did a retrospective analysis of all patients treated after the September 2002 increase in threshold for classification of HAT disease stage 2, and who were eligible for at least 1 year of follow-up." }, { "infon": 6, "offset": -1, "text": "Primary outcome was survival without death or relapse within 1 year of discharge." }, { "infon": 7, "offset": -1, "text": "Risk factors for treatment failure, in particular CSF white cell count on diagnosis, were assessed." }, { "infon": 8, "offset": -1, "text": "FINDINGS: Between September 2002 to April 2004, 692 patients eligible for our analysis were treated with pentamidine." }, { "infon": 9, "offset": -1, "text": "All were discharged alive." }, { "infon": 10, "offset": -1, "text": "Relapse rate was 5% (n = 33)." }, { "infon": 11, "offset": -1, "text": "The only identified risk factor for relapse was a CSF white cell count of 6-10 cells/mm3 rather than 0-5 cells/mm3 (adjusted hazard ratio 3.27 (95% confidence interval, 1.52-7.01); P = 0.002)." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: A threshold of 5 white cells/mm3 in CSF is safer than 10 cells/mm3 to determine stage 2 HAT and reduce risk of relapse." } ] } ] }, { "id": "S0042-96862006001000013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Are health interventions implemented where they are most needed?" }, { "infon": 1, "offset": -1, "text": "District uptake of the Integrated Management of Childhood Illness strategy in Brazil, Peru and the United Republic of Tanzania." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs." }, { "infon": 1, "offset": -1, "text": "METHODS: We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI." }, { "infon": 2, "offset": -1, "text": "Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years." }, { "infon": 3, "offset": -1, "text": "FINDINGS: In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system." }, { "infon": 4, "offset": -1, "text": "In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics." }, { "infon": 5, "offset": -1, "text": "In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower." }, { "infon": 6, "offset": -1, "text": "In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments." }, { "infon": 7, "offset": -1, "text": "In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts." }, { "infon": 8, "offset": -1, "text": "Implementation was not associated with baseline mortality levels in any country studied." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized." }, { "infon": 10, "offset": -1, "text": "Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most." } ] } ] }, { "id": "S0042-96862006001000016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme." }, { "infon": 1, "offset": -1, "text": "METHODS: The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs." }, { "infon": 2, "offset": -1, "text": "Study participants were mothers, grandmothers, grandfathers, fathers or \"nannies\" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area." }, { "infon": 3, "offset": -1, "text": "Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Many household practices were observed which could adversely affect maternal and neonatal health." }, { "infon": 5, "offset": -1, "text": "Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3." }, { "infon": 6, "offset": -1, "text": "More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates." }, { "infon": 7, "offset": -1, "text": "Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying." }, { "infon": 8, "offset": -1, "text": "Health care was sought for 46 (23%) neonates." }, { "infon": 9, "offset": -1, "text": "Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign." } ] } ] }, { "id": "S0042-96862006001100009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Understanding enrolment in community health insurance in sub-Saharan Africa: a population-based case-control study in rural Burkina Faso." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To identify factors associated with decision to enrol in a community health insurance (CHI) scheme." }, { "infon": 1, "offset": -1, "text": "METHODS: We conducted a population-based case-control study among 15 communities offered insurance in 2004 in rural Burkina Faso." }, { "infon": 2, "offset": -1, "text": "For inclusion in the study, we selected all 154 enrolled (cases) and a random sample of 393 non-enrolled (controls) households." }, { "infon": 3, "offset": -1, "text": "We used unconditional logistic regression (applying Huber-White correction to account for clustering at the community level) to explore the association between enrolment status and a set of household head, household and community characteristics." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Multivariate analysis revealed that enrolment in CHI was associated with Bwaba ethnicity, higher education, higher socioeconomic status, a negative perception of the adequacy of traditional care, a higher proportion of children living within the household, greater distance from the health facility, and a lower level of socioeconomic inequality within the community, but not with household health status or previous household health service utilization." }, { "infon": 5, "offset": -1, "text": "CONCLUSION: Our study provides evidence that the decision to enrol in CHI is shaped by a combination of household head, household, and community factors." }, { "infon": 6, "offset": -1, "text": "Policies aimed at enhancing enrolment ought to act at all three levels." }, { "infon": 7, "offset": -1, "text": "On the basis of our findings, we discuss specific policy recommendations and highlight areas for further research." } ] } ] }, { "id": "S0042-96862006001100011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services." }, { "infon": 1, "offset": -1, "text": "We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia." }, { "infon": 2, "offset": -1, "text": "Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services." }, { "infon": 3, "offset": -1, "text": "The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility." }, { "infon": 4, "offset": -1, "text": "While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting." }, { "infon": 5, "offset": -1, "text": "The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms." }, { "infon": 6, "offset": -1, "text": "Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance." } ] } ] }, { "id": "S0042-96862006001100013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Performance-based financing and changing the district health system: experience from Rwanda." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Evidence from low-income Asian countries shows that performance-based financing (as a specific form of contracting) can improve health service delivery more successfully than traditional input financing mechanisms." }, { "infon": 1, "offset": -1, "text": "We report a field experience from Rwanda demonstrating that performance-based financing is a feasible strategy in sub-Saharan Africa too." }, { "infon": 2, "offset": -1, "text": "Performance-based financing requires at least one new actor, an independent well equipped fundholder organization in the district health system separating the purchasing, service delivery as well as regulatory roles of local health authorities from the technical role of contract negotiation and fund disbursement." }, { "infon": 3, "offset": -1, "text": "In Rwanda, local community groups, through patient surveys, verified the performance of health facilities and monitored consumer satisfaction." }, { "infon": 4, "offset": -1, "text": "A precondition for the success of performance-based financing is that authorities must respect the autonomous management of health facilities competing for public subsidies." }, { "infon": 5, "offset": -1, "text": "These changes are an opportunity to redistribute roles within the health district in a more transparent and efficient fashion." } ] } ] }, { "id": "S0042-96862006001100015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The benefits of setting the ground rules and regulating contracting practices." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In recent years, health systems have increasingly made use of contracting practices; despite results that are often promising, there have also been failures and occasionally harsh criticism of such practices." }, { "infon": 1, "offset": -1, "text": "This has made it even more necessary to regulate contracting practices." }, { "infon": 2, "offset": -1, "text": "As part of its stewardship function, in other words its responsibility to protect the public interest, the ministry of health has the responsibility of introducing the tools needed for such regulation." }, { "infon": 3, "offset": -1, "text": "Several tools are available to help it do this." }, { "infon": 4, "offset": -1, "text": "Some of them, such as standard contracts or framework contracts, useful as they may be, are nevertheless specific and ad hoc." }, { "infon": 5, "offset": -1, "text": "Contracting policies, when carefully linked to overall health policies, are undoubtedly the most comprehensive of these tools, since they enable contracting to be accommodated within the management of the health system as a whole and thus take into account its potential contribution to improving health system performance." }, { "infon": 6, "offset": -1, "text": "However, the requirements for success are not present automatically and it has to be ensured that there are mechanisms for vitalizing these regulatory mechanisms and that the key actors make proper use of the framework laid down by the ministry of health." }, { "infon": 7, "offset": -1, "text": "The first three authors of this article have participated in the preparation and implementation of national policies on contracting in their own countries, viz. Chad, Madagascar and Senegal." } ] } ] }, { "id": "S0042-96862006001100017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Is contracting a form of privatization?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Contracting is often seen as a form of privatization, with contracts functioning as the tool that makes privatization possible." }, { "infon": 1, "offset": -1, "text": "But contracting is also viewed by some as a means for the private sector to expand in a covert way its presence within the health sector." }, { "infon": 2, "offset": -1, "text": "This article discusses the wider meaning of the term privatization in the health sector and the ways in which it is achieved." }, { "infon": 3, "offset": -1, "text": "Privatization is seen here not simply as an action that leads to a new situation but also as one that leads to a change in behaviour." }, { "infon": 4, "offset": -1, "text": "It is proposed that privatization may be assessed by looking at the ownership, management, and mission or objectives of the entity being privatized." }, { "infon": 5, "offset": -1, "text": "Discussed also is the use of contracting by the state as a tool for state interventionism that is not based on authoritarian regulation." } ] } ] }, { "id": "S0042-96862006001200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimating cause-specific mortality from community- and facility-based data sources in the United Republic of Tanzania: options and implications for mortality burden estimates." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To compare mortality burden estimates based on direct measurement of levels and causes in communities with indirect estimates based on combining health facility cause-specific mortality structures with community measurement of mortality levels." }, { "infon": 1, "offset": -1, "text": "METHODS: Data from sentinel vital registration (SVR) with verbal autopsy (VA) were used to determine the cause-specific mortality burden at the community level in two areas of the United Republic of Tanzania." }, { "infon": 2, "offset": -1, "text": "Proportional cause-specific mortality structures from health facilities were applied to counts of deaths obtained by SVR to produce modelled estimates." }, { "infon": 3, "offset": -1, "text": "The burden was expressed in years of life lost." }, { "infon": 4, "offset": -1, "text": "FINDINGS: A total of 2884 deaths were recorded from health facilities and 2167 recorded from SVR/VAs." }, { "infon": 5, "offset": -1, "text": "In the perinatal and neonatal age group cause-specific mortality rates were dominated by perinatal conditions and stillbirths in both the community and the facility data." }, { "infon": 6, "offset": -1, "text": "The modelled estimates for chronic causes were very similar to those from SVR/VA." }, { "infon": 7, "offset": -1, "text": "Acute febrile illnesses were coded more specifically in the facility data than in the VA. Injuries were more prevalent in the SVR/VA data than in that from the facilities." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: In this setting, improved International classification of diseases and health related problems, tenth revision (ICD-10) coding practices and applying facility-based cause structures to counts of deaths from communities, derived from SVR, appears to produce reasonable estimates of the cause-specific mortality burden in those aged 5 years and older determined directly from VA. For the perinatal and neonatal age group, VA appears to be required." }, { "infon": 9, "offset": -1, "text": "Use of this approach in a nationally representative sample of facilities may produce reliable national estimates of the cause-specific mortality burden for leading causes of death in adults." } ] } ] }, { "id": "S0042-96862006001200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Use of weight-for-age-data to optimize tablet strength and dosing regimens for a new fixed-dose artesunate-amodiaquine combination for treating falciparum malaria." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To test a novel methodology to define age-based dosing regimens for the treatment of malaria with a new, user-friendly, blister-packaged fixed-dose combination of artesunate and amodiaquine." }, { "infon": 1, "offset": -1, "text": "METHODS: A weight-for-age reference database of 88 054 individuals from sub-Saharan Africa was compiled using data from Demographic Health Surveys, observational and intervention studies, and standardized for sex, age and malaria risk." }, { "infon": 2, "offset": -1, "text": "We then determined the optimal tablet strength (milligram (mg) per tablet) and age-dose categories for the combination of artesunate and amodiaquine." }, { "infon": 3, "offset": -1, "text": "The proportions of patients predicted to receive doses within newly defined therapeutic ranges for amodiaquine (7-15 mg/kg/day) and artesunate (2-10 mg/kg/day), were estimated for different age categories and mg tablet strengths using models based on the weight-for-age reference database." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The optimal paediatric (p) and adult (a) strength tablets contained 25/67.5 and 100/270 mg artesunate/amodiaquine, respectively." }, { "infon": 5, "offset": -1, "text": "A regimen with five age categories: 0-1 months (½ p), 2-11 months (1 p), 1-5 years (2 p), 6-13 years (1 a), and > 14 years (2 a) had an overall dosing accuracy of 83.4% and 99.9% for amodiaquine and artesunate, respectively." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: The proposed method to use weight-for-age reference data from countries where malaria is endemic is a useful tool for designing age-based dosing regimens for antimalarial drugs for drug registration and field use." } ] } ] }, { "id": "S0042-96862006001200014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Socioeconomic disadvantage and changes in health risk behaviours in Australia: 1989-90 to 2001." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Lower socioeconomic status (SES) is associated in industrialized countries with unhealthy lifestyle characteristics, such as smoking, physical inactivity and being overweight or obese." }, { "infon": 1, "offset": -1, "text": "This paper examines changes over time in the association between SES and smoking status, physical activity and being overweight or obese in Australia." }, { "infon": 2, "offset": -1, "text": "METHODS: Data were taken from three successive national health surveys in Australia carried out in 1989-90 (n = 54 576), 1995 (n = 53 828) and 2001 (n = 26 863)." }, { "infon": 3, "offset": -1, "text": "Participants in these surveys were selected using a national probability sampling strategy, and aggregated data for geographical areas are used to determine the changing association between SES and lifestyle over time." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Overall, men had less healthy lifestyles." }, { "infon": 5, "offset": -1, "text": "In 2001 inverse SES trends for both men and women showed that those living in lower SES areas were more likely to smoke and to be sedentary and obese." }, { "infon": 6, "offset": -1, "text": "There were some important socioeconomic changes over the period 1989-90 to 2001." }, { "infon": 7, "offset": -1, "text": "The least socioeconomically disadvantaged areas had the largest decrease in the percentage of people smoking tobacco (24% decrease for men and 12% for women) and the largest decrease in the percentage of people reporting sedentary activity levels (25% decrease for men and 22% for women)." }, { "infon": 8, "offset": -1, "text": "While there has been a general increase in the percentage over time of those who are overweight or obese, there is a modest trend for being overweight to have increased (by about 16% only among females) among those living in areas of higher SES." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Socioeconomic inequalities have been increasing for several key risk behaviours related to health; this suggests that specific population-based prevention strategies intended to reduce health inequalities are needed." } ] } ] }, { "id": "S0042-96862006001200016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Responsive parenting: interventions and outcomes." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In addition to food, sanitation and access to health facilities children require adequate care at home for survival and optimal development." }, { "infon": 1, "offset": -1, "text": "Responsiveness, a mother's/caregiver's prompt, contingent and appropriate interaction with the child, is a vital parenting tool with wide-ranging benefits for the child, from better cognitive and psychosocial development to protection from disease and mortality." }, { "infon": 2, "offset": -1, "text": "We examined two facets of responsive parenting - its role in child health and development and the effectiveness of interventions to enhance it - by conducting a systematic review of literature from both developed and developing countries." }, { "infon": 3, "offset": -1, "text": "Our results revealed that interventions are effective in enhancing maternal responsiveness, resulting in better child health and development, especially for the neediest populations." }, { "infon": 4, "offset": -1, "text": "Since these interventions were feasible even in poor settings, they have great potential in helping us achieve the Millennium Development Goals." }, { "infon": 5, "offset": -1, "text": "We suggest that responsiveness interventions be integrated into child survival strategies." } ] } ] }, { "id": "S0042-96862007000100008", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children." }, { "infon": 1, "offset": -1, "text": "METHODS: A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran." }, { "infon": 2, "offset": -1, "text": "PA and dietary pattern were assessed by self-administered validated questionnaires." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day." }, { "infon": 4, "offset": -1, "text": "The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families)." }, { "infon": 5, "offset": -1, "text": "The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students." }, { "infon": 6, "offset": -1, "text": "Among boys, the frequency of consumption of vegetables and plant proteins (R2 = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI (R2 = 0.57)." }, { "infon": 7, "offset": -1, "text": "Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight." }, { "infon": 8, "offset": -1, "text": "When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life." }, { "infon": 10, "offset": -1, "text": "When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered." } ] } ] }, { "id": "S0042-96862007000100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Human immunodeficiency virus (HIV) infection patterns and risk behaviours in different population groups and provinces in Viet Nam." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To study patterns and determinants of HIV prevalence and risk-behaviour characteristics in different population groups in four border provinces of Viet Nam." }, { "infon": 1, "offset": -1, "text": "METHODS: We surveyed four population groups during April-June 2002." }, { "infon": 2, "offset": -1, "text": "We used stratified random-cluster sampling and collected data concomitantly on HIV status and risk behaviours." }, { "infon": 3, "offset": -1, "text": "The groups included were female sex workers (n = 2023), injecting drug users (n = 1391), unmarried males aged 15-24 years (n = 1885) and different categories of mobile groups (n = 1923)." }, { "infon": 4, "offset": -1, "text": "FINDINGS: We found marked geographical contrasts in HIV prevalence, particularly among female sex workers (range 0-24%)." }, { "infon": 5, "offset": -1, "text": "The HIV prevalence among injecting drug users varied at high levels in all provinces (range 4-36%), whereas lower prevalences were found among both unmarried young men (range 0-1.3%) and mobile groups (range 0-2.5%)." }, { "infon": 6, "offset": -1, "text": "All groups reported sex with female sex workers." }, { "infon": 7, "offset": -1, "text": "Less than 40% of the female sex workers had used condoms consistently." }, { "infon": 8, "offset": -1, "text": "The strongest determinants of HIV infection among female sex workers were inconsistent condom use (adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 2.4-11.8), history of injecting drug use and mobility, and, among injecting drug users, sharing of injection equipment (adjusted OR, 7.3; 95% CI, 2.3-24.0) and sex with non-regular partners (adjusted OR 3.4; 95% CI 1.4-8.5)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: The finding of marked geographical variation in HIV prevalence underscores the value of understanding local contexts in the prevention of HIV infection." }, { "infon": 10, "offset": -1, "text": "Although lacking support from data from all provinces, there would appear to be a potential for sex work to drive a self-sustaining heterosexual epidemic." }, { "infon": 11, "offset": -1, "text": "That the close links to serious injecting drug use epidemics can have an accelerating effect in increasing the spread of HIV merits further study." } ] } ] }, { "id": "S0042-96862007000100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A proposal for measuring the degree of public health-sensitivity of patent legislation in the context of the WTO TRIPS Agreement." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: This study aims to propose a framework for measuring the degree of public health-sensitivity of patent legislation reformed after the World Trade Organization's TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement entered into force." }, { "infon": 1, "offset": -1, "text": "METHODS: The methodology for establishing and testing the proposed framework involved three main steps:(1) a literature review on TRIPS flexibilities related to the protection of public health and provisions considered \"TRIPS-plus\"; (2) content validation through consensus techniques (an adaptation of Delphi method); and (3) an analysis of patent legislation from nineteen Latin American and Caribbean countries." }, { "infon": 2, "offset": -1, "text": "FINDINGS: The results show that the framework detected relevant differences in countries' patent legislation, allowing for country comparisons." }, { "infon": 3, "offset": -1, "text": "CONCLUSION: The framework's potential usefulness in monitoring patent legislation changes arises from its clear parameters for measuring patent legislation's degree of health sensitivity." }, { "infon": 4, "offset": -1, "text": "Nevertheless, it can be improved by including indicators related to government and organized society initiatives that minimize free-trade agreements' negative effects on access to medicines." } ] } ] }, { "id": "S0042-96862007000100014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Using a fingerprint recognition system in a vaccine trial to avoid misclassification." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: The potential for misidentification of trial participants, leading to misclassification, is a threat to the integrity of randomized controlled trials." }, { "infon": 1, "offset": -1, "text": "The correct identification of study subjects in large trials over prolonged periods is of vital importance to those conducting clinical trials." }, { "infon": 2, "offset": -1, "text": "Currently used means of identifying study participants, such as identity cards and records of name, address, name of household head and demographic characteristics, require large numbers of well-trained personnel, and still leave room for uncertainty." }, { "infon": 3, "offset": -1, "text": "APPROACH: We used fingerprint recognition technology for the identification of trial participants." }, { "infon": 4, "offset": -1, "text": "This technology is already widely used in security and commercial contexts but not so far in clinical trials." }, { "infon": 5, "offset": -1, "text": "LOCAL SETTING: A phase 2 cholera vaccine trial in SonLa, Viet Nam." }, { "infon": 6, "offset": -1, "text": "RELEVANT CHANGES: An optical sensor was used to scan fingerprints." }, { "infon": 7, "offset": -1, "text": "The fingerprint template of each participant was used to verify his or her identity during each of eight follow-up visits." }, { "infon": 8, "offset": -1, "text": "LESSONS LEARNED: A system consisting of a laptop computer and sensor is small in size, requires minimal training and on average six seconds for scanning and recognition." }, { "infon": 9, "offset": -1, "text": "All participants' identities were verified in the trial." }, { "infon": 10, "offset": -1, "text": "Fingerprint recognition should become the standard technology for identification of participants in field trials." }, { "infon": 11, "offset": -1, "text": "Fears exist, however, regarding the potential for invasion of privacy." }, { "infon": 12, "offset": -1, "text": "It will therefore be necessary to convince not only trial participants but also investigators that templates of fingerprints stored in databases are less likely to be subject to abuse than currently used information databases." } ] } ] }, { "id": "S0042-96862007000200007", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Unwanted fertility among the poor: an inequity?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine if higher fertility and lower contraceptive use among the poorer segments of society should be considered an inequality, reflecting a higher desire for large families among the poor, or an inequity, a product of the poor being prevented from achieving their desired fertility to the same degree as wealthier segments of society." }, { "infon": 1, "offset": -1, "text": "METHODS: Using the most recent Demographic and Health Surveys from 41 countries, we analysed the differences in fertility in light of modern contraceptive use, unwanted fertility (defined as actual fertility in excess of desired fertility) and the availability of family planning services found among poorer and wealthier segments of society." }, { "infon": 2, "offset": -1, "text": "The asset index in each survey was used to construct wealth quintiles and the concentration index (CI) of income inequality was found in health variables." }, { "infon": 3, "offset": -1, "text": "FINDINGS: The relationship between the CI found in the total fertility rate and the use of contraceptives was linear, R-square of 0.289." }, { "infon": 4, "offset": -1, "text": "Unwanted births in the poorest quintile were more than twice that found in the wealthiest quintile, respectively 1.2 and 0.5, although there was wide variation among the 41 countries." }, { "infon": 5, "offset": -1, "text": "The CI in our measure of family planning availability (radio messages, knowledge of services and contact with field workers) was largely positively associated with the CI in modern contraceptive prevalence, respectively R-squares of 0.392, 0.692 and 0.526." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: In many countries the higher fertility and lower contraceptive use found among poorer relative to wealthier populations should be considered an inequity." } ] } ] }, { "id": "S0042-96862007000200009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Progression to WHO criteria for antiretroviral therapy in a 7-year cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire." }, { "infon": 1, "offset": -1, "text": "METHODS: We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was < 36 months." }, { "infon": 2, "offset": -1, "text": "Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity." }, { "infon": 3, "offset": -1, "text": "We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines." }, { "infon": 4, "offset": -1, "text": "FINDINGS: 217 adults (77 women (35%)) were followed up during 668 person-years (PY)." }, { "infon": 5, "offset": -1, "text": "The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.6/100 PY), herpes zoster (3.4/100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY)." }, { "infon": 6, "offset": -1, "text": "The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0.16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa." } ] } ] }, { "id": "S0042-96862007000200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The prevalence of HIV, HBV and HCV among Filipino blood donors and overseas work visa applicants." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Our aim was to estimate the prevalence of HIV, HBV and HCV among the general population of the Philippines using data sources outside of the limited existing active surveillance network." }, { "infon": 1, "offset": -1, "text": "METHODS: We analysed aggregate HIV, HBV and HCV test results for hospital-based blood donors (BDs) and overseas Filipino worker candidates (OFWCs) that had been reported from licensed laboratories to the National STD/AIDS Cooperative Central Laboratory in Manila between 2002 and 2004." }, { "infon": 2, "offset": -1, "text": "FINDINGS: From over 144 000 blood-screening results, the HIV prevalence was 0.006% in BDs and 0.001% in OFWCs; that of HBV was 4.2% in both groups; and that of HCV was 0.3% in BDs and 0.9% in OFWCs." }, { "infon": 3, "offset": -1, "text": "Males were at increased risk of both HBV and HCV; among OFWCs, younger women were at increased risk." }, { "infon": 4, "offset": -1, "text": "Laboratories that tested sequentially but stopped testing after the first positive result were far less likely to detect HCV, indicating that sequential testing protocols may underestimate HCV and HIV prevalence." }, { "infon": 5, "offset": -1, "text": "OFWCs were at low risk of HIV, and the risk of testing positive for these viruses was not increased among OFWCs applying for a repeated work visa, compared with first time-applicants." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: Based on these data, we conclude that HIV is rare in the Philippines." }, { "infon": 7, "offset": -1, "text": "In contrast with prior reports, we found no evidence that OFWCs constitute a high-risk group for HIV." }, { "infon": 8, "offset": -1, "text": "Further research is needed to understand why younger women are at increased risk of acquiring HBV." } ] } ] }, { "id": "S0042-96862007000200013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A balanced scorecard for health services in Afghanistan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Ministry of Public Health (MOPH) in Afghanistan has developed a balanced scorecard (BSC) to regularly monitor the progress of its strategy to deliver a basic package of health services." }, { "infon": 1, "offset": -1, "text": "Although frequently used in other health-care settings, this represents the first time that the BSC has been employed in a developing country." }, { "infon": 2, "offset": -1, "text": "The BSC was designed via a collaborative process focusing on translating the vision and mission of the MOPH into 29 core indicators and benchmarks representing six different domains of health services, together with two composite measures of performance." }, { "infon": 3, "offset": -1, "text": "In the absence of a routine health information system, the 2004 BSC for Afghanistan was derived from a stratified random sample of 617 health facilities, 5719 observations of patient-provider interactions, and interviews with 5597 patients, 1553 health workers, and 13 843 households." }, { "infon": 4, "offset": -1, "text": "Nationally, health services were found to be reaching more of the poor than the less-poor population, and providing for more women than men, both key concerns of the government." }, { "infon": 5, "offset": -1, "text": "However, serious deficiencies were found in five domains, and particularly in counselling patients, providing delivery care during childbirth, monitoring tuberculosis treatment, placing staff and equipment, and establishing functional village health councils." }, { "infon": 6, "offset": -1, "text": "The BSC also identified wide variations in performance across provinces; no province performed better than the others across all domains." }, { "infon": 7, "offset": -1, "text": "The innovative adaptation of the BSC in Afghanistan has provided a useful tool to summarize the multidimensional nature of health-services performance, and is enabling managers to benchmark performance and identify strengths and weaknesses in the Afghan context." } ] } ] }, { "id": "S0042-96862007000200015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Malawi's contribution to \"3 by 5\": achievements and challenges." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: Many resource-poor countries have started scaling up antiretroviral therapy (ART)." }, { "infon": 1, "offset": -1, "text": "While reports from individual clinics point to successful implementation, there is limited information about progress in government institutions at a national level." }, { "infon": 2, "offset": -1, "text": "APPROACH: Malawi started national ART scale-up in 2004 using a structured approach." }, { "infon": 3, "offset": -1, "text": "There is a focus on one generic, fixed-dose combination treatment with stavudine, lamivudine and nevirapine." }, { "infon": 4, "offset": -1, "text": "Treatment is delivered free of charge to eligible patients with HIV and there is a standardized system for recruiting patients, monthly follow-up, registration, monitoring and reporting of cases and outcomes." }, { "infon": 5, "offset": -1, "text": "All treatment sites receive quarterly supervision and evaluation." }, { "infon": 6, "offset": -1, "text": "LOCAL SETTING: In January 2004, there were nine public sector facilities delivering ART to an estimated 4 000 patients." }, { "infon": 7, "offset": -1, "text": "By December 2005, there were 60 public sector facilities providing free ART to 37 840 patients using national standardized systems." }, { "infon": 8, "offset": -1, "text": "Analysis of quarterly cohort treatment outcomes at 12 months showed 80% of patients were alive, 10% dead, 9% lost to follow-up and 1% had stopped treatment." }, { "infon": 9, "offset": -1, "text": "LESSONS LEARNED: Achievements were the result of clear national ART guidelines, implementing partners working together, an intensive training schedule focused on clinical officers and nurses, a structured system of accrediting facilities for ART delivery, quarterly supervision and monitoring, and no stock-outs of antiretroviral drugs." }, { "infon": 10, "offset": -1, "text": "The main challenges are to increase the numbers of children, pregnant women and patients with tuberculosis being started on ART, and to avert high early mortality and losses to follow-up." }, { "infon": 11, "offset": -1, "text": "The capacity of the health sector to cope with escalating case loads and to scale up prevention alongside treatment will determine the future success of ART delivery in Malawi." } ] } ] }, { "id": "S0042-96862007000300009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The importance of militaries from developing countries in global infectious disease surveillance." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Military forces from developing countries have become increasingly important as facilitators of their government's foreign policy, taking part in peacekeeping operations, military exercises and humanitarian relief missions." }, { "infon": 1, "offset": -1, "text": "Deployment of these forces presents both challenges and opportunities for infectious disease surveillance and control." }, { "infon": 2, "offset": -1, "text": "Troop movements may cause or extend epidemics by introducing novel agents to susceptible populations." }, { "infon": 3, "offset": -1, "text": "Conversely, military units with disease surveillance and response capabilities can extend those capabilities to civilian populations not served by civilian public health programmes, such as those in remote or post-disaster settings." }, { "infon": 4, "offset": -1, "text": "In Peru and Thailand, military health organizations in partnership with the military of the United States use their laboratory, epidemiological, communications and logistical resources to support civilian ministry of health efforts." }, { "infon": 5, "offset": -1, "text": "As their role in international affairs expands, surveillance capabilities of militaries from developing countries should be enhanced, perhaps through partnerships with militaries from high-income countries." }, { "infon": 6, "offset": -1, "text": "Military-to-military and military-to-civilian partnerships, with the support of national and international civilian health organizations, could also greatly strengthen global infectious disease surveillance, particularly in remote and post-disaster areas where military forces are present." } ] } ] }, { "id": "S0042-96862007000300011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Foreign policy matters: a normative view of the G8 and population health." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Group of Eight (G8) countries occupy a dominant position in the international economic and political order." }, { "infon": 1, "offset": -1, "text": "Given what is known about influences on the social determinants of health in an interconnected world, the G8 are a logical starting point for any enquiry into the relations between foreign policy and health." }, { "infon": 2, "offset": -1, "text": "We first make five arguments for adopting an explicitly normative, equity-oriented perspective on the performance of G8 policy in areas related to population health." }, { "infon": 3, "offset": -1, "text": "We then examine G8 performance with respect to the crucial policy triad of development assistance, debt relief and trade, finding that neither rhetoric nor promising institutional innovation has been matched by resources commensurate with demonstrated levels of need." }, { "infon": 4, "offset": -1, "text": "We conclude that it is necessary to pursue advocacy efforts based on the normative perspective we have put forward and that doing so effectively requires further investigation of why some polities are more receptive than others to policies of redistribution both within and outside their borders." } ] } ] }, { "id": "S0042-96862007000300013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health and foreign policy: influences of migration and population mobility." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "International interest in the relationship between globalization and health is growing, and this relationship is increasingly figuring in foreign policy discussions." }, { "infon": 1, "offset": -1, "text": "Although many globalizing processes are known to affect health, migration stands out as an integral part of globalization, and links between migration and health are well documented." }, { "infon": 2, "offset": -1, "text": "Numerous historical interconnections exist between population mobility and global public health, but since the 1990s new attention to emerging and re-emerging infectious diseases has promoted discussion of this topic." }, { "infon": 3, "offset": -1, "text": "The containment of global disease threats is a major concern, and significant international efforts have received funding to fight infectious diseases such as malaria, tuberculosis and HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome)." }, { "infon": 4, "offset": -1, "text": "Migration and population mobility play a role in each of these public health challenges." }, { "infon": 5, "offset": -1, "text": "The growing interest in population mobility's health-related influences is giving rise to new foreign policy initiatives to address the international determinants of health within the context of migration." }, { "infon": 6, "offset": -1, "text": "As a result, meeting health challenges through international cooperation and collaboration has now become an important foreign policy component in many countries." }, { "infon": 7, "offset": -1, "text": "However, although some national and regional projects address health and migration, an integrated and globally focused approach is lacking." }, { "infon": 8, "offset": -1, "text": "As migration and population mobility are increasingly important determinants of health, these issues will require greater policy attention at the multilateral level." } ] } ] }, { "id": "S0042-96862007000300015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health impact assessment, human rights and global public policy: a critical appraisal." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Public policy decisions in both the social and economic spheres have enormous impact on global public health." }, { "infon": 1, "offset": -1, "text": "As a result of this, and of the skewed global distribution of power and resources, health impact assessment (HIA) potentially has a key role to play in foreign policy-making and global public policy-making." }, { "infon": 2, "offset": -1, "text": "Governments, multilateral bodies and transnational corporations need to be held to account for the health impacts of their policies and practices." }, { "infon": 3, "offset": -1, "text": "One route towards achieving this objective involves the inclusion of human rights assessments within HIA." }, { "infon": 4, "offset": -1, "text": "International commitments to human rights instruments and standards can be used as a global auditing tool." }, { "infon": 5, "offset": -1, "text": "Methodological issues may limit the effectiveness of HIA in promoting health equity." }, { "infon": 6, "offset": -1, "text": "These issues include the use of procedures that favour those holding power in the policy process or the use of procedures that fail to apply values of equity and participation." }, { "infon": 7, "offset": -1, "text": "The identification and production of evidence that includes the interests of less powerful groups is a priority for HIA and would be furthered if a human rights-based method of HIA were developed." }, { "infon": 8, "offset": -1, "text": "Because HIA considers all types of policies and examines all potential determinants of health, it can play a part when foreign policy is developed and global decisions are made to treat people as rights holders." }, { "infon": 9, "offset": -1, "text": "Since the human right to health is shaped by the determinants of health, developing links between the right to health assessment (that is, an assessment of the impact of policies on the right to health) and HIA - as recently proposed by the United Nations Special Rapporteur on the right to health - could strengthen the development of foreign policy and global decisions." }, { "infon": 10, "offset": -1, "text": "Such links should be pursued and applied to the development of foreign policy and to the operation of multilateral bodies." } ] } ] }, { "id": "S0042-96862007000300017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health imperatives in foreign policy: the case of Malaysia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Malaysia's global, regional and bilateral international health relations are surveyed against the historical backdrop of the country's foreign policy." }, { "infon": 1, "offset": -1, "text": "Malaysia has always participated in multilateral agencies, most notably the World Health Organization, as such agencies are part of the longstanding fabric of \"good international citizenship\"." }, { "infon": 2, "offset": -1, "text": "The threats of infectious diseases to human health and economic activity have caused an intensification and an organizational formalization of Malaysian health diplomacy, both regionally and bilaterally." }, { "infon": 3, "offset": -1, "text": "Such diplomacy has also established a basis for developing a wider set of cooperative relationships that go beyond responding to the threat of pandemics." }, { "infon": 4, "offset": -1, "text": "As Malaysia approaches \"developed\" status, its health sector is becoming increasingly integrated into the global economy through joint research and development ventures and transnational investment." }, { "infon": 5, "offset": -1, "text": "At the same time, it will have the technological, financial and human resources to play an expanded altruistic role in global and regional health." } ] } ] }, { "id": "S0042-96862007000400011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Determinants of women's participation in cervical cancer screening trial, Maharashtra, India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a randomized controlled trial." }, { "infon": 1, "offset": -1, "text": "The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid, cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra, India." }, { "infon": 2, "offset": -1, "text": "METHODS: Between October 1999 and November 2003 women aged 30-59 years were randomized to receive one of the three tests or to a control group." }, { "infon": 3, "offset": -1, "text": "Participation was analysed for all three intervention arms." }, { "infon": 4, "offset": -1, "text": "The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100 800 eligible women invited for screening." }, { "infon": 5, "offset": -1, "text": "Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high-grade lesions." }, { "infon": 6, "offset": -1, "text": "Participation in screening and compliance with treatment were also analysed according to the type of test used." }, { "infon": 7, "offset": -1, "text": "FINDINGS: Compared with women who were not tested, screened women were younger (aged 30-39), better educated and had ever used contraception." }, { "infon": 8, "offset": -1, "text": "A higher proportion of screened women were married and a lower proportion had never been pregnant." }, { "infon": 9, "offset": -1, "text": "Of the 932 women diagnosed with high-grade lesions or invasive cancer, 85.3% (795) received treatment." }, { "infon": 10, "offset": -1, "text": "Women with higher levels of education, who had had fewer pregnancies and those who were married were more likely to comply with treatment." }, { "infon": 11, "offset": -1, "text": "There were no differences in rates of screening or compliance with treatment when results were analysed by the test received." }, { "infon": 12, "offset": -1, "text": "CONCLUSIONS: Irrespective of the test being used, good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services." }, { "infon": 13, "offset": -1, "text": "Communication methods and delivery strategies aimed at encouraging older, less-educated women, who have less contact with reproductive services, are needed to further increase screening uptake." } ] } ] }, { "id": "S0042-96862007000400013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the availability and affordability of medicines used to treat cardiovascular disease, diabetes, chronic respiratory disease and glaucoma and to provide palliative cancer care in six low- and middle-income countries." }, { "infon": 1, "offset": -1, "text": "METHODS: A survey of the availability and price of 32 medicines was conducted in a representative sample of public and private medicine outlets in four geographically defined areas in Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka." }, { "infon": 2, "offset": -1, "text": "We analysed the percentage of these medicines available, the median price versus the international reference price (expressed as the median price ratio) and affordability in terms of the number of days' wages it would cost the lowest-paid government worker to purchase one month of treatment." }, { "infon": 3, "offset": -1, "text": "FINDINGS: In all countries < 7.5% of these 32 medicines were available in the public sector, except in Brazil, where 30% were available, and Sri Lanka, where 28% were available." }, { "infon": 4, "offset": -1, "text": "Median price ratios varied substantially, from 0.09 for losartan in Sri Lanka to 30.44 for aspirin in Brazil." }, { "infon": 5, "offset": -1, "text": "In the private sector in Malawi and Sri Lanka, the cost of innovator products (the pharmaceutical product first given marketing authorization) was three times more than generic medicines." }, { "infon": 6, "offset": -1, "text": "One month of combination treatment for coronary heart disease cost 18.4 days' wages in Malawi, 6.1 days' wages in Nepal, 5.4 in Pakistan and 5.1 in Brazil; in Bangladesh the cost was 1.6 days' wages and in Sri Lanka it was 1.5." }, { "infon": 7, "offset": -1, "text": "The cost of one month of combination treatment for asthma ranged from 1.3 days' wages in Bangladesh to 9.2 days' wages in Malawi." }, { "infon": 8, "offset": -1, "text": "The cost of a one-month course of intermediate-acting insulin ranged from 2.8 days' wages in Brazil to 19.6 in Malawi." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Context-specific policies are required to improve access to essential medicines." }, { "infon": 10, "offset": -1, "text": "Generic products should be promoted by educating professionals and consumers, by implementing appropriate policies and incentives, and by introducing market competition and/or price regulation." }, { "infon": 11, "offset": -1, "text": "Improving governance and management efficiency, and assessing local supply options, may improve availability." }, { "infon": 12, "offset": -1, "text": "Prices could be reduced by improving purchasing efficiency, eliminating taxes and regulating mark-ups." } ] } ] }, { "id": "S0042-96862007000400015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To measure the prevalence of Trichomonas vaginalis (TV) infection and bacterial vaginosis (BV) among pregnant women in Botswana, and to evaluate the syndromic approach and alternative management strategies for these conditions in pregnancy." }, { "infon": 1, "offset": -1, "text": "METHODS: In a cross-sectional study, 703 antenatal care attendees were interviewed and examined, and specimens were collected to identify TV, BV, Candida species, Chlamydia trachomatis and Neisseria gonorrhoeae." }, { "infon": 2, "offset": -1, "text": "Information on reproductive tract infections earlier in pregnancy was obtained from a structured interview and the antenatal record." }, { "infon": 3, "offset": -1, "text": "FINDINGS: TV was found in 19% and BV in 38% of the attendees." }, { "infon": 4, "offset": -1, "text": "Three-fourths of women with TV or BV were asymptomatic." }, { "infon": 5, "offset": -1, "text": "Syndromic management according to the vaginal discharge algorithm would lead to substantial under-diagnosis and over-treatment of TV and BV." }, { "infon": 6, "offset": -1, "text": "Signs of vaginal discharge were more predictive of the presence of these conditions than were symptoms." }, { "infon": 7, "offset": -1, "text": "Among the 546 attendees on a repeat antenatal visit, 142 (26%) had been diagnosed with vaginal discharge earlier in their pregnancy - 14 of them twice." }, { "infon": 8, "offset": -1, "text": "In 143 cases, an attendee was diagnosed with vaginal discharge in the second or third trimester; however, metronidazole had been prescribed only 17 times (12%)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Diagnosis and treatment of TV and BV among pregnant women in sub-Saharan Africa presents major challenges." }, { "infon": 10, "offset": -1, "text": "Half the pregnant women in this study were diagnosed with TV or BV, but these conditions were not detected and treated during antenatal care with syndromic management." }, { "infon": 11, "offset": -1, "text": "Also, health workers did not adhere to treatment guidelines." }, { "infon": 12, "offset": -1, "text": "These results indicate that management guidelines for TV and BV in antenatal care should be revised." } ] } ] }, { "id": "S0042-96862007000400017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Improving national data collection systems from voluntary counselling and testing centres in Kenya." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: Voluntary counselling and testing (VCT) data from the registered sites in Kenya have been fraught with challenges, leading to insufficient statistics in the national office for planning purposes." }, { "infon": 1, "offset": -1, "text": "An exercise was carried out to determine the barriers to the flow of data in VCT sites in Kenya." }, { "infon": 2, "offset": -1, "text": "APPROACH: A record-based survey was conducted at 332 VCT sites in Kenya." }, { "infon": 3, "offset": -1, "text": "Data from on-site records were compared with those in the national office." }, { "infon": 4, "offset": -1, "text": "The exercise was conducted in 2004 between 5 September and 15 October." }, { "infon": 5, "offset": -1, "text": "LOCAL SETTING: All registered VCT sites in Kenya." }, { "infon": 6, "offset": -1, "text": "RELEVANT CHANGES: After the exercise, various measures to enhance VCT data collection and reporting were implemented." }, { "infon": 7, "offset": -1, "text": "They include the provision of a uniform data collection and reporting tool to all the districts in the country, the strengthening of a feedback mechanism to update provinces and districts on their reporting status and increased support to the data component of the national quality assurance for VCT." }, { "infon": 8, "offset": -1, "text": "LESSONS LEARNED: Periodical field visits by the national officials to offer on-the-job training about data management to data collectors and to address data quality issues can dramatically improve the quality and completeness of VCT reports." }, { "infon": 9, "offset": -1, "text": "The perceived relevance of the data and the data collection process to those working at the sites is the critical factor for data quality and timeliness of reporting." } ] } ] }, { "id": "S0042-96862007000500010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Planning to improve global health: the next decade of tuberculosis control." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Global Plan to Stop TB 2006-2015 is a road map for policy-makers and managers of national programmes." }, { "infon": 1, "offset": -1, "text": "It sets out the key actions needed to achieve the targets of the Millennium Development Goals relating to tuberculosis (TB): to halve the prevalence and deaths by 2015 relative to 1990 levels and to save 14 million lives." }, { "infon": 2, "offset": -1, "text": "Developed by a broad coalition of partners, the plan presents a model approach combining interventions that can feasibly be supplied on the ground." }, { "infon": 3, "offset": -1, "text": "The main areas of activity set out in the plan are: scaling up interventions to control tuberculosis; promoting the research and development of improved diagnostics, drugs and vaccines; and engaging in related activities for advocacy, communications and social mobilization." }, { "infon": 4, "offset": -1, "text": "Scenarios for the planning process were developed; these looked at issues both globally and in seven epidemiological regions." }, { "infon": 5, "offset": -1, "text": "The scenarios made ambitious but realistic assumptions about the pace of scale-up and implementation coverage of the activities." }, { "infon": 6, "offset": -1, "text": "A mathematical model was used to estimate the impact of scaling up current interventions based on data from studies of tuberculosis biology and from experience with tuberculosis control in diverse settings." }, { "infon": 7, "offset": -1, "text": "The estimated costs of the activities set out in the Global Plan were based on implementing interventions and researching and developing drugs, diagnostics and vaccines; these costs were US$ 56 billion over 10 years." }, { "infon": 8, "offset": -1, "text": "When translated into cost per disability adjusted life year averted, these costs compare favourably with those of other public health interventions." }, { "infon": 9, "offset": -1, "text": "This approach to planning for global tuberculosis control is a valuable example of developing plans to improve global health that has relevance for other health issues." } ] } ] }, { "id": "S0042-96862007000500012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Roles of laboratories and laboratory systems in effective tuberculosis programmes." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system." }, { "infon": 1, "offset": -1, "text": "New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment." }, { "infon": 2, "offset": -1, "text": "To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics." }, { "infon": 3, "offset": -1, "text": "QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes." }, { "infon": 4, "offset": -1, "text": "Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills." }, { "infon": 5, "offset": -1, "text": "Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories' functions and to extend control programme activities to the private sector." }, { "infon": 6, "offset": -1, "text": "Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB." } ] } ] }, { "id": "S0042-96862007000500014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Did we reach the 2005 targets for tuberculosis control?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The World Health Assembly set targets to detect by 2005 at least 70% of all new sputum smear-positive cases arising each year and to cure at least 85% of these cases." }, { "infon": 1, "offset": -1, "text": "The national tuberculosis (TB) control programmes of 199 countries reported that in 2005, 2.3 million new smear-positive cases were diagnosed under WHO's DOTS strategy, out of an estimated 3.9 million (95% confidence limit (CL) 3.4 million to 4.4 million) new smear-positive cases arising in that year, a global case detection rate of 60% (95% CL 52% to 69%)." }, { "infon": 2, "offset": -1, "text": "Of 2.1 million new smear-positive patients registered for treatment in 2004, 84% had successful outcomes." }, { "infon": 3, "offset": -1, "text": "Of the regions, only the WHO Western Pacific Region reached both targets, with case detection and treatment success rates of 76% and 91%, respectively; South-East Asia reached the treatment success target with a rate of 87%." }, { "infon": 4, "offset": -1, "text": "In relation to countries, WHO estimates that 67 achieved the target detection rates and 57 achieved the target for treatment success, with 26 - including high-burden countries China, the Philippines and Viet Nam - achieving both targets." }, { "infon": 5, "offset": -1, "text": "DOTS programmes diagnosed more than 26 million patients (all forms of TB) in 1995-2005." }, { "infon": 6, "offset": -1, "text": "Building on this success, the Global Plan to Stop TB 2006-2015, describes the actions needed to implement WHO's new Stop TB Strategy over the coming decade to reduce TB incidence, prevalence and deaths in line with the Millennium Development Goals." } ] } ] }, { "id": "S0042-96862007000500016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reaching the targets for tuberculosis control: the impact of HIV." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended by WHO and 85% treatment success of those detected." }, { "infon": 1, "offset": -1, "text": "This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control." }, { "infon": 2, "offset": -1, "text": "Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB." }, { "infon": 3, "offset": -1, "text": "Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment." }, { "infon": 4, "offset": -1, "text": "Integration of TB and HIV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources." }, { "infon": 5, "offset": -1, "text": "Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will." } ] } ] }, { "id": "S0042-96862007000500020", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Critical evaluation of the Global DOTS Expansion Plan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The development of the DOTS Expansion Plan has been a milestone in tuberculosis (TB) control at the global and national levels." }, { "infon": 1, "offset": -1, "text": "Key challenges that remain are overcoming the weakness of a strategy built on case management, sustaining commitment, competing priorities, the threat of HIV, maintaining high quality of care and preventing drug resistance, building human resource capacity, improving diagnosis and fostering operations research." }, { "infon": 2, "offset": -1, "text": "The ability to address these challenges will determine the success or failure of the Global Plan to Stop TB, 2006-2015." } ] } ] }, { "id": "S0042-96862007000600010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Height- and weight-based anthropometric indicators are used worldwide to characterize the nutritional status of populations." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "As such, the SD of Z-scores can be used as quality indicators for anthropometric data." }, { "infon": 3, "offset": -1, "text": "In 2006, WHO published new growth standards." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "METHODS: We examined data on children aged 0-59 months from 51 Demographic and Health Surveys (DHS) in 34 developing countries." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "We also did a stratified analysis by age group." }, { "infon": 8, "offset": -1, "text": "FINDINGS: The SD for all four indicators were independent of their respective mean Z-scores across countries." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "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." }, { "infon": 11, "offset": -1, "text": "However, the ranges of SDs for all four indicators analysed were consistently wider than those published previously by WHO." } ] } ] }, { "id": "S0042-96862007000600012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Assessment of the age-specific disability weight of chronic schistosomiasis japonica." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the age-specific disability weight of chronic schistosomiasis japonica in China." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Of 2843 seropositive individuals, 1419 (49.9%) were classified as having chronic schistosomiasis." }, { "infon": 5, "offset": -1, "text": "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)." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "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)." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: The disability weight attributable to chronic schistosomiasis japonica is high and increases with age." }, { "infon": 11, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007000600014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Global comparative assessments of life expectancy: the impact of migration with reference to Australia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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)." }, { "infon": 1, "offset": -1, "text": "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)." }, { "infon": 2, "offset": -1, "text": "Mean differences in life expectancy for each sex were compared using paired t-tests." }, { "infon": 3, "offset": -1, "text": "Rankings of life expectancy among OECD countries were reassessed, and rank changes measured using the Wilcoxon signed rank test." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Life expectancy of males and females was significantly lower in the Australian-born group than in the total Australian population." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "This effect needs to be considered in international comparative assessments of mortality levels." } ] } ] }, { "id": "S0042-96862007000600016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Global eradication of polio: the case for \"finishing the job\"." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "While seven years have passed since 2000, the target set for the eradication of polio, success remains elusive." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "The polio eradication programme faces new hurdles such as importation, re-emergence and failure of political and community mobilization." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "This paper describes the ongoing conventional strategy adopted for polio eradication, then analyses existing challenges and some possible solutions." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "This appears to be the best way to achieve eradication at the earliest opportunity." } ] } ] }, { "id": "S0042-96862007000700009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Prevalence, intensity and associated morbidity of Schistosoma japonicum infection in the Dongting Lake region, China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: We used data from the third national schistosomiasis periodic epidemiological survey (PES) of 2004." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "Serological examinations were performed using the enzyme linked immunosorbent assay technique and human stool samples were examined by the Kato-Katz method." }, { "infon": 4, "offset": -1, "text": "Stools from buffaloes and other domestic animals were examined for schistosome infection by the miracidial hatching test." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "The prevalence of infection among buffaloes was 9.5% (0-66.7%)." }, { "infon": 7, "offset": -1, "text": "Extrapolating to the entire population of the Dongting Lake region, an estimated 73 225 people and 13 973 buffaloes were infected." }, { "infon": 8, "offset": -1, "text": "Most frequently reported symptoms were abdominal pain (6.2%) and bloody stools (2.7%)." }, { "infon": 9, "offset": -1, "text": "More than half of the clinically examined people reported having had at least one prior antischistosomal treatment." }, { "infon": 10, "offset": -1, "text": "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." }, { "infon": 11, "offset": -1, "text": "However, a near-stable number of buffalo infections suggest continuing human re-infection, which may lead to future increases in human prevalence." } ] } ] }, { "id": "S0042-96862007000700011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "Blindness was maintained by referring cases to study physicians working from community centres." }, { "infon": 4, "offset": -1, "text": "Investigations included oxygen saturation (SaO2), respiratory syncytial virus (RSV) antigen test and chest X-ray (CXR)." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Fieldworkers referred > 90% of children meeting ALRI criteria, of whom about 70% attended a physician." }, { "infon": 6, "offset": -1, "text": "Referrals for cough without respiratory signs and self-referrals contributed 19.0% and 17.9% of physician-diagnosed ALRI cases respectively." }, { "infon": 7, "offset": -1, "text": "Intervention group attendance following ALRI referral was 7% higher than controls, a trend also seen in compliance with RSV tests and CXR." }, { "infon": 8, "offset": -1, "text": "There was no evidence of bias by intervention status in fieldworker classification or physician diagnosis." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "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." }, { "infon": 11, "offset": -1, "text": "There was no evidence of bias in fieldworkers' classifications despite lack of concealment at home visits." }, { "infon": 12, "offset": -1, "text": "Pulse oximetry offers practical, objective severity assessment for field studies of ALRI." } ] } ] }, { "id": "S0042-96862007000700013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "True outcomes for patients on antiretroviral therapy who are \"lost to follow-up\" in Malawi." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: In many resource-poor countries that are scaling up antiretroviral therapy (ART), 5-25% of patients are reported as \"lost to follow-up\"." }, { "infon": 1, "offset": -1, "text": "This figure is 9% in Malawi." }, { "infon": 2, "offset": -1, "text": "There is no published information about the true outcome status of these patients." }, { "infon": 3, "offset": -1, "text": "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\"." }, { "infon": 4, "offset": -1, "text": "Clinic staff attempted to trace these patients and ascertain their true outcome status." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "Sixty-eight patients (27%) could not be traced, most commonly because of an incorrect address in the register." }, { "infon": 8, "offset": -1, "text": "Fewer patients were alive and more patients could not be traced from the central hospital compared with the peripheral hospitals." }, { "infon": 9, "offset": -1, "text": "RELEVANT CHANGES:Better documentation of patients' addresses and prompt follow-up of patients who are late for their appointments are required." }, { "infon": 10, "offset": -1, "text": "LESSONS LEARNED: ART clinics in resource-poor countries should ensure that patients' addresses are correct and comprehensive." }, { "infon": 11, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007000700015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reducing vector-borne disease by empowering farmers in integrated vector management." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: Irrigated agriculture exposes rural people to health risks associated with vector-borne diseases and pesticides used in agriculture and for public health protection." }, { "infon": 1, "offset": -1, "text": "Most developing countries lack collaboration between the agricultural and health sectors to jointly address these problems." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "Teaching farmers about these two concepts together is known as \"integrated pest and vector management\"." }, { "infon": 4, "offset": -1, "text": "LOCAL SETTING: An intersectoral project targeting rice irrigation systems in Sri Lanka." }, { "infon": 5, "offset": -1, "text": "RELEVANT CHANGES: Project partners developed a new curriculum for the field school that included a component on vector-borne diseases." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "They also reduced their use of agricultural pesticides, especially insecticides." }, { "infon": 8, "offset": -1, "text": "LESSONS LEARNED: The intervention motivated and enabled rural people to take part in vector-management activities and to reduce several environmental health risks." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "Benefits of this approach for community-based health programmes have not yet been optimally assessed." }, { "infon": 11, "offset": -1, "text": "Also, the institutional basis of the integrated management approach needs to be broadened so that people from a wider range of organizations take part." }, { "infon": 12, "offset": -1, "text": "A monitoring and evaluation system needs to be established to measure the performance of integrated management initiatives." } ] } ] }, { "id": "S0042-96862007000800010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Evaluating the potential impact of the new Global Plan to Stop TB: Thailand, 2004-2005." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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)." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "The catchment area included 3.6 million people in four provinces." }, { "infon": 4, "offset": -1, "text": "We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003)." }, { "infon": 5, "offset": -1, "text": "FINDINGS: In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000)." }, { "infon": 6, "offset": -1, "text": "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%." }, { "infon": 7, "offset": -1, "text": "Private facilities diagnosed 634 (11%) of all TB cases." }, { "infon": 8, "offset": -1, "text": "In 2005, 1392 (24%) cases were known to be HIV positive." }, { "infon": 9, "offset": -1, "text": "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)." }, { "infon": 10, "offset": -1, "text": "Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%)." }, { "infon": 11, "offset": -1, "text": "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." }, { "infon": 12, "offset": -1, "text": "Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness." } ] } ] }, { "id": "S0042-96862007000800012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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)." }, { "infon": 1, "offset": -1, "text": "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)." }, { "infon": 2, "offset": -1, "text": "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)." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "For those using inpatient care at district hospitals, the corresponding catastrophic expenditures figures were 6.5% and 7.3% in 2002 and 2004, respectively." }, { "infon": 5, "offset": -1, "text": "The catastrophic expenditures incidence for outpatient services from private hospitals moved from 27.9% to 28.5% between 2002 and 2004." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Households using inpatient services, especially at private hospitals, were more likely to face catastrophic expenditures and impoverishment from out-of-pocket payments." }, { "infon": 10, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007000800014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A comprehensive assessment of maternal deaths in Argentina: translating multicentre collaborative research into action." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "FINDINGS: A total of 121 maternal deaths occurred during 2002." }, { "infon": 3, "offset": -1, "text": "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%)." }, { "infon": 4, "offset": -1, "text": "Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26)." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007000800016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Resistance and renewal: health sector reform and Cambodia's national tuberculosis programme." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms." }, { "infon": 3, "offset": -1, "text": "It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment." } ] } ] }, { "id": "S0042-96862007000900011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Risk of arsenic-related skin lesions in Bangladeshi villages at relatively low exposure: a report from Gonoshasthaya Kendra." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Arsenic concentrations in 25% of tube wells in Bangladesh exceed 50mg/L, a level known to be hazardous." }, { "infon": 1, "offset": -1, "text": "Levels in individual wells vary widely." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "In the case-control analysis, relative risk of skin lesions increased threefold at concentrations above 50mg/L (P < 0.05)." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "More research is needed on feasible prevention of toxic effects from arsenic exposure in Bangladesh." } ] } ] }, { "id": "S0042-96862007000900013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Measuring health inequalities between genders and age groups with realization of potential life years (RePLY)." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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)." }, { "infon": 2, "offset": -1, "text": "The RePLY distribution is used to measure avoidable health inequalities between sex and age groups respectively." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Also, gender inequality is more pronounced among those aged < 30." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "Finally, high avoidable health inequality is associated with low average income, high income inequality and high population fractionalization." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: It is important to distinguish between unavoidable and avoidable mortality when measuring health outcomes and their distribution in society." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007000900015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The high burden of injuries in South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE To estimate the magnitude and characteristics of the injury burden in South Africa within a global context." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Causes of death were determined from the National Injury Mortality Surveillance System profile." }, { "infon": 3, "offset": -1, "text": "Injury death rates and years of life lost (YLL) were estimated using the Global Burden of Disease methodology." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Mortality and disability-adjusted life years' (DALYs) rates were compared with African and global estimates." }, { "infon": 6, "offset": -1, "text": "FINDINGS: Interpersonal violence dominated the South African injury profile with age-standardized mortality rates at seven times the global rate." }, { "infon": 7, "offset": -1, "text": "Injuries were the second-leading cause of loss of healthy life, accounting for 14.3% of all DALYs in South Africa in 2000." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Injuries are an important public health issue in South Africa." }, { "infon": 10, "offset": -1, "text": "Social and economic determinants of violence, many a legacy of apartheid policies, must be addressed to reduce inequalities in society and build community cohesion." }, { "infon": 11, "offset": -1, "text": "Multisectoral interventions to reduce traffic injuries are also needed." }, { "infon": 12, "offset": -1, "text": "We highlight this heavy burden to stress the need for effective prevention programmes." } ] } ] }, { "id": "S0042-96862007000900017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Towards sustainable delivery of health services in Afghanistan: options for the future." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "Irrespective of the option chosen, an important challenge remaining is the recalcitrant problem of high out-of-pocket payments." }, { "infon": 7, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007000900019", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Improving tuberculosis case detection rate with a lay informant questionnaire: an experience from the Lao People's Democratic Republic." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: In many countries, the tuberculosis (TB) annual case detection rate is below the target of 70%." }, { "infon": 1, "offset": -1, "text": "In the Lao People's Democratic Republic in 2005, it did not exceed 55% APPROACH: The DOTS strategy promotes passive case detection of TB." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "A three-item questionnaire was sent through the district health departments to all villages in six districts in six provinces." }, { "infon": 4, "offset": -1, "text": "The village headmen were asked to notify chronic cough patients." }, { "infon": 5, "offset": -1, "text": "Answers were validated in a door-to-door survey (20 villages/district)." }, { "infon": 6, "offset": -1, "text": "In a sub-sample (four villages/district) all confirmed patients were screened for TB and paragonimiasis." }, { "infon": 7, "offset": -1, "text": "LOCAL SETTING: Attapeu, Luang Namtha, Luang Prabang, Saravane, Savanakhet and Vientiane provinces in the Lao People's Democratic Republic." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "LESSONS LEARNED: Out of 456 questionnaires, 295 were returned (65%)." }, { "infon": 11, "offset": -1, "text": "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)." }, { "infon": 12, "offset": -1, "text": "In sub-sampled villages (13 541 population) 19 (5.1%) TB and 26 (7.0%) paragonimiasis cases were detected in 374 chronic cough patients." }, { "infon": 13, "offset": -1, "text": "This quick questionnaire approach proved motivating for district authorities and village key informants, although no incentives were provided." }, { "infon": 14, "offset": -1, "text": "The highly operator-dependent approach yielded a consistent detection rate of TB and paragonimiasis cases." }, { "infon": 15, "offset": -1, "text": "This approach brings health services and populations in need in close contact, which is particularly crucial in remote and underserved areas." } ] } ] }, { "id": "S0042-96862007001000011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Delivery settings and caesarean section rates in China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To quantify the influence of increasing use of health-care services on rising rates of caesarean section in China." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "The study sample (derived from birth history schedule) consisted of 3803 births to mothers aged less than 40 years between 1993 and 2002." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Decomposition analysis showed that 69% of the increase in rates of caesarean section was driven by the increase in births within institutions." }, { "infon": 6, "offset": -1, "text": "The adjusted odds of a caesarean section were 4.6 times (95% confidence interval, CI: 3.4-11.8) higher for recent births." }, { "infon": 7, "offset": -1, "text": "The adjusted odds were also significantly higher for mothers who had at least one antenatal ultrasound test." }, { "infon": 8, "offset": -1, "text": "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)." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007001000013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Contraceptive injections by community health workers in Uganda: a nonrandomized community trial." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "The primary outcome measures were safety, acceptability and continuation rates." }, { "infon": 3, "offset": -1, "text": "FINDINGS: A total of 945 new DMPA users were recruited by community workers, clinic-based nurses and midwives." }, { "infon": 4, "offset": -1, "text": "Researchers successfully followed 777 (82% follow-up): 449 community worker clients and 328 clinic-based clients." }, { "infon": 5, "offset": -1, "text": "Ninety-five percent of community-worker clients were \"satisfied\" or \"highly satisfied\" with services, and 85% reported receiving information on side-effects." }, { "infon": 6, "offset": -1, "text": "There were no serious injection site problems in either group." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "This research reinforces experience from other regions suggesting that well-trained community health workers can safely provide contraceptive injections." } ] } ] }, { "id": "S0042-96862007001000015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Are skilled birth attendants really skilled?" }, { "infon": 1, "offset": -1, "text": "A measurement method, some disturbing results and a potential way forward." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide - the fifth Millennium Development Goal." }, { "infon": 1, "offset": -1, "text": "Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications." }, { "infon": 2, "offset": -1, "text": "We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement." }, { "infon": 3, "offset": -1, "text": "METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I)." }, { "infon": 6, "offset": -1, "text": "These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II)." }, { "infon": 7, "offset": -1, "text": "FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps." }, { "infon": 8, "offset": -1, "text": "Phase II participants were correct for 62% of the knowledge questions." }, { "infon": 9, "offset": -1, "text": "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%." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications." }, { "infon": 11, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007001000017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The Chilean infant mortality decline: improvement for whom?" }, { "infon": 1, "offset": -1, "text": "Socioeconomic and geographic inequalities in infant mortality, 1990-2005." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "Socioeconomic inequalities were then mapped to 29 regional health services." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "These vulnerable households are particularly prone to infant mortality risk due to infectious disease and trauma." }, { "infon": 6, "offset": -1, "text": "We also identify clustering of high socioeconomic inequalities in infant mortality throughout the poorer north, indigenous south and densely populated metropolitan centre of Santiago." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007001000019", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "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." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "We identified 30 eligible studies, 12 of which were of high or moderate quality, from 23 countries." }, { "infon": 5, "offset": -1, "text": "Results of these studies showed wide variation in use of maternal health care." }, { "infon": 6, "offset": -1, "text": "Methodological factors (e.g. inaccurate identification of population in need or range of potential confounders controlled for) played a part in this variation." }, { "infon": 7, "offset": -1, "text": "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)." }, { "infon": 8, "offset": -1, "text": "Variation was usually framed by contextual issues relating to funding and organization of health care or social and cultural issues." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007001100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Routine offer of antenatal HIV testing (\"opt-out\" approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe." }, { "infon": 1, "offset": -1, "text": "METHODS: Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005." }, { "infon": 2, "offset": -1, "text": "Key outcomes during the first 6 months of routine testing were compared with the prior 6-month \"opt-in\" period, and clients were interviewed." }, { "infon": 3, "offset": -1, "text": "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)." }, { "infon": 4, "offset": -1, "text": "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)." }, { "infon": 5, "offset": -1, "text": "Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful." }, { "infon": 6, "offset": -1, "text": "HIV-infected women reported low levels of spousal abuse and other adverse social consequences." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: Routine antenatal HIV testing should be implemented at all sites in Zimbabwe to maximize the public health impact of PMTCT." } ] } ] }, { "id": "S0042-96862007001100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mental health reform in the Russian Federation: an integrated approach to achieve social inclusion and recovery." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To facilitate mental health reform in one Russian oblast (region) using systematic approaches to policy design and implementation." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "FINDINGS: Training programmes developed in this process have been adopted into routine curricula with measurable changes in staff skills." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Lessons learned have informed the development of regional and federal mental health policies." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "This can help facilitate significant and sustainable changes in policy and reduce institutionalization." } ] } ] }, { "id": "S0042-96862007001100014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Intermittent preventive treatment of malaria during pregnancy in central Mozambique." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management." }, { "infon": 1, "offset": -1, "text": "APPROACH: A pilot MiP programme in Mozambique was designed to determine requirements for scale-up." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "National-level formulary restrictions on SP needed to be waived." }, { "infon": 5, "offset": -1, "text": "The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses." }, { "infon": 6, "offset": -1, "text": "Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcome." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "At the second antenatal visit, 13.5% of women used bednets." }, { "infon": 9, "offset": -1, "text": "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)." }, { "infon": 10, "offset": -1, "text": "LESSONS LEARNED: National-level scale-up will require attention to staffing, supplies, bednet availability, drug policy, gestational-age estimation and harmonization of vertical initiatives." } ] } ] }, { "id": "S0042-96862007001200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Mapping Africa's advanced public health education capacity: the AfriHealth project." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Literature on human resources for health in Africa has focused on personal health services." }, { "infon": 1, "offset": -1, "text": "Little is known about graduate public health education." }, { "infon": 2, "offset": -1, "text": "This paper maps \"advanced\" public health education in Africa." }, { "infon": 3, "offset": -1, "text": "Public health includes all professionals needed to manage and optimize health systems and the public's health." }, { "infon": 4, "offset": -1, "text": "METHODS: Data were collected through questionnaires and personal visits to departments, institutes and schools of community medicine or public health." }, { "infon": 5, "offset": -1, "text": "Simple descriptive statistics were used to analyse the data." }, { "infon": 6, "offset": -1, "text": "FINDINGS: For more than 900 million people, there are fewer than 500 full-time staff, around two-thirds of whom are male." }, { "infon": 7, "offset": -1, "text": "More men (89%) than women (72%) hold senior degrees." }, { "infon": 8, "offset": -1, "text": "Over half (55%) of countries do not have any postgraduate public health programme." }, { "infon": 9, "offset": -1, "text": "This shortage is most severe in lusophone and francophone Africa." }, { "infon": 10, "offset": -1, "text": "The units offering public health programmes are small: 81% have less than 20 staff, and 62% less than 10." }, { "infon": 11, "offset": -1, "text": "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." }, { "infon": 12, "offset": -1, "text": "Programmes are often narrowly focused on medical professionals, but \"open\" programmes are increasing in number." }, { "infon": 13, "offset": -1, "text": "Public health education and research are not linked." }, { "infon": 14, "offset": -1, "text": "CONCLUSION: Africa urgently needs a plan for developing its public health education capacity." }, { "infon": 15, "offset": -1, "text": "Lack of critical mass seems a key gap to be addressed by strengthening subregional centres, each of which should provide programmes to surrounding countries." }, { "infon": 16, "offset": -1, "text": "Research linked to public health education and to educational institutions needs to increase." } ] } ] }, { "id": "S0042-96862007001200013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Capacity-building for public health: http://peoples-uni.org." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "These reflect societal developments, especially those associated with Web 2.0." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Second, teaching through online facilitation by volunteers in conjunction with members of local universities." }, { "infon": 6, "offset": -1, "text": "Third, accrediting learned competences." }, { "infon": 7, "offset": -1, "text": "Situation analyses already performed suggest that the need for this education is great and that this solution may be feasible in many countries." }, { "infon": 8, "offset": -1, "text": "Several partners have already agreed to be involved and exemplar course modules are being prepared." }, { "infon": 9, "offset": -1, "text": "We call for volunteers to help take this initiative further." } ] } ] }, { "id": "S0042-96862007001200015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "International perspectives on the ethics and regulation of human cell and tissue transplantation." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The transplantation of human cells and tissues has become a global enterprise for both life-saving and life-enhancing purposes." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862007001200017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The state of the international organ trade: a provisional picture based on integration of available information." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Organ transplantation is widely practised worldwide." }, { "infon": 1, "offset": -1, "text": "The expansion of organ transplantation has led to a critical shortage of organs and the development of the organ trade." }, { "infon": 2, "offset": -1, "text": "Many patients travel to areas where organs are obtainable through commercial transactions." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "The international organ trade is described in terms of its forms, the organ-exporting countries, the organ-importing countries and its outcomes and consequences." } ] } ] }, { "id": "S0042-96862008000100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Global costs of attaining the Millennium Development Goal for water supply and sanitation." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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\"." }, { "infon": 1, "offset": -1, "text": "Because of its impacts on a range of diseases, it is a health-related MDG target." }, { "infon": 2, "offset": -1, "text": "This study presents cost estimates of attaining MDG target 10." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "We assume this estimate is achieved in equal annual increments from the base year, 2005, until 2014." }, { "infon": 5, "offset": -1, "text": "Costs per capita for investment and recurrent costs are applied." }, { "infon": 6, "offset": -1, "text": "Country data is aggregated to 11 WHO developing country subregions and globally." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "Spending for new coverage is largely rural (64%), while for maintaining existing coverage it is largely urban (73%)." }, { "infon": 10, "offset": -1, "text": "Additional programme costs, incurred administratively outside the point of delivery of interventions, of between 10% and 30% are required for effective implementation." }, { "infon": 11, "offset": -1, "text": "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." }, { "infon": 12, "offset": -1, "text": "Country-level costing studies are needed to guide sector financing." } ] } ] }, { "id": "S0042-96862008000100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle- income countries." }, { "infon": 2, "offset": -1, "text": "Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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 $27 billion for scaling-up." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000100014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "How much is not enough?" }, { "infon": 1, "offset": -1, "text": "Human resources requirements for primary health care: a case study from South Africa." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: We use a model to estimate staffing requirements at primary health care facilities." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "We also calculate the number of HIV-related consultations per district." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "Overall the number of doctors is only 7% of the required amount." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "The number of enrolled nurses is 60% of what it should be." }, { "infon": 9, "offset": -1, "text": "There are 17% too few enrolled nurse assistants." }, { "infon": 10, "offset": -1, "text": "Across all districts there is wide variation in staffing levels between facilities leading to inefficient use of professional staff." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: The application of an adapted WHO workload tool identified important human resource planning issues." } ] } ] }, { "id": "S0042-96862008000100016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in new paediatric infections by 2010." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000100018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Increasing tuberculosis case detection: lessons from the Republic of Moldova." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "The number of TB cases notified increased overall by 50% during 2001-2005." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "These developments and improvements in laboratories, surveillance, medical personnel skills, and public awareness contributed to increased case detection." }, { "infon": 4, "offset": -1, "text": "The Republic of Moldova addressed both demand and supply sides in these efforts." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "It increased the supply of TB services by upgrading the laboratory network, revamping surveillance and training practitioners." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "Innovative TB communications reached the general public, vulnerable groups, practitioners and the media." }, { "infon": 9, "offset": -1, "text": "TB control projects built on each other and national coordination mechanisms served to identify funding for the most pressing needs." }, { "infon": 10, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000200011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: We used a decision tree model and probabilistic sensitivity analysis applied to outpatients presenting at rural health facilities with suspected malaria." }, { "infon": 2, "offset": -1, "text": "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)." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Data were drawn from published and unpublished sources, supplemented with expert opinion." }, { "infon": 5, "offset": -1, "text": "FINDINGS: RDTs were cost-effective compared with presumptive treatment up to high prevalences of Plasmodium falciparum parasitaemia." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "RDTs were more than 50% likely to be cost-saving below 58% prevalence." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "Results were robust to extensive sensitivity analysis." }, { "infon": 10, "offset": -1, "text": "The cost-effectiveness of RDTs mainly reflected improved treatment and health outcomes for non-malarial febrile illness, plus savings in antimalarial drug costs." }, { "infon": 11, "offset": -1, "text": "Results were dependent on the assumption that prescribers used test results to guide treatment decisions." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: RDTs have the potential to be cost-effective in most parts of sub-Saharan Africa." }, { "infon": 13, "offset": -1, "text": "Appropriate management of malaria and non-malarial febrile illnesses is required to reap the full benefits of these tests." } ] } ] }, { "id": "S0042-96862008000200013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Comparison of rubella seroepidemiology in 17 countries: progress towards international disease control targets." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To standardize serological surveillance to compare rubella susceptibility in Australia and 16 European countries, and measure progress towards international disease-control targets." }, { "infon": 1, "offset": -1, "text": "METHODS: Between 1996 and 2004, representative serum banks were established in 17 countries by collecting residual sera or community sampling." }, { "infon": 2, "offset": -1, "text": "Serum banks were tested in each country and assay results were standardized." }, { "infon": 3, "offset": -1, "text": "With a questionnaire, we collected information on current and past rubella vaccination programmes in each country." }, { "infon": 4, "offset": -1, "text": "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%)." }, { "infon": 5, "offset": -1, "text": "The proportion of women of childbearing age without rubella protection (< 10 IU/ml) was calculated and compared with WHO targets of < 5%." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "The percentage of susceptible children defined five countries as group I, seven as group II and four as group III." }, { "infon": 8, "offset": -1, "text": "Women of childbearing age without rubella protection were < 5% in only five countries." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000200015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Additional data were collected from inspection of ward supplies and hospital reports." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Among 509 inpatients weight was recorded in the case notes in 250 (49%), respiratory rate in 54 (11%) and mental state in 47 (9%)." }, { "infon": 5, "offset": -1, "text": "Of 206 malaria diagnoses, 123 (60%) were with a negative or absent slide result, and of these 44 (36%) were treated with quinine only." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "CONCLUSION: Clinical assessment of children admitted to paediatric wards is disturbingly poor and associated with missed diagnoses and inappropriate treatments." }, { "infon": 9, "offset": -1, "text": "Improved assessment and records are essential to initiate change, but achieving this will be a challenging task." } ] } ] }, { "id": "S0042-96862008000200017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Resistance to implementing policy change: the case of Ukraine." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Tuberculosis (TB) is a major public health problem in eastern Europe." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Collectively, along with Africa, these problems in eastern Europe remain the principal obstacle to meeting the Millennium Development Goals for TB in Europe." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "The TB and HIV epidemics are converging." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000300009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Stillbirth in rural Bangladesh: arsenic exposure and other etiological factors: a report from Gonoshasthaya Kendra." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "After univariate analysis, a multivariate, multilevel, logistic model for stillbirth was developed." }, { "infon": 4, "offset": -1, "text": "The additional effect of arsenic was calculated having adjusted for all potential confounders thus identified." }, { "infon": 5, "offset": -1, "text": "FINDINGS: The overall stillbirth rate was 3.4% (1056/30 984) and increased with estimated arsenic concentration (2.96% at < 10 µg/l; 3.79% at 10 µg/l to < 50 µg/l; 4.43% at > 50 µg/l)." }, { "infon": 6, "offset": -1, "text": "Having adjusted for 17 socioeconomic and health factors, the odds ratios estimated for arsenic (with < 10 µg/l as reference) remained raised: 1.23 (95% confidence interval, CI: 0.87–1.74) at 10 µg/l to < 50 µg/l and 1.80 (95% CI: 1.14–2.86) at 50 µg/l or greater." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: A increased risk of stillbirth is associated with arsenic contamination." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000300011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Reconstructing historical changes in the force of infection of dengue fever in Singapore: implications for surveillance and control." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: Seroprevalence data were abstracted from surveys performed in Singapore from 1982 to 2002." }, { "infon": 2, "offset": -1, "text": "These data were used to develop two mathematical models of age seroprevalence." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Model-predicted temporal trends were analysed using linear regression." }, { "infon": 5, "offset": -1, "text": "Time series techniques were employed to investigate periodicity in predicted forces of infection, dengue fever incidence and mosquito breeding." }, { "infon": 6, "offset": -1, "text": "FINDINGS: Force of infection estimates showed a significant downward trend from 1966, when vector control was instigated." }, { "infon": 7, "offset": -1, "text": "Force of infection estimates from both models reproduced significant increases in the percentage and average age of the population susceptible to dengue infections." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000300013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Acute pesticide poisoning: a proposed classification tool." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide." }, { "infon": 1, "offset": -1, "text": "Developing countries are particularly susceptible due to poorer regulation, lack of surveillance systems, less enforcement, lack of training and inadequate access to information systems." }, { "infon": 2, "offset": -1, "text": "Previous research has demonstrated wide variability in incidence rates for APP." }, { "infon": 3, "offset": -1, "text": "This is possibly due to inconsistent reporting methodology and exclusion of occupational and non-intentional poisonings." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "This document is a synthesis of existing literature and case definitions that have been previously proposed by other authors around the world." }, { "infon": 6, "offset": -1, "text": "It provides a standardized case definition and classification scheme for APP into categories of probable, possible and unlikely/unknown cases." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000300015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Strategies for implementing the new International Health Regulations in federal countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "The International Health Regulations (IHR), the principal legal instrument guiding the international management of public health emergencies, have recently undergone an extensive revision process." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "However, doing so may be particularly challenging for decentralized countries, specifically those with federal systems of government." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "We hosted a workshop to examine how federal countries could address some of the challenges they may face in implementing the IHR (2005)." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000300017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "How can we achieve global equity in provision of renal replacement therapy?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Select low- and middle-income countries demonstrate more equitable provision of renal replacement therapy is possible outside high-income countries." }, { "infon": 6, "offset": -1, "text": "For other low- and middleincome countries, education, the development of good public policy and a supportive international environment are critical." }, { "infon": 7, "offset": -1, "text": "Prevention of end-stage kidney disease, ideally as part of an integrated approach to chronic vascular diseases, must also be a key objective." } ] } ] }, { "id": "S0042-96862008000400010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A study of typhoid fever in five asian countries: disease burden and implications for controls." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To inform policy-makers about introduction of preventive interventions against typhoid, including vaccination." }, { "infon": 1, "offset": -1, "text": "METHODS: A population-based prospective surveillance design was used." }, { "infon": 2, "offset": -1, "text": "Study sites where typhoid was considered a problem by local authorities were established in China, India, Indonesia, Pakistan and Viet Nam." }, { "infon": 3, "offset": -1, "text": "Standardized clinical, laboratory, and surveillance methods were used to investigate cases of fever of > 3 days' duration for a one-year period." }, { "infon": 4, "offset": -1, "text": "A total of 441 435 persons were under surveillance, 159 856 of whom were aged 5-15 years." }, { "infon": 5, "offset": -1, "text": "FINDINGS: A total of 21 874 episodes of fever were detected." }, { "infon": 6, "offset": -1, "text": "Salmonella typhi was isolated from 475 (2%) blood cultures, 57% (273/475) of which were from 5-15 year-olds." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "Altogether, 23% (96/413) of isolates were multidrug resistant (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole)." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000400012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Disease burden and health-care clinic attendances for young children in remote aboriginal communities of northern Australia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: Children born after 1 January 2001, who were resident at 30 September 2005 and for whom consent was obtained, were studied." }, { "infon": 2, "offset": -1, "text": "Clinic records were reviewed for all presentations between 1 January 2002 and 30 September 2005." }, { "infon": 3, "offset": -1, "text": "Data collected included reason for presentation (if infectious), antibiotic prescription and referral to hospital." }, { "infon": 4, "offset": -1, "text": "FINDINGS: There were 7273 clinic presentations for 174 children aged 0-4.75 years, 55% of whom were male." }, { "infon": 5, "offset": -1, "text": "The median presentation rate per child per year was 16 (23 in the first year of life)." }, { "infon": 6, "offset": -1, "text": "Upper-respiratory-tract infections (32%) and skin infections (18%) were the most common infectious reasons for presentation." }, { "infon": 7, "offset": -1, "text": "First presentations for scabies and skin sores peaked at the age of 2 months." }, { "infon": 8, "offset": -1, "text": "By 1 year of age, 63% and 69% of children had presented with scabies and skin sores, respectively." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: These Aboriginal children average about two visits per month to PHC centres during their first year of life." }, { "infon": 10, "offset": -1, "text": "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." }, { "infon": 11, "offset": -1, "text": "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." }, { "infon": 12, "offset": -1, "text": "Appropriate prevention and treatment strategies should encompass early infancy to reduce the high burden of infectious diseases in this population." } ] } ] }, { "id": "S0042-96862008000400015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Acceptability of routine HIV counselling and testing, and HIV seroprevalence in Ugandan hospitals." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Mulago and Mbarara hospitals are large tertiary hospitals in Uganda with a high HIV/AIDS burden." }, { "infon": 1, "offset": -1, "text": "Until recently, HIV testing was available only upon request and payment." }, { "infon": 2, "offset": -1, "text": "From November 2004, routine free HIV testing and counselling has been offered to improve testing coverage and the clinical management of patients." }, { "infon": 3, "offset": -1, "text": "All patients in participating units who had not previously tested HIV-positive were offered HIV testing." }, { "infon": 4, "offset": -1, "text": "Family members of patients seen at the hospitals were also offered testing." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "FINDINGS: Of the 51 642 patients offered HIV testing, 50 649 (98%) accepted." }, { "infon": 7, "offset": -1, "text": "In those who had not previously tested HIV-positive, the overall HIV prevalence was 25%, with 81% being tested for the first time." }, { "infon": 8, "offset": -1, "text": "The highest prevalence was found in medical inpatients (35%) and the lowest, in surgical inpatients (12%)." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "Of the 10 439 family members offered testing, 9720 (93%) accepted." }, { "infon": 11, "offset": -1, "text": "The prevalence in family members was 20%." }, { "infon": 12, "offset": -1, "text": "Among 1213 couples tested, 224 (19%) had a discordant HIV status." }, { "infon": 13, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000500009", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Children aged 1-59 months from November 2005 to August 2007 were included." }, { "infon": 3, "offset": -1, "text": "Verbal and social autopsies were done to determine likely cause of death and care-seeking actions." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Cause of death was assigned for 164 children, 27% with pneumonia." }, { "infon": 5, "offset": -1, "text": "Of the pneumonia deaths, half occurred in hospital and one-third at home." }, { "infon": 6, "offset": -1, "text": "Median duration of pneumonia illness was 7 days, and median time taken to seek care outside the home was 2 days." }, { "infon": 7, "offset": -1, "text": "Most first received drugs at home: 52% antimalarials and 27% antibiotics." }, { "infon": 8, "offset": -1, "text": "Most were taken for care outside the home, 36% of whom first went to public hospitals." }, { "infon": 9, "offset": -1, "text": "One-third of those reaching the district hospital were referred to the regional hospital, and 19% reportedly improved after hospital treatment." }, { "infon": 10, "offset": -1, "text": "The median treatment cost for a child with fatal pneumonia was US$ 5.8." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: There was mistreatment with antimalarials, delays in seeking care and likely low quality of care for children with fatal pneumonia." }, { "infon": 12, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000500011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "LOCAL SETTING: The paediatric wards in 3 regional and 22 government district hospitals and 3 regional electromedical engineering departments in Malawi." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "LESSONS LEARNED: It is feasible to implement an oxygen system using concentrators throughout a low-income country." }, { "infon": 6, "offset": -1, "text": "Oxygen delivery requires trained staff with necessary equipment and supplies." }, { "infon": 7, "offset": -1, "text": "Regular maintenance and supervision are essential to ensure optimal utilization." } ] } ] }, { "id": "S0042-96862008000500013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Acute lower respiratory infections in childhood: opportunities for reducing the global burden through nutritional interventions." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Inadequate nutrition and acute lower respiratory infection (ALRI) are overlapping and interrelated health problems affecting children in developing countries." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "There was insufficient evidence regarding other potentially beneficial nutritional interventions." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000500015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Safety profile of pneumococcal conjugate vaccines: systematic review of pre- and post-licensure data." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "We conducted a systematic review of the safety of PCV7 and other pneumococcal conjugate vaccines." }, { "infon": 2, "offset": -1, "text": "A total of 42 studies were included in the review." }, { "infon": 3, "offset": -1, "text": "Reactogenicity data from some randomized trials suggest that PCV7 may result in more local reactions and fever than certain comparison vaccines." }, { "infon": 4, "offset": -1, "text": "However, the reactions were mild and self-limited, and PCV7 did not carry an increased risk of severe injection-site reactions or high fever." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "Another large trial of PCV9, however, did not find an increased risk of asthma." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000500017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Reduction of indoor air pollution (IAP) exposure from solid fuel use is a potentially important intervention for childhood pneumonia prevention." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Searches were made of electronic databases (including Africa, China and Latin America) without language restriction." }, { "infon": 3, "offset": -1, "text": "Search terms covered all sources of IAP and wide-ranging descriptions of acute lower respiratory infections, including viral and bacterial agents." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Due to substantial statistical heterogeneity, random effects models were used." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "There was evidence of publication bias, and the implications for the results are explored." }, { "infon": 8, "offset": -1, "text": "Sensitivity subanalyses assessed the impact of control selection, adjustment for confounding, exposure and outcome assessment, and age, but no strong effects were identified." }, { "infon": 9, "offset": -1, "text": "Evidence on respiratory syncytial virus was conflicting, while risk for severe or fatal pneumonia was similar to or higher than that for all pneumonia." }, { "infon": 10, "offset": -1, "text": "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." }, { "infon": 11, "offset": -1, "text": "Greater efforts are now required to implement effective interventions." } ] } ] }, { "id": "S0042-96862008000500019", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Epidemiology and etiology of childhood pneumonia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Childhood pneumonia is the leading single cause of mortality in children aged less than 5 years." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "This translates into about 156 million new episodes each year worldwide, of which 151 million episodes are in the developing world." }, { "infon": 3, "offset": -1, "text": "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)." }, { "infon": 4, "offset": -1, "text": "Of all community cases, 7-13% are severe enough to be life-threatening and require hospitalization." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000600011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Anthropometric and immunological success of antiretroviral therapy and prediction of virological success in west African adults." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step." }, { "infon": 1, "offset": -1, "text": "In sub-Saharan Africa, few people have access to plasma viral-load measurement." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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)." }, { "infon": 6, "offset": -1, "text": "With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%." }, { "infon": 7, "offset": -1, "text": "All results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000600013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Implementing community-based perinatal care: results from a pilot study in rural Pakistan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: The intervention was implemented in four of eight village clusters (315 villages, total population 138 600), while four served as a comparison group." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "The intervention was delivered within the regular government LHW programme and was supported by the creation of voluntary community health committees." }, { "infon": 4, "offset": -1, "text": "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)." }, { "infon": 5, "offset": -1, "text": "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%." }, { "infon": 6, "offset": -1, "text": "A household survey indicated a higher frequency of key behaviours (e.g. early and exclusive breastfeeding, delayed bathing and cord care) in intervention villages." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "These preliminary observations require confirmation in an adequately powered trial." } ] } ] }, { "id": "S0042-96862008000600015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Evaluating the WHO Assessment Instrument for Mental Health Systems by comparing mental health policies in four countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Mental health is a low priority in most countries around the world." }, { "infon": 1, "offset": -1, "text": "Minimal research and resources have been invested in mental health at the national level." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "Furthermore, WHO-AIMS provides a standardized database for cross-country comparisons." }, { "infon": 7, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000600017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Global epidemiology of haemoglobin disorders and derived service indicators." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "We obtained data on demographics and prevalence of gene variants responsible for haemoglobin disorders from online databases, reference resources, and published articles." }, { "infon": 2, "offset": -1, "text": "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)." }, { "infon": 3, "offset": -1, "text": "Haemoglobin disorders present a significant health problem in 71% of 229 countries, and these 71% of countries include 89% of all births worldwide." }, { "infon": 4, "offset": -1, "text": "Over 330 000 affected infants are born annually (83% sickle cell disorders, 17% thalassaemias)." }, { "infon": 5, "offset": -1, "text": "Haemoglobin disorders account for about 3.4% of deaths in children less than 5 years of age." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "Carriers and at-risk couples should be informed of their risk and the options for reducing it." }, { "infon": 8, "offset": -1, "text": "Screening for haemoglobin disorders should form part of basic health services in most countries." } ] } ] }, { "id": "S0042-96862008000700010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Lack of active follow-up of cancer patients in Chennai, India: implications for population-based survival estimates." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To measure the bias in absolute cancer survival estimates in the absence of active follow-up of cancer patients in developing countries." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Registered incident cases were first matched with those in the all-cause mortality database from the vital statistics division of the Corporation of Chennai." }, { "infon": 3, "offset": -1, "text": "Unmatched incident cancer cases were then actively followed up to determine their survival status." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "FINDINGS: Before active follow-up, matches between cases ranged from 20% to 66%, depending on the site of the primary tumour." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "The smallest survival estimates were obtained when cases lost to follow-up were excluded from the analysis." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "Passive case follow-up alone or applying standard methods to estimate survival is likely to result in an upward bias." } ] } ] }, { "id": "S0042-96862008000700012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Funding agencies in low- and middle-income countries: support for knowledge translation." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "We also surveyed web sites." }, { "infon": 3, "offset": -1, "text": "FINDINGS: We found a commitment to knowledge translation in the mandate of 18 of 23 agencies." }, { "infon": 4, "offset": -1, "text": "However, there was a lack of common terminology." }, { "infon": 5, "offset": -1, "text": "Most of the activities were traditional efforts to disseminate to a broad audience, for example using web sites and publications." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "One-third (9 of 23) of funding agencies described a mandate to enhance health equity through improving knowledge translation." }, { "infon": 8, "offset": -1, "text": "Only 3 of 23 agencies were able to describe evaluation of knowledge translation activities." }, { "infon": 9, "offset": -1, "text": "Furthermore, we found national funding agencies made greater knowledge translation efforts when compared to international agencies." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: Funding agencies are engaged in a wide range of creative knowledge translation activities." }, { "infon": 11, "offset": -1, "text": "They might consider their role as knowledge brokers, with an ability to promote research syntheses and a focus on health equity." }, { "infon": 12, "offset": -1, "text": "There is an urgent need to evaluate the knowledge translation activities of funding agencies." } ] } ] }, { "id": "S0042-96862008000700014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Schizophrenia is a highly disabling disease and is costly to treat." }, { "infon": 1, "offset": -1, "text": "We set out to establish what are the most cost-effective interventions applicable to developing regions and countries." }, { "infon": 2, "offset": -1, "text": "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)." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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)." }, { "infon": 6, "offset": -1, "text": "The relative cost-effectiveness of interventions making use of newer, \"atypical\" antipsychotic drugs is estimated to be much less favourable." }, { "infon": 7, "offset": -1, "text": "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)." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000700016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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)." }, { "infon": 4, "offset": -1, "text": "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)." }, { "infon": 5, "offset": -1, "text": "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)." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "Measures to maximize ART programme retention are required in resource-poor countries." } ] } ] }, { "id": "S0042-96862008000800010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "We describe the different contributions of the international community, women's health advocates and human rights activists." }, { "infon": 2, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000800012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Denaturalizing scarcity: a strategy of enquiry for public- health ethics." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "One of these involves the multiple relationships that link rich and poor across national borders in today's interconnected world." }, { "infon": 4, "offset": -1, "text": "The paper then briefly describes ways in which globalization and the associated institutions are linked to health-threatening scarcities." }, { "infon": 5, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000800014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Demographic and health surveillance: longitudinal ethical considerations." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Longitudinal data gathered from health surveillance, when combined with detailed demographic information, can provide invaluable insight into disease outcomes." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "This regulatory vacuum is further compounded by a lack of attention to longitudinal surveillance systems in ethics literature." }, { "infon": 4, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000800016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "A personalist approach to public-health ethics." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "First we give an overview of the historical development of public health." }, { "infon": 1, "offset": -1, "text": "Then we present some public-health deontology codes and some ethical principles." }, { "infon": 2, "offset": -1, "text": "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)." }, { "infon": 3, "offset": -1, "text": "We then mention some proposals drafted from North American bioethics \"principles\" and utilitarian, liberal and communitarian views." }, { "infon": 4, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000800018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Health-sector responses to intimate partner violence in low- and middle-income settings: a review of current models, challenges and opportunities." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives." }, { "infon": 3, "offset": -1, "text": "The findings suggest that a few models of integration are being replicated in many settings." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000900011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Antiretroviral therapy and early mortality in South Africa." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: The treatment programme started in 2001 through innovator sites." }, { "infon": 2, "offset": -1, "text": "Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities." }, { "infon": 3, "offset": -1, "text": "Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated." }, { "infon": 4, "offset": -1, "text": "Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART." }, { "infon": 5, "offset": -1, "text": "FINDINGS: By the end of March 2006, 16 234 patients were in care." }, { "infon": 6, "offset": -1, "text": "The cohort analysis included 12 587 adults and 1709 children." }, { "infon": 7, "offset": -1, "text": "Women accounted for 70% of adults enrolled." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "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)." }, { "infon": 10, "offset": -1, "text": "Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART." }, { "infon": 11, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008000900013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Declining HIV prevalence among young pregnant women in Lusaka, Zambia." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: HIV prevention has been ongoing in Lusaka for many years." }, { "infon": 1, "offset": -1, "text": "Recent reports suggest a possible decline in HIV sero-incidence in Zambia and some neighbouring countries." }, { "infon": 2, "offset": -1, "text": "This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Between July 2002 and December 2006, the Lusaka district tested 243 302 antenatal women for HIV; 54 853 (22.5%) were HIV infected." }, { "infon": 5, "offset": -1, "text": "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)." }, { "infon": 6, "offset": -1, "text": "The cord-blood surveillances were conducted between June and August 2003 and again between October 2005 and January 2006." }, { "infon": 7, "offset": -1, "text": "Overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005-2006 (P = 0.001)." }, { "infon": 8, "offset": -1, "text": "Among women < 17 years of age, seroprevalence declined from 12.1% to 7.7% (P = 0.015)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: HIV seroprevalence appears to be declining among antenatal and parturient women in Lusaka." }, { "infon": 10, "offset": -1, "text": "The decline is most dramatic among women < \" 17 years of age, suggesting a reduction in sero-incidence in this important age group." } ] } ] }, { "id": "S0042-96862008000900015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Estimating child mortality due to diarrhoea in developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: A systematic and comprehensive literature review was undertaken of all studies published since 1980 reporting under-5 diarrhoea mortality." }, { "infon": 2, "offset": -1, "text": "Information was collected on characteristics of each study and its population." }, { "infon": 3, "offset": -1, "text": "A regression model was used to relate these characteristics to proportional mortality from diarrhoea and to predict its distribution in national populations." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "The methods used here provide country-level estimates that constitute alternative information for planning in settings without adequate data." } ] } ] }, { "id": "S0042-96862008000900017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Methods of suicide: international suicide patterns derived from the WHO mortality database." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention." }, { "infon": 1, "offset": -1, "text": "Our knowledge of the methods used and their variation across countries and world regions is still limited." }, { "infon": 2, "offset": -1, "text": "The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods." }, { "infon": 3, "offset": -1, "text": "METHODS: Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database." }, { "infon": 4, "offset": -1, "text": "The classification was used to differentiate suicide methods." }, { "infon": 5, "offset": -1, "text": "Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries." }, { "infon": 10, "offset": -1, "text": "The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means." }, { "infon": 11, "offset": -1, "text": "The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever." } ] } ] }, { "id": "S0042-96862008001000012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Is mass treatment the appropriate schistosomiasis elimination strategy?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: In the year 2000, the Philippines' Department of Health adopted mass chemotherapy using praziquantel to eliminate schistosomiasis." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "This paper describes the mass-treatment activities and factors associated with participation." }, { "infon": 3, "offset": -1, "text": "METHODS: Advocacy, information dissemination and social mobilization activities were conducted before mass chemotherapy." }, { "infon": 4, "offset": -1, "text": "Village leaders were primarily responsible for community mobilization." }, { "infon": 5, "offset": -1, "text": "Mass treatment was offered in village meeting halls and schools." }, { "infon": 6, "offset": -1, "text": "Participation proportions were estimated based on the 2002-2003 census." }, { "infon": 7, "offset": -1, "text": "Community involvement was measured using a participation index." }, { "infon": 8, "offset": -1, "text": "A Bayesian hierarchical logistic regression model was fitted to estimate the association between sociodemographic factors and residents coming to the treatment site." }, { "infon": 9, "offset": -1, "text": "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)." }, { "infon": 10, "offset": -1, "text": "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." }, { "infon": 11, "offset": -1, "text": "At the village-level, better community involvement was associated with increased participation whereas a larger census was associated with decreased participation." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: The conduct of mass treatment in the 50 villages resulted in far lower participation than expected." }, { "infon": 13, "offset": -1, "text": "This raises concern for the ongoing mass-treatment initiatives now taking place in developing countries." } ] } ] }, { "id": "S0042-96862008001000014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Two-year impact of single praziquantel treatment on infection in the national control programme on schistosomiasis in Burkina Faso." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: A cohort of 1727 schoolchildren (6-14 years old) was monitored at yearly intervals through a longitudinal survey." }, { "infon": 2, "offset": -1, "text": "Additional groups of schoolchildren were monitored in cross-sectional surveys." }, { "infon": 3, "offset": -1, "text": "Parasitological examinations for Schistosoma haematobium and Schistosoma mansoni were performed, and prevalence and intensity of infection before and after treatment were analysed." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "The impact on infection was also confirmed by a cross-sectional survey 2 years post-treatment." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "A significant reduction in S. mansoni infection was also achieved." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Significant and sustained reduction in S. haematobium infection was achieved by biennial treatment in school-age children in Burkina Faso." }, { "infon": 10, "offset": -1, "text": "This may provide a cost-effective treatment strategy for similar national schistosomiasis control programmes in sub-Saharan Africa." } ] } ] }, { "id": "S0042-96862008001000016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "The primary outcome measure was reduction of neonatal mortality." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth." }, { "infon": 9, "offset": -1, "text": "The effect on mortality remained statistically significant when excluding babies who died on the day of birth." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level." }, { "infon": 11, "offset": -1, "text": "A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths." } ] } ] }, { "id": "S0042-96862008001100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Effects of mutual health organizations on use of priority health-care services in urban and rural Mali: a case-control study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: Four MHOs were established in two districts in Mali." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "We compiled MHO register data by household for a 22-month period." }, { "infon": 4, "offset": -1, "text": "Outcome measures included utilization of priority services, health expenditures and out-of-pocket payments." }, { "infon": 5, "offset": -1, "text": "Independent variables included individual, household and community demographic, socioeconomic and access characteristics, as determined through a household survey in 2004." }, { "infon": 6, "offset": -1, "text": "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" }, { "infon": 7, "offset": -1, "text": "in all cases)." }, { "infon": 8, "offset": -1, "text": "However, distance was also a significant negative predictor for the utilization of many services, particularly assisted deliveries." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008001100014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Coping with out-of-pocket health payments: empirical evidence from 15 African countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Households selling assets or borrowing money were compared to those that financed health care from income or savings." }, { "infon": 5, "offset": -1, "text": "Those that used insurance were excluded." }, { "infon": 6, "offset": -1, "text": "For the analysis, a value of 1 was assigned to selling assets or borrowing money and a value of 0 to other coping mechanisms." }, { "infon": 7, "offset": -1, "text": "FINDINGS: Coping through borrowing and selling assets ranged from 23% of households in Zambia to 68% in Burkina Faso." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "In eight countries, the coefficient on the highest quintile of inpatient spending had a P-value below 0.01." }, { "infon": 11, "offset": -1, "text": "CONCLUSION: In most African countries, the health financing system is too weak to protect households from health shocks." }, { "infon": 12, "offset": -1, "text": "Borrowing and selling assets to finance health care are common." }, { "infon": 13, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008001100016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Development assistance for health: should policy-makers worry about its macroeconomic impact?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "Increased aid for health will be required." }, { "infon": 2, "offset": -1, "text": "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'." }, { "infon": 3, "offset": -1, "text": "We review cross-country and country-level empirical studies and propose a simple framework to gauge the extent of macroeconomic risks." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "These conditions also apply in one-quarter of the 42 countries not presently increasing spending." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "They should also realize that there are effective means for mitigating the risk of Dutch disease associated with increasing development assistance for health." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008001100018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Are current debt relief initiatives an option for scaling up health financing in beneficiary countries?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "The health sector was expected to benefit from a considerable share of these funds." }, { "infon": 2, "offset": -1, "text": "The volume of released resources is important enough in certain countries to make a difference for priority programmes that have been underfunded so far." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "This paper intends to narrow the information gap by classifying debt relief savings management systems observed in practice." }, { "infon": 7, "offset": -1, "text": "We illustrate some of the major advantages and stated drawbacks and outline the policy implications for health officials operating in the countries concerned." }, { "infon": 8, "offset": -1, "text": "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)." } ] } ] }, { "id": "S0042-96862008001100020", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Can countries of the WHO African Region wean themselves off donor funding for health?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "More than 20% of total health expenditure in 48% of the 46 countries in the WHO African Region is provided by external sources." }, { "infon": 1, "offset": -1, "text": "Issues surrounding aid effectiveness suggest that these countries ought to implement strategies for weaning off aid dependency." }, { "infon": 2, "offset": -1, "text": "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?" }, { "infon": 3, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008001200010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Effect of presumptive co-trimoxazole prophylaxis on pneumococcal colonization rates, seroepidemiology and antibiotic resistance in Zambian infants: a longitudinal cohort study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To ascertain the microbiological consequences of WHO's recommendation for presumptive co-trimoxazole prophylaxis for infants with perinatal HIV exposure." }, { "infon": 1, "offset": -1, "text": "METHODS: Using a longitudinal cohort design, we followed HIV-exposed and HIV-unexposed infants trimonthly for up to 18 months per infant." }, { "infon": 2, "offset": -1, "text": "HIV-exposed infants received daily co-trimoxazole prophylaxis from 6 weeks to > 12 months of age." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "FINDINGS: From 260 infants followed for 3096 patient-months, we detected pneumococci in 360/1394 (25.8%) samples." }, { "infon": 5, "offset": -1, "text": "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)." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "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)." }, { "infon": 8, "offset": -1, "text": "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)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: Co-trimoxazole prophylaxis modestly suppresses pneumococcal colonization but accelerates infant acquisition of co-trimoxazole- and clindamycin-resistant pneumococci." }, { "infon": 10, "offset": -1, "text": "Co-trimoxazole prophylaxis appears unlikely to compromise the future efficacy of conjugate vaccines." } ] } ] }, { "id": "S0042-96862008001200012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Epidemiological impact of a nationwide measles immunization campaign in Viet Nam: a critical review." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: A nationwide mass immunization campaign was conducted in the north and south of Viet Nam in 2002 and 2003, respectively." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "National measles case-based surveillance data collected during 2001-2006 were reviewed and analysed." }, { "infon": 4, "offset": -1, "text": "Surveillance performance was assessed in terms of case investigation and specimen collection rates and reporting sensitivity for febrile rash cases." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "Rapid measles resurgence was observed in 2005 and 2006 only in the north-western mountainous region of the country." }, { "infon": 8, "offset": -1, "text": "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)." }, { "infon": 9, "offset": -1, "text": "CONCLUSION: A campaign approach for controlling measles in developing parts of Asia can prove effective." }, { "infon": 10, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008001200014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Global campaign against epilepsy: assessment of a demonstration project in rural China." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "The intervention consisted of a treatment programme available to patients without prior appropriate treatment and a public health educational programme about epilepsy." }, { "infon": 4, "offset": -1, "text": "The sampled population in the second survey was 51 644 people." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "The lifetime prevalence and prevalence of active epilepsy in the first survey were 7.0/1000 and 4.6/1000, respectively." }, { "infon": 7, "offset": -1, "text": "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%)." }, { "infon": 8, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862008001200016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986-2002." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Current smoking was defined as either daily or occasional cigarette use." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "The contributions of treatment effects increased with age." }, { "infon": 10, "offset": -1, "text": "Elevated mean BMI in men and elderly women offset part of the decline of their mean SBP." }, { "infon": 11, "offset": -1, "text": "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." }, { "infon": 12, "offset": -1, "text": "However, a substantial part of the decline was left unexplained and needs to be investigated further." }, { "infon": 13, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000100010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Noncommunicable disease mortality and life expectancy in immigrants to Israel from the former Soviet Union: country of origin compared with host country." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: Data from 926 870 FSU-immigrants who migrated to Israel between 1990 and 2003 (study cohort) were analysed." }, { "infon": 2, "offset": -1, "text": "Life expectancy was calculated for the study cohort, all Israelis, and the population of the Russian Federation." }, { "infon": 3, "offset": -1, "text": "Age-standardized death rates were calculated for grouped causes of death." }, { "infon": 4, "offset": -1, "text": "FSU immigrants were additionally compared with other Israelis and with inhabitants of the Russian Federation using cause-specific standardized mortality ratios (SMRs)." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "Relative to Israelis, the study cohort had a higher SMR for neoplasms, and particularly for stomach cancer." }, { "infon": 8, "offset": -1, "text": "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)." }, { "infon": 9, "offset": -1, "text": "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)." }, { "infon": 10, "offset": -1, "text": "CONCLUSION: Noncommunicable disease mortality among FSU immigrants to Israel is lower than in the population of the Russian Federation." }, { "infon": 11, "offset": -1, "text": "Mortality rates in FSU immigrants, particularly from circulatory diseases, have rapidly adjusted and have become similar to those of the destination country." }, { "infon": 12, "offset": -1, "text": "However, immigrants from the FSU have considerably higher mortality than other Israelis from external causes and some noncommunicable diseases such as cancer." }, { "infon": 13, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000100012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "Do lifestyle interventions work in developing countries?" }, { "infon": 1, "offset": -1, "text": "Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran." } ] }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities." }, { "infon": 1, "offset": -1, "text": "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)." }, { "infon": 2, "offset": -1, "text": "Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak." }, { "infon": 3, "offset": -1, "text": "In each community, a random sample of adults was selected yearly by multi-stage cluster sampling." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "The scores for all behaviours were then added to derive an overall lifestyle score." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women." }, { "infon": 9, "offset": -1, "text": "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)." }, { "infon": 10, "offset": -1, "text": "Leisure time devoted to physical activities showed an increasing trend in all areas." }, { "infon": 11, "offset": -1, "text": "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." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting." } ] } ] }, { "id": "S0042-96862009000100014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Provision of abortion by mid-level providers: international policy, practice and perspectives." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice." } ] } ] }, { "id": "S0042-96862009000200010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Laboratory confirmation of measles in elimination settings: experience from the Republic of the Marshall Islands, 2003." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: This case study was undertaken in the Republic of the Marshall Islands during a measles outbreak in 2003, when response immunization was conducted." }, { "infon": 2, "offset": -1, "text": "A measles case was defined as fever and rash and one or more of cough, coryza or conjunctivitis." }, { "infon": 3, "offset": -1, "text": "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)." }, { "infon": 4, "offset": -1, "text": "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)." }, { "infon": 5, "offset": -1, "text": "The proportion of IgM+ results varied with clinical presentation, the timing of specimen collection and vaccination status." }, { "infon": 6, "offset": -1, "text": "Positive results on RT-PCR occurred in specimens from eight IgM-negative and four IgM+ individuals who had recently been vaccinated." }, { "infon": 7, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000200012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Further efforts needed to achieve measles elimination in Germany: results of an outbreak investigation." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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)." }, { "infon": 2, "offset": -1, "text": "WHO's clinical case definition was used, and surveillance data from 2006 and 2001 were compared." }, { "infon": 3, "offset": -1, "text": "All cases notified in Duisburg, the most severely affected city, were contacted and interviewed or sent a questionnaire." }, { "infon": 4, "offset": -1, "text": "Health-care provider costs were calculated using information on complications, hospitalization and physician consultations." }, { "infon": 5, "offset": -1, "text": "FINDINGS: In NRW, 1749 cases were notified over a 48-week period." }, { "infon": 6, "offset": -1, "text": "Compared with 2001, the distribution of cases shifted to older age groups (especially the 10-14 year group)." }, { "infon": 7, "offset": -1, "text": "Most cases (n = 614) occurred in Duisburg." }, { "infon": 8, "offset": -1, "text": "Of these, 81% were interviewed; 15% were hospitalized and two died." }, { "infon": 9, "offset": -1, "text": "Of the 464 for whom information was available, 80% were reported as unvaccinated." }, { "infon": 10, "offset": -1, "text": "Common reasons for non-vaccination were parents either forgetting (36%) or rejecting (28%) vaccination." }, { "infon": 11, "offset": -1, "text": "The average cost per measles case was estimated at €373." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: An accumulation of non-immune individuals led to this outbreak." }, { "infon": 13, "offset": -1, "text": "The shift in age distribution has implications for the effectiveness of measles control and the elimination strategy in place." }, { "infon": 14, "offset": -1, "text": "Immediate nationwide school-based catch-up vaccination campaigns targeting older age groups are needed to close critical immunity gaps." }, { "infon": 15, "offset": -1, "text": "Otherwise, the elimination of measles in Germany and thus in Europe by 2010 will not be feasible." } ] } ] }, { "id": "S0042-96862009000200014", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE: To estimate the cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) using sulfadoxine-pyrimethamine (SP)." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "The cost of the intervention, including start-up and recurrent costs, was then assessed on the basis of these figures." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "CONCLUSION: From the health system and societal perspectives, IPTi with SP is expected to produce health improvements in a cost-effective way." }, { "infon": 7, "offset": -1, "text": "From an economic perspective, it offers good value for money for public health programmes." } ] } ] }, { "id": "S0042-96862009000200016", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "How to establish a successful revolving drug fund: the experience of Khartoum state in the Sudan." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "PROBLEM: During the 1990s, the Sudan began several initiatives to establish new medicine-financing mechanisms as part of the health reform process." }, { "infon": 1, "offset": -1, "text": "Initial seed stocks were provided to each hospital." }, { "infon": 2, "offset": -1, "text": "Unfortunately these facility-based funds did not regenerate and the hospitals were left without funds for medicines." }, { "infon": 3, "offset": -1, "text": "The Revolving Drug Fund (RDF) was established in 1989 to facilitate access to medicines in health facilities in Khartoum state." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Data from personal observations and from archival and statistical records were also analysed." }, { "infon": 6, "offset": -1, "text": "Seven health facilities were sampled for this research." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "This policy is based on the experience of the RDF within Khartoum state." }, { "infon": 9, "offset": -1, "text": "RELEVANT CHANGES: Khartoum state has a high (97%) level of availability of essential medicines and this is attributed to the RDF." }, { "infon": 10, "offset": -1, "text": "The RDF medicines were mostly considered affordable by users and very few (6%) patients failed to obtain the prescribed medicines for financial reasons." }, { "infon": 11, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000200018", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "The six major EPSD are scabies, pediculosis (capitis, corporis and pubis), tungiasis and hookworm-related cutaneous larva migrans." }, { "infon": 2, "offset": -1, "text": "We summarize the current knowledge on EPSD and show that these diseases are widespread, polyparasitism is common, and significant primary and secondary morbidity occurs." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "This results in an extraordinarily high prevalence and intensity of infestation of EPSD in resource-poor populations." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "We advocate integrating control of EPSD into intervention measures directed against other neglected diseases such as filariasis and intestinal helminthiases." } ] } ] }, { "id": "S0042-96862009000300011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Data on transfers to secondary- and tertiary-level facilities were obtained for a 6-month period from 30 peripheral hospitals." }, { "infon": 3, "offset": -1, "text": "The cost of the inputs in United States dollars (US$), using 2005 figures, was derived from hospital accounts." }, { "infon": 4, "offset": -1, "text": "FINDINGS: The average total cost of treating a self-poisoned patient at the general hospital was US$ 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." }, { "infon": 5, "offset": -1, "text": "The average total cost of treatment was highest for self-poisoning with pesticides (US$ 49.12)." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "The average total cost of treating self-poisoned patients at peripheral hospitals was US$ 3.33." }, { "infon": 8, "offset": -1, "text": "The average patient cost per transfer was US$ 14.03." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "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." }, { "infon": 11, "offset": -1, "text": "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." }, { "infon": 12, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000300013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "High incidence of childhood pneumonia at high altitudes in Pakistan: a longitudinal cohort study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "OBJECTIVE:To determine the incidence of pneumonia and severe pneumonia among children living at high altitudes in Pakistan." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Community health workers enrolled 5204 eligible children at home and followed them over a 14-month period, ending on 31 December 2002." }, { "infon": 4, "offset": -1, "text": "Health centre staff identified 1397 cases of pneumonia and 377 of severe pneumonia in enrolled children aged 2-35 months." }, { "infon": 5, "offset": -1, "text": "Among children reported with pneumonia, 28% had multiple episodes." }, { "infon": 6, "offset": -1, "text": "Incidence rates per 100 child-years of observation were 29.9 for pneumonia and 8.1 for severe pneumonia." }, { "infon": 7, "offset": -1, "text": "Factors associated with a high incidence of pneumonia were younger age, male gender and living at high altitude." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "More studies are needed to determine the causes of pneumonia in these high-mountain communities." }, { "infon": 10, "offset": -1, "text": "However, early introduction of the vaccines that are known to prevent pneumonia should be considered." } ] } ] }, { "id": "S0042-96862009000300015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Use of active management of the third stage of labour in seven developing countries." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Policies on active management were assessed through document review and interviews with relevant professionals." }, { "infon": 3, "offset": -1, "text": "FINDINGS: Use of a uterotonic during the third or fourth stages of labour was nearly universal." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "In every country except Indonesia, policies regarding active management were conflicting." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "Studies are needed to identify the most effective components of active management so that the most efficient package of practices can be promoted." } ] } ] }, { "id": "S0042-96862009000300017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The health worker shortage in Africa: are enough physicians and nurses being trained?." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "Because of shortages of data in some settings, the study was restricted to 12 countries in sub-Saharan Africa." }, { "infon": 4, "offset": -1, "text": "FINDINGS: Our results suggest that the health workforce shortage in Africa is even more critical than previously estimated." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000300019", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Limitations of methods for measuring out-of-pocket and catastrophic private health expenditures." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "This was done by calculating the ratio of the average obtained with the single-item measure to that obtained with the eight-item measure." }, { "infon": 4, "offset": -1, "text": "Estimates of catastrophic spending from the two measures were also compared." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "However, when the effects of aggregation and recall period are combined, it is difficult to predict which of the two has the greater influence." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "Thus, it is crucial to establish a method to generate valid, reliable and comparable information on private health spending." } ] } ] }, { "id": "S0042-96862009000400011", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Emergency triage assessment for hypoxaemia in neonates and young children in a Kenyan hospital: an observational study." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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)." }, { "infon": 4, "offset": -1, "text": "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)." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "However, 5-15% of the children who had hypoxaemia on admission were missed, and 18% of the children were incorrectly identified as hypoxaemic." }, { "infon": 7, "offset": -1, "text": "CONCLUSION: The syndromes of pneumonia make it possible to identify most hypoxaemic children, including those without LRTI." }, { "infon": 8, "offset": -1, "text": "Shock, bradycardia and irregular breathing are important predictive signs, and severe malaria with respiratory distress is a common cause of hypoxaemia." }, { "infon": 9, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000400013", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Financial barriers to HIV treatment in Yaoundé, Cameroon: first results of a national cross-sectional survey." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "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)." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000400015", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "The persistence of tuberculosis in the age of DOTS: reassessing the effect of case detection." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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)." }, { "infon": 1, "offset": -1, "text": "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%." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "The model was applied in two hypothetical populations: one without HIV and the other with a stable HIV incidence representative of the African Region." }, { "infon": 4, "offset": -1, "text": "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." }, { "infon": 5, "offset": -1, "text": "Immediately increasing the TB CDR from 0% to 70% caused a 74% reduction in TB incidence within 10 years." }, { "infon": 6, "offset": -1, "text": "However, once case detection stabilized at any constant level < 80%, projected TB incidence also stabilized." }, { "infon": 7, "offset": -1, "text": "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." }, { "infon": 8, "offset": -1, "text": "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." }, { "infon": 9, "offset": -1, "text": "TB control programmes and researchers should vigorously pursue improvements in case detection, regardless of current CDRs." } ] } ] }, { "id": "S0042-96862009000400017", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Promoting the health of marginalized populations in Ecuador through international collaboration and educational innovations." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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)." }, { "infon": 1, "offset": -1, "text": "We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." } ] } ] }, { "id": "S0042-96862009000500010", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Severe physical punishment: risk of mental health problems for poor urban children in Brazil." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "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." }, { "infon": 2, "offset": -1, "text": "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%)." }, { "infon": 3, "offset": -1, "text": "This study focused on children aged 6-17 years (n = 480)." }, { "infon": 4, "offset": -1, "text": "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)." }, { "infon": 5, "offset": -1, "text": "Severe physical punishment was defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon." }, { "infon": 6, "offset": -1, "text": "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)." }, { "infon": 7, "offset": -1, "text": "The WHO Self-Reporting Questionnaire (SRQ-20) was used to identify maternal anxiety or depression (score > 7)." }, { "infon": 8, "offset": -1, "text": "Backward logistic regression analysis identified independent correlates and significant interactions." }, { "infon": 9, "offset": -1, "text": "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." }, { "infon": 10, "offset": -1, "text": "It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression." }, { "infon": 11, "offset": -1, "text": "Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment." }, { "infon": 12, "offset": -1, "text": "CONCLUSION: Severe punishment may be related to child mental health problems, with the mechanism depending on the type of problem." }, { "infon": 13, "offset": -1, "text": "Its influence persists in the presence of family stressors such as the father's absence and maternal anxiety or depression." } ] } ] }, { "id": "S0042-96862009000500012", "passage": [ { "infon": [ "EN", "title" ], "offset": -1, "sentence": { "infon": 0, "offset": -1, "text": "Child maltreatment prevention: a systematic review of reviews." } }, { "infon": [ "EN", "abstract" ], "offset": -1, "sentence": [ { "infon": 0, "offset": -1, "text": "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." }, { "infon": 1, "offset": -1, "text": "METHODS: A systematic review of reviews was conducted." }, { "infon": 2, "offset": -1, "text": "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." }, { "infon": 3, "offset": -1, "text": "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." }, { "infon": 4, "offset": -1, "text": "Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment." }, { "infon": 5, "offset": -1, "text": "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." }, { "infon": 6, "offset": -1, "text": "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." }, { "infon": 7, "offset": -1, "text": "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." } ] } ] } ] } }