ethansimrm/wmt16_biomed_test · Datasets at Hugging Face

S0004-05922010000100015

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EN

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Response of broiler chicks to diets with bambaranut (Voandzeia subterranea) as a protein source

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EN

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abstract

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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.

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The test diets were formulated such that bambaranut constituted 25% of the diets.

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Treatment 1 (control) contained no bambaranut, treatment 2 contained raw bambaranut and treatment 3 toasted bambaranut.

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The study lasted for 6 weeks during which weight gain and feed consumption were measured.

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The performance of the various groups was evaluated using weight gain, feed conversion ratio and cost per kg weight gain.

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At slaughter, various internal organs were excised, evaluated for gross lesions and weighed.

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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.

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Cost per kg weight gain was higher in the toasted bambaranut groups.

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8

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There were neither statistically significant differences (p>0.05) in the organ weights nor observable abdominal fat and gross pathology of the internal organs.

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S0004-05922011000300039

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EN

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Effects of reducing postpartum re-mating timeperiod on reproductive performance of the doe

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EN

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abstract

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Rabbits being induced ovulators can be rebred within 24 hours after parturition.

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However, reproductive efficiency and the doe's physiology can be affected by postpartum re-mating interval.

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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.

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Three groups of crossbred (New Zealand White × Chinchilla) does were used in a randomized complete block design.

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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.

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Acceptance of mating decreased with increasing postpartum remating interval.

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Conception rate was highest in the 21-28 days group (98.8%) and lowest in the 1020 days group (68.4%).

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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).

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Litter size and weight at birth were not significantly affected.

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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%).

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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).

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Reducing the re-mating interval after parturition enhanced sexual activity.

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Fertility was comparable in does re-mated 1-9 and 21-28 days after parturition.

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S0004-05922013000200020

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EN

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Factors influencing reproduction parameters of ewes Ouled Djellal

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EN

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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 %.

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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.

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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.

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As for prolificacy, it is significantly influenced by the physiological state during the mating and very significantly by the month of mating.

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S0042-96862000000100003

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EN

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Socioeconomic inequalities in child mortality: comparisons across nine developing countries.

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EN

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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.

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The data were obtained from the Living Standards Measurement Study and the Cebu Longitudinal Health and Nutrition Survey.

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Mortality rates were estimated directly where complete fertility histories were available and indirectly otherwise.

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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.

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S0042-96862000000100005

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EN

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Defining and measuring health inequality: an approach based on the distribution of health expectancy.

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EN

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This paper proposes an approach to conceptualizing and operationalizing the measurement of health inequality, defined as differences in health across individuals in the population.

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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.

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In the measurement of health inequality, the complete range of fatal and non-fatal health outcomes should be incorporated.

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This notion is operationalized through the concept of healthy lifespan.

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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.

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In other words, the quantity of interest for studying health inequality is the distribution of health expectancy across individuals in the population.

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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.

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The exact form of the measure to summarize inequality depends on three normative choices.

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8

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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.

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S0042-96862000000100007

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EN

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Public spending on health care in Africa: do the poor benefit?.

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EN

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abstract

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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.

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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.

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It concludes that this targeting problem cannot be solved simply by adjusting the subsidy allocations.

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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

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S0042-96862000000100017

language

EN

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Deterioration in the nutritional status of young children and their mothers in Brazzaville, Congo, following the 1994 devaluation of the CFA franc.

language

EN

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abstract

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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.

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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.

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2

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The surveys involved a representative sample of 4206 households with a child aged 4-23 months.

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Complementary feeding practices and the anthropometric indices of the children and their mothers were compared, adjusting for changes in household socioeconomic characteristics.

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4

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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.

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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.

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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.

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7

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The influence of these factors on nutritional status is discussed.

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S0042-96862000000100019

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EN

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Health system reform and the role of field sites based upon demographic and health surveillance.

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EN

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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.

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Their role in health system reform, whether national or international, has, however, proved considerably more limited.

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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.

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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.

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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.

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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.

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S0042-96862000000200003

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EN

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Safety of immunization injections in Africa: not simply a problem of logistics.

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EN

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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.

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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.

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2

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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.

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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.

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Facilities for the proper disposal of used materials were rarely present.

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Although the official EPI choice was to use sterilizable equipment, use of a combination of sterilizable and disposable equipment was observed in the field.

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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.

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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.

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S0042-96862000000200005

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EN

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Monitoring signals for vaccine safety: the assessment of individual adverse event reports by an expert advisory committee.

language

EN

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abstract

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Monitoring vaccine safety is a complex and shared responsibility.

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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.

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2

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The task is difficult because ascribing causality to an individual case report is fraught with challenges.

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A standardized evaluation instrument - known as the causality assessment form - was therefore developed for use by an expert advisory committee to facilitate the process.

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By following the several sections in this form, the members of the committee are taken through series of points to establish causality.

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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.

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The form concludes with consensus assessment of causality, a commentary about the assessment, and advice for further study or follow-up.

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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.

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8

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Through analyses such as this, new signals can be identified and investigated further.

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S0042-96862000000200007

language

EN

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Simian virus 40, poliovirus vaccines, and human cancer: research progress versus media and public interests.

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EN

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abstract

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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.

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SV40 was discovered in 1960 and subsequently eliminated from poliovirus vaccines.

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2

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This article reviews current knowledge about SV40 and considers public responses to reports in the media.

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SV40 is a potent tumour virus with broad tissue tropism that induces tumours in rodents and transforms cultured cells from many species.

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It is also an important laboratory model for basic studies of molecular processes in eukaryotic cells and mechanisms of neoplastic transformation.

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SV40 neutralizing antibodies have been detected in individuals not exposed to contaminated poliovirus vaccines.

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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.

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However, additional studies are necessary to prove that SV40 is the cause of certain human cancers.

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8

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A recently published review article evaluated the status of the field and received much media attention.

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The public response emphasized that there is great interest in the possibility of health risks today from vaccinations received in the past.

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S0042-96862000000200014

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EN

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title

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0

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Directly observed treatment, short-course strategy and multidrug-resistant tuberculosis: are any modifications required?.

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EN

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abstract

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0

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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.

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Short-course chemotherapy is a key ingredient in the tuberculosis control strategy known as directly observed treatment, short-course (DOTS).

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For populations in which multidrug-resistant tuberculosis is endemic, the outcome of the standard short-course chemotherapy regimen remains uncertain.

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Unacceptable failure rates have been reported and resistance to additional agents may be induced.

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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.

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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.

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S0042-96862000000200016

language

EN

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title

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0

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Preventing trachoma through environmental sanitation: a review of the evidence base.

language

EN

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abstract

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0

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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.

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1

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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.

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2

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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.

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3

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Person-to-person contact and flies appear to constitute the major transmission pathways.

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4

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Improvement of personal and community hygiene has great potential for a sustainable reduction in trachoma transmission.

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5

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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.

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6

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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.

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S0042-96862000000300003

language

EN

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title

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0

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Disease eradication as a public health strategy: a case study of poliomyelitis eradication.

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EN

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abstract

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0

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Disease eradication as a public health strategy was discussed at international meetings in 1997 and 1998.

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1

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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).

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2

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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'.

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The costs are found to be financial and finite, despite some disturbances to the delivery of other health services.

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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).

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5

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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.

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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.

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S0042-96862000000300005

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EN

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title

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0

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Polio as a platform: using national immunization days to deliver vitamin A supplements.

language

EN

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abstract

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0

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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".

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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.

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Importantly, this integration is helping to achieve the World Summit for Children goal of eliminating vitamin A deficiency by the year 2000.

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It is estimated that between 140 million and 250 million preschool children are at risk of subclinical vitamin A deficiency.

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In 1998 more than 60 million children at risk received vitamin A supplements during polio national immunization days (NIDs).

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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.

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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.

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S0042-96862000000300007

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EN

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title

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Poliomyelitis surveillance: the model used in India for polio eradication.

language

EN

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abstract

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Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases.

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The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis (AFP).

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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.

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3

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Data reported at the national level are analysed and distributed weekly.

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4

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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.

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5

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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.

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6

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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.

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7

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Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh.

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8

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In order to achieve polio eradication in India during 2000, extra national immunization days and house-to-house mopping-up rounds should be organized.

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S0042-96862000000300010

language

EN

section

title

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0

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Stopping poliovirus vaccination after eradication: issues and challenges.

language

EN

section

abstract

-1

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0

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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.

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1

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With eradication of poliomyelitis approaching, issues potentially affecting when and how vaccination against poliovirus can be stopped become extremely important.

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2

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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.

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3

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The scientific basis for stopping polio immunization has been reviewed by WHO.

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4

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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.

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5

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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.

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S0042-96862000000300014

language

EN

section

title

-1

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0

-1

The role of son preference in reproductive behaviour in Pakistan.

language

EN

section

abstract

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0

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The sex of surviving children is an important determinant of reproductive behaviour in South Asia in general and Pakistan in particular.

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1

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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.

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2

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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.

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3

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The results show that pregnancies became increasingly unwanted as the number of surviving sons increased.

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4

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The sex of surviving children was strongly correlated with subsequent fertility and contraceptive behaviour.

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5

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However, rather than an exclusive son preference, couples strove for one or more sons and at least one surviving daughter.

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6

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The policy implications of the link between overt son preference and low status of women are discussed.

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S0042-96862000000300016

language

EN

section

title

-1

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0

-1

A proposal to declare neurocysticercosis an international reportable disease.

language

EN

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abstract

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0

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Neurocysticercosis is an infection of the nervous system caused by Taenia solium.

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1

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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.

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2

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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.

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3

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Intestinal tapeworms cause few symptoms, but adult taeniae carried by humans release large numbers of infective eggs and are extremely contagious.

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Ingestion of poorly cooked pig meat infested with T. solium larvae results in intestinal taeniosis but not neurocysticercosis.

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5

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With a view to hastening the control of taeniosis and neurocysticercosis we propose that neurocysticercosis be declared an international reportable disease.

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New cases of neurocysticercosis should be reported by physicians or hospital administrators to their health ministries.

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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.

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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.

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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.

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S0042-96862000000400004

language

EN

section

title

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0

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The burden of mental disorders: a comparison of methods between the Australian burden of disease studies and the Global Burden of Disease study.

language

EN

section

abstract

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0

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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.

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1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

null

S0042-96862000000400006

language

EN

section

title

-1

sentnum

0

-1

Why does the burden of disease persist?

language

EN

section

abstract

-1

sentnum

0

-1

Why does the burden of mental disorders persist in established market economies?

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

The efficacy of treatments for both disorders has been established.

sentnum

5

-1

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.

sentnum

6

-1

Treatment was not predictive of disorders that remitted during the year.

sentnum

7

-1

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.

null

sentnum

1

-1

Relating the burden of anxiety and depression to effectiveness of treatment.

null

S0042-96862000000400009

language

EN

section

title

-1

sentnum

0

-1

Mental health policy development in Africa.

language

EN

section

abstract

-1

sentnum

0

-1

Mental health issues are usually given very low priority in health service policies.

sentnum

1

-1

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.

sentnum

2

-1

Every country must formulate a mental health policy based on its own social and cultural realities.

sentnum

3

-1

Such policies must take into account the scope of mental health problems, provide proven and affordable interventions, safeguard patients' rights, and ensure equity.

null

S0042-96862000000400011

language

EN

section

title

-1

sentnum

0

-1

Towards a global alcohol policy: alcohol, public health and the role of WHO.

language

EN

section

abstract

-1

sentnum

0

-1

In 1983 the World Health Assembly declared alcohol-related problems to be among the world's major health concerns.

sentnum

1

-1

Since then, alcohol consumption has risen in developing countries, where it takes a heavy toll.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

Development agencies and international trade agreements have treated alcohol as a normal commodity, overlooking the adverse consequences of its consumption on productivity and health.

sentnum

7

-1

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.

sentnum

8

-1

Such leadership can play a significant part in diminishing the health and social problems associated with alcohol use.

null

S0042-96862000000400017

language

EN

section

title

-1

sentnum

0

-1

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.

language

EN

section

abstract

-1

sentnum

0

-1

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).

sentnum

1

-1

A total of 518 infants who were attending mother-and-child health clinics were included.

sentnum

2

-1

Age, weight and length were recorded.

sentnum

3

-1

Anthropometric Z-scores were calculated in two ways: by applying the NCHS growth reference and by using the WHO breastfed data set.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

After the age of 7 months, similar prevalences of stunting or underweight were observed.

sentnum

7

-1

Relatively few infants were classified as wasted.

sentnum

8

-1

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.

null

S0042-96862000000400019

language

EN

section

title

-1

sentnum

0

-1

Global public-private partnerships: part I - a new development in health?.

language

EN

section

abstract

-1

sentnum

0

-1

The proliferation of public-private partnerships is rapidly reconfiguring the international health landscape.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

While GPPPs bring much needed resources to problems of international health, we highlight concerns regarding this new organizational format.

sentnum

6

-1

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.

null

S0042-96862000000500003

language

EN

section

title

-1

sentnum

0

-1

Making abortions safe: a matter of good public health policy and practice.

language

EN

section

abstract

-1

sentnum

0

-1

Globally, abortion mortality accounts for at least 13% of all maternal mortality.

sentnum

1

-1

Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together.

sentnum

2

-1

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.

sentnum

3

-1

This article examines the changes in policy and health service provision required to make abortions safe.

sentnum

4

-1

It is based on a wide-ranging review of published and unpublished sources.

sentnum

5

-1

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.

sentnum

6

-1

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.

sentnum

7

-1

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.

null

S0042-96862000000500005

language

EN

section

title

-1

sentnum

0

-1

Maternal mortality in rural Gambia: levels, causes and contributing factors.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

A total of 9 of the 18 deaths had a direct obstetric cause - haemorrhage (6 deaths), early pregnancy (2), and obstructed labour (1).

sentnum

5

-1

Indirect causes of obstetric deaths were anaemia (4 deaths), hepatitis (1), and undetermined (4).

sentnum

6

-1

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.

null

S0042-96862000000500007

language

EN

section

title

-1

sentnum

0

-1

Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh.

language

EN

section

abstract

-1

sentnum

0

-1

Very few population-based studies of perinatal mortality in developing countries have examined the role of intrapartum risk factors.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

Premature labour, which occurred in 20% of pregnancies, accounted for 27% of perinatal mortality.

sentnum

4

-1

Better care by qualified staff during delivery and improved care of newborns should substantially reduce perinatal mortality in this study population.

null

S0042-96862000000500009

language

EN

section

title

-1

sentnum

0

-1

Measuring reproductive health: review of community-based approaches to assessing morbidity.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

Subsequently, it reviews epidemiological studies that have used a range of methods to estimate the prevalence of reproductive morbidities.

sentnum

2

-1

A detailed review of recent community or hospital based health interview validation studies that compare self-reported, clinical and laboratory measures is presented.

sentnum

3

-1

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.

sentnum

4

-1

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.

null

S0042-96862000000500011

language

EN

section

title

-1

sentnum

0

-1

Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

null

S0042-96862000000500014

language

EN

section

title

-1

sentnum

0

-1

Antibody response of patients after postexposure rabies vaccination with small intradermal doses of purified chick embryo cell vaccine or purified Vero cell rabies vaccine.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

The patients presented at two Thai hospitals and were randomized into three groups.

sentnum

3

-1

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.

sentnum

4

-1

Group 2 was treated similarly, except that purified Vero cell rabies vaccine (PVRV) was used instead of PCECV.

sentnum

5

-1

Group 3 received 1.0 ml PCECV intramuscularly on days 0, 3, 7, 14, 30 and 90.

sentnum

6

-1

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.

sentnum

7

-1

After 14 days the GMT of 59 patients vaccinated intradermally with PCECV was equivalent to that of patients who received PVRV.

sentnum

8

-1

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.

sentnum

9

-1

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.

null

S0042-96862000000600004

language

EN

section

title

-1

sentnum

0

-1

A framework for assessing the performance of health systems.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

This paper proposes a framework to advance the understanding of health system performance.

sentnum

2

-1

A first step is to define the boundaries of the health system, based on the concept of health action.

sentnum

3

-1

Health action is defined as any set of activities whose primary intent is to improve or maintain health.

sentnum

4

-1

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.

sentnum

5

-1

Improving health means both increasing the average health status and reducing health inequalities.

sentnum

6

-1

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).

sentnum

7

-1

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).

sentnum

8

-1

This implies that everyone is protected from financial risks due to health care.

sentnum

9

-1

The measurement of performance relates goal attainment to the resources available.

sentnum

10

-1

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).

sentnum

11

-1

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.

null

S0042-96862000000600006

language

EN

section

title

-1

sentnum

0

-1

Benchmarks of fairness for health care reform: a policy tool for developing countries.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

We describe briefly the history of the benchmark approach, the tool itself, and the uses to which it may be put.

sentnum

2

-1

Fairness is a wide term that includes exposure to risk factors, access to all forms of care, and to financing.

sentnum

3

-1

It also includes efficiency of management and resource allocation, accountability, and patient and provider autonomy.

sentnum

4

-1

The benchmarks standardize the criteria for fairness.

sentnum

5

-1

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.

sentnum

6

-1

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.

sentnum

7

-1

The benchmarks can be used at both national and provincial or district levels, and we describe plans for such uses in the collaborating sites.

sentnum

8

-1

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.

null

S0042-96862000000600008

language

EN

section

title

-1

sentnum

0

-1

Benchmarks for health expenditures, services and outcomes in Africa during the 1990s.

language

EN

section

abstract

-1

sentnum

0

-1

There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s.

sentnum

1

-1

We intend to make statistical information available for national level comparisons.

sentnum

2

-1

National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews.

sentnum

3

-1

The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

Similar trends were found for health services and outcomes.

sentnum

7

-1

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.

sentnum

8

-1

Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management.

sentnum

9

-1

Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries.

null

S0042-96862000000600010

language

EN

section

title

-1

sentnum

0

-1

Make or buy" decisions in the production of health care goods and services: new insights from institutional economics and organizational theory.

language

EN

section

abstract

-1

sentnum

0

-1

A central theme of recent health care reforms has been a redefinition of the roles of the state and private providers.

sentnum

1

-1

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.

sentnum

2

-1

Empirical evidence from actual production modalities is also taken into consideration.

sentnum

3

-1

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.

sentnum

4

-1

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).

sentnum

5

-1

These valuable resources are often ignored by the public sector.

sentnum

6

-1

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.

sentnum

7

-1

Subsidiary activities within the production process can often be unbundled and outsourced.

null

S0042-96862000000600012

language

EN

section

title

-1

sentnum

0

-1

The role of the hospital in a changing environment.

language

EN

section

abstract

-1

sentnum

0

-1

Hospitals pose many challenges to those undertaking reform of health care systems.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

The size and distribution of hospitals are matters for ongoing debate.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

Isolated behavioural interventions have a limited impact, but are more effective when combined.

sentnum

7

-1

Financial incentives are blunt instruments that must be monitored.

sentnum

8

-1

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.

sentnum

9

-1

Overall, evidence on the effectiveness of policies relating to hospitals is limited and this paper indicates where such evidence can be found.

null

S0042-96862000000600014

language

EN

section

title

-1

sentnum

0

-1

The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

null

S0042-96862000000700003

language

EN

section

title

-1

sentnum

0

-1

Tobacco use by youth: a surveillance report from the Global Youth Tobacco Survey project.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

The GYTS is school based and employs a two-stage sample design to produce representative data on smoking among students aged 13-15 years.

sentnum

2

-1

The first stage consists of a probabilistic selection of schools, and the second consists of a random selection of classes from the participating schools.

sentnum

3

-1

All students in the selected classes are eligible for the survey.

sentnum

4

-1

In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries.

sentnum

5

-1

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.

sentnum

6

-1

The findings show that tobacco use in the surveyed age group ranged from a high of 33% to a low of 10%.

sentnum

7

-1

While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme.

sentnum

8

-1

In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare.

sentnum

9

-1

The majority of young people reported being taught in school about the dangers of smoking.

sentnum

10

-1

Environmental tobacco smoke exposure was very high in all countries.

sentnum

11

-1

These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes.

null

S0042-96862000000700005

language

EN

section

title

-1

sentnum

0

-1

Building the evidence base for global tobacco control.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

The methods used to compile the data are described in the present paper.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

In 1998, men were almost four times more likely than women to be smokers.

sentnum

7

-1

The prevalence of smoking among men was highest in the Western Pacific Region.

sentnum

8

-1

The differential in gender-specific smoking prevalence was narrowest in the Region of the Americas and the European Region.

sentnum

9

-1

It was wider in the South-East Asia Region and the Western Pacific Region.

sentnum

10

-1

The lowest and highest per capita consumption of manufactured cigarettes occurred in the lowest and highest HDI categories respectively.

sentnum

11

-1

In the medium HDI category, China's growing cigarette consumption after 1975 had a major bearing on the rise in per capita consumption.

sentnum

12

-1

Cigarette price trends suggest that there is considerable scope for increasing taxes on tobacco products, particularly in low or medium HDI countries.

null

sentnum

13

-1

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.

null

S0042-96862000000700007

language

EN

section

title

-1

sentnum

0

-1

Tobacco industry tactics for resisting public policy on health.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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'.

sentnum

2

-1

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.

sentnum

3

-1

Societal action is therefore required to ensure that the public health takes precedence over corporate profits.

sentnum

4

-1

Recommendations for reducing the political influence of the tobacco industry include the following.

sentnum

5

-1

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.

sentnum

6

-1

The industry should be required to guarantee internationally recognized basic consumer rights to its customers.

sentnum

7

-1

Trade associations and other industry groupings established to deceive the public should be disbanded.

sentnum

8

-1

These recommendations should be incorporated into WHO's Framework Convention on Tobacco Control.

null

S0042-96862000000700010

language

EN

section

title

-1

sentnum

0

-1

WHO Framework Convention on Tobacco Control: a global good' for public health.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

Scientific evidence in public health and economics has provided the foundation for the elaboration of this evidence-based strategy.

sentnum

5

-1

The present tobacco epidemic poses a range of transnational challenges that are best addressed through coordinated action.

sentnum

6

-1

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.

null

S0042-96862000000800003

language

EN

section

title

-1

sentnum

0

-1

Pattern of susceptibility to measles in Italy.

language

EN

section

abstract

-1

sentnum

0

-1

On the basis of seroprevalence and incidence data we describe the distribution of individuals susceptible and immune to measles in Italy in 1996-97.

sentnum

1

-1

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.

sentnum

2

-1

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%.

sentnum

3

-1

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.

sentnum

4

-1

These data confirm the partial reduction in measles incidence in Italy, although transmission has still not been interrupted.

sentnum

5

-1

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.

null

S0042-96862000000800005

language

EN

section

title

-1

sentnum

0

-1

Low-cost technology for screening uterine cervical cancer.

language

EN

section

abstract

-1

sentnum

0

-1

We report on an illuminated, low-cost (Rs 1500 (US$ 36)) magnifying device (Magnivisualizer) for detecting precancerous lesions of the uterine cervix.

sentnum

1

-1

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.

sentnum

2

-1

Pap smears were obtained at the same time.

sentnum

3

-1

The results were compared with those obtained using colposcopy and/or histology.

sentnum

4

-1

The Magnivisualizer improved the detection rate of early cancerous lesions from 60%, for unaided visual inspection, to 95%.

sentnum

5

-1

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.

sentnum

6

-1

For low-grade dysplasia the sensitivity of detection by means of the Magnivisualizer was 57.5%, in contrast with 75.3% for cytological examination.

sentnum

7

-1

However, the two methodologies had similar sensitivities for higher grades of lesions.

sentnum

8

-1

The specificity of screening with the Magnivisualizer was 94.3%, while that of cytology was 99%.

sentnum

9

-1

The cost per screening was approximately US$ 0.55 for the Magnivisualizer and US$ 1.10 for cytology.

null

S0042-96862000000800007

language

EN

section

title

-1

sentnum

0

-1

Validation of spot-testing kits to determine iodine content in salt.

language

EN

section

abstract

-1

sentnum

0

-1

Iodine deficiency disorders are a major public health problem, and salt iodization is the most widely practised intervention for their elimination.

sentnum

1

-1

For the intervention to be successful and sustainable, it is vital to monitor the iodine content of salt regularly.

sentnum

2

-1

Iodometric titration, the traditional method for measuring iodine content, has problems related to accessibility and cost.

sentnum

3

-1

The newer spot-testing kits are inexpensive, require minimal training, and provide immediate results.

sentnum

4

-1

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.

sentnum

5

-1

Salt samples from Delhi were collected from 30 schools, chosen using the Expanded Programme on Immunization (EPI) cluster sampling technique.

sentnum

6

-1

A single observer made the measurement for iodine content using the kit.

sentnum

7

-1

Salt samples from Madhya Pradesh were from 30 rural and 30 urban clusters, identified by using census data and the EPI cluster sampling technique.

sentnum

8

-1

In each cluster, salt samples were collected from 10 randomly selected households and all retailers.

sentnum

9

-1

The 15 investigators performing the survey estimated the iodine content of salt samples in the field using the kit.

sentnum

10

-1

All the samples were brought to the central laboratory in Delhi, where iodine content was estimated using iodometric titration as a reference method.

sentnum

11

-1

The agreement between the kit and titration values decreased as the number of observers increased.

sentnum

12

-1

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).

null

sentnum

13

-1

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.

sentnum

14

-1

This overestimation could result in complacency.

sentnum

15

-1

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.

null

S0042-96862000000800009

language

EN

section

title

-1

sentnum

0

-1

Why aircraft disinsection?.

language

EN

section

abstract

-1

sentnum

0

-1

A serious problem is posed by the inadvertent transport of live mosquitoes aboard aircraft arriving from tropical countries where vector-borne diseases are endemic.

sentnum

1

-1

Surveys at international airports have found many instances of live insects, particularly mosquitoes, aboard aircraft arriving from countries where malaria and arboviruses are endemic.

sentnum

2

-1

In some instances mosquito species have been established in countries in which they have not previously been reported.

sentnum

3

-1

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.

sentnum

4

-1

There is an important on-going need for the disinsection of aircraft coming from airports in tropical disease endemic areas into nonendemic areas.

sentnum

5

-1

The methods and materials available for use in aircraft disinsection and the WHO recommendations for their use are described.

null

S0042-96862000000800011

language

EN

section

title

-1

sentnum

0

-1

New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes.

language

EN

section

abstract

-1

sentnum

0

-1

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).

sentnum

1

-1

As safety information changes, however, checklists can quickly become outdated.

sentnum

2

-1

Inconsistent checklists and eligibility criteria often cause uneven access to contraceptives.

sentnum

3

-1

In 1996, WHO produced updated eligibility criteria for the use of all contraceptive methods.

sentnum

4

-1

Based on these criteria, new checklists for COCs and DMPA were developed.

sentnum

5

-1

This article describes the new checklists and their development.

sentnum

6

-1

Several rounds of expert review produced checklists that were correct, comprehensible and consistent with the eligibility requirements.

sentnum

7

-1

Nevertheless, field-testing of the checklists revealed that approximately half (48%) of the respondents felt that one or more questions still needed greater comprehensibility.

sentnum

8

-1

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.

sentnum

9

-1

The article reflects also the resulting updated checklist.

null

S0042-96862000000800013

language

EN

section

title

-1

sentnum

0

-1

Antiretroviral interventions to reduce mother-to-child transmission of human immunodeficiency virus: challenges for health systems, communities and society.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

Interventions aiming to reduce mother-to-child transmission should be concerned with the rights of both the child and the mother.

sentnum

2

-1

Women should not be seen as vectors of transmission but as people entitled to adequate health care and social services in their own right.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

Problems arise in relation to the basic requirements for introducing such interventions via the health services in developing countries.

sentnum

6

-1

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.

null

S0042-96862000000800015

language

EN

section

title

-1

sentnum

0

-1

Overlooked opportunities for investing in health research and development.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

In situations of uncertainty or complexity, a method of priority-setting that emphasizes certainty and simplicity may actually mislead.

sentnum

3

-1

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.

null

S0042-96862000000900004

language

EN

section

title

-1

sentnum

0

-1

Indoor air pollution in developing countries: a major environmental and public health challenge.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

These materials are typically burnt in simple stoves with very incomplete combustion.

sentnum

2

-1

Consequently, women and young children are exposed to high levels of indoor air pollution every day.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

Conflicting evidence exists with regard to asthma.

sentnum

6

-1

All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding.

sentnum

7

-1

As a result, risk estimates are poorly quantified and may be biased.

sentnum

8

-1

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.

sentnum

9

-1

Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making.

sentnum

10

-1

Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections.

sentnum

11

-1

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.

null

S0042-96862000000900006

language

EN

section

title

-1

sentnum

0

-1

Guidelines for the microbiological quality of treated wastewater used in agriculture: recommendations for revising WHO guidelines.

language

EN

section

abstract

-1

sentnum

0

-1

Three different approaches for establishing guidelines for the microbiological quality of treated wastewater that is reused for agriculture are reviewed.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

This combined approach is more cost-effective than the first approach and adequately protects public health.

sentnum

4

-1

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.

sentnum

5

-1

A limit of < 103 faecal coliform bacteria/100 ml is recommended if flood irrigation is used or children are exposed.

sentnum

6

-1

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.

null

S0042-96862000000900009

language

EN

section

title

-1

sentnum

0

-1

Climate change and vector-borne diseases: a regional analysis.

language

EN

section

abstract

-1

sentnum

0

-1

Current evidence suggests that inter-annual and inter-decadal climate variability have a direct influence on the epidemiology of vector-borne diseases.

sentnum

1

-1

This evidence has been assessed at the continental level in order to determine the possible consequences of the expected future climate change.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

For many diseases these lie in the range 14-18 °C at the lower end and about 35-40 °C at the upper end.

sentnum

5

-1

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.

sentnum

6

-1

Encephalitis is also becoming a public health concern.

sentnum

7

-1

Health risks due to climatic changes will differ between countries that have developed health infrastructures and those that do not.

sentnum

8

-1

Human settlement patterns in the different regions will influence disease trends.

sentnum

9

-1

While 70% of the population in South America is urbanized, the proportion in sub-Saharan Africa is less than 45%.

sentnum

10

-1

Climatic anomalies associated with the El Niño-Southern Oscillation phenomenon and resulting in drought and floods are expected to increase in frequency and intensity.

sentnum

11

-1

They have been linked to outbreaks of malaria in Africa, Asia and South America.

sentnum

12

-1

Climate change has far-reaching consequences and touches on all life-support systems.

null

sentnum

13

-1

It is therefore a factor that should be placed high among those that affect human health and survival.

null

S0042-96862000001000004

language

EN

section

title

-1

sentnum

0

-1

The decline in child mortality: a reappraisal.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

Our analysis updates previous studies by UNICEF, the World Bank and the United Nations.

sentnum

2

-1

It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

On average about 15% of newborn children in Africa are expected to die before reaching their fifth birthday.

sentnum

6

-1

The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%.

sentnum

7

-1

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.

sentnum

8

-1

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.

sentnum

9

-1

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.

sentnum

10

-1

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.

null

S0042-96862000001000006

language

EN

section

title

-1

sentnum

0

-1

Trends in under-5 mortality rates and the HIV/AIDS epidemic.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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%).

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

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.

sentnum

7

-1

DISCUSSION: The contribution of HIV/AIDS to childhood mortality therefore appears to be most noticeable in settings where the epidemic is most severe.

null

S0042-96862000001000008

language

EN

section

title

-1

sentnum

0

-1

Is malnutrition declining?

language

EN

section

abstract

-1

sentnum

0

-1

Nutritional status is the best global indicator of well-being in children.

sentnum

1

-1

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.

sentnum

2

-1

Cross-sectional data from 241 nationally representative surveys were analysed in a standard way to produce comparable results of low height-for-age (stunting).

sentnum

3

-1

Multilevel modelling was applied to estimate regional and global trends from 1980 to 2005.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

Despite an overall decrease of stunting in developing countries, child malnutrition still remains a major public health problem in these countries.

sentnum

7

-1

In some countries rates of stunting are rising, while in many others they remain disturbingly high.

sentnum

8

-1

The data we have presented provide a baseline for assessing progress and help identify countries and regions in need of population wide interventions.

sentnum

9

-1

Approaches to lower child malnutrition should be based on successful nutrition programmes and policies.

null

sentnum

1

-1

An analysis of changes in levels of child malnutrition since 1980.

null

S0042-96862000001000011

language

EN

section

title

-1

sentnum

0

-1

Factors associated with trends in infant and child mortality in developing countries during the 1990s.

language

EN

section

abstract

-1

sentnum

0

-1

The 1990s have seen a remarkable decrease in mortality among infants and children in most developing countries.

sentnum

1

-1

In some countries, particularly in sub-Saharan Africa, these declines in mortality among children have slowed and are now increasing again.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

Both simple analyses and multivariate analyses of changes in these factors between surveys indicate that all factors affected the mortality trends.

sentnum

5

-1

However, to explain trends in mortality, the variables themselves had to have changed over time.

sentnum

6

-1

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.

sentnum

7

-1

This study confirms that trends in mortality during the 1990s were related to more than just a handful of variables.

sentnum

8

-1

It would, therefore, be a mistake to concentrate policy actions on one or a few of these while forsaking others.

sentnum

9

-1

Countries with the largest decreases in mortality have had substantial improvements in most of the factors that might be used to explain these changes.

sentnum

10

-1

In some countries mortality has risen.

sentnum

11

-1

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.

sentnum

12

-1

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.

null

S0042-96862000001100004

language

EN

section

title

-1

sentnum

0

-1

Associations between socioeconomic status and cardiovascular risk factors in an urban population in China.

language

EN

section

abstract

-1

sentnum

0

-1

INTRODUCTIONS: In developed countries socioeconomic status has been proven to be an important factor in the progression of cardiovascular disease.

sentnum

1

-1

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.

sentnum

2

-1

METHODS: In 1996, a behavioural risk factor survey was carried out in Tianjin, the third largest city in China.

sentnum

3

-1

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.

sentnum

4

-1

The present study covers respondents aged 25-69 years (1615 men and 1592 women).

sentnum

5

-1

Four socioeconomic indicators (education, occupation, income, and marital status), blood pressure, body mass index, and cigarette smoking were determined in the survey.

sentnum

6

-1

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.

sentnum

7

-1

People with lower socioeconomic status had higher levels of cardiovascular risk factors.

sentnum

8

-1

The association between socioeconomic status and cardiovascular risk factors was more consistent among women than men.

sentnum

9

-1

DISCUSSION: Our findings do not seem to differ from those observed in developed countries.

null

S0042-96862000001100006

language

EN

section

title

-1

sentnum

0

-1

Association of diarrhoea and upper respiratory infections with weight and height gains in Bangladeshi children aged 5 to 11 years.

language

EN

section

abstract

-1

sentnum

0

-1

INTRODUCTION: The association between infection and growth delay is not well documented in school-age children in developing countries.

sentnum

1

-1

We conducted a prospective cohort study to examine the association between infectious disease and weight and height gains among Bangladeshi children.

sentnum

2

-1

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.

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3

-1

The study included 135 households randomly selected from four villages in the Matlab area.

sentnum

4

-1

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).

sentnum

5

-1

The number of episodes and their duration decreased significantly with age.

sentnum

6

-1

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.

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7

-1

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).

sentnum

8

-1

Neither the incidence nor the duration of upper respiratory infections was associated with weight gain.

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9

-1

Height gain was not significantly associated with the duration or incidence of either category of illness.

sentnum

10

-1

Diarrhoea was a significant correlate of retarded weight gain among children above preschool age, whereas upper respiratory infections were not.

sentnum

11

-1

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.

sentnum

12

-1

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.

null

S0042-96862000001100008

language

EN

section

title

-1

sentnum

0

-1

Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia.

language

EN

section

abstract

-1

sentnum

0

-1

INTRODUCTION: There is a paucity of published data on the type of conditions that require surgery among children in sub-Saharan Africa.

sentnum

1

-1

Such information is necessary for assessing the impact of such conditions on child health and for setting priorities to improve paediatric surgical care.

sentnum

2

-1

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.

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3

-1

RESULTS: A total of 1726 children were admitted with surgical problems.

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4

-1

Surgical patients accounted for 11.3% of paediatric admissions and 34 625 total inpatient days.

sentnum

5

-1

The most common admission diagnoses were injuries (46.9%), congenital anomalies (24.3%), and infections requiring surgery (14.5%).

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6

-1

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%).

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7

-1

Gambian children were rarely admitted for appendicitis and never admitted for hypertrophic pyloric stenosis.

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8

-1

The leading causes of surgical deaths were burns, congenital anomalies, and injuries other than burns.

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9

-1

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.

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10

-1

Surgical care of children should be considered an essential component of child health programmes in developing countries.

null

S0042-96862000001100010

language

EN

section

title

-1

sentnum

0

-1

Information systems: the key to evidence-based health practice.

language

EN

section

abstract

-1

sentnum

0

-1

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making.

sentnum

1

-1

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.

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2

-1

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.

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3

-1

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.

sentnum

4

-1

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.

null

S0042-96862000001100012

language

EN

section

title

-1

sentnum

0

-1

Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economy.

language

EN

section

abstract

-1

sentnum

0

-1

Globalization has led to an increase in the spread of emerging and re-emerging infectious diseases.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

The article presents two cases - plague in India and cholera in Peru - that illuminate some of the limitations of current practices.

sentnum

5

-1

Recommendations are made on measures that could be taken by WHO and the world community to make global surveillance acceptable.

null

S0042-96862000001200006

language

EN

section

title

-1

sentnum

0

-1

Comparison of house spraying and insecticide-treated nets for malaria control.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

Possible explanations include the longer duration of most of the earlier spraying projects and the use of non-irritant insecticides.

sentnum

4

-1

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).

sentnum

5

-1

Comparative tests with non-irritant insecticides, including their use on nets, are advocated.

sentnum

6

-1

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.

sentnum

7

-1

The importance of high population coverage is emphasized, and the advantages of providing treatment free of charge, rather than charging individuals, are pointed out.

null

S0042-96862000001200008

language

EN

section

title

-1

sentnum

0

-1

Molecular entomology and prospects for malaria control.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

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.

null

S0042-96862000001200010

language

EN

section

title

-1

sentnum

0

-1

Using a geographical information system to plan a malaria control programme in South Africa.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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).

sentnum

2

-1

METHODS: To better map control programme activities to their geographical location, the malaria notification system was overhauled and a geographical information system implemented.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

DISCUSSION: The geographical information system for malaria was enormously valuable in enabling malaria risk at town and village level to be shown.

sentnum

7

-1

Matching malaria control measures to specific strata of endemic malaria has provided the opportunity for more efficient malaria control in Mpumalanga province.

null

S0042-96862000001200015

language

EN

section

title

-1

sentnum

0

-1

Safety of community drinking-water and outbreaks of waterborne enteric disease: Israel, 1976-97.

language

EN

section

abstract

-1

sentnum

0

-1

Waterborne disease remains a major public health problem in many countries.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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).

sentnum

6

-1

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.

sentnum

7

-1

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.

null

S0042-96862001000100004

language

EN

section

title

-1

sentnum

0

-1

Pilot study of the use of community volunteers to distribute azithromycin for trachoma control in Ghana.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the skills of community health volunteers in diagnosing active trachoma and distributing azithromycin in the Northern Region of Ghana.

sentnum

1

-1

METHODS: Six community health volunteers from Daboya were trained to diagnose trachoma and to treat the disease using azithromycin.

sentnum

2

-1

They were also informed of the drug's possible side-effects.

sentnum

3

-1

Under supervision, each volunteer then examined, and if necessary treated, 15 households.

sentnum

4

-1

The dose of azithromycin was determined by weight; height was also measured.

sentnum

5

-1

Tablets were given in preference to suspension when possible.

sentnum

6

-1

RESULTS: The volunteers' diagnostic sensitivity for active trachoma was 63%; their specificity was 96%.

sentnum

7

-1

At the household level, their decision to treat' was correct in 83% of households.

sentnum

8

-1

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).

sentnum

9

-1

The volunteers' drug management skills were good, the response of the community was excellent, and adverse reactions were infrequent.

sentnum

10

-1

Diagnosis of active trachoma, record-keeping skills, and knowledge of side-effects were found to need greater emphasis in any future education programme.

sentnum

11

-1

Most people aged four years or older were able to swallow tablets.

sentnum

12

-1

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.

null

sentnum

13

-1

CONCLUSION: Trained community health volunteers have a potential role in identifying active trachoma and distributing azithromycin.

sentnum

14

-1

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.

null

S0042-96862001000100006

language

EN

section

title

-1

sentnum

0

-1

The use of hospital-based nurses for the surveillance of potential disease outbreaks.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

Sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

No secondary cases followed detection and prompt response to 14 patients with meningococcal disease.

sentnum

6

-1

By the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time.

sentnum

7

-1

Formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system.

sentnum

8

-1

CONCLUSION: The primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response.

sentnum

9

-1

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.

sentnum

10

-1

This review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action.

null

S0042-96862001000100008

language

EN

section

title

-1

sentnum

0

-1

Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples.

sentnum

6

-1

Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing.

sentnum

7

-1

CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this disease.

null

S0042-96862001000100010

language

EN

section

title

-1

sentnum

0

-1

Community-based trials of sexually transmitted disease treatment: repercussions for epidemiology and HIV prevention.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

The importance of a study's location and explanations for the divergent results of these trials are discussed.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

However, the Rakai trial was stopped because there was no difference in the incidence of HIV between the intervention and control arms.

sentnum

5

-1

If Mwanza is seen as the trial that needs explaining, another paradigm becomes relevant.

sentnum

6

-1

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.

sentnum

7

-1

Because of their shorter latency periods, STDs may prompt attendance at a clinic before the early signs of HIV-1 infection appear.

sentnum

8

-1

Part of the management of STDs is to recommend abstinence or the consistent use of condoms until treatment is completed.

sentnum

9

-1

This recommendation may cover the earliest period of viraemia during primary HIV-1 infection.

sentnum

10

-1

This paradigm appears to explain the results from Mwanza and Rakai, emphasizing behavioural aspects of syndromic management.

null

S0042-96862001000200003

language

EN

section

title

-1

sentnum

0

-1

Awareness of eye diseases in an urban population in southern India.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the level of awareness of eye diseases in the urban population of Hyderabad in southern India.

sentnum

1

-1

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.

sentnum

2

-1

Of these subjects, 1859 aged >15 years responded to a structured questionnaire on cataract, glaucoma, night blindness and diabetic retinopathy to trained field investigators.

sentnum

3

-1

Having heard of the eye disease in question was defined as awareness' and having some understanding of the eye disease was defined as knowledge'.

sentnum

4

-1

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.

sentnum

5

-1

Knowledge of all the eye diseases assessed was poor.

sentnum

6

-1

Subjects aged > 30 years were significantly more aware of all eye diseases assessed except night blindness.

sentnum

7

-1

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).

sentnum

8

-1

Education played a significant role in awareness of these eye diseases.

sentnum

9

-1

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).

sentnum

10

-1

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).

sentnum

11

-1

The major source of awareness of the eye diseases was a family member/friend/relative suffering from that eye disease.

sentnum

12

-1

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.

null

sentnum

13

-1

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.

null

S0042-96862001000200005

language

EN

section

title

-1

sentnum

0

-1

Local problems, local solutions: improving tuberculosis control at the district level in Malawi.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

There is one TB treatment unit, but several other organizations are involved with TB control.

sentnum

3

-1

An examination of case-holding activities was carried out, potential areas for improvement were identified, and interventions performed.

sentnum

4

-1

FINDINGS: In 1990-91, the cure rate was 24% among smear-positive cases (29% among survivors to end of treatment).

sentnum

5

-1

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.

sentnum

6

-1

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)).

sentnum

7

-1

High cure rates are therefore achievable despite high HIV prevalence.

sentnum

8

-1

CONCLUSIONS: Simple, inexpensive, local programmatic interventions can dramatically improve TB case holding.

sentnum

9

-1

This study demonstrates the need for evaluation, training, and supervision at all levels of the programme.

null

S0042-96862001000200007

language

EN

section

title

-1

sentnum

0

-1

Situation analysis for cervical cancer diagnosis and treatment in East, Central and Southern African countries.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To determine the factors influencing cervical cancer diagnosis and treatment in countries of East, Central and Southern Africa (ECSA).

sentnum

1

-1

METHODS: Data were collected from randomly selected primary health care centres, district and provincial hospitals, and tertiary hospitals in each participating country.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

Lack of policy guidelines, infrequent supply of basic materials, and a lack of suitable qualified staff were the most common reasons reported.

sentnum

5

-1

CONCLUSIONS: This study demonstrates that there is an urgent need for more investment in the diagnosis and treatment of cervical cancer in ECSA countries.

sentnum

6

-1

In these, and other countries with low resources, suitable screening programmes should be established.

null

S0042-96862001000200009

language

EN

section

title

-1

sentnum

0

-1

Coping with changing conditions: alternative strategies for the delivery of maternal and child health and family planning services in Dhaka, Bangladesh.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

The doorstep delivery strategy, however, is labour- intensive and costly.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

The clinic-based service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka.

sentnum

6

-1

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.

null

S0042-96862001000300005

language

EN

section

title

-1

sentnum

0

-1

Estimates of maternal mortality for 1995.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

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).

sentnum

7

-1

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.

sentnum

8

-1

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.

sentnum

9

-1

CONCLUSION: The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely.

sentnum

10

-1

It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes.

null

S0042-96862001000300007

language

EN

section

title

-1

sentnum

0

-1

Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal.

sentnum

1

-1

METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

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.

sentnum

7

-1

Less expensive targeting methods are required in order to make targeted household treatment more cost-effective.

null

S0042-96862001000300010

language

EN

section

title

-1

sentnum

0

-1

Blindness prevention programmes: past, present, and future.

language

EN

section

abstract

-1

sentnum

0

-1

Blindness and visual impairment have far-reaching implications for society, the more so when it is realized that 80% of visual disability is avoidable.

sentnum

1

-1

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.

sentnum

2

-1

However, if available knowledge and skills were made accessible to those communities in greatest need, much of this needless blindness could be alleviated.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

This effort is poised to take the steps necessary to achieve the goal of eliminating avoidable blindness worldwide by the year 2020.

null

S0042-96862001000300012

language

EN

section

title

-1

sentnum

0

-1

The SAFE strategy for the elimination of trachoma by 2020: will it work?.

language

EN

section

abstract

-1

sentnum

0

-1

WHO has recently launched a programme (GET 2020) for the elimination of trachoma, the leading cause of preventable blindness.

sentnum

1

-1

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).

sentnum

2

-1

The present article reviews the strengths and weaknesses of each component of the strategy.

sentnum

3

-1

Although significant hurdles remain to be overcome there is every reason to hope that GET 2020 will be successful.

null

S0042-96862001000300014

language

EN

section

title

-1

sentnum

0

-1

Prevention of blindness and priorities for the future.

language

EN

section

abstract

-1

sentnum

0

-1

The impact of visual loss has profound implications for the person affected and society as a whole.

sentnum

1

-1

The majority of blind people live in developing countries, and generally, their blindness could have been avoided or cured.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

Effective preventive measures for these diseases can only be established as more is known about their etiology.

sentnum

6

-1

As the longevity of the world's population increases, the visual requirements at the workplace are also changing.

sentnum

7

-1

People with low vision may be at a disadvantage in many common activities, and may face unemployment - particularly in technological societies.

sentnum

8

-1

The definition of blindness needs to be rethought, to ensure that people with economic' blindness are not forgotten.

sentnum

9

-1

Efforts should be made to recognize and treat those affected at an early stage, for the benefit of the individual and society.

null

S0042-96862001000400003

language

EN

section

title

-1

sentnum

0

-1

Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

CONCLUSION: Household contamination of drinking-water significantly contributed to diarrhoea in this population.

sentnum

7

-1

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.

null

S0042-96862001000400005

language

EN

section

title

-1

sentnum

0

-1

Mass measles vaccination in urban Burkina Faso, 1998.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the impact of the National Immunization Days (NIDs) on measles vaccine coverage in Burkina Faso in 1998.

sentnum

1

-1

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.

sentnum

2

-1

Interviewers visited the parents of 1267 children aged up to 59 months and examined vaccination cards.

sentnum

3

-1

We analysed the data using cluster sample methodology for the 1041 children who were aged 9-59 months.

sentnum

4

-1

FINDINGS: A total of 604 (57%) children had received routine measles vaccination prior to the campaign, and 823 (79%) were vaccinated during the NIDs.

sentnum

5

-1

Among those who had previously had a routine vaccination, 484 (81%) were revaccinated during the NIDs.

sentnum

6

-1

Among those not previously vaccinated, 339 (78%) received one dose during the NIDs.

sentnum

7

-1

After the campaign, 943 (91%) children had received at least one dose of measles vaccine.

sentnum

8

-1

Better socioeconomic status was associated with a higher chance of having been vaccinated routinely, but it was not associated with NID coverage.

sentnum

9

-1

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.

null

S0042-96862001000400007

language

EN

section

title

-1

sentnum

0

-1

Leprosy in China: epidemiological trends between 1949 and 1998.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To report the epidemiological trends of leprosy in China from 1949 to 1998.

sentnum

1

-1

METHODS: Data for the study were obtained from the computerized database of the National System of Leprosy Surveillance.

sentnum

2

-1

FINDINGS: A total of 474 774 leprosy patients were detected during this 50-year period.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

The peak prevalences of the 1960s (i.e. >2 per 10 000 population) decreased annually from the 1970s onwards.

sentnum

7

-1

By the end of 1998 the prevalence was 0.05 per 10 000 population.

sentnum

8

-1

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.

sentnum

9

-1

However, leprosy is still unevenly distributed in the country.

sentnum

10

-1

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.

sentnum

11

-1

Special attention must therefore be given to achieve elimination and final eradication of leprosy in China.

null

S0042-96862001000400009

language

EN

section

title

-1

sentnum

0

-1

Family history: an opportunity for early interventions and improved control of hypertension, obesity and diabetes.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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).

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

Those with a family history of obesity had a higher BMI and were at increased risk of obesity.

sentnum

6

-1

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.

sentnum

7

-1

Subjects with a family history of stroke had a higher BMI, as well as higher cholesterol, triglyceride and uric acid concentrations.

sentnum

8

-1

CONCLUSION: A family history of hypertension, obesity, diabetes, or stroke was a significant risk factor for obesity and hyperlipidaemia.

sentnum

9

-1

With increase of age, more pathological manifestations can develop in this high-risk group.

sentnum

10

-1

Health professionals should therefore utilize every opportunity to include direct family members in health education.

null

S0042-96862001000400011

language

EN

section

title

-1

sentnum

0

-1

Safety of the intradermal Copenhagen 1331 BCG vaccine in neonates in Durban, South Africa.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

METHODS: A prospective study was carried out over a two-year period between July 1997 and June 1999.

sentnum

2

-1

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.

sentnum

3

-1

FINDINGS: In total, 9763 neonates were examined: in 95.4% the vaccination scar had healed and 1.5% had no visible scar.

sentnum

4

-1

Adverse events occurred in 3.1%.

sentnum

5

-1

The proportion of neonates with no visible vaccination scars decreased over the study period, as did the number with adverse events.

sentnum

6

-1

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.

sentnum

7

-1

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.

sentnum

8

-1

To minimize adverse events, however, it is essential to continue training health personnel involved in implementing intradermal BCG vaccination programmes.

null

S0042-96862001000400013

language

EN

section

title

-1

sentnum

0

-1

Health services under the General Agreement on Trade in Services.

language

EN

section

abstract

-1

sentnum

0

-1

The potential for trade in health services has expanded rapidly in recent decades.

sentnum

1

-1

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.

sentnum

2

-1

As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS).

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

The present paper is intended to contribute to this process.

sentnum

6

-1

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.

sentnum

7

-1

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.

null

S0042-96862001000500004

language

EN

section

title

-1

sentnum

0

-1

Comparison of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis in Kenya.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To compare the use of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis (kala-azar).

sentnum

1

-1

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.

sentnum

2

-1

FINDINGS: There were no significant differences in baseline demographic characteristics or disease severity, or in events during treatment.

sentnum

3

-1

There were 3 deaths in the PSM group and 1 in the SSG group; 2 patients defaulted in each group.

sentnum

4

-1

Only 1 out of 80 test-of-cure splenic aspirates was positive for Leishmania spp.; this patient was in the SSG group.

sentnum

5

-1

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.

sentnum

6

-1

No outcome variable was significantly different between the two groups.

sentnum

7

-1

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.

null

S0042-96862001000500006

language

EN

section

title

-1

sentnum

0

-1

Estimates of the maternal mortality ratio in two districts of the Brong-Ahafo region, Ghana.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

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.

sentnum

4

-1

Biases during data collection may account for this difference, including the fact that biases underestimating mortality are more common than those overestimating it.

sentnum

5

-1

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.

sentnum

6

-1

CONCLUSIONS: The results indicate that the sisterhood method is still being refined and the extent and impact of biases have only recently received attention.

sentnum

7

-1

Users of this method should be aware of limitations when interpreting results.

sentnum

8

-1

We recommend using confidence limits around estimates, both to dispel false impressions of precision and to reduce overinterpretation of data.

null

S0042-96862001000500008

language

EN

section

title

-1

sentnum

0

-1

Prevalence of vitamin A deficiency in children aged 6-9 years in Wukro, northern Ethiopia.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To determine the prevalence of vitamin A deficiency in children aged 6-9 years in northern Ethiopia.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

The liver vitamin A reserve (modified relative dose response ratio > 0.06) was low in 41.0% of the children.

sentnum

4

-1

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.

null

S0042-96862001000500010

language

EN

section

title

-1

sentnum

0

-1

The impact of a clinical training unit on integrated child health care in Mexico.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

The staff kept a computerized database for all patients seen and they were supervised once a month.

sentnum

3

-1

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%.

sentnum

4

-1

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.

sentnum

5

-1

Fifty-eight per cent of these mothers were evaluated as being properly trained.

sentnum

6

-1

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.

sentnum

7

-1

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%.

sentnum

8

-1

The corresponding figures for AD mortality reduction were 36.3% and 33.6%.

sentnum

9

-1

In this same period, 11 clinical research protocols were written.

sentnum

10

-1

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.

null

S0042-96862001000500012

language

EN

section

title

-1

sentnum

0

-1

Transmission of Helicobacter pylori: a role for food?.

language

EN

section

abstract

-1

sentnum

0

-1

Helicobacter pylori colonizes and grows in human gastric epithelial tissue and mucus.

sentnum

1

-1

Its presence is associated with gastritis and there is substantial evidence that it causes peptic and duodenal ulcers and chronic gastritis.

sentnum

2

-1

Since 1994, H. pylori has been classified as carcinogenic to humans.

sentnum

3

-1

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.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

Under conditions where growth is not possible, H. pylori can enter a viable, but nonculturable state.

sentnum

7

-1

H. pylori has been detected in such states in water, but not in food.

sentnum

8

-1

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.

null

S0042-96862001000600003

language

EN

section

title

-1

sentnum

0

-1

Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentre study.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To evaluate the prevalence, awareness, treatment and control of hypertension among elderly individuals in Bangladesh and India.

sentnum

1

-1

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.

sentnum

2

-1

FINDINGS: The overall prevalence of hypertension (WHO-International Society for Hypertension criteria) was 65% (95% confidence interval = 62-67%).

sentnum

3

-1

The prevalence was higher in urban than rural areas, but did not differ significantly between the sexes.

sentnum

4

-1

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.

sentnum

5

-1

Physical activity, rural residence, and current smoking were inversely related to the prevalence of hypertension.

sentnum

6

-1

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.

sentnum

7

-1

A visit to a physician in the previous year, higher educational attainment and being female emerged as important correlates of hypertension awareness.

sentnum

8

-1

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.

sentnum

9

-1

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.

null

S0042-96862001000600005

language

EN

section

title

-1

sentnum

0

-1

Estimating the prevalence of anaemia: a comparison of three methods.

language

EN

section

abstract

-1

sentnum

0

-1

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).

sentnum

1

-1

METHODS: Samples of venous and capillary blood from 121 mothers in Indonesia were compared using all three methods.

sentnum

2

-1

FINDINGS: When the indirect cyanmethaemoglobin method was used the prevalence of anaemia was 31-38%.

sentnum

3

-1

When the direct cyanmethaemoglobin or HemoCue method was used the prevalence was 14-18%.

sentnum

4

-1

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).

sentnum

5

-1

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.

sentnum

6

-1

CONCLUSIONS: Where field conditions and local resources allow it, haemoglobin concentration should be assessed with the direct cyanmethaemoglobin method, the gold standard.

sentnum

7

-1

However, the HemoCue method can be used for surveys involving different laboratories or which are conducted in relatively remote areas.

sentnum

8

-1

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.

null

S0042-96862001000600007

language

EN

section

title

-1

sentnum

0

-1

Evidence of behaviour change following a hygiene promotion programme in Burkina Faso.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

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.

sentnum

2

-1

METHODS: Two population surveys recorded the coverage of the programme among target audiences (mothers of children aged 0-35 months).

sentnum

3

-1

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.

sentnum

4

-1

FINDINGS: After the programme had run for 3 years, three-quarters of the mothers targeted had had contact with programme activities.

sentnum

5

-1

Half could cite the two main messages of the programme correctly.

sentnum

6

-1

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%.

sentnum

7

-1

The proportion of mothers who washed their hands with soap after using the latrine increased from 1% to 17%.

sentnum

8

-1

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.

null

S0042-96862001000600009

language

EN

section

title

-1

sentnum

0

-1

Iodine concentration in household salt in South Africa.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

METHOD: The iodometric titration method was used to analyse 2043 household salt samples collected using a national, multistage, stratified, cluster survey.

sentnum

2

-1

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.

sentnum

3

-1

There was considerable variation within and between geographical areas.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

The iodine concentration in salt was lower in rural areas than in urban and periurban areas.

sentnum

7

-1

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.

sentnum

8

-1

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.

sentnum

9

-1

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.

null

S0042-96862001000600011

language

EN

section

title

-1

sentnum

0

-1

The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

METHODS: Data were taken from the Maputo City death register and autopsy records for 1994.

sentnum

2

-1

FINDINGS: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%.

sentnum

3

-1

Of these, 8114 deaths (92%) were classified by cause.

sentnum

4

-1

Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961.

sentnum

5

-1

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).

sentnum

6

-1

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.

sentnum

7

-1

AIDS-related deaths were underreported.

sentnum

8

-1

With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City.

sentnum

9

-1

The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

null

S0042-96862001000600013

language

EN

section

title

-1

sentnum

0

-1

Maternal mortality at the end of a decade: signs of progress?.

language

EN

section

abstract

-1

sentnum

0

-1

ABSTRACT: Maternal mortality is an important measure of women's health and indicative of the performance of health care systems.

sentnum

1

-1

Several international conferences, most recently the Millennium Summit in 2000, have included the goal of reducing maternal mortality.

sentnum

2

-1

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.

sentnum

3

-1

This has led to interest in using alternative indicators for monitoring progress.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

Progress has been greatest in Asia, the Middle East and North Africa, with annual increases of over 2%.

sentnum

7

-1

In sub-Saharan Africa, on the other hand, coverage has stagnated.

sentnum

8

-1

In general, caesarean delivery rates were stable over the 1990s.

sentnum

9

-1

Countries where rates of caesarean deliveries were the lowest - and where the needs were greatest - showed the least change.

sentnum

10

-1

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.

null

S0042-96862001000700003

language

EN

section

title

-1

sentnum

0

-1

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.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To assess the suitability of using oral-fluid samples for determining the prevalence of immunity to vaccine-preventable infections.

sentnum

1

-1

METHODS: Paired blood and oral-fluid samples were obtained from 853 individuals of all ages from a rural Ethiopian community.

sentnum

2

-1

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.

sentnum

3

-1

IgG antibodies in serum to measles, rubella and HBc were determined using commercial ELISAs.

sentnum

4

-1

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.

sentnum

5

-1

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).

sentnum

6

-1

CONCLUSION: Our results suggest that oral fluid could have the potential to replace serum in IgG antibody prevalence surveys.

sentnum

7

-1

Further progress requires assessment of variation in assay performance between populations as well as the availability of standardized, easy to use assays.

null

S0042-96862001000700005

language

EN

section

title

-1

sentnum

0

-1

Neonatal mortality of low-birth-weight infants in Bangladesh.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To ascertain the role of low birth weight (LBW) in neonatal mortality in a periurban setting in Bangladesh.

sentnum

1

-1

METHODS: LBW neonates were recruited prospectively and followed up at one month of age.

sentnum

2

-1

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.

sentnum

3

-1

FINDINGS: The neonatal mortality rate (NMR) for these infants was 133 per 1000 live births (95% confidence interval: 110-159).

sentnum

4

-1

The corresponding NMRs (and confidence intervals) for early and late neonates were 112 (91-136) and 21 (12-33) per thousand live births, respectively.

sentnum

5

-1

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.

sentnum

6

-1

Eighty-four per cent of neonatal deaths occurred in the first seven days; half within 48 hours.

sentnum

7

-1

Preterm delivery was implicated in three-quarters of neonatal deaths, but was associated with only one-third of LBW neonates.

sentnum

8

-1

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.

sentnum

9

-1

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.

null

S0042-96862001000700007

language

EN

section

title

-1

sentnum

0

-1

Efficacy trial of Vi polysaccharide vaccine against typhoid fever in south-western China.

language

EN

section

abstract

-1

sentnum

0

-1

OBJECTIVE: To test the efficacy of locally produced Vi vaccine over a time period of longer than one year.

sentnum

1

-1

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.

sentnum

2

-1

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.

sentnum

3

-1

A total of 131 271 people were systematically allocated a single dose of 30 mg of Vi polysaccharide or saline placebo.

sentnum

4

-1

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).

sentnum

5

-1

Clinically suspected cases of typhoid fever were confirmed by blood culture, or by serological reaction with O-antigen (Widal tests).

sentnum

6

-1

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%).

sentnum

7

-1

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%).

sentnum

8

-1

No serious post-injection reactions were observed.

sentnum

9

-1

The locally produced Vi polysaccharide vaccine showed levels of protective efficacy similar to those for Vi vaccine produced in industrial countries.

sentnum

10

-1

CONCLUSION: The slightly higher dose of vaccine did not seem to alter efficacy significantly in China.

null

S0042-96862001000700009

language

EN

section

title

-1

sentnum

0

-1

Operational issues in preventing mother-to-child transmission of HIV-1 in Abidjan, Côte d'Ivoire, 1998-99.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

METHODS: Voluntary counselling and HIV serotesting were routinely provided in four health centres in Abidjan, Côte d'Ivoire, for six months in 1998-99.

sentnum

2

-1

Peripartum treatment with zidovudine and alternatives to breastfeeding were provided free to HIV-infected women.

sentnum

3

-1

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.

sentnum

4

-1

Overall HIV prevalence was (12.89%) and 5% for women aged under 18 years.

sentnum

5

-1

Among the 2998 HIV-negative women, 71% returned for their test result, whereas only 60% of the 445 HIV-positive women did so.

sentnum

6

-1

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.

sentnum

7

-1

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.

sentnum

8

-1

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.

sentnum

9

-1

An insufficient proportion of women returned to obtain their test results.

sentnum

10

-1

This was especially so among HIV-positive women, the target group for preventing mother-to-child transmission of HIV.

sentnum

11

-1

Additional staff were required in order to offer voluntary counselling and HIV testing to the study women.

sentnum

12

-1

Close supervision and strong commitment of health workers were essential.

null

sentnum

13

-1

Alternatives to breastfeeding were effectively proposed to HIV-positive women, with active follow-up of children and clinical, nutritional and social support.

null

S0042-96862001000700011

language

EN

section

title

-1

sentnum

0

-1

Every death counts: measurement of maternal mortality via a census.

language

EN

section

abstract

-1

sentnum

0

-1

Methods for measuring maternal mortality at national and subnational levels in the developing world lag far behind the demand for estimates.

sentnum

1

-1

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.

sentnum

2

-1

Standard demographic methods were used to evaluate the completeness of reporting of adult female deaths and births in the year prior to the census.

sentnum

3

-1

The results from these exercises were used to adjust the data.

sentnum

4

-1

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.

sentnum

5

-1

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.

sentnum

6

-1

Age patterns of the various maternal mortality indicators were plausible and consistent with external sources of data for other populations.

sentnum

7

-1

Our data suggest that under favourable conditions a national census is a feasible and promising approach for the measurement of maternal mortality.

sentnum

8

-1

Moreover, use of the census circumvents several of the weaknesses of methods currently in use.

sentnum

9

-1

However, it should also be noted that careful evaluation of the data and adjustment, if necessary, are essential.

sentnum

10

-1

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.

null

S0042-96862001000700013

language

EN

section

title

-1

sentnum

0

-1

Reinsurance of health insurance for the informal sector.

language

EN

section

abstract

-1

sentnum

0

-1

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.

sentnum

1

-1

The role of communities in solving this problem has been recognized, and many initiatives are under way.

sentnum

2

-1

However, community financing is rarely structured as health insurance.

sentnum

3

-1

Communities that pool risks (or offer insurance) have been described as micro-insurance units.

sentnum

4

-1

The sources of their financial instability and the options for stabilization are explained.

sentnum

5

-1

Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments.

sentnum

6

-1

The article focuses on risk transfer from micro-insurance units to reinsurance.

sentnum

7

-1

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.

sentnum

8

-1

The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality.

null