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S0042-96862003000600014 | language | EN | section | title | -1 | sentnum | 0 | -1 | Health impact assessment needs in south-east Asian countries. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | A situation analysis was undertaken to assess impediments to health impact assessment (HIA) in the South-East Asia Region of WHO (SEARO). | sentnum | 1 | -1 | The countries of the region were assessed on the policy framework and procedures for HIA, existing infrastructure required to support HIA, the capacity for undertaking HIA, and the potential for intersectoral collaboration. | sentnum | 2 | -1 | The findings show that environmental impact assessment (EIA) is being used implicitly as a substitute for HIA, which is not explicitly or routinely conducted in virtually all countries of the Region. | sentnum | 3 | -1 | Therefore, policy, infrastructure, capacity, and intersectoral collaboration need strengthening for the routine implementation of HIA. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000700005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Importation and circulation of poliovirus in Bulgaria in 2001. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response. | sentnum | 1 | -1 | METHODS: Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhanced surveillance for acute flaccid paralysis, and conducted supplemental immunization activities. | sentnum | 2 | -1 | FINDINGS: The three cases of polio studied had not been vaccinated and lived in socioeconomically deprived areas of two cities. | sentnum | 3 | -1 | Four Roma children from the Bourgas district had antibody titres to serotype 1 poliovirus only, and wild type 1 virus was isolated from the faeces of two asymptomatic Roma children in the Bourgas and Sofia districts. | sentnum | 4 | -1 | Poliovirus isolates were related genetically and represented a single evolutionary lineage; genomic sequences were less than 90% identical to poliovirus strains isolated previously in Europe, but 98.3% similar to a strain isolated in India in 2000. | sentnum | 5 | -1 | No cases or wild virus isolates were found after supplemental immunization activities were launched in May 2001. | sentnum | 6 | -1 | CONCLUSIONS: In Bulgaria, an imported poliovirus was able to circulate for two to five months among minority populations. | sentnum | 7 | -1 | Surveillance data strongly suggest that wild poliovirus circulation ceased shortly after supplemental immunization activities with oral poliovirus vaccine were conducted. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000700007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To draw up evidence-based guidelines to make injections safer. | sentnum | 1 | -1 | METHODS: A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings. | sentnum | 2 | -1 | The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review. | sentnum | 3 | -1 | FINDINGS: Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. | sentnum | 4 | -1 | However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the preventio... | sentnum | 5 | -1 | CONCLUSION: The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections. | sentnum | 6 | -1 | WHO will revise the best practices five years after initial development, i.e. in 2005. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000700009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Cost of work-related injuries in insured workplaces in Lebanon. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. | sentnum | 1 | -1 | METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. | sentnum | 2 | -1 | Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. | sentnum | 3 | -1 | FINDINGS: The median cost per injury was US$ 83 (mean, US$ 198; range, US$ 0-16 401). | sentnum | 4 | -1 | The overall cost for all 3748 injuries was US$ 742 100 (76% of this was medical costs). | sentnum | 5 | -1 | Extrapolated to all injuries within insured workplaces, the overall cost was US$4.5 million a year; this increased to US$ 10 million-13 million when human value cost (pain and suffering) was accounted for. | sentnum | 6 | -1 | Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the overall costs and hospitalized injuries (245, 6.5%) for 45%. | sentnum | 7 | -1 | Cost per injury was highest among older workers and for injuries that involved falls and vehicle incidents. | sentnum | 8 | -1 | Medical, but not compensation, costs were higher among female workers. | sentnum | 9 | -1 | CONCLUSION: The computed costs of work injuries - a fraction of the real burden of occupational injuries in Lebanon - represent a considerable economic loss. | sentnum | 10 | -1 | This calls for a national policy to prevent work injuries, with a focus on preventing the most serious injuries. | sentnum | 11 | -1 | Options for intervention and research are discussed. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000700011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub-Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult. | sentnum | 1 | -1 | METHODS: In an observational study at first-level health facilities in Uganda, the United Republic of Tanzania, and Niger, over 3-5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines. | sentnum | 2 | -1 | We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities. | sentnum | 3 | -1 | FINDINGS: We studied 7195 children aged 2-59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital. | sentnum | 4 | -1 | Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia. | sentnum | 5 | -1 | Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral. | sentnum | 6 | -1 | Legal constraints and a lack of simple equipment (suction pumps, nebulizers, and oxygen concentrators) and supplies (nasogastric tubes and 50% glucose) could prevent health workers from dealing more appropriately with sick children when referral was not possible. | sentnum | 7 | -1 | CONCLUSION: When referral is difficult or impossible, some additional supplies and equipment, as well as provision of simple guidelines, may improve management of seriously ill infants and children. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000700013 | language | EN | section | title | -1 | sentnum | 0 | -1 | Poverty, equity, human rights and health. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. | sentnum | 1 | -1 | Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. | sentnum | 2 | -1 | Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. | sentnum | 3 | -1 | Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. | sentnum | 4 | -1 | Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public healt... | sentnum | 5 | -1 | causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000800005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Labour complications remain the most important risk factors for perinatal mortality in rural Kenya. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). | sentnum | 1 | -1 | METHODS: A cross-sectional study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. | sentnum | 2 | -1 | FINDINGS: The perinatal mortality rate was 118 per 1000 births. | sentnum | 3 | -1 | Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. | sentnum | 4 | -1 | Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. | sentnum | 5 | -1 | CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000800007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Annual risk of tuberculous infection in the northern zone of India. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To estimate the annual risk of infection with tubercle bacilli in the northern zone of India. | sentnum | 1 | -1 | METHODS: A community-based cross-sectional tuberculin survey was conducted among children aged 1-9 years who lived in a sample of villages and urban blocks of six selected districts in a defined north zone of India. | sentnum | 2 | -1 | A two-stage cluster sampling method was used to select rural and urban clusters. | sentnum | 3 | -1 | A total of 48 624 children in 598 clusters were subjected to tuberculin testing with one tuberculin unit (1 TU) of PPD RT23 stabilized with Tween 80. | sentnum | 4 | -1 | The maximum transverse diameter of induration was measured about 72 hours after the test. | sentnum | 5 | -1 | FINDINGS: Among the 48 624 test-read children, 22 064 (45.4%) had a bacille Calmette-Guérin (BCG) scar. | sentnum | 6 | -1 | On the basis of the frequency distribution of tuberculin reaction size among 25 816 children without a BCG scar, the prevalence of infection with tubercle bacilli was estimated as 10.3%. | sentnum | 7 | -1 | The annual risk of infection was computed as 1.9%. | sentnum | 8 | -1 | The proportion of infected children was significantly higher in urban than rural areas. | sentnum | 9 | -1 | CONCLUSION: The high rate of tuberculous infection in the north zone of India suggests the need for further intensification of tuberculosis control efforts on a sustained and long-term basis. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000800009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Injury prevention counselling to improve safety practices by parents in Mexico. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To evaluate the effectiveness of educational counselling programmes aimed at increasing parents' practice of childhood safety in Monterrey, Mexico, and to provide information aimed at helping to improve the effectiveness of future efforts in this field. | sentnum | 1 | -1 | METHODS: Three different counselling programmes were designed to meet the needs of the upper, middle and lower socioeconomic strata. | sentnum | 2 | -1 | Evaluation involved the use of baseline questionnaires on parents' existing safety-related practices for intervention and control groups and the administration of corresponding questionnaires after the programmes had been carried out. | sentnum | 3 | -1 | FINDINGS: Data were obtained on 1124 children before counselling took place and on 625 after it had been given. | sentnum | 4 | -1 | Overall safety scores (% safe responses) increased from 54% and 65% for the lower and upper socioeconomic strata, respectively, before counselling to 62% and 73% after counselling (P <0.001 for all groups). | sentnum | 5 | -1 | Improvements occurred both for activities that required caution and for activities that required the use of safety-related devices (e.g. helmets, car seats). | sentnum | 6 | -1 | However, scores for the use of such devices remained suboptimal even after counselling and there were wide discrepancies between the socioeconomic strata. | sentnum | 7 | -1 | The post-counselling scores for the use of safety-related devices were 55%, 38% and 19% for the upper, middle and lower socioeconomic strata, respectively. | sentnum | 8 | -1 | CONCLUSIONS: Brief educational interventions targeting parents' practice of childhood safety improved safe behaviours. | sentnum | 9 | -1 | Increased attention should be given to specific safety-related devices and to the safety of pedestrians. | sentnum | 10 | -1 | Educational efforts should be combined with other strategies for injury prevention, such as the use of legislation and the improvement of environmental conditions. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000800011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Poverty and common mental disorders in developing countries. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries. | sentnum | 1 | -1 | Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education. | sentnum | 2 | -1 | A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. | sentnum | 3 | -1 | Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders. | sentnum | 4 | -1 | The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. | sentnum | 5 | -1 | Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors. | sentnum | 6 | -1 | Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders. | sentnum | 7 | -1 | Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000900005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Community wells to mitigate the arsenic crisis in Bangladesh. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To monitor the effectiveness of deep community wells in reducing exposure to elevated levels of arsenic in ground-water pumped from shallower aquifers. | sentnum | 1 | -1 | METHODS: Six community wells ranging in depth from 60 m to 140 m were installed in villages where very few of the wells already present produced safe water. | sentnum | 2 | -1 | By means of flow meters and interviews with villagers carrying water from the community wells, a study was made of the extent to which these were used during one year. | sentnum | 3 | -1 | The results were compared with household and well data obtained during a previous survey in the same area. | sentnum | 4 | -1 | FINDINGS: The mean arsenic concentration in water pumped from wells already in use in the villages where the community wells, were installed was 180 ± 140 µg/l (n = 956). | sentnum | 5 | -1 | Monthly sampling for 4-11 months showed that arsenic levels in groundwater from five of the six newly installed wells were consistently within the WHO guideline value of 10 µg/l for drinking-water. | sentnum | 6 | -1 | One of these wells met the Bangladesh standard of 50 µg/l arsenic but failed to meet the WHO guideline values for manganese and uranium in drinking-water. | sentnum | 7 | -1 | The community wells were very popular. | sentnum | 8 | -1 | Many women walked hundreds of metres each day to fetch water from them. | sentnum | 9 | -1 | On average, 2200 litres were hand-pumped daily from each community well, regardless of the season. | sentnum | 10 | -1 | CONCLUSION: A single community well can meet the needs of some 500 people residing within a radius of 150 m of it in a densely populated village. | sentnum | 11 | -1 | Properly monitored community wells should become more prominent in campaigns to reduce arsenic exposure in Bangladesh. | sentnum | 12 | -1 | Between 8000 and 10 000 deep community wells are needed to provide safe water for the four to five million people living in the most severely affected parts of the country. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000900007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Burden of major musculoskeletal conditions. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. | sentnum | 1 | -1 | This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. | sentnum | 2 | -1 | This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. | sentnum | 3 | -1 | Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged >60 years. | sentnum | 4 | -1 | Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. | sentnum | 5 | -1 | Joint replacement surgery, where available, provides effective relief. | sentnum | 6 | -1 | Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. | sentnum | 7 | -1 | It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. | sentnum | 8 | -1 | Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. | sentnum | 9 | -1 | The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. | sentnum | 10 | -1 | Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. | sentnum | 11 | -1 | Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. | sentnum | 12 | -1 | Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. | null | null | null | null | sentnum | 13 | -1 | Cultural factors greatly influence the prevalence and prognosis of low back pain. | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003000900009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Rehabilitation of landmine victims : the ultimate challenge. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Antipersonnel landmines are often used indiscriminately and frequently result in injury or death of non-combatants. | sentnum | 1 | -1 | In the last 65 years, over 110 million mines have been spread throughout the world into an estimated 70 countries. | sentnum | 2 | -1 | Landmine victims use a disproportionately high amount of medical resources; the vast majority of incidents occur in regions and countries without a sophisticated medical infrastructure and with limited resources, where rehabilitation is difficult in the best of circumstances. | sentnum | 3 | -1 | It is suggested that only a quarter of the patients with amputation secondary to landmines receive appropriate care. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001000004 | language | EN | section | title | -1 | sentnum | 0 | -1 | Dried venous blood samples for the detection and quantification of measles IgG using a commercial enzyme immunoassay. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To determine whether samples of dried venous blood (DVB) were an acceptable alternative to serum for detecting measles-specific IgG in a commercial enzyme immunoassay. | sentnum | 1 | -1 | METHODS: Paired samples of serum and DVB were collected from 98 suspected cases of measles and 1153 schoolchildren in Victoria, Australia. | sentnum | 2 | -1 | All samples were tested using the Dade Behring Enzygnost® Anti-Measles-Virus/IgG immunoassay. | sentnum | 3 | -1 | DVB samples were eluted using either the sample buffer provided with the kit or 5% dry milk powder in phosphate-buffered saline-Tween 20. | sentnum | 4 | -1 | FINDINGS: DVB samples eluted by sample buffer showed significantly better linear correlation to the serum samples than did DVB samples eluted in 5% dry milk in phosphate-buffered saline-Tween 20. | sentnum | 5 | -1 | To improve the comparability of serum and DVB samples an adjustment factor of 1.28 was applied to the optical density (OD) values of DVB. | sentnum | 6 | -1 | This adjustment also enabled quantification of the titre of measles IgG in mIU/ml directly from the OD value using the alpha calculation as specified by the kit protocol. | sentnum | 7 | -1 | For DVB samples stored for less than six months at 4 °C, the assay showed an overall sensitivity of 98.4% and a specificity of 97.2% compared with the results of serum testing. | sentnum | 8 | -1 | CONCLUSION: These results illustrate the potential for DVB samples to be widely used with the Dade Behring enzyme immunoassay system for determining the immunity of the individual and the population to the measles virus. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001000006 | language | EN | section | title | -1 | sentnum | 0 | -1 | Risk factors for early infant mortality in Sarlahi district, Nepal. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. | sentnum | 1 | -1 | Identification of risk factors for early infant mortality may help inform the design of intervention strategies. | sentnum | 2 | -1 | METHODS: Over the period 1994-97, 15 469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. | sentnum | 3 | -1 | FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. | sentnum | 4 | -1 | Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR =1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR =1.85, 95% CI 1.24-2.75). | sentnum | 5 | -1 | A larger maternal mid_upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). | sentnum | 6 | -1 | Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. | sentnum | 7 | -1 | Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR =11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). | sentnum | 8 | -1 | CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. | sentnum | 9 | -1 | Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001000008 | language | EN | section | title | -1 | sentnum | 0 | -1 | Meta-analysis of residential exposure to radon gas and lung cancer. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To investigate the relation between residential exposure to radon and lung cancer. | sentnum | 1 | -1 | METHODS: A literature search was performed using Medline and other sources. | sentnum | 2 | -1 | The quality of studies was assessed. | sentnum | 3 | -1 | Adjusted odds ratios with 95% confidence intervals (CI) for the risk of lung cancer among categories of levels of exposure to radon were extracted. | sentnum | 4 | -1 | For each study, a weighted log-linear regression analysis of the adjusted odds ratios was performed according to radon concentration. | sentnum | 5 | -1 | The random effect model was used to combine values from single studies. | sentnum | 6 | -1 | Separate meta-analyses were performed on results from studies grouped with similar characteristics or with quality scores above or equal to the median. | sentnum | 7 | -1 | FINDINGS: Seventeen case-control studies were included in the meta-analysis. | sentnum | 8 | -1 | Quality scoring for individual studies ranged from 0.45 to 0.77 (median, 0.64). | sentnum | 9 | -1 | Meta-analysis based on exposure at 150 Bq/m3 gave a pooled odds ratio estimate of 1.24 (95% CI, 1.11-1.38), which indicated a potential effect of residential exposure to radon on the risk of lung cancer. | sentnum | 10 | -1 | Pooled estimates of fitted odds ratios at several levels of radon exposure were all significantly different from unity - ranging from 1.07 at 50 Bq/m3 to 1.43 at 250 Bq/m3. | sentnum | 11 | -1 | No remarkable differences from the baseline analysis were found for odds ratios from sensitivity analyses of studies in which >75% of eligible cases were recruited (1.12, 1.00-1.25) and studies that included only women (1.29, 1.04-1.60). | sentnum | 12 | -1 | CONCLUSION: Although no definitive conclusions may be drawn, our results suggest a dose-response relation between residential exposure to radon and the risk of lung cancer. | null | null | null | null | sentnum | 13 | -1 | They support the need to develop strategies to reduce human exposure to radon. | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001000010 | language | EN | section | title | -1 | sentnum | 0 | -1 | Meningococcal meningitis in sub-Saharan Africa: the case for mass and routine vaccination with available polysaccharide vaccines. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Endemic and epidemic group A meningococcal meningitis remains a major cause of morbidity and mortality in sub-Saharan Africa, despite the availability of the safe and inexpensive group A meningococcal polysaccharide vaccine, which is protective at all ages when administered as directed. | sentnum | 1 | -1 | Despite optimal therapy, meningococcal meningitis has a 10% fatality rate and at least 15% central nervous system damage. | sentnum | 2 | -1 | WHO's policy of epidemic containment prevents, at best, about 50% of cases and ignores endemic meningitis, which is estimated at 50 000 cases per year. | sentnum | 3 | -1 | The effectiveness of group A, C, W135, and Y capsular polysaccharides is the basis for recommending universal vaccination with group A meningococcal polysaccharide twice in infancy, followed by the four-valent vaccine in children aged two and six years. | sentnum | 4 | -1 | This could eliminate epidemic and endemic disease, prepare for the use of conjugates when they become available, and probably could have prevented the recent epidemics of groups A and W135 meningitis in Burkina Faso. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001100005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Influence of pesticide regulation on acute poisoning deaths in Sri Lanka. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To assess in a developing Asian country the impact of pesticide regulation on the number of deaths from poisoning. | sentnum | 1 | -1 | These regulations, which were implemented in Sri Lanka from the 1970s, aimed to reduce the number of deaths - the majority from self-poisoning - by limiting the availability and use of highly toxic pesticides. | sentnum | 2 | -1 | METHODS: Information on legislative changes was obtained from the Ministry of Agriculture, national and district hospital admission data were obtained from the Sri Lanka Health Statistics Unit, and individual details of deaths by pesticide poisoning were obtained from a manual review of patients' notes and intensive ca... | sentnum | 3 | -1 | FINDINGS: Between 1986 and 2000, the total national number of admissions due to poisoning doubled, and admissions due to pesticide poisoning increased by more than 50%. | sentnum | 4 | -1 | At the same time, the case fatality proportion (CFP) fell for total poisonings and for poisonings due to pesticides. | sentnum | 5 | -1 | In 1991_92, 72% of pesticide-induced deaths in Anuradhapura were caused by organophosphorus (OP) and carbamate pesticides - in particular, the WHO class I OPs monocrotophos and methamidophos. | sentnum | 6 | -1 | From 1991, the import of these pesticides was reduced gradually until they were banned for routine use in January 1995, with a corresponding fall in deaths. | sentnum | 7 | -1 | Unfortunately, their place in agricultural practice was taken by the WHO class II organochlorine endosulfan, which led to a rise in deaths from status epilepticus - from one in 1994 to 50 in 1998. | sentnum | 8 | -1 | Endosulfan was banned in 1998, and over the following three years the number of endosulfan deaths fell to three. | sentnum | 9 | -1 | However, at the end of the decade, the number of deaths from pesticides was at a similar level to that of 1991, with WHO class II OPs causing the most deaths. | sentnum | 10 | -1 | Although these drugs are less toxic than class I OPs, the management of class II OPs remains difficult because they are, nevertheless, still highly toxic, and their toxicity is exacerbated by the paucity of available facilities. | sentnum | 11 | -1 | CONCLUSION: The fall in CFP amidst a rising incidence of self-poisoning suggests that Sri Lanka's programmes of pesticide regulation were beneficial. | sentnum | 12 | -1 | However, a closer inspection of pesticide-induced deaths in one hospital revealed switching to other highly toxic pesticides, as one was banned and replaced in agricultural practice by another. | null | null | null | null | sentnum | 13 | -1 | Future regulation must predict this switching and bear in mind the ease of treatment of replacement pesticides. | sentnum | 14 | -1 | Furthermore, such regulations must be implemented alongside other strategies, such as integrated pest management, to reduce the overall pesticide availability for self-harm. | null | null | null | null | null | null | null | null |
S0042-96862003001100008 | language | EN | section | title | -1 | sentnum | 0 | -1 | Knowledge for better health : a conceptual framework and foundation for health research systems. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. | sentnum | 1 | -1 | We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. | sentnum | 2 | -1 | The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. | sentnum | 3 | -1 | The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. | sentnum | 4 | -1 | In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. | sentnum | 5 | -1 | Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. | sentnum | 6 | -1 | The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001100010 | language | EN | section | title | -1 | sentnum | 0 | -1 | Exercise interventions: defusing the world's osteoporosis time bomb. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Osteoporosis is a major public health problem, affecting millions of people worldwide. | sentnum | 1 | -1 | The associated health care costs are growing in parallel with increases in elderly populations, and it is expected that the number of osteoporotic fractures will double over the next 50 years. | sentnum | 2 | -1 | The best way to address osteoporosis is prevention. | sentnum | 3 | -1 | Some interventions to maximize and preserve bone mass have multiple health benefits and are cost-effective. | sentnum | 4 | -1 | For example, modifications to diet and lifestyle can help to prevent osteoporosis, and could potentially lead to a significant decrease in fracture rates; and exercise is a valuable adjunct to programmes aimed at alleviating the risks and symptoms of osteoporosis. | sentnum | 5 | -1 | Practising exercise at a young age helps maximize the mineral density of bones while they are still growing and maturing, and continuing to excercise minimizes bone loss later in life. | sentnum | 6 | -1 | Not only does exercise improve bone health, it also increases muscle strength, coordination, balance, flexibility and leads to better overall health. | sentnum | 7 | -1 | Walking, aerobic exercise, and t'ai chi are the best forms of exercise to stimulate bone formation and strengthen the muscles that help support bones. | sentnum | 8 | -1 | Encouraging physical activity at all ages is therefore a top priority to prevent osteoporosis. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001200005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Human health benefits from livestock vaccination for brucellosis: case study. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock. | sentnum | 1 | -1 | METHODS: Cost-effectiveness and economic benefit for human society and the agricultural sector of mass vaccination against brucellosis was modelled. | sentnum | 2 | -1 | The intervention consisted of a planned 10-year livestock mass vaccination campaign using Rev-1 livestock vaccine for small ruminants and S19 livestock vaccine for cattle. | sentnum | 3 | -1 | Cost-effectiveness, expressed as cost per disability-adjusted life year (DALY) averted, was the primary outcome. | sentnum | 4 | -1 | FINDINGS: In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49 027 DALYs could be averted. | sentnum | 5 | -1 | Estimated intervention costs were US$ 8.3 million, and the overall benefit was US$ 26.6 million. | sentnum | 6 | -1 | This results in a net present value of US$ 18.3 million and an average benefit-cost ratio for society of 3.2 (2.27-4.37). | sentnum | 7 | -1 | If the costs of the intervention were shared between the sectors in proportion to the benefit to each, the public health sector would contribute 11%, which gives a cost-effectiveness of US$ 19.1 per DALY averted (95% confidence interval 5.3-486.8). | sentnum | 8 | -1 | If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the cost-effectiveness would decrease to US$ 71.4 per DALY averted. | sentnum | 9 | -1 | CONCLUSION: If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001200007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. | sentnum | 1 | -1 | This article reviews the available evidence on private sector utilization and quality of care. | sentnum | 2 | -1 | It provides a framework for analysing the private sector's influence on child health outcomes. | sentnum | 3 | -1 | This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). | sentnum | 4 | -1 | Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. | sentnum | 5 | -1 | Many governments are experimenting with strategies to engage the private sector to improve child health. | sentnum | 6 | -1 | The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. | sentnum | 7 | -1 | Few experiences are clearly described, monitored, and evaluated. | sentnum | 8 | -1 | The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. | sentnum | 9 | -1 | The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862003001200009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Progress with new malaria vaccines. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Malaria is a parasitic disease of major global health significance that causes an estimated 2.7 million deaths each year. | sentnum | 1 | -1 | In this review we describe the burden of malaria and discuss the complicated life cycle of Plasmodium falciparum, the parasite responsible for most of the deaths from the disease, before reviewing the evidence that suggests that a malaria vaccine is an attainable goal. | sentnum | 2 | -1 | Significant advances have recently been made in vaccine science, and we review new vaccine technologies and the evaluation of candidate malaria vaccines in human and animal studies worldwide. | sentnum | 3 | -1 | Finally, we discuss the prospects for a malaria vaccine and the need for iterative vaccine development as well as potential hurdles to be overcome. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000100005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Cost analysis of post-polio certification immunization policies. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: An analysis was conducted to estimate the costs of different potential post-polio certification immunization policies currently under consideration, with the objective of providing this information to policy-makers. | sentnum | 1 | -1 | METHODS: We analysed three global policy options: continued use of oral poliovirus vaccine (OPV); OPV cessation with optional inactivated poliovirus vaccine (IPV); and OPV cessation with universal IPV. | sentnum | 2 | -1 | Assumptions were made on future immunization policy decisions taken by low-, middle-, and high-income countries. | sentnum | 3 | -1 | We estimated the financial costs of each immunization policy, the number of vaccine-associated paralytic poliomyelitis (VAPP) cases, and the global costs of maintaining an outbreak response capacity. | sentnum | 4 | -1 | The financial costs of each immunization policy were based on estimates of the cost of polio vaccine, its administration, and coverage projections. | sentnum | 5 | -1 | The costs of maintaining outbreak response capacity include those associated with developing and maintaining a vaccine stockpile in addition to laboratory and epidemiological surveillance. | sentnum | 6 | -1 | We used the period 2005-20 as the time frame for the analysis. | sentnum | 7 | -1 | FINDINGS: OPV cessation with optional IPV, at an estimated cost of US$ 20 412 million, was the least costly option. | sentnum | 8 | -1 | The global cost of outbreak response capacity was estimated to be US$ 1320 million during 2005-20. | sentnum | 9 | -1 | The policy option continued use of OPV resulted in the highest number of VAPP cases. | sentnum | 10 | -1 | OPV cessation with universal IPV had the highest financial costs, but it also had the least number of VAPP cases. | sentnum | 11 | -1 | Sensitivity analyses showed that global costs were sensitive to assumptions on the cost of the vaccine. | sentnum | 12 | -1 | Analysis also showed that if the price per dose of IPV was reduced to US$ 0.50 for low-income countries, the cost of OPV cessation with universal IPV would be the same as the costs of continued use of OPV. | null | null | null | null | sentnum | 13 | -1 | CONCLUSION: Projections on the vaccine price per dose and future coverage rates were major drivers of the global costs of post-certification polio immunization. | sentnum | 14 | -1 | The break-even price of switching to IPV compared with continuing with OPV immunizations is US$ 0.50 per dose of IPV. | sentnum | 15 | -1 | However, this does not account for the cost of vaccine-derived poliovirus cases resulting from the continued use of OPV. | sentnum | 16 | -1 | In addition to financial costs, risk assessments related to the re-emergence of polio will be major determinants of policy decisions. |
S0042-96862004000100007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Certification of polio eradication: process and lessons learned. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, considerable progress has been made towards interrupting the transmission of wild poliovirus globally. | sentnum | 1 | -1 | A formal process for the certification of polio eradication was established on the basis of experience gained during smallpox eradication. | sentnum | 2 | -1 | Independent groups of experts were designated at the global, regional, and country levels to conduct the process. | sentnum | 3 | -1 | The main requirements for the global certification of the eradication of wild poliovirus are the absence of wild poliovirus, isolated from suspect polio cases, healthy individuals, or environmental samples, in all WHO regions for a period of at least three years in the presence of high-quality, certification-standard s... | sentnum | 4 | -1 | Three WHO regions - the Region of the Americas (1994), Western Pacific Region (2000), and European Region (2002) - have already been certified free of indigenous wild poliovirus. | sentnum | 5 | -1 | Eradication and certification activities are progressing well in the three endemic regions (African, Eastern Mediterranean, and South-East Asia). | sentnum | 6 | -1 | Several challenges remain for the certification of polio eradication: the need for even closer coordination of certification activities between WHO regions, the verification of laboratory containment, the development of an appropriate mechanism to verify the absence of circulating vaccine-derived polioviruses in the fu... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000100009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Framework for evaluating the risks of paralytic poliomyelitis after global interruption of wild poliovirus transmission. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | With the interruption of wild poliovirus transmission globally, the need for new policies to deal with the post certification era will rapidly arise. | sentnum | 1 | -1 | New policies will be required in four areas: detection and notification of circulating polioviruses; biocontainment of wild, vaccine-derived and attenuated strains of poliovirus; vaccine stockpiles and response mechanisms; and routine immunization against polioviruses. | sentnum | 2 | -1 | A common understanding of the potential risks of paralytic poliomyelitis in the post-certification period is essential to the development of these policies. | sentnum | 3 | -1 | Since 2000, there has been increasing international consensus that the risks of paralytic poliomyelitis in the post-certification era fall into two categories: those due to the continued use of the oral poliovirus vaccine (OPV) and those due to future improper handling of wild polioviruses. | sentnum | 4 | -1 | The specific risks within both categories have now been defined, and an understanding of the frequency and potential burden of disease associated with each is rapidly improving. | sentnum | 5 | -1 | This knowledge and clarity have provided a framework that is already proving valuable for identifying research priorities and discussing potential policy options with national authorities. | sentnum | 6 | -1 | However, this framework must be regarded as a dynamic tool, requiring regular updating as additional information on these risks becomes available through further scientific research, programmatic work, and policy decisions. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000100011 | language | EN | section | title | -1 | sentnum | 0 | -1 | A developing country perspective on vaccine-associated paralytic poliomyelitis. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | When the Expanded Programme on Immunization was established and oral poliovirus vaccine (OPV) was introduced for developing countries to use exclusively, national leaders of public health had no opportunity to make an informed choice between OPV and the inactivated poliovirus vaccine (IPV). | sentnum | 1 | -1 | Today, as progress is made towards the goal of global eradication of poliomyelitis attributable to wild polioviruses, all developing countries where OPV is used face the risk of vaccine-associated paralytic poliomyelitis (VAPP). | sentnum | 2 | -1 | Until recently, awareness of VAPP has been poor and quantitative risk analysis scanty but it is now well known that the continued use of OPV perpetuates the risk of VAPP. | sentnum | 3 | -1 | Discontinuation or declining immunization coverage of OPV will increase the risk of emergence of circulating vaccine-derived polioviruses (cVDPV) that re-acquire wild virus-like properties and may cause outbreaks of polio. | sentnum | 4 | -1 | To eliminate the risk of cVDPV, either very high immunization coverage must be maintained as long as OPV is in use, or IPV should replace OPV. | sentnum | 5 | -1 | Stopping OPV without first achieving high immunization coverage with IPV is unwise on account of the possibility of emergence of cVDPV. | sentnum | 6 | -1 | Increasing numbers of developed nations prefer IPV, and manufacturing capacities have not been scaled up, so its price remains prohibitively high and unaffordable by developing countries, where, in addition, large-scale field experience with IPV is lacking. | sentnum | 7 | -1 | Under these circumstances, a policy shift to increase the use of IPV in national immunization programmes in developing countries is a necessary first step; once IPV coverage reaches high levels (over 85%), the withdrawal of OPV may begin. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000200004 | language | EN | section | title | -1 | sentnum | 0 | -1 | Child mortality in a West African population protected with insecticide-treated curtains for a period of up to 6 years. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To determine the impact of insecticide-treated curtains (ITC) on all-cause child mortality (6-59 months) over a period of six years. | sentnum | 1 | -1 | To determine whether initial reductions in child mortality following the implementation of ITC are sustained over the longer term or whether "delayed" mortality occurs. | sentnum | 2 | -1 | METHODS: A rural population of ca 100 000 living in an area with high, seasonal Plasmodium falciparum transmission was studied in Burkina Faso. | sentnum | 3 | -1 | Annual censuses were conducted from 1993 to 2000 to measure child mortality. | sentnum | 4 | -1 | ITC to cover doors, windows, and eaves were provided to half the population in 1994 with the remainder receiving ITC in 1996. | sentnum | 5 | -1 | Curtains were re-treated or, if necessary, replaced annually. | sentnum | 6 | -1 | FINDINGS: Over six years of implementation of ITC, no evidence of the shift in child mortality from younger to older children was observed. | sentnum | 7 | -1 | Estimates of the reduction in child mortality associated with ITC ranged from 19% to 24%. | sentnum | 8 | -1 | CONCLUSIONS: In our population there was no evidence to suggest that initial reduction in child mortality associated with the introduction of insecticide-treated materials was subsequently compromised by a shift in child mortality to older-aged children. | sentnum | 9 | -1 | Estimates of the impact of ITC on child mortality in this population range from 19% to 24%. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000200006 | language | EN | section | title | -1 | sentnum | 0 | -1 | Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVES: To document and characterize freezing temperatures in the Indonesian vaccine cold chain and to evaluate the feasibility of changes designed to reduce the occurrence of freezing. | sentnum | 1 | -1 | METHODS: Data loggers were used to measure temperatures of shipments of hepatitis B vaccine from manufacturer to point of use. | sentnum | 2 | -1 | Baseline conditions and three intervention phases were monitored. | sentnum | 3 | -1 | During each of the intervention phases, vaccines were removed progressively from the standard 2-8 °C cold chain. | sentnum | 4 | -1 | FINDINGS: Freezing temperatures were recorded in 75% of baseline shipments. | sentnum | 5 | -1 | The highest rates of freezing occurred during transport from province to district, storage in district-level ice-lined refrigerators, and storage in refrigerators in health centres. | sentnum | 6 | -1 | Interventions reduced freezing, without excessive heat exposure. | sentnum | 7 | -1 | CONCLUSIONS: Inadvertent freezing of freeze-sensitive vaccines is widespread in Indonesia. | sentnum | 8 | -1 | Simple strategies exist to reduce freezing - for example, selective transport and storage of vaccines at ambient temperatures. | sentnum | 9 | -1 | The use of vaccine vial monitors reduces the risk associated with heat-damaged vaccines in these scenarios. | sentnum | 10 | -1 | Policy changes that allow limited storage of freeze-sensitive vaccines at temperatures >2-8 °C would enable flexible vaccine distribution strategies that could reduce vaccine freezing, reduce costs, and increase capacity. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000200008 | language | EN | section | title | -1 | sentnum | 0 | -1 | Patient advocacy and arthritis: moving forward. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Patient advocacy is based on the premise that people have the right to make their own choices about their health care. | sentnum | 1 | -1 | Personal advocacy is centred on the experiential expertise of the individual affected by the condition, whereas group advocacy is grounded on patient-centred strategies and actions. | sentnum | 2 | -1 | The first patient advocacy groups for arthritis were set up over 20 years ago in the USA and have subsequently spread to many other countries. | sentnum | 3 | -1 | This paper discusses the growth and impact of personal advocacy as well as recent developments in group advocacy in the Asia-Pacific region, Europe, and North America, in terms of arthritis awareness, research, corporate partnerships, and the Bone and Joint Decade global initiative. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000200010 | language | EN | section | title | -1 | sentnum | 0 | -1 | Regulatory pathways for vaccines for developing countries. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Vaccines that are designed for use only in developing countries face regulatory hurdles that may restrict their use. | sentnum | 1 | -1 | There are two primary reasons for this: most regulatory authorities are set up to address regulation of products for use only within their jurisdictions and regulatory authorities in developing countries traditionally have been considered weak. | sentnum | 2 | -1 | Some options for regulatory pathways for such products have been identified: licensing in the country of manufacture, file review by the European Medicines Evaluation Agency on behalf of WHO, export to a country with a competent national regulatory authority (NRA) that could handle all regulatory functions for the deve... | sentnum | 3 | -1 | These options have been evaluated on the basis of five criteria: assurance of all regulatory functions for the life of the product, appropriateness of epidemiological assessment, applicability to products no longer used in the domestic market of the manufacturing country, reduction of regulatory risk for the manufactur... | sentnum | 4 | -1 | No one option satisfies all criteria. | sentnum | 5 | -1 | For all options, national infrastructures (including the underlying regulatory legislative framework, particularly to formulate and implement local evidence-based vaccine policy) must be developed. | sentnum | 6 | -1 | WHO has led work to develop this capacity with some success. | sentnum | 7 | -1 | The paper outlines additional areas of action required by the international community to assure development and use of vaccines needed for the developing world. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000300005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF. | sentnum | 1 | -1 | The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. | sentnum | 2 | -1 | METHODS: Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and ... | sentnum | 3 | -1 | Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. | sentnum | 4 | -1 | Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. | sentnum | 5 | -1 | Time needed to prepare one feed of replacement milk was simulated. | sentnum | 6 | -1 | FINDINGS: When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. | sentnum | 7 | -1 | PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. | sentnum | 8 | -1 | FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8-60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. | sentnum | 9 | -1 | Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended a-linolenic acid per 450 ml mixture. | sentnum | 10 | -1 | It took 21-25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30-35 minutes for the fresh milk preparation. | sentnum | 11 | -1 | PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%. | sentnum | 12 | -1 | CONCLUSION: No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months. | null | null | null | null | sentnum | 13 | -1 | Commercial infant formula is the only replacement milk that meets all nutritional needs. | sentnum | 14 | -1 | Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed. | sentnum | 15 | -1 | If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and a-linolenic acids, and additional vitamins and minerals. | null | null | null | null |
S0042-96862004000300007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Condom use within marriage: a neglected HIV intervention. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To assess the contraceptive effectiveness of condoms versus oral contraceptive pills and estimate the reproductive consequences of a major shift from pill to condom use. | sentnum | 1 | -1 | METHODS: Secondary analysis was performed on nationally representative cross-sectional surveys of women in 16 developing countries. | sentnum | 2 | -1 | FINDINGS: In the 16 countries, the median per cent of married couples currently using condoms was 2%, compared with 13% for the pill. | sentnum | 3 | -1 | Condom users reported a higher 12-month failure and higher method-related discontinuation rates than pill users (9% and 44% vs 6% and 30%, respectively). | sentnum | 4 | -1 | Condom users were more likely to report subsequent abortion following failure (21% vs 14%), and also more likely to switch rapidly to another method (76% vs 58%). | sentnum | 5 | -1 | The reproductive consequences, in terms of abortion and unwanted births, of a hypothetical reversal of the relative prevalence of condom and pill were estimated to be minor. | sentnum | 6 | -1 | The main reason for this unexpected result is that the majority of abortions and unwanted births arise from non-use of any contraceptive method. | sentnum | 7 | -1 | CONCLUSION: A massive shift from the more effective oral contraceptive pills to the less effective condom would not jeopardize policy goals of reducing abortions and unwanted births. | sentnum | 8 | -1 | However, such a shift would potentially have an added benefit of preventing human immunodeficiency virus (HIV) infections, especially in countries with generalized HIV epidemics. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000300009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Effectiveness of residual spraying of peridomestic ecotopes with deltamethrin and permethrin on Triatoma infestans in rural western Argentina: a district-wide randomized trial. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To compare the effectiveness of a single residual spraying of pyrethroids on the occurrence and abundance of Triatoma infestans in peridomestic ecotopes in rural La Rioja. | sentnum | 1 | -1 | METHODS: A total of 667 (32.8%) peridomestic sites positive for T. infestans in May 1999 were randomly assigned to treatment within each village, sprayed in December 1999, and reinspected in December 2000. | sentnum | 2 | -1 | Treatments included 2.5% suspension concentrate (SC) deltamethrin in water at 25 mg active ingredient (a.i.)/m2 applied with: (a) manual compression sprayers (standard treatment) or (b) power sprayers; (c) 1.5% emulsifiable concentrate (EC) deltamethrin at 25 mg a.i./m2; and (d) 10% EC cis-permethrin at 170 mg a.i./m2. | sentnum | 3 | -1 | EC pyrethroids were diluted in soybean oil and applied with power sprayers. | sentnum | 4 | -1 | All habitations were sprayed with the standard treatment. | sentnum | 5 | -1 | FINDINGS: The prevalence of T. infestans 1-year post-spraying was significantly lower in sites treated with SC deltamethrin applied with manual (24%) or power sprayers (31%) than in sites treated with EC deltamethrin (40%) or EC permethrin (53%). | sentnum | 6 | -1 | The relative odds of infestation and catch of T. infestans 1-year post-spraying significantly increased with the use of EC pyrethroids, the abundance of bugs per site before spraying, total surface, and host numbers. | sentnum | 7 | -1 | All insecticides had poor residual effects on wooden posts. | sentnum | 8 | -1 | CONCLUSION: Most of the infestations probably originated from triatomines that survived exposure to insecticides at each site. | sentnum | 9 | -1 | Despite the standard treatment proving to be the most effective, the current tactics and procedures fail to eliminate peridomestic populations of T. infestans in semiarid rural areas and need to be revised. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000300011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Tobacco smoking and oral clefts: a meta-analysis. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To examine the association between maternal smoking and non-syndromic orofacial clefts in infants. | sentnum | 1 | -1 | METHODS: A meta-analysis of the association between maternal smoking during pregnancy was carried out using data from 24 case-control and cohort studies. | sentnum | 2 | -1 | FINDINGS: Consistent, moderate and statistically significant associations were found between maternal smoking and cleft lip, with or without cleft palate (relative risk 1.34, 95% confidence interval 1.25-1.44) and between maternal smoking and cleft palate (relative risk 1.22, 95% confidence interval 1.10-1.35). | sentnum | 3 | -1 | There was evidence of a modest dose-response effect for cleft lip with or without cleft palate. | sentnum | 4 | -1 | CONCLUSION: The evidence of an association between maternal tobacco smoking and orofacial clefts is strong enough to justify its use in anti-smoking campaigns. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000400005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Use of medicinal plants and pharmaceuticals by indigenous communities in the Bolivian Andes and Amazon. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To investigate, by means of household surveys, the use of medicinal plants and pharmaceuticals in Apillapampa, a large Andean community of Quechua peasants, and in six small communities of Yuracaré-Trinitario "slash-and-burn" cultivators of the National Park Isiboro-Sécure (the NPIS) in the Bolivian Amazon. | sentnum | 1 | -1 | METHODS: A total of 12% of households in Apillapampa and nearly all households in the NPIS were interviewed about their use of medicinal plants and pharmaceuticals for treating illnesses. | sentnum | 2 | -1 | Informants were also asked to name any medicinal plants they knew. | sentnum | 3 | -1 | FINDINGS: In spite of the presence of a primary health care service (PHC) with medical doctor in Apillapampa, an equal number of informants used medicinal plants and pharmaceuticals. | sentnum | 4 | -1 | In the NPIS, the prevalent use of medicinal plants or pharmaceuticals in any community depended on the distance of the community from the nearest village and from a PHC with medical doctor (r = 0.85 and r = -0.96; both P = 0.05. | sentnum | 5 | -1 | The NPIS communities' knowledge of plants expressed as the average number of medicinal plants mentioned correlated positively and negatively with distance from the nearest village and use of pharmaceuticals, respectively (r = 0.95, P<0.005 and r = -0.90, P<0.05, respectively). | sentnum | 6 | -1 | CONCLUSION: The cultural importance of traditional medicine and the physical isolation of communities, both in general and from PHCs, are factors that influence the use of and knowledge about medicinal plants. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000400007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Rubella serosurveys at three Aravind Eye Hospitals in Tamil Nadu, India. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To determine the susceptibility of female eye hospital staff to rubella infection and the potential risk for hospital-based rubella outbreaks. | sentnum | 1 | -1 | METHODS: A prospective cohort study on the seroprevalence of rubella IgG antibodies was conducted at three large eye hospitals in Coimbatore, Madurai and Tirunelveli, Tamil Nadu, India, where young children with eye abnormalities attributable to congenital rubella are treated. | sentnum | 2 | -1 | A total of 1000 female hospital employees aged 18-40 years agreed to participate and gave written informed consent. | sentnum | 3 | -1 | FINDINGS: The proportions of rubella-seronegative women were: 11.7% at Coimbatore, with a 95% confidence interval (CI) of 8.1-16.5; 15% at Madurai (95% CI = 12.3-18.1), and 20.8 at Tirunelveli (95% CI = 14.7-28.6). | sentnum | 4 | -1 | For the entire cohort the proportion seronegative was significantly higher among married women (21.5%) than among single women (14.0%) (P = 0.02). | sentnum | 5 | -1 | Rates of seronegativity were highest among physicians and lowest among housekeepers. | sentnum | 6 | -1 | All 150 seronegative women in the study sample accepted a dose of rubella vaccine. | sentnum | 7 | -1 | CONCLUSION: These are the first rubella serosurveys to have been reported from eye hospitals in any country. | sentnum | 8 | -1 | The relatively high rate of susceptibility indicated a risk of a rubella outbreak, and this was reduced by vaccinating all seronegative women. | sentnum | 9 | -1 | A policy has been established at all three hospitals for the provision of rubella vaccine to new employees. | sentnum | 10 | -1 | Other hospitals, especially eye hospitals and hospitals in countries without routine rubella immunization, should consider the rubella susceptibility of staff and the risk of hospital-based rubella outbreaks. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000400009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Do family-planning workers in China support provision of sexual and reproductive health services to unmarried young people?. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To ascertain the perspectives of family-planning service providers in eight sites in China on the provision of sexual and reproductive health services to unmarried young people. | sentnum | 1 | -1 | METHODS: Data were drawn from a survey of 1927 family-planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99. | sentnum | 2 | -1 | FINDINGS: Family-planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people; however, perceptions about the appropriate age for an... | sentnum | 3 | -1 | While about 70% of family-planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, only one quarter agreed that the services could be extended to senior high schools. | sentnum | 4 | -1 | CONCLUSION: Family-planning workers in China are ambivalent about the provision of sexual and reproductive health services to unmarried young people, which potentially poses a significant obstacle to the adoption of safe sex behaviours by young people, as well as to the provision of sexual and reproductive health infor... | sentnum | 5 | -1 | Training programmes for family-planning workers are urgently needed to address this issue. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000400011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Reconsidering empirical cotrimoxazole prophylaxis for infants exposed to HIV infection. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Infants with HIV infection are vulnerable to Pneumocystis carinii pneumonia (PCP) during their first year of life. | sentnum | 1 | -1 | WHO and the Joint United Nations Programme on HIV/AIDS now recommend that all children of HIV-positive mothers receive prophylactic cotrimoxazole against PCP from six weeks of age and continue this therapy until exposure through breast milk ceases and the infant is confirmed to be HIV-negative (rarely before one year o... | sentnum | 2 | -1 | Empirical prophylaxis invokes a trade-off between possible benefit to the infant versus the risk of resistance to antibiotics and antimalarials. | sentnum | 3 | -1 | From a critical analysis of the literature, we offer a conceptual model demonstrating how, under certain circumstances, a policy of mass cotrimoxazole prophylaxis may be counterproductive. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000500005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Signs of illness in Kenyan infants aged less than 60 days. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: Little data has been published on the presenting symptoms and signs among ill infants aged <60 days from developing countries. | sentnum | 1 | -1 | We aimed to describe and evaluate the potential of simple clinical features to identify severe illness among young infants who present to rural district hospitals in Kenya. | sentnum | 2 | -1 | METHODS: Standardized assessment tools were designed to record clinical symptoms and signs. | sentnum | 3 | -1 | Data were collected prospectively on all infants aged <60 days who weighed >1.5 kg and were admitted over an 18-month period. | sentnum | 4 | -1 | The same data were collected prospectively from infants recruited to a contemporaneous hospital birth cohort who became ill and were assessed and treated as outpatients at the same hospital. | sentnum | 5 | -1 | FINDINGS: Data on 467 outpatient consultations and 769 inpatient episodes were available for analysis. | sentnum | 6 | -1 | These data highlighted the importance of findings in the history, particularly breathing difficulties, abnormal feeding, and abnormal behaviour, as well as clinical signs in the evaluation of young infants. | sentnum | 7 | -1 | They indicated possible important differences in the panel of signs useful for detecting severe illness in infants aged 0-6 days and those aged 7-59 days. | sentnum | 8 | -1 | They also showed that some simplification of current guidelines that still preserved the sensitivity and specificity for detecting very severe disease might be possible. | sentnum | 9 | -1 | CONCLUSION: Simple clinical features may allow distinction between severe and non-severe illness to be made with reasonable confidence. | sentnum | 10 | -1 | Prospective studies on an adequate scale are needed urgently to provide current integrated management of childhood illness guidelines for young infants with an adequate evidence base. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000500007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Cost-effectiveness analysis of cataract surgery: a global and regional analysis. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. | sentnum | 1 | -1 | METHODS: Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance. | sentnum | 2 | -1 | A population model was applied to follow the lifelong impact on individuals having cataract surgery. | sentnum | 3 | -1 | Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. | sentnum | 4 | -1 | Costings were estimated for different geographical coverage levels using non-linear cost functions. | sentnum | 5 | -1 | FINDINGS: Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. | sentnum | 6 | -1 | Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. | sentnum | 7 | -1 | Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally. | sentnum | 8 | -1 | The cost-effectiveness ranges from 57 International dollars (I$) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to I$ 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality. | sentnum | 9 | -1 | CONCLUSION: Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. | sentnum | 10 | -1 | Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000500010 | language | EN | section | title | -1 | sentnum | 0 | -1 | A simplified screening strategy for thalassaemia and haemoglobin E in rural communities in south-east Asia. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To evaluate a simple screening strategy for thalassaemia and haemoglobin (Hb) E in a prevention and control programme for thalassaemia in rural communities with limited resources. | sentnum | 1 | -1 | METHODS: Blood samples from 301 Thai-Khmer participants were screened for thalassaemia and Hb E using a combined modified one-tube osmotic fragility (OF) test and a modified dichlorophenolindophenol (DCIP) precipitation test. | sentnum | 2 | -1 | Results were evaluated with standard haematological analyses including erythrocyte indices, Hb typing and quantification and polymerase chain reaction (PCR) analysis of a-globin and b-globin genes. | sentnum | 3 | -1 | FINDINGS: Participants were divided into four groups according to the results of the combined tests. | sentnum | 4 | -1 | Altogether, 104 of 301 participants (34.6%) had negative results on both tests; 48 (15.9%) were positive on the OF test but not the DCIP test; 40 (13.3%) were negative on the OF test but positive on DCIP test; and 109 (36.2%) were positive on both tests. | sentnum | 5 | -1 | No carrier of clinically significant forms of thalassaemia (aº-thalassaemia, b-thalassaemia) or Hb E was found among the group that had negative results for both tests. | sentnum | 6 | -1 | All participants with Hb E had positive DCIP tests. | sentnum | 7 | -1 | Carriers of a+-thalassaemia or Hb Constant Spring could generate either positive or negative OF test results but they all had negative DCIP tests. | sentnum | 8 | -1 | Using both tests as a preliminary screening for the three important groups of carriers gave a sensitivity of 100% and a specificity of 69.8%. | sentnum | 9 | -1 | The positive predictive value of the combined test was 77.2%. | sentnum | 10 | -1 | The negative predictive value was 100%. | sentnum | 11 | -1 | Further evaluation of the screening system by local staff at three community hospitals found a sensitivity of 98.1-100% and a specificity of 65.4-88.4% with positive predictive values of 75.0-86.9% and negative predictive values of 98.1-100%. | sentnum | 12 | -1 | CONCLUSION: A combined test using OF and DCIP could be used as an effective preliminary screening alternative to an electronic blood cell count for identifying carriers with aº-thalassaemia, b-thalassaemia and Hb E. The strategy should prove useful for population screening in prevention and control programmes in rural ... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000500013 | language | EN | section | title | -1 | sentnum | 0 | -1 | Genomics knowledge and equity: a global public goods perspective of the patent system. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Genomics, the comprehensive examination of an organism's entire set of genes and their interactions, will have a major impact on the way disease is diagnosed, prevented and treated in the new millennium. | sentnum | 1 | -1 | Despite the tremendous potential it holds for improving global health, genomics challenges policy-makers to ensure that its benefits are harnessed equitably across populations and nations. | sentnum | 2 | -1 | The classification of genomics as a global public good and the inequity encountered in the development and application of genomics knowledge are outlined in this paper. | sentnum | 3 | -1 | We examine the effect of the current patent system on the distribution of costs and benefits relating to genomics knowledge between countries of different economic strength. | sentnum | 4 | -1 | The global public goods concept provides a normative economic rationale for the modification of certain aspects of the current patent system and for the creation of complementary mechanisms to respond to the health needs of low-income and middle-income countries. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000600005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Maternal and congenital syphilis programmes: case studies in Bolivia, Kenya and South Africa. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Preventing congenital syphilis is not technically difficult, however operational difficulties limit the effectiveness of programmes in many settings. | sentnum | 1 | -1 | This paper reports on programmes in Bolivia, Kenya, and South Africa. | sentnum | 2 | -1 | All three countries have established antenatal syphilis control programmes. | sentnum | 3 | -1 | Early antenatal syphilis screening and management of positive cases were difficult to implement since most women presented for their first antenatal clinic visit after 6 months of pregnancy. | sentnum | 4 | -1 | Most women had rapid plasma reagin (RPR) testing; results were available on the same day in some clinics but took up to 4 weeks in others. | sentnum | 5 | -1 | No clinic had a system for tracking RPR-reactive women who did not return for their results. | sentnum | 6 | -1 | There were no guidelines for providers in Kenya and Bolivia. | sentnum | 7 | -1 | In all countries, supplies, drugs, notification cards, and other consumables were often unavailable. | sentnum | 8 | -1 | Health-care providers were unmotivated in Kenya and reported an excessive client load. | sentnum | 9 | -1 | In South Africa and Kenya some clients reported at their exit interview that they had never heard of syphilis nor had they been informed why blood was collected. | sentnum | 10 | -1 | Several prevention strategies could be implemented at the clinic level. | sentnum | 11 | -1 | These include encouraging women to attend for antenatal care before the fourth month of pregnancy, providing point-of-care testing so that results are available immediately and women who test positive can be treated, implementing presumptive treatment of sexual partners of women who test positive, adding a second test ... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000600007 | language | EN | section | title | -1 | sentnum | 0 | -1 | The prevention and management of congenital syphilis: an overview and recommendations. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. | sentnum | 1 | -1 | More than 1 million infants are born with congenital syphilis each year. | sentnum | 2 | -1 | Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. | sentnum | 3 | -1 | The weak organization of services and the costs of screening are the principal obstacles facing programmes. | sentnum | 4 | -1 | Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. | sentnum | 5 | -1 | Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. | sentnum | 6 | -1 | Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. | sentnum | 7 | -1 | Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. | sentnum | 8 | -1 | Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. | sentnum | 9 | -1 | They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. | sentnum | 10 | -1 | This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000600010 | language | EN | section | title | -1 | sentnum | 0 | -1 | Diagnostic tools for preventing and managing maternal and congenital syphilis: an overview. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Syphilis is a major cause of adverse outcomes in pregnancy in developing countries. | sentnum | 1 | -1 | Fetal death and morbidity due to congenital syphilis are preventable if infected mothers are identified and treated appropriately by the middle of the second trimester. | sentnum | 2 | -1 | Most pregnant women with syphilis are asymptomatic and can only be identified through serological screening. | sentnum | 3 | -1 | Non-treponemal tests, such as the rapid plasma reagin (RPR) test, are sensitive, simple to perform, and inexpensive. | sentnum | 4 | -1 | However, they have often not been available at primary health-care settings because they required cold storage for reagents and electricity to operate a rotator. | sentnum | 5 | -1 | Additionally, as many as 28% of positive RPR results in pregnant women are biological false positives. | sentnum | 6 | -1 | Confirmatory assays are usually available only in reference laboratories. | sentnum | 7 | -1 | Technological advances have resulted in improved serodiagnostic tools for syphilis. | sentnum | 8 | -1 | New enzyme immunoassays are available for surveillance and for large-scale screening programmes. | sentnum | 9 | -1 | Decentralized antenatal screening with on-site confirmation is now possible since new RPR reagents that are stable at room temperature have become commercially available, as have solar-powered rotators and simple, rapid point-of-care treponemal tests that use whole blood and do not require electricity or equipment. | sentnum | 10 | -1 | These will be valuable tools for preventing or eliminating congenital syphilis. | sentnum | 11 | -1 | The development of a non-invasive rapid treponemal test that distinguishes between active and past infections remains a high priority in areas where syphilis is endemic. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000600012 | language | EN | section | title | -1 | sentnum | 0 | -1 | Effectiveness of condoms in preventing sexually transmitted infections. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | In June 2000, the United States National Institutes of Health (NIH) organized a review of the scientific evidence on the effectiveness of condoms in preventing sexually transmitted infections (STIs). | sentnum | 1 | -1 | The review concluded that condoms were effective in protecting against transmission of HIV to women and men and in reducing the risk of men becoming infected with gonorrhoea. | sentnum | 2 | -1 | Evidence for the effectiveness of condoms in preventing other STIs was considered to be insufficient. | sentnum | 3 | -1 | We review the findings of prospective studies published after June 2000 that evaluated the effectiveness of condoms in preventing STIs. | sentnum | 4 | -1 | We searched Medline for publications in English and included other articles, reports, and abstracts of which we were aware. | sentnum | 5 | -1 | These prospective studies, published since June 2000, show that condom use is associated with statistically significant protection of men and women against several other types of STIs, including chlamydial infection, gonorrhoea, herpes simplex virus type 2, and syphilis. | sentnum | 6 | -1 | Condoms may also be associated with protecting women against trichomoniasis. | sentnum | 7 | -1 | While no published prospective study has found protection against genital human papillomavirus (HPV) infection, two studies reported that condom use was associated with higher rates of regression of cervical intraepithelial neoplasia and clearance of cervical HPV infection in women and with regression of HPV-associated... | sentnum | 8 | -1 | Research findings available since the NIH review add considerably to the evidence of the effectiveness of condoms against STIs. | sentnum | 9 | -1 | Although condoms are not 100% effective, partial protection can substantially reduce the spread of STIs within populations. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000700005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Reproductive tract infections in rural women from the highlands, jungle, and coastal regions of Peru. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. | sentnum | 1 | -1 | METHODS: During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. | sentnum | 2 | -1 | We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma vi... | sentnum | 3 | -1 | FINDINGS: The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. | sentnum | 4 | -1 | Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). | sentnum | 5 | -1 | One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). | sentnum | 6 | -1 | Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. | sentnum | 7 | -1 | Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. | sentnum | 8 | -1 | CONCLUSION: Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. | sentnum | 9 | -1 | Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000700007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Secondary prevention of stroke : results from the Southern Africa Stroke Prevention Initiative (SASPI) study. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To describe the prevalence of risk factors and experience of preventive interventions in stroke survivors, and identify barriers to secondary prevention in rural South Africa. | sentnum | 1 | -1 | METHODS: A clinician visited individuals in the Agincourt field site (in South Africa's rural north east) who were identified in a census as possible stroke victims to confirm the diagnosis of stroke. | sentnum | 2 | -1 | We explored the impact of stroke on the individual's family, and health-seeking behaviour following stroke by conducting in-depth interviews in the households of 35 stroke survivors. | sentnum | 3 | -1 | We held two workshops to understand the knowledge, experience, and views of primary care nurses, who provide the bulk of professional health care. | sentnum | 4 | -1 | FINDINGS: We identified 103 stroke survivors (37 men), 73 (71%) of whom had hypertension, but only 8 (8%) were taking anti-hypertensive treatment. | sentnum | 5 | -1 | Smoking was uncommon; 8 men and 1 woman smoked a maximum of ten cigarettes daily. | sentnum | 6 | -1 | 94 (91%) stroke survivors had sought help, which involved allopathic health care for most of them (81; 79%). | sentnum | 7 | -1 | 42 had also sought help from traditional healers and churches, while another 13 people had sought help only from those sources. | sentnum | 8 | -1 | Of the 35 survivors who were interviewed, 29 reported having been prescribed anti-hypertensive pills after their stroke. | sentnum | 9 | -1 | Barriers to secondary prevention included cost of treatment, reluctance to use pills, difficulties with access to drugs, and lack of equipment to measure blood pressure. | sentnum | 10 | -1 | A negative attitude to allopathic care was not an important factor. | sentnum | 11 | -1 | CONCLUSION: In this rural area hypertension is the most important modifiable risk factor in stroke survivors. | sentnum | 12 | -1 | Effective secondary prevention may reduce the incidence of recurrent strokes, but there is no system to deliver such care. | null | null | null | null | sentnum | 13 | -1 | New strategies for care are needed involving both allopathic and non-allopathic-health care providers. | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000700009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Wheezing conditions in early childhood: prevalence and risk factors in the city of São Paulo, Brazil. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To investigate the prevalence and risk factors for wheezing disorders in early childhood in São Paulo, Brazil, the largest metropolitan area of South America. | sentnum | 1 | -1 | METHODS: A population-based cross-sectional survey of 1132 children aged 6-59 months was carried out between 1995 and 1996 to obtain information on recent wheezing and on independent variables such as demographic, socioeconomic, environmental, maternal and nutritional variables and immunization status. | sentnum | 2 | -1 | Intestinal parasitic infections were diagnosed using standard techniques. | sentnum | 3 | -1 | Multiple unconditional logistic regression was used to describe associations between outcome and independent variables. | sentnum | 4 | -1 | FINDINGS: The prevalence of recent wheezing (one or more reported episodes in the past 12 months) was 12.5%; 93% of children with wheezing were also reported to have a medical diagnosis of asthma. | sentnum | 5 | -1 | Recent wheezing was associated with low per capita income, poor quality of housing, day-care attendance, low birth weight and infection with intestinal helminths. | sentnum | 6 | -1 | CONCLUSION: Wheezing in early childhood in São Paulo, although more common than in most developing countries, remains less prevalent than in urban areas of industrialized countries. | sentnum | 7 | -1 | Low income and conditions associated with poverty (poor housing, low birth weight and parasitic infections) are some of the main risk factors for wheezing disorders among young children in this city. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000700011 | language | EN | section | title | -1 | sentnum | 0 | -1 | China's public health-care system: facing the challenges. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. | sentnum | 1 | -1 | A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. | sentnum | 2 | -1 | The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. | sentnum | 3 | -1 | For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. | sentnum | 4 | -1 | A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. | sentnum | 5 | -1 | China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. | sentnum | 6 | -1 | China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000800005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Selective mass treatment with ivermectin to control intestinal helminthiases and parasitic skin diseases in a severely affected population. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil. | sentnum | 1 | -1 | METHODS: An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. | sentnum | 2 | -1 | The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. | sentnum | 3 | -1 | A total of 525 people out of a target population of 576 were treated at baseline. | sentnum | 4 | -1 | The majority of these were treated with ivermectin (200 µg/kg with a second dose given after 10 days). | sentnum | 5 | -1 | If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. | sentnum | 6 | -1 | Follow-up examinations were performed at 1 month and 9 months after treatment. | sentnum | 7 | -1 | FINDINGS: Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respec... | sentnum | 8 | -1 | Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. | sentnum | 9 | -1 | Adverse events occurred in 9.4% of treatments. | sentnum | 10 | -1 | They were all of mild to moderate severity and were transient. | sentnum | 11 | -1 | CONCLUSION: Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. | sentnum | 12 | -1 | The effects of treatment lasted for a prolonged period of time. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000800007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Public-private mix for DOTS implementation: what makes it work?. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To compare processes and outcomes of four public-private mix (PPM) projects on DOTS implementation for tuberculosis (TB) control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India. | sentnum | 1 | -1 | METHODS: Cross-project analysis of secondary data from separate project evaluations was used. | sentnum | 2 | -1 | Differences among PPM project sites in impact on TB control (change in case detection, treatment outcomes and equity in access) were correlated with differences in chosen intervention strategies and structural conditions. | sentnum | 3 | -1 | FINDINGS: The analysis suggests that an effective intervention package should include the following provider-side components: (1) orienting private providers (PPs) and the staff of the national TB programme (NTP); (2) improving the referral and information system through simple practical tools; (3) the NTP adequately s... | sentnum | 4 | -1 | CONCLUSION: Getting such an intervention package to work requires that the NTP be strongly committed to supporting, supervising and evaluating PPM projects. | sentnum | 5 | -1 | Further, using a local nongovernmental organization or a medical association as an intermediary may facilitate collaboration. | sentnum | 6 | -1 | Investing time and effort to ensure that sufficient dialogue takes place among all stakeholders is important to help build trust and achieve a high level of agreement. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000800009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Migration of health-care workers from developing countries: strategic approaches to its management. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. | sentnum | 1 | -1 | The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries. | sentnum | 2 | -1 | Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. | sentnum | 3 | -1 | It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. | sentnum | 4 | -1 | The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000800011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Plumbing the brain drain. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Opportunity is the driving force of migration. | sentnum | 1 | -1 | Unsatisfied demands for higher education and skills, which have been created by the knowledge-based global economy, have generated unprecedented opportunities in knowledge-intensive service industries. | sentnum | 2 | -1 | These multi-trillion dollar industries include information, communication, finance, business, education and health. | sentnum | 3 | -1 | The leading industrialized nations are also the focal points of knowledge-intensive service industries and as such constitute centres of research and development activity that proactively draw in talented individuals worldwide through selective immigration policies, employment opportunities and targeted recruitment. | sentnum | 4 | -1 | Higher education is another major conduit of talent from less-developed countries to the centres of the knowledge-based global economy. | sentnum | 5 | -1 | Together career and educational opportunities drive "brain drain and recirculation". | sentnum | 6 | -1 | The departure of a large proportion of the most competent and innovative individuals from developing nations slows the achievement of the critical mass needed to generate the enabling context in which knowledge creation occurs. | sentnum | 7 | -1 | To favourably modify the asymmetric movement and distribution of global talent, developing countries must implement bold and creative strategies that are backed by national policies to: provide world-class educational opportunities, construct knowledge-based research and development industries, and sustainably finance ... | sentnum | 8 | -1 | Brazil, China and India have moved in this direction, offering world-class education in areas crucial to national development, such as biotechnology and information technology, paralleled by investments in research and development. | sentnum | 9 | -1 | As a result, only a small proportion of the most highly educated individuals migrate from these countries, and research and development opportunities employ national talent and even attract immigrants. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000900005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in Pakistan. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: This study aimed to estimate the incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in the Loralai district of Pakistan. | sentnum | 1 | -1 | The supplemental immunization activities were carried out in two phases during 2001-03. | sentnum | 2 | -1 | METHODS: A state-transition model was used to estimate the effect of routine vaccination with tetanus toxoid as well as vaccination with tetanus toxoid during supplementary immunization activities. | sentnum | 3 | -1 | The model follows each woman in the target population from birth until the end of her childbearing years, using age-specific fertility data and vaccination history to determine the number of births at risk for neonatal tetanus. | sentnum | 4 | -1 | Recently published data on the incidence of neonatal tetanus from Loralai was used to determine the number of cases occurring with and without supplementary immunization activities. | sentnum | 5 | -1 | Data on the costs of the activities were collected from the UNICEF office in Balochistan and from the Provincial Health Department. | sentnum | 6 | -1 | FINDINGS: Using base-case assumptions we estimated that the supplementary immunization activities would prevent 280 cases of neonatal tetanus and 224 deaths from neonatal tetanus between 2001 and 2034. | sentnum | 7 | -1 | Implementation of the supplementary activities was relatively inexpensive. | sentnum | 8 | -1 | The cost per tetanus toxoid dose delivered was US$ 0.40. | sentnum | 9 | -1 | In the base-case analysis the cost per death averted was US$ 117.00 (95% confidence interval (CI) = US$ 78-205) and the cost per disability-adjusted life year (DALY) averted was US$ 3.61 (95% CI = US$ 2.43-6.39). | sentnum | 10 | -1 | CONCLUSION: Compared with similar analyses of other interventions, the cost per DALY averted is a favourable cost-effectiveness ratio. | sentnum | 11 | -1 | However, if routine diphtheria-tetanus-pertussis vaccination coverage in the Loralai district had been higher (at a coverage rate of about 80%) the cost-effectiveness of the intervention would have been even more favourable, at US$ 2.65 per DALY averted. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000900007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Improving immunization equity through a public-private partnership in Cambodia. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To examine the effects on immunization equity of the large-scale contracting of primary health-care services in rural areas of Cambodia. | sentnum | 1 | -1 | METHODS: Data were obtained pre-intervention and post-intervention from a large-scale quasi-experiment in contracting with nongovernmental organizations to provide primary health care in nine rural districts of Cambodia between 1999 and mid-2001. | sentnum | 2 | -1 | Coverage targets and equity targets for all primary health-care services, including immunization of children, were explicitly included in the contracts awarded in five of nine rural districts which together have a population of over 1.25 million people. | sentnum | 3 | -1 | The remaining four districts used the traditional government model for providing services and were given identical targets. | sentnum | 4 | -1 | FINDINGS: After the 2.5 years of the trial, bivariate and multivariate analyses of the results suggested that although there was a substantial increase in the proportion of children who were fully immunized in all districts, children in the poorest 50% of households in the districts served by contractors were more like... | sentnum | 5 | -1 | CONCLUSION: The contracting approach described in this paper suggests a means of moving towards a more equitable distribution of immunization services in developing countries. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000900009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Variation in the costs of delivering routine immunization services in Peru. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: Estimates of vaccination costs usually provide only point estimates at national level with no information on cost variation. | sentnum | 1 | -1 | In practice, however, such information is necessary for programme managers. | sentnum | 2 | -1 | This paper presents information on the variations in costs of delivering routine immunization services in three diverse districts of Peru: Ayacucho (a mountainous area), San Martin (a jungle area) and Lima (a coastal area). | sentnum | 3 | -1 | METHODS: We consider the impact of variability on predictions of cost and reflect on the likely impact on expected cost-effectiveness ratios, policy decisions and future research practice. | sentnum | 4 | -1 | All costs are in 2002 prices in US$ and include the costs of providing vaccination services incurred by 19 government health facilities during the January-December 2002 financial year. | sentnum | 5 | -1 | Vaccine wastage rates have been estimated using stock records. | sentnum | 6 | -1 | FINDINGS: The cost per fully vaccinated child ranged from US$ 16.63-24.52 in Ayacucho, US$ 21.79-36.69 in San Martin and US$ 9.58-20.31 in Lima. | sentnum | 7 | -1 | The volume of vaccines administered and wastage rates are determinants of the variation in costs of delivering routine immunization services. | sentnum | 8 | -1 | CONCLUSION: This study shows there is considerable variation in the costs of providing vaccines across geographical regions and different types of facilities. | sentnum | 9 | -1 | Information on how costs vary can be used as a basis from which to generalize to other settings and provide more accurate estimates for decision-makers who do not have disaggregated data on local costs. | sentnum | 10 | -1 | Future studies should include sufficiently large sample sizes and ensure that regions are carefully selected in order to maximize the interpretation of cost variation. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000900011 | language | EN | section | title | -1 | sentnum | 0 | -1 | The costs, effects and cost-effectiveness of strategies to increase coverage of routine immunizations in low- and middle-income countries: systematic review of the grey literature. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Evidence-based reviews of published literature can be subject to several biases. | sentnum | 1 | -1 | Grey literature, however, can be of poor quality and expensive to access. | sentnum | 2 | -1 | Effective search strategies also vary by topic and are rarely known in advance. | sentnum | 3 | -1 | This paper complements a systematic review of the published literature on the costs and effects of expanding immunization services in developing countries. | sentnum | 4 | -1 | The quality of data on the effectiveness and cost-effectiveness of strategies to increase immunization coverage is shown to be similar across literatures, but the quality of information on costing is much lower in the grey literature. | sentnum | 5 | -1 | After excluding poorer quality studies from this review we found the quantity of available evidence almost doubled, particularly for more complex health-system interventions and cost or cost-effectiveness analyses. | sentnum | 6 | -1 | Interventions in the grey literature are more up to date and cover a different geographical spread. | sentnum | 7 | -1 | Consequently the conclusions of the published and grey literatures differ, although the number of papers is still too low to account for differences across types of interventions. | sentnum | 8 | -1 | We recommend that in future researchers consider using non-English keywords in their searches. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004000900013 | language | EN | section | title | -1 | sentnum | 0 | -1 | Does earmarked donor funding make it more or less likely that developing countries will allocate their resources towards programmes that yield the greatest health benefits?. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | It should not be assumed that earmarked donor funding automatically increases the allocation of developing-country resources towards programmes that yield the greatest health benefits. | sentnum | 1 | -1 | Sometimes it does, sometimes it does not - how the funding is designed can influence this. | sentnum | 2 | -1 | This is true particularly in the longer term, once the earmarked funding has ended. | sentnum | 3 | -1 | Even in the short term, total funding does not necessarily increase because of fungibility (i.e. recipient governments adjust their spending to offset donor funding preferences). | sentnum | 4 | -1 | The author explores six problems with earmarked funding: the multiplicity of earmarked funds confuses the situation for decision-makers; earmarking works against the spirit of the sectorwide approach; from the national perspective, it makes sense not to double-fund activities; local ownership of an activity is often co... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001000007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Estimating the economic value to societies of the impact of health research: a critical review. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Estimating the economic value to societies of health research is a complex but essential step in establishing and justifying appropriate levels of investment in research. | sentnum | 1 | -1 | The practical difficulties encountered include: identifying and valuing the relevant research inputs (when many pieces of research may contribute to a clinical advance); accurately ascribing the impact of the research; and appropriately valuing the attributed economic impact. | sentnum | 2 | -1 | In this review, relevant studies identified from the literature were grouped into four categories on the basis of the methods used to value the benefits of research. | sentnum | 3 | -1 | The first category consists of studies that value the direct cost savings that could arise from research leading either to new, less-costly treatments or to developments such as vaccines that reduce the number of patients needing treatment. | sentnum | 4 | -1 | The second category comprises studies that consider the value to the economy of a healthy workforce. | sentnum | 5 | -1 | According to this "human capital" approach, indirect cost savings arise when better health leads to the avoidance of lost production. | sentnum | 6 | -1 | The third category includes studies that examine gains to the economy in terms of product development, consequent employment and sales. | sentnum | 7 | -1 | The studies placed in the fourth category measure the intrinsic value to society of the health gain, by placing a monetary value on a life. | sentnum | 8 | -1 | The review did not identify any consistency of methodology, but the fourth approach has most promise as a measure of social value. | sentnum | 9 | -1 | Many of the studies reviewed come from industrialized nations and a proposal is made by the present reviewers for an international initiative, covering developed and developing countries, to undertake further methodological analysis and testing. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001000009 | language | EN | section | title | -1 | sentnum | 0 | -1 | From research to practice: the example of antenatal care in Thailand. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. | sentnum | 1 | -1 | The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. | sentnum | 2 | -1 | However, in developing countries there is wide variation in the proportion of women who receive antenatal care. | sentnum | 3 | -1 | The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. | sentnum | 4 | -1 | This new model of antenatal care is being implemented in Thailand. | sentnum | 5 | -1 | Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations. | sentnum | 6 | -1 | The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001000011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Making research matter: a civil society perspective on health research. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Complex global public health challenges such as the rapidly widening health inequalities, and unprecedented emergencies such as the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) demand a reappraisal of existing priorities in health policies, expenditure and research. | sentnum | 1 | -1 | Research can assist in mounting an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives. | sentnum | 2 | -1 | Civil society organizations (CSOs) are already at the forefront of such research. | sentnum | 3 | -1 | We suggest that there are at least three ways in which the participation of CSOs in research can be increased: namely, influencing commissioning and priority-setting; becoming involved in the review process and in conducting research; and through formal partnerships between communities and universities that link CSOs w... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001000013 | language | EN | section | title | -1 | sentnum | 0 | -1 | Beyond informed consent. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Although a relatively recent phenomenon, the role of informed consent in human research is central to its ethical regulation and conduct. | sentnum | 1 | -1 | However, guidelines often recommend procedures for obtaining informed consent (usually written consent) that are difficult to implement in developing countries. | sentnum | 2 | -1 | This paper reviews the guidelines for obtaining informed consent and also discusses prevailing views on current controversies, ambiguities and problems with these guidelines and suggests potential solutions. | sentnum | 3 | -1 | The emphasis in most externally sponsored research projects in developing countries is on laborious documentation of several mechanical aspects of the research process rather than on assuring true comprehension and voluntary participation. | sentnum | 4 | -1 | The onus for the oversight of this process is often left to overworked and ill-equipped local ethics review committees. | sentnum | 5 | -1 | Current guidelines and processes for obtaining informed consent should be reviewed with the specific aim of developing culturally appropriate methods of sharing information about the research project and obtaining and documenting consent that is truly informed. | sentnum | 6 | -1 | Further research is needed to examine the validity and user friendliness of innovations in information sharing procedures for obtaining consent in different cultural settings. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001000015 | language | EN | section | title | -1 | sentnum | 0 | -1 | Ownership of knowledge: the role of patents in pharmaceutical R&D. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Both the public and the private sectors contribute to research and development (R&D) in pharmaceuticals. | sentnum | 1 | -1 | The public sector originates many of the discoveries of new drugs. | sentnum | 2 | -1 | The private sector, which focuses on development, is heavily reliant on patents. | sentnum | 3 | -1 | Though patents are presumed to reward genuine inventions, lax rules on patentability and shortcomings in procedures permit protection to be obtained on a myriad of minor developments. | sentnum | 4 | -1 | These patents, though weak and possibly invalid in many cases, are used to restrain competition and delay the entry of generic competition. | sentnum | 5 | -1 | Developing countries should design and implement their patent laws so as to prevent strategic patenting and promote competition and access to medicines. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001100006 | language | EN | section | title | -1 | sentnum | 0 | -1 | Back to basics: does decentralization improve health system performance? | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To examine whether decentralization has improved health system performance in the State of Ceará, north-east Brazil. | sentnum | 1 | -1 | METHODS: Ceará is strongly committed to decentralization. | sentnum | 2 | -1 | A survey across 45 local (município) health systems collected data on performance and formal organization, including decentralization, informal management and local political culture. | sentnum | 3 | -1 | The indicators for informal management and local political culture were based on prior ethnographic research. | sentnum | 4 | -1 | Data were analysed using analysis of variance, Duncan's post-hoc test and multiple regression. | sentnum | 5 | -1 | FINDINGS: Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. | sentnum | 6 | -1 | Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. | sentnum | 7 | -1 | However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators. | sentnum | 8 | -1 | CONCLUSION: Good management practices in the study led to decentralized local health systems rather than vice versa. | sentnum | 9 | -1 | Any apparent association between decentralization and performance seems to be an artefact of the informal management, and the wider political culture in which a local health system is embedded strongly influences the performance of local health systems. | null | null | null | null | null | null | null | null | null | null | null | null | sentnum | 1 | -1 | Evidence from Ceará in north-east Brazil. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001100008 | language | EN | section | title | -1 | sentnum | 0 | -1 | Tuberculosis situation among tribal population of Car Nicobar, India, 15 years after intensive tuberculosis control project and implementation of a national tuberculosis programme. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To assess the tuberculosis (TB) situation in the tribal community of Car Nicobar island 15 years after the national TB programme was implemented in this area after an intensive phase of TB control in 1986. | sentnum | 1 | -1 | METHODS: The entire population of Car Nicobar was enumerated through a house-to-house survey. | sentnum | 2 | -1 | Children aged <14 years were tuberculin tested and read for reaction sizes. | sentnum | 3 | -1 | Individuals aged >15 years were asked about the presence of chest symptoms (cough, chest pain, and unexplained fever for two weeks or longer and haemoptysis), and sputum samples were collected from patients with chest symptoms. | sentnum | 4 | -1 | Sputum samples were examined for presence of acid-fast bacilli. | sentnum | 5 | -1 | FINDINGS: Among the 4543 children enumerated, 4351 (95.8%) were tuberculin tested and read. | sentnum | 6 | -1 | Of the 981 children without bacille Calmette-Guérin scars, 161 (16.4%) were infected with TB. | sentnum | 7 | -1 | A total of 77 cases who were smear-positive for TB were detected from among 10 570 people aged >15 years; the observed smear-positive case prevalence was 728.5 per 100 000. | sentnum | 8 | -1 | The standardized prevalence of TB infection, annual risk of TB infection, and prevalence of cases smear-positive for TB were 17.0%, 2.5%, and 735.3 per 100 000, respectively. | sentnum | 9 | -1 | CONCLUSION: The prevalence of TB infection and smear-positive cases of TB increased significantly between 1986 and 2002. | sentnum | 10 | -1 | Such escalation took place despite the implementation of the national TB programme on this island, which was preceded by a set of special anti-TB measures that resulted in sputum conversion in a substantially large proportion of the smear-positive cases prevalent in the community. | sentnum | 11 | -1 | The most likely reason for the increase seems to be the absence of a district TB programme with enough efficiency to sustain the gains made from the one-time initial phase of special anti-TB measures. | sentnum | 12 | -1 | High risk of transmission of TB infection currently observed on this island calls for a drastic and sustained improvement in TB control measures. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001100010 | language | EN | section | title | -1 | sentnum | 0 | -1 | The laboratory confirmation of suspected measles cases in settings of low measles transmission: conclusions from the experience in the Americas. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | The Americas have set a goal of interrupting indigenous transmission of measles using a strategy developed by the Pan American Health Organization (PAHO). | sentnum | 1 | -1 | This strategy includes recommendations for vaccination activities to achieve and sustain high immunity in the population and is complemented by sensitive epidemiological surveillance systems developed to monitor illnesses characterized by febrile rash, and to provide effective virological and serological surveillance. | sentnum | 2 | -1 | A key component in ensuring the success of the programme has been a laboratory network comprising 22 national laboratories including reference centres. | sentnum | 3 | -1 | Commercially available indirect enzyme immunoassay kits (EIA) for immunoglobulin M (IgM)-class antibodies are currently being used throughout the region. | sentnum | 4 | -1 | However, because there are few or no true measles cases in the region, the positive predictive value of these diagnostic tests has decreased. | sentnum | 5 | -1 | False-positive results of IgM tests can also occur as a result of testing suspected measles cases with exanthemata caused by Parvovirus B19, rubella and Human herpesvirus 6, among others. | sentnum | 6 | -1 | In addition, as countries maintain high levels of vaccination activity and increased surveillance of rash and fever, the notification of febrile rash illness in recently vaccinated people can be anticipated. | sentnum | 7 | -1 | Thus, managers in the measles elimination programme must be prepared to address the interpretation of a positive result of a laboratory test for measles IgM when clinical and epidemiological data may indicate that the case is not measles. | sentnum | 8 | -1 | The interpretation of an IgM-positive test under different circumstances and the definition of a vaccine-related rash illness in a setting of greatly reduced, or absent, transmission of measles is discussed. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001100012 | language | EN | section | title | -1 | sentnum | 0 | -1 | Health information technology in primary health care in developing countries: a literature review. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | This paper explores the debate and initiatives concerning the use of information technology (IT) in primary health care in developing countries. | sentnum | 1 | -1 | The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases. | sentnum | 2 | -1 | The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO). | sentnum | 3 | -1 | For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries. | sentnum | 4 | -1 | These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS). | sentnum | 5 | -1 | The main advantages, limitations and perspectives are discussed. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001200005 | language | EN | section | title | -1 | sentnum | 0 | -1 | Global estimate of the incidence of clinical pneumonia among children under five years of age. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: Clinical pneumonia (defined as respiratory infections associated with clinical signs of pneumonia, principally pneumonia and bronchiolitis) in children under five years of age is still the leading cause of childhood mortality in the world. | sentnum | 1 | -1 | In this paper we aim to estimate the worldwide incidence of clinical pneumonia in young children. | sentnum | 2 | -1 | METHODS: Our estimate for the developing world is based on an analysis of published data on the incidence of clinical pneumonia from community based longitudinal studies. | sentnum | 3 | -1 | Among more than 2000 studies published since 1961, we identified 46 studies that reported the incidence of clinical pneumonia, and 28 of these met pre-defined quality criteria. | sentnum | 4 | -1 | FINDINGS: The estimate of the median incidence from those studies was 0.28 episodes per child-year (e/cy). | sentnum | 5 | -1 | The 25-75% interquartile range was 0.21-0.71. | sentnum | 6 | -1 | We assessed the plausibility of this estimate using estimates of global mortality from acute respiratory infections and reported case fatality rates for all episodes of clinical pneumonia reported in community-based studies or the case-fatality rate reported only for severe cases and estimates of the proportion of seve... | sentnum | 7 | -1 | CONCLUSION: The overlap between the ranges of the estimates implies that a plausible incidence estimate of clinical pneumonia for developing countries is 0.29 e/cy. | sentnum | 8 | -1 | This equates to an annual incidence of 150.7 million new cases, 11-20 million (7-13%) of which are severe enough to require hospital admission. | sentnum | 9 | -1 | In the developed world no comparable data are available. | sentnum | 10 | -1 | However, large population-based studies report that the incidence of community-acquired pneumonia among children less than five years old is approximately 0.026 e/cy, suggesting that more than 95% of all episodes of clinical pneumonia in young children worldwide occur in developing countries. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001200007 | language | EN | section | title | -1 | sentnum | 0 | -1 | Respiratory syncytial virus infection: denominator-based studies in Indonesia, Mozambique, Nigeria and South Africa. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To assess the burden of respiratory syncytial virus (RSV)-associated lower respiratory infections (LRI) in children in four developing countries. | sentnum | 1 | -1 | METHODS: A WHO protocol for prospective population-based surveillance of acute respiratory infections in children aged less than 5 years was used at sites in Indonesia, Mozambique, Nigeria and South Africa. | sentnum | 2 | -1 | RSV antigen was identified by enzyme-linked immunosorbent assay performed on nasopharyngeal specimens from children meeting clinical case definitions. | sentnum | 3 | -1 | FINDINGS: Among children aged < 5 years, the incidence of RSV-associated LRI per 1000 child-years was 34 in Indonesia and 94 in Nigeria. | sentnum | 4 | -1 | The incidence of RSV-associated severe LRI per 1000 child-years was 5 in Mozambique, 10 in Indonesia, and 9 in South Africa. | sentnum | 5 | -1 | At all study sites, the majority of RSV cases occurred in infants. | sentnum | 6 | -1 | CONCLUSION: These studies demonstrate that RSV contributes to a substantial but quite variable burden of LRI in children aged < 5 years in four developing countries. | sentnum | 7 | -1 | The possible explanations for this variation include social factors, such as family size and patterns of seeking health care; the proportion of children infected by human immunodeficiency syndrome (HIV); and differences in clinical definitions used for obtaining samples. | sentnum | 8 | -1 | The age distribution of cases indicates the need for an RSV vaccine that can protect children early in life. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001200009 | language | EN | section | title | -1 | sentnum | 0 | -1 | The antimicrobial resistance containment and surveillance approach - a public health tool. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Antimicrobial drug resistance (AMR) is widely recognized as a global public health threat because it endangers the effectiveness of treatment of infectious diseases. | sentnum | 1 | -1 | In 2001 WHO issued the Global Strategy for Containment of Antimicrobial Resistance, but it has proved difficult to translate the recommendations of the Global Strategy into effective public health actions. | sentnum | 2 | -1 | The purpose of the Antimicrobial Resistance Containment and Surveillance (ARCS) approach is to facilitate the formulation of public health programmes and the mobilization of human and financial resources for the containment of AMR. | sentnum | 3 | -1 | The ARCS approach highlights the fundamental link between rational drug use and containment of AMR. | sentnum | 4 | -1 | Clinical management of human and animal infections should be improved through better disease control and prevention, high quality diagnostic testing, appropriate treatment regimens and consumer health education. | sentnum | 5 | -1 | At the same time, systems for supplying antimicrobial drugs should include appropriate regulations, lists of essential drugs, and functional mechanisms for the approval and delivery of drugs. | sentnum | 6 | -1 | Containment of AMR is defined in the ARCS approach as the continuous application of this package of core interventions. | sentnum | 7 | -1 | Surveillance of the extent and trends of antimicrobial resistance as well as the supply, selection and use of antimicrobial drugs should be established to monitor the process and outcome of containment of AMR. | sentnum | 8 | -1 | The ARCS approach is represented in the ARCS diagram (Fig. | sentnum | 9 | -1 | 2) which provides a simplified, but comprehensive illustration of the complex problem of containment and monitoring of AMR. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862004001200011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Socioeconomic status and obesity in adult populations of developing countries: a review. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. | sentnum | 1 | -1 | The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. | sentnum | 2 | -1 | Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. | sentnum | 3 | -1 | Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. | sentnum | 4 | -1 | 2. | sentnum | 5 | -1 | The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases. | sentnum | 6 | -1 | 3. | sentnum | 7 | -1 | The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. | sentnum | 8 | -1 | The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US$ 2500, the mid-point value for lower-middle-income economies. | sentnum | 9 | -1 | The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consi... | sentnum | 10 | -1 | A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000100009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy. | sentnum | 1 | -1 | However, changing to alternative antimicrobial agents, such as amoxicillin, is costly. | sentnum | 2 | -1 | We compared the clinical efficacy of twice-daily cotrimoxazole in standard versus double dosage for treating non-severe pneumonia in children. | sentnum | 3 | -1 | METHODS: A randomized controlled multicentre trial was implemented in seven hospital outpatient departments and two community health programmes. | sentnum | 4 | -1 | A total of 1143 children aged 2-59 months with non-severe pneumonia were randomly allocated to receive 4 mg trimethoprim plus 20 mg sulfamethoxazole/kg of body weight or 8 mg trimethoprim plus 40 mg sulfamethoxazole/kg of body weight orally twice-daily for 5 days Treatment failure occurred when a child required a chang... | sentnum | 5 | -1 | Children required a change of therapy if their condition worsened (they developed chest indrawing or danger signs) or if at 48 hours after enrolment, their clinical condition was the same (defined as having a respiratory rate that was 5 breaths/minute higher or lower than at the time of enrolment). | sentnum | 6 | -1 | FINDINGS: The results of 1134 children were analysed: 578 were assigned to the standard dose of cotrimoxazole and 556 to the double dose. | sentnum | 7 | -1 | Treatment failed in 112 children (19.4%) in the standard group and 118 (21.2%) in the double-dose group (relative risk 1.10; 95% confidence interval = 0.87-1.37). | sentnum | 8 | -1 | Using multivariate analysis we found that treatment was more likely to fail in children who were not given the medicine correctly (P = 0.001), in those younger than 12 months (P = 0.004), those who had used antibiotics previously (P = 0.002), those whose respiratory rate was > 20 breaths/minute above the age-specific c... | sentnum | 9 | -1 | CONCLUSION: Both standard and double strength cotrimoxazole were equally effective in treating non-severe pneumonia. | sentnum | 10 | -1 | Close follow-up of patients is essential to prevent worsening of disease. | sentnum | 11 | -1 | Definitions of clinical failure need to be more specific. | sentnum | 12 | -1 | Surveillance in both rural and urban areas is essential in the development of treatment policies that are based on clinical outcomes. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000100011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Helping northern Ethiopian communities reduce childhood mortality: population-based intervention trial. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: More than 10 million children die each year mostly from preventable causes and particularly in developing countries. | sentnum | 1 | -1 | WHO guidelines for the Integrated Management of Childhood Illness (IMCI) are intended to reduce childhood mortality and are being implemented in Ethiopia. | sentnum | 2 | -1 | As well as specific clinical interventions, the role of the community in understanding and acting on childhood sickness is an important factor in improving survival. | sentnum | 3 | -1 | This trial sought to assess the effect on survival of community-based health promotion activities. | sentnum | 4 | -1 | METHODS: Two districts in northern Ethiopia were studied, each with a random sample of more than 4000 children less than 5 years old. | sentnum | 5 | -1 | Regular six-monthly visits were made to document deaths among children. | sentnum | 6 | -1 | After the first year, communities in one district were educated about issues of good childcare and caring for sick children while the other district received this information only after the trial ended. | sentnum | 7 | -1 | FINDINGS: Although overall mortality was higher in the post-intervention period, most of the increase was seen in the control area. | sentnum | 8 | -1 | A Cox proportional hazards model gave an adjusted hazard ratio of 0.66 (95% confidence interval = 0.46-0.95) for the intervention area compared with the control area in the post-intervention period, with no significant pre-intervention difference. | sentnum | 9 | -1 | Significant survival advantages were found for females, children of younger fathers, those with married parents, those living in larger households, and those whose nearest health facility was a health centre. | sentnum | 10 | -1 | For all of the children who died, only 44% of parents or caregivers had sought health care before the child's death. | sentnum | 11 | -1 | CONCLUSION: This non-specific community-based public health intervention, as an addition to IMCI strategies in local health facilities, appears to have significantly reduced childhood mortality in these communities. | sentnum | 12 | -1 | The possibility that such interventions may not effectively reach certain social groups (for example single parents) is an important consideration for implementation of similar strategies in future. | null | null | null | null | sentnum | 13 | -1 | The synergy between community awareness and the availability of effective peripheral health services is also an issue that needs further exploration. | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000100013 | language | EN | section | title | -1 | sentnum | 0 | -1 | Schistosomiasis control in China: the impact of a 10-year World Bank Loan Project (1992-2001). | language | EN | section | abstract | -1 | sentnum | 0 | -1 | China has been carrying out large-scale schistosomiasis control since the mid-1950s, but in the early 1990s, schistosomiasis was still endemic in eight provinces. | sentnum | 1 | -1 | A World Bank Loan Project enabled further significant progress to be made during the period 1992-2001. | sentnum | 2 | -1 | The control strategy was focused on the large-scale use of chemotherapy - primarily to reinforce morbidity control - while at the same time acting on transmission with the ultimate goal of interrupting it. | sentnum | 3 | -1 | Chemotherapy was complemented by health education, chemical control of snails and environmental modification where appropriate. | sentnum | 4 | -1 | A final evaluation in 2002 showed that infection rates in humans and livestock had decreased by 55% and 50%, respectively. | sentnum | 5 | -1 | The number of acute infections and of individuals with advanced disease had also significantly decreased. | sentnum | 6 | -1 | Although snail infection rates continued to fluctuate at a low level, the densities of infected snails had decreased by more than 75% in all endemic areas. | sentnum | 7 | -1 | The original objectives of the China World Bank Loan Project for schistosomiasis control had all been met. | sentnum | 8 | -1 | One province, Zhejiang, had already fulfilled the criteria for elimination of schistosomiasis by 1995. | sentnum | 9 | -1 | The project was therefore a success and has provided China with a sound basis for further control. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000100015 | language | EN | section | title | -1 | sentnum | 0 | -1 | Participation in health impact assessment: objectives, methods and core values. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Health impact assessment (HIA) is a multidisciplinary aid to decision-making that assesses the impact of policy on public health and on health inequalities. | sentnum | 1 | -1 | Its purpose is to assist decision-makers to maximize health gains and to reduce inequalities. | sentnum | 2 | -1 | The 1999 Gothenburg Consensus Paper (GCP) provides researchers with a rationale for establishing community participation as a core value of HIA. | sentnum | 3 | -1 | According to the GCP, participation in HIA empowers people within the decision-making process and redresses the democratic deficit between government and society. | sentnum | 4 | -1 | Participation in HIA generates a sense that health and decision-making is community-owned, and the personal experiences of citizens become integral to the formulation of policy. | sentnum | 5 | -1 | However, the participatory and empowering dimensions of HIA may prove difficult to operationalize. | sentnum | 6 | -1 | In this review of the participation strategies adopted in key applications of HIA in the United Kingdom, we found that HIA's aim of influencing decision-making creates tension between its participatory and knowledge-gathering dimensions. | sentnum | 7 | -1 | Accordingly, researchers have decreased the participatory dimension of HIA by reducing the importance attached to the community's experience of empowerment, ownership and democracy, while enlarging its knowledge-gathering dimension by giving pre-eminence to "expert" and "research-generated" evidence. | sentnum | 8 | -1 | Recent applications of HIA offer a serviceable rationale for participation as a means of information gathering and it is no longer tenable to uphold HIA as a means of empowering communities and advancing the aims of participatory democracy. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000100017 | language | EN | section | title | -1 | sentnum | 0 | -1 | Mental and social health during and after acute emergencies: emerging consensus?. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial. | sentnum | 1 | -1 | There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services. | sentnum | 2 | -1 | A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion. | sentnum | 3 | -1 | Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health. | sentnum | 4 | -1 | In terms of early interventions, this agreement is exemplified by the recent inclusion of a "mental and social aspects of health" standard in the Sphere handbook's revision on minimal standards in disaster response. | sentnum | 5 | -1 | This affirmation of emerging agreement is important and should give clear messages to health planners. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000200010 | language | EN | section | title | -1 | sentnum | 0 | -1 | The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: We estimated the global burden of disease attributable to low consumption of fruit and vegetables, an increasingly recognized risk factor for cardiovascular disease and cancer, and compared its impact with that of other major risk factors for disease. | sentnum | 1 | -1 | METHODS: The burden of disease attributable to suboptimal intake of fruit and vegetables was estimated using information on fruit and vegetable consumption in the population, and on its association with six health outcomes (ischaemic heart disease, stroke, stomach, oesophageal, colorectal and lung cancer). | sentnum | 2 | -1 | Data from both sources were stratified by sex, age and by 14 geographical regions. | sentnum | 3 | -1 | FINDINGS: The total worldwide mortality currently attributable to inadequate consumption of fruit and vegetables is estimated to be up to 2.635 million deaths per year. | sentnum | 4 | -1 | Increasing individual fruit and vegetable consumption to up to 600 g per day (the baseline of choice) could reduce the total worldwide burden of disease by 1.8%, and reduce the burden of ischaemic heart disease and ischaemic stroke by 31% and 19% respectively. | sentnum | 5 | -1 | For stomach, oesophageal, lung and colorectal cancer, the potential reductions were 19%, 20%, 12% and 2%, respectively. | sentnum | 6 | -1 | CONCLUSION: This study shows the potentially large impact that increasing fruit and vegetable intake could have in reducing many noncommunicable diseases. | sentnum | 7 | -1 | It highlights the need for much greater emphasis on dietary risk factors in public health policy in order to tackle the rise in noncommunicable diseases worldwide, and suggests that the proposed intersectoral WHO/FAO fruit and vegetable promotion initiative is a crucial component in any global diet strategy. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000200012 | language | EN | section | title | -1 | sentnum | 0 | -1 | The global distribution of risk factors by poverty level. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To estimate the individual-level association of income poverty with being underweight, using tobacco, drinking alcohol, having access only to unsafe water and sanitation, being exposed to indoor air pollution and being obese. | sentnum | 1 | -1 | METHODS: Using survey data for as many countries as possible, we estimated the relative risk association between income or assets and risk factors at the individual level within 11 medium- and low-income subregions of WHO. | sentnum | 2 | -1 | WHO and The World Bank data on the prevalence of risk factors and income poverty (defined as living on < US$ 1.00 per day, US$ 1-2.00 per day and > US$ 2.00 per day) were analysed to impute the association between poverty and risk factors for each subregion. | sentnum | 3 | -1 | The possible effect of poverty reduction on the prevalence of risk factors was estimated using population-attributable risk percentages. | sentnum | 4 | -1 | FINDINGS: There were strong associations between poverty and malnutrition among children, having access only to unsafe water and sanitation, and being exposed to indoor air pollution within each subregion (relative risks were twofold to threefold greater for those living on < US$ 1.00 per day compared with those living... | sentnum | 5 | -1 | Associations between poverty and obesity, tobacco use and alcohol use varied across subregions. | sentnum | 6 | -1 | If everyone living on < US$ 2.00 per day had the risk factor profile of those living on > US$ 2.00 per day, 51% of exposures to unimproved water and sanitation could be avoided as could 37% of malnutrition among children and 38% of exposure to indoor air pollution. | sentnum | 7 | -1 | The more realistic, but still challenging, Millennium Development Goal of halving the number of people living on < US$ 1.00 per day would achieve much smaller reductions. | sentnum | 8 | -1 | CONCLUSION: To achieve large gains in global health requires both poverty eradication and public health action. | sentnum | 9 | -1 | The methods used in this study may be useful for monitoring pro-equity progress towards Millennium Development Goals. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000200014 | language | EN | section | title | -1 | sentnum | 0 | -1 | Prevention and treatment of human immunodeficiency virus/acquired immunodeficiency syndrome in resource-limited settings. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Strategies for confronting the epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have included a range of different approaches that focus on prevention and treatment. | sentnum | 1 | -1 | However, debate persists over what levels of emphasis are appropriate for the different components of the global response. | sentnum | 2 | -1 | This paper presents an overview of this debate and briefly summarizes the evidence on a range of interventions designed to prevent the spread of HIV infection, paying particular attention to voluntary counselling and testing, treatment for sexually transmitted infections and prevention of mother-to-child transmission. | sentnum | 3 | -1 | We also review the experience with antiretroviral therapy to date in terms of response rates and survival rates, adherence, drug resistance, behavioural change and epidemiological impact. | sentnum | 4 | -1 | Although various studies have identified strategies with proven effectiveness in reducing the risks of HIV infection and AIDS mortality, considerable uncertainties remain. | sentnum | 5 | -1 | Successful integration of treatment and prevention of HIV/AIDS will require a balanced approach and rigorous monitoring of the impact of programmes in terms of both individual and population outcomes. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000300010 | language | EN | section | title | -1 | sentnum | 0 | -1 | Monitoring low birth weight: an evaluation of international estimates and an updated estimation procedure. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To critically examine the data used to produce estimates of the proportion of infants with low birth weight in developing countries and to describe biases in these data. | sentnum | 1 | -1 | To assess the effect of adjustment procedures on the estimates and propose a modified estimation procedure for international reporting purposes. | sentnum | 2 | -1 | METHODS: Mothers' reports about their recent births in 62 nationally representative Demographic and Health Surveys (DHS) conducted between 1990 and 2000 were analysed. | sentnum | 3 | -1 | The proportion of infants weighed at birth, characteristics of those weighed, extent of misreporting, and mothers' subjective assessments of their children's size at birth were examined. | sentnum | 4 | -1 | FINDINGS: In many developing countries the majority of infants were not weighed at birth. | sentnum | 5 | -1 | Those who were weighed were more likely to have mothers who live in urban areas and are educated, and to be born in a medical facility with assistance from medically trained personnel. | sentnum | 6 | -1 | Birth weights reported by mothers are "heaped" on multiples of 500 grams. | sentnum | 7 | -1 | CONCLUSION: Current survey-based estimates of the prevalence of low birth weight are biased substantially downwards. | sentnum | 8 | -1 | Two adjustments to reported data are recommended: a weighting procedure that combines reported birth weights with mothers' assessment of the child's size at birth, and categorization of one-quarter of the infants reported to have a birth weight of exactly 2500 grams as having low birth weight. | sentnum | 9 | -1 | Averaged over all surveys, these procedures increased the proportion classified as having low birth weight by 25%. | sentnum | 10 | -1 | We also recommend that the proportion of infants not weighed at birth be routinely reported. | sentnum | 11 | -1 | Efforts are needed to increase the weighing of newborns and the recording of their weights. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000300012 | language | EN | section | title | -1 | sentnum | 0 | -1 | Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign. | sentnum | 1 | -1 | METHODS: In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months-15 years. | sentnum | 2 | -1 | Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet. | sentnum | 3 | -1 | The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign. | sentnum | 4 | -1 | Volunteers visited homes to inform caregivers about the campaign and encourage them to participate. | sentnum | 5 | -1 | We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites. | sentnum | 6 | -1 | Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use. | sentnum | 7 | -1 | Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory. | sentnum | 8 | -1 | FINDINGS: At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet. | sentnum | 9 | -1 | Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed. | sentnum | 10 | -1 | Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign. | sentnum | 11 | -1 | For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%)). | sentnum | 12 | -1 | The marginal operational cost was US$ 0.32 per insecticide-treated bednet delivered. | null | null | null | null | sentnum | 13 | -1 | CONCLUSION: These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets. | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000300014 | language | EN | section | title | -1 | sentnum | 0 | -1 | Poverty, child undernutrition and morbidity: new evidence from India. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Undernutrition continues to be a primary cause of ill-health and premature mortality among children in developing countries. | sentnum | 1 | -1 | This paper examines how the prevalence of undernutrition in children is measured and argues that the standard indices of stunting, wasting and underweight may each be underestimating the scale of the problem. | sentnum | 2 | -1 | This has important implications for policy-makers, planners and organizations seeking to meet international development targets. | sentnum | 3 | -1 | Using anthropometric data on 24 396 children in India, we constructed an alternative composite index of anthropometric failure (CIAF) and compared it with conventional indices. | sentnum | 4 | -1 | The CIAF examines the relationship between distinct subgroups of anthropometric failure, poverty and morbidity, showing that children with multiple anthropometric failures are at a greater risk of morbidity and are more likely to come from poorer households. | sentnum | 5 | -1 | While recognizing that stunting, wasting and underweight reflect distinct biological processes of clear importance, the CIAF is the only measure that provides a single, aggregated figure of the number of undernourished children in a population. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000300016 | language | EN | section | title | -1 | sentnum | 0 | -1 | Should nevirapine be used to prevent mother-to-child transmission of HIV among women of unknown serostatus?. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | At present, HIV testing and counselling during pregnancy represent the key entry point for women to learn their serostatus and for them to access, if they are HIV-positive, specific interventions to reduce mother-to-child transmission (MTCT) of HIV. | sentnum | 1 | -1 | However, the provision and uptake of testing and counselling services are inadequate, and many pregnant women in countries most affected by the HIV/AIDS epidemic remain unaware of their HIV status. | sentnum | 2 | -1 | The offer of single-dose nevirapine prophylaxis to women whose HIV status is unknown at the time of delivery has been proposed to circumvent these problems in high-prevalence settings. | sentnum | 3 | -1 | The potential advantages and disadvantages of three different programme approaches are considered: targeted programmes in which antiretroviral drugs are offered only to women who are known to be HIV-positive; combined programmes in which nevirapine prophylaxis is offered to women whose serostatus remains unknown at the... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000400008 | language | EN | section | title | -1 | sentnum | 0 | -1 | Staff training and ambulatory tuberculosis treatment outcomes: a cluster randomized controlled trial in South Africa. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatment in primary care clinics with treatment success rates below 70%. | sentnum | 1 | -1 | METHODS: A cluster randomized controlled trial was conducted from July 1996 to July 2000 in nurse-managed ambulatory primary care clinics in Cape Town, South Africa. | sentnum | 2 | -1 | Clinics with successful TB treatment completion rates of less than 70% and annual adult pulmonary TB loads of more than 40 patients per year were randomly assigned to either the intervention (n = 12) or control (n = 12) groups. | sentnum | 3 | -1 | All clinics completed follow-up. | sentnum | 4 | -1 | Treatment outcomes were measured in cohorts of adult, pulmonary TB patients before the intervention (n = 1200) and 9 months following the training (n = 1177). | sentnum | 5 | -1 | The intervention comprised an 18-hour experiential, participatory in-service training programme for clinic staff delivered by nurse facilitators and focusing on patient centredness, critical reflection on practice, and quality improvement. | sentnum | 6 | -1 | The main outcome measure was successful treatment, defined as patients who were cured and those who had completed tuberculosis treatment. | sentnum | 7 | -1 | FINDINGS: The estimated effect of the intervention was an increase in successful treatment rates of 4.8% (95% confidence interval (CI): -5.5% to 15.2%) and in bacteriological cure rates of 10.4% (CI: -1.2% to 22%). | sentnum | 8 | -1 | A treatment effect of 10% was envisaged, based on the views of policy-makers on the minimum effect size for large-scale implementation. | sentnum | 9 | -1 | CONCLUSION: This is the first evidence from a randomized controlled trial on the effects of experiential, participatory training on TB outcomes in primary care facilities in a developing country. | sentnum | 10 | -1 | Such training did not appear to improve TB outcomes. | sentnum | 11 | -1 | However, the results were inconclusive and further studies are required. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000400010 | language | EN | section | title | -1 | sentnum | 0 | -1 | Polio eradication: mobilizing and managing the human resources. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Between 1988 and 2004, the Global Polio Eradication Initiative grew to become the largest international health effort in history, operating in every country of the world. | sentnum | 1 | -1 | An estimated 10 million health workers and volunteers have been engaged in implementing the necessary polio supplementary immunization activities (SIAs) on a recurring basis, and at least 35 000 well-trained workers have been conducting polio surveillance. | sentnum | 2 | -1 | A combination of task simplification, technological innovations and adaptation of strategies to fit local circumstances has allowed the Initiative to use a wide range of workers and volunteers, from both inside and outside the health sector, to deliver the polio vaccine during SIAs and to monitor progress in virtually ... | sentnum | 3 | -1 | This approach has required sustained political advocacy and mass community mobilization, together with strong management and supervisory processes. | sentnum | 4 | -1 | Non-monetary incentives, reimbursement of costs and substantial technical assistance have been essential. | sentnum | 5 | -1 | Given the unique features of eradication programmes in general, and polio eradication in particular, the implications of this approach for the broader health system must continue to be studied if it is to be replicated for the delivery and monitoring of other interventions. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000400012 | language | EN | section | title | -1 | sentnum | 0 | -1 | Ethical issues in health workforce development. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. | sentnum | 1 | -1 | The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. | sentnum | 2 | -1 | These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health wor... | sentnum | 3 | -1 | The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000400014 | language | EN | section | title | -1 | sentnum | 0 | -1 | Human resources for the control of road traffic injury. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. | sentnum | 1 | -1 | We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care. | sentnum | 2 | -1 | Many low-cost strategies to improve these functions in low- or middle-income countries can be identified. | sentnum | 3 | -1 | For all these strategies, there is need for adequate institutional capacity, including funding, legal authority, and human resources. | sentnum | 4 | -1 | Several categories of human resources need to be developed: epidemiologists who can handle injury data, design surveillance systems, and undertake research; engineers and planners versed in safety aspects of road design, traffic flow, urban planning, and vehicle design; police and lawyers who understand the health impa... | sentnum | 5 | -1 | RTI control can be strengthened by enhancing such training in these disciplines, as well as encouraging retention of those who have the needed skills. | sentnum | 6 | -1 | Mechanisms to enhance collaboration between these different fields need to be promoted. | sentnum | 7 | -1 | Finally, the burden of RTI is borne disproportionately by the poor; in addition to technical issues, more profound equity issues must be addressed. | sentnum | 8 | -1 | This mandates that people from all professional backgrounds who work for RTI control should develop skills in advocacy and politics. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000400016 | language | EN | section | title | -1 | sentnum | 0 | -1 | Understanding dengue pathogenesis: implications for vaccine design. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | In the second half of the twentieth century dengue spread throughout the tropics, threatening the health of a third of the world's population. | sentnum | 1 | -1 | Dengue viruses cause 50 -100 million cases of acute febrile disease every year, including more than 500 000 reported cases of the severe forms of the disease - dengue haemorrhagic fever and dengue shock syndrome. | sentnum | 2 | -1 | Attempts to create conventional vaccines have been hampered by the lack of suitable experimental models, the need to provide protection against all four serotypes simultaneously and the possible involvement of virus-specific immune responses in severe disease. | sentnum | 3 | -1 | The current understanding of dengue pathogenesis is outlined in this review, with special emphasis on the role of the immune response. | sentnum | 4 | -1 | The suspected involvement of the immune system in increased disease severity and vascular damage has raised concerns about every vaccine design strategy proposed so far. | sentnum | 5 | -1 | Clearly more research is needed on understanding the correlates of protection and mechanisms of pathogenesis. | sentnum | 6 | -1 | There is, however, an urgent need to provide a solution to the escalating global public health problems caused by dengue infections. | sentnum | 7 | -1 | Better disease management, vector control and improved public health measures will help reduce the current disease burden, but a safe and effective vaccine is probably the only long-term solution. | sentnum | 8 | -1 | Although concerns have been raised about the possible safety and efficacy of both conventional and novel vaccine technologies, the situation is now so acute that it is not possible to wait for the perfect vaccine. | sentnum | 9 | -1 | Consequently the careful and thorough evaluation of several of the current candidate vaccines may be the best approach to halting the spread of disease. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000500009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Modelling the effectiveness of financing policies to address underutilization of children's health services in Nepal. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To estimate the price responsiveness of utilization of formal children's health-care services in Nepal and to use this information to model the impact on utilization of subsidies or increases in user fees. | sentnum | 1 | -1 | METHODS: A total of 8112 individual observations (of children aged < 15 years) from 2847 households in 274 communities were obtained from the 1996 Nepal Living Standards Survey. | sentnum | 2 | -1 | A logit model was applied to determine the net impact of price on a parent or caregiver's decision to seek care for a given instance of illness. | sentnum | 3 | -1 | The model's coefficients were used to calculate the price responsiveness of utilization decisions. | sentnum | 4 | -1 | FINDINGS: Parents or caregivers reported that 9.7% of children (788/8112) had been ill or injured in the previous month. | sentnum | 5 | -1 | Parents reported that they had sought care in 566 (71.8%) of these cases; care was most frequently sought from public providers. | sentnum | 6 | -1 | The price elasticity of demand for children's health-care services in the formal sector was estimated at -0.16. | sentnum | 7 | -1 | As prices rise, the demand curve exhibits continuous and declining price elasticity. | sentnum | 8 | -1 | Overall, a 100% subsidy of user fees would increase current utilization rates by 56%, while a 100% increase in fees would lead to a drop in utilization of only 12%. | sentnum | 9 | -1 | The differential in utilization across income groups was substantial after changes in fees were implemented. | sentnum | 10 | -1 | CONCLUSION: While the effect of price on the utilization of children's health-care services in Nepal is statistically significant, the size of the impact is modest. | sentnum | 11 | -1 | Policies to subsidize fees could increase utilization substantially, while fee increases would lead to modest declines in utilization and generate increased revenue. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000500011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | BACKGROUND: Although radiological pneumonia is used as an outcome measure in epidemiological studies, there is considerable variability in the interpretation of chest radiographs. | sentnum | 1 | -1 | A standardized method for identifying radiological pneumonia would facilitate comparison of the results of vaccine trials and epidemiological studies of pneumonia. | sentnum | 2 | -1 | METHODS: A WHO working group developed definitions for radiological pneumonia. | sentnum | 3 | -1 | Inter-observer variability in categorizing a set of 222 chest radiographic images was measured by comparing the readings made by 20 radiologists and clinicians with a reference reading. | sentnum | 4 | -1 | Intra-observer variability was measured by comparing the initial readings of a randomly chosen subset of 100 radiographs with repeat readings made 8-30 days later. | sentnum | 5 | -1 | FINDINGS: Of the 222 images, 208 were considered interpretable. | sentnum | 6 | -1 | The reference reading categorized 43% of these images as showing alveolar consolidation or pleural effusion (primary end-point pneumonia); the proportion thus categorized by each of the 20 readers ranged from 8% to 61%. | sentnum | 7 | -1 | Using the reference reading as the gold standard, 14 of the 20 readers had sensitivity and specificity of > 0.70 in identifying primary end-point pneumonia; 13 out of 20 readers had a kappa index of > 0.6 compared with the reference reading. | sentnum | 8 | -1 | For the 92 radiographs deemed to be interpretable among the 100 images used for intra-observer variability, 19 out of 20 readers had a kappa index of > 0.6. | sentnum | 9 | -1 | CONCLUSION: Using standardized definitions and training, it is possible to achieve agreement in identifying radiological pneumonia, thus facilitating the comparison of results of epidemiological studies that use radiological pneumonia as an outcome. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000500013 | language | EN | section | title | -1 | sentnum | 0 | -1 | Does the Integrated Management of Childhood Illness cost more than routine care? | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. | sentnum | 1 | -1 | Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. | sentnum | 2 | -1 | Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. | sentnum | 3 | -1 | METHODS: Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. | sentnum | 4 | -1 | We also included administrative and support costs incurred by national and district administrations. | sentnum | 5 | -1 | The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. | sentnum | 6 | -1 | FINDINGS: The annual cost per child of caring for children less than five years old in districts with IMCI was US$ 11.19, 44% lower than the cost in the districts without IMCI (US$ 16.09). | sentnum | 7 | -1 | Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. | sentnum | 8 | -1 | Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. | sentnum | 9 | -1 | CONCLUSION:IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. | sentnum | 10 | -1 | Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI. | null | null | null | null | null | null | null | null | sentnum | 1 | -1 | Results from the United Republic of Tanzania. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000500016 | language | EN | section | title | -1 | sentnum | 0 | -1 | Monitoring equity in immunization coverage. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | This paper analyses trends in coverage of three doses of diphtheria-pertussis-tetanus vaccine (DPT3) by wealth groups in selected countries. | sentnum | 1 | -1 | It discusses the depth of disparities in coverage by wealth and changes during the 1990s. | sentnum | 2 | -1 | Complete assessment of equity in income and its trends have been discussed in other papers, however issues related to children's well-being have often been brushed aside because the comparable data needed to fully understand and rectify inequalities is lacking. | sentnum | 3 | -1 | A focal point of this paper pertains to gathering any and all information recorded about the immunization of children and then transcribing these data so that it is applicable to all countries. | sentnum | 4 | -1 | We analyse the technical difficulties and methodological solutions that would enable comparisons to be made between various measures of inequity taken from different surveys at two or three points in time among a variety of subpopulations in order to obtain disaggregated data. | sentnum | 5 | -1 | This paper argues for a simultaneous analysis of changes in averages and disparities in immunization coverage along variables of interest, such as wealth, gender and place of residence in order to achieve a better understanding of trends. | sentnum | 6 | -1 | We also focus on measurement issues and describe trends in immunization by wealth. | sentnum | 7 | -1 | We conclude with a brief discussion of issues related to monitoring equitable outcomes and offer suggestions for further research. | sentnum | 8 | -1 | In addition, the paper presents some lessons that can be drawn about monitoring and policies. | sentnum | 9 | -1 | We hope that this analysis of patterns of disparities will help policy-makers in devising, proposing and executing efficient policies and interventions. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000600009 | language | EN | section | title | -1 | sentnum | 0 | -1 | Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To determine the association of different feeding patterns for infants (exclusive breastfeeding, predominant breastfeeding, partial breastfeeding and no breastfeeding) with mortality and hospital admissions during the first half of infancy. | sentnum | 1 | -1 | METHODS: This paper is based on a secondary analysis of data from a multicentre randomized controlled trial on immunization-linked vitamin A supplementation. | sentnum | 2 | -1 | Altogether, 9424 infants and their mothers (2919 in Ghana, 4000 in India and 2505 in Peru) were enrolled when infants were 18-42 days old in two urban slums in New Delhi, India, a periurban shanty town in Lima, Peru, and 37 villages in the Kintampo district of Ghana. | sentnum | 3 | -1 | Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru. | sentnum | 4 | -1 | At each visit, mothers were queried about what they had offered their infant to eat or drink during the past week. | sentnum | 5 | -1 | Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months. | sentnum | 6 | -1 | The main outcome measures were all-cause mortality, diarrhoea-specific mortality, mortality caused by acute lower respiratory infections, and hospital admissions. | sentnum | 7 | -1 | FINDINGS: There was no significant difference in the risk of death between children who were exclusively breastfed and those who were predominantly breastfed (adjusted hazard ratio (HR) = 1.46; 95% confidence interval (CI) = 0.75-2.86). | sentnum | 8 | -1 | Non-breastfed infants had a higher risk of dying when compared with those who had been predominantly breastfed (HR = 10.5; 95% CI = 5.0-22.0; P < 0.001) as did partially breastfed infants (HR = 2.46; 95% CI = 1.44-4.18; P = 0.001). | sentnum | 9 | -1 | CONCLUSION: There are two major implications of these findings. | sentnum | 10 | -1 | First, the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants. | sentnum | 11 | -1 | Second, our finding that the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achi... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000600011 | language | EN | section | title | -1 | sentnum | 0 | -1 | Operational and economic evaluation of an NGO-led sexually transmitted infections intervention: north-western Cambodia. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: Sexually transmitted infection (STI) services were offered by the nongovernmental organization Médecins Sans Frontières-Holland in Banteay Meanchey province, Cambodia, between 1997 and 1999. | sentnum | 1 | -1 | These services targeted female sex workers but were available to the general population. | sentnum | 2 | -1 | We conducted an evaluation of the operational performance and costs of this real-life project. | sentnum | 3 | -1 | METHODS: Effectiveness outcomes (syndromic cure rates of STIs) were obtained by retrospectively analysing patients' records. | sentnum | 4 | -1 | Annual financial and economic costs were estimated from the provider's perspective. | sentnum | 5 | -1 | Unit costs for the cost-effectiveness analysis included the cost per visit, per partner treated, and per syndrome treated and cured. | sentnum | 6 | -1 | FINDINGS: Over 30 months, 11 330 patients attended the clinics; of these, 7776 (69%) were STI index patients and only 1012 (13%) were female sex workers. | sentnum | 7 | -1 | A total of 15 269 disease episodes and 30 488 visits were recorded. | sentnum | 8 | -1 | Syndromic cure rates ranged from 39% among female sex workers with genital ulcers to 74% among men with genital discharge; there were variations over time. | sentnum | 9 | -1 | Combined rates of syndromes classified as cured or improved were around 84-95% for all syndromes. | sentnum | 10 | -1 | The total economic costs of the project were US$ 766 046. | sentnum | 11 | -1 | The average cost per visit over 30 months was US$ 25.12 and the cost per partner treated for an STI was US$ 50.79. | sentnum | 12 | -1 | The average cost per STI syndrome treated was US$ 48.43, of which US$ 4.92 was for drug treatment. | null | null | null | null | sentnum | 13 | -1 | The costs per syndrome cured or improved ranged from US$ 46.95-153.00 for men with genital ulcers to US$ 57.85-251.98 for female sex workers with genital discharge. | sentnum | 14 | -1 | CONCLUSION: This programme was only partly successful in reaching its intended target population of sex workers and their male partners. | sentnum | 15 | -1 | Decreasing cure rates among sex workers led to relatively poor cost-effectiveness outcomes overall despite decreasing unit costs. | null | null | null | null |
S0042-96862005000600013 | language | EN | section | title | -1 | sentnum | 0 | -1 | Reliability of data on caesarean sections in developing countries. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To examine the reliability of reported rates of caesarean sections from developing countries and make recommendations on how data collection for surveys and health facility-based studies could be improved. | sentnum | 1 | -1 | METHODS: Population-based rates for caesarean section obtained from two sources: Demographic and Health Surveys (DHS) and health facility-based records of caesarean sections from the Unmet Obstetric Need Network, together with estimates of the number of live births, were compared for six developing countries. | sentnum | 2 | -1 | Sensitivity analyses were conducted using several different definitions of the caesarean section rate, and the rates obtained from the two data sources were compared. | sentnum | 3 | -1 | FINDINGS: The DHS rates for caesarean section were consistently higher than the facility-based rates. | sentnum | 4 | -1 | However, in three quarters of the cases, the facility-based rates for caesarean sections fell within the 95% confidence intervals for the DHS estimate. | sentnum | 5 | -1 | CONCLUSION: The importance of the differences between these two series of rates depends on the analyst's perspective. | sentnum | 6 | -1 | For national and global monitoring, DHS data on caesarean sections would suffice, although the imprecision of the rates would make the monitoring of trends difficult. | sentnum | 7 | -1 | However, the imprecision of DHS data on caesarean sections precludes their use for the purposes of programme evaluation at the regional level. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000600015 | language | EN | section | title | -1 | sentnum | 0 | -1 | National maternal mortality ratio in Egypt halved between 1992-93 and 2000. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms. | sentnum | 1 | -1 | The numbers of maternal deaths were determined and interviews conducted. | sentnum | 2 | -1 | The medical causes of death and avoidable factors were determined. | sentnum | 3 | -1 | Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100 000 live births). | sentnum | 4 | -1 | The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt. | sentnum | 5 | -1 | In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000. | sentnum | 6 | -1 | Consideration of the intermediate and outcome indicators suggests that the greatest effect of maternal health interventions was on the death-related avoidable factors "substandard care by health providers" and "delays in recognizing problems or seeking medical care". | sentnum | 7 | -1 | The enormous improvements in these areas are certainly due in part to extensive training, revised curricula, the publication of medical protocols and services standards, the upgrading of facilities, and successful community outreach programmes and media campaigns. | sentnum | 8 | -1 | The impact on the utilization of antenatal care (ANC) has been less successful. | sentnum | 9 | -1 | Other areas that remain problematic are inadequate supplies of blood, drugs and equipment. | sentnum | 10 | -1 | Although the number of maternal deaths linked to haemorrhage has been drastically reduced, it remains the primary cause. | sentnum | 11 | -1 | The drop in maternal mortality in the 1990s in response to Safe Motherhood programmes was impressive and the ability to tailor interventions based on the data from the NMMS of 1992-93 and 2000 was clearly demonstrated. | sentnum | 12 | -1 | To ensure the continuing availability of information to guide and evaluate programmes for reducing maternal mortality, an Egyptian national maternal mortality surveillance system is being developed. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000700008 | language | EN | section | title | -1 | sentnum | 0 | -1 | Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: The aim of this study was to estimate the field efficacy of the first routine programme for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) initiated in South Africa, in the subdistrict of Khayelitsha. | sentnum | 1 | -1 | METHODS: A consecutive sample of 658 mother-infant pairs, identified from the PMTCT register from 1 March to 30 November 2003, were identified for enrolment in this study. | sentnum | 2 | -1 | Details of the regimen received were established and HIV status of the infants at between 6 and 10 weeks of age was determined by qualitative DNA polymerase chain reaction. | sentnum | 3 | -1 | Zidovudine (AZT) was provided antenatally from week 34 of gestation and during labour. | sentnum | 4 | -1 | Infant formula milk was offered to mothers who chose not to breastfeed. | sentnum | 5 | -1 | The protocol was amended in July 2003 such that women who had received < 2 weeks of treatment with AZT were given a single dose of nevirapine (NVP) at the onset of labour, and the infant received a weight-adjusted dose of NVP within 72 h of delivery. | sentnum | 6 | -1 | RESULTS: Of the 535 mother-infant pairs (81%) eventually included in the study, 410 (77%) received an effective PMTCT intervention according to the protocol. | sentnum | 7 | -1 | The rate of transmission of HIV from mother to child was 8.8% (95% confidence interval (CI), 6.2-10.9). | sentnum | 8 | -1 | A maternal age of > 25 years was the only significant independent risk factor for transmission (odds ratio, 2.12; 95% CI, 1.14-4.07). | sentnum | 9 | -1 | CONCLUSION: The results of this study demonstrate the feasibility and effectiveness of a large-scale PMTCT programme in an urban public-sector setting. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
S0042-96862005000700010 | language | EN | section | title | -1 | sentnum | 0 | -1 | The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems. | language | EN | section | abstract | -1 | sentnum | 0 | -1 | OBJECTIVE: To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. | sentnum | 1 | -1 | METHODS: The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanus-pertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. | sentnum | 2 | -1 | The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. | sentnum | 3 | -1 | These indices were applied to each level of the health service (health unit, district and national). | sentnum | 4 | -1 | FINDINGS: The proportion of verified DTP-3 doses was lower than 85% in 16 countries. | sentnum | 5 | -1 | Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. | sentnum | 6 | -1 | All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. | sentnum | 7 | -1 | CONCLUSION: Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. | sentnum | 8 | -1 | Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. | sentnum | 9 | -1 | The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. | sentnum | 10 | -1 | It provides a useful example for other global health initiatives. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null |
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