In this month's Bulletin
Unconfirmed polio cases pinpoint weaknesses in the system
In India in 2000, there were 265 cases of acute flaccid paralysis (AFP) whose cause was confirmed to be wild poliovirus, and a further 362 cases that were compatible with poliomyelitis but could not be confirmed as such. Confirmation depends on the collection of two stool specimens at least 24 hours apart both within 14 days of the onset of paralysis and both arriving at the laboratory in good condition. Unconfirmed but compatible cases indicate weaknesses in the surveillance system. Long interval between the onset of paralysis and case notification was the main weakness found. Data on compatible cases indicated the need to increase the number of surveillance medical officers, decrease the size of their areas of responsibility, and intensify vigilance in the areas where these cases occurred.
Violence against mothers associated with child mortality
An association was found between violence against mothers before or during pregnancy and an increased risk of mortality in their children before reaching the age of five. In León, a department of Nicaragua, mothers of children who had died before the age of five were interviewed about their experience of physical and sexual violence. For each mother who had lost a child, two mothers of children matched for age and sex were asked the same questions. Of the mothers who had lost a child, 61% had experienced violence during their lifetime, whereas for those who had not the figure was 37%.
Cost of diabetes in Latin America and the Caribbean: high
The annual cost of diabetes in Latin America and the Caribbean works out at US$ 65.2 billion that is US$ 10.7 billion in direct costs and US$ 54.5 billion in indirect costs. The authors based their calculations on prevalence estimates for the year 2000 in this group of countries. The direct costs included drugs, hospitalizations, consultations, and management. For the indirect costs, the human capital approach was used to estimate foregone earnings due to premature disability attributed to diabetes. An estimated 339 000 deaths were caused by diabetes in these countries in the year 2000, representing a loss of 757 000 years of productive life.
Iodine deficiency declining but still present in Lesotho
Iodine deficiency in Lesotho was found to be from mild to moderate. It is more prevalent in girls than in boys, increases with age, and is more severe in children living in the mountains than in the lowlands. The findings are from a crosssectional study of 10 randomly selected children from each of 50 primary schools. Palpation for goitre, urine analysis, a structured questionnaire, and the children's health booklets were used to obtain the data. Prevalence of goitre ranged from 2.2% to 8.8% in the different districts. In 1960 the total goitre rate had been 41%, indicating severe iodine deficiency. Iodized salt, combined with iodized oil supplementation, is the main cause of improvement.
Treatment for common helminth infections selected
Albendazole in combination with ivermectin was found to work best against lymphatic filariasis and trichuriasis. The other options tried in a randomized trial with infected children were: albendazole with placebo, ivermectin with placebo, diethylcarbamazine with placebo, and albendazole with diethylcarbamazine. The study was conducted in 1998 in the province of Laguna, in the Philippines. The cumulative prevalence of common intestinal helminth infection in the area at that time was 94%.
Healthy life expectancy depends on how you count
In Hong Kong Special Administrative Region of China, men can expect 70.3 years of healthy life, which is more than in any other part of the world except Japan (71.2 years) and Switzerland (70.4). Women can expect 75.7 healthy years, second only to Japan (76.3). However, this is only true if you work it out using Sullivan's method. If you use the classical linear regression model instead, men can only expect 69.3 healthy years, and women 72.4, which ranks them both only 13th in the world. In fact, though, Sullivan's method may be more accurate because it can take more factors into account.
India prepares for antitobacco offensive
In India, the third largest grower of tobacco in the world, 65% of the men and 38% of the women smoke. The loss of disabilityadjusted lifeyears attributed to smoking in 1990 was 1.7 million. New legislation proposed in 2001 includes outlawing smoking in public places, forbidding sale of tobacco to minors, using more prominent health warning labels, and banning advertising at sports and cultural events. This will not reduce demand sufficiently, however: higher taxes, smuggling control, closing loopholes in the advertising ban, and enforcement of tobacco control laws are also needed.
High prevalence of domestic violence in Uganda
In a survey in Rakai, Uganda, 70% of the men and 90% of the women questioned thought it was all right to beat your wife in some circumstances. Of the 5109 women of reproductive age included in the survey, 30% had experienced physical threats or abuse from their current partners. Of those, three out of five had suffered three or more specific acts of violence during the preceding year, and almost half reported injuries as a result. Major factors related to male violence were alcohol consumption and perceived risk of HIV infection.
Immunization of HIVinfected children generally safe
Children infected with HIV can in most cases safely benefit from the routine immunization programmes. However, HIVinfected children who are symptomatic should not receive the BCG and yellow fever vaccines. The policy of administering the standard vaccines to all children, regardless of possible HIV exposure, continues to be highly effective for the control of preventable diseases. 