Bulletin of the World Health Organizationhttps://scielosp.org/feed/bwho/2003.v81n3/2016-01-01T00:02:00ZUnknown authorVol. 81 No. 3 - 2003WerkzeugIn this month's BulletinS0042-968620030003000012016-01-01T00:02:00Z2001-01-28T00:08:00ZHealthy environments for childrenS0042-968620030003000022016-01-01T00:02:00Z2001-01-28T00:08:00ZBellamy, Carol
<em>Bellamy, Carol</em>;
<br/><br/>
New water forum will repeat old messageS0042-968620030003000032016-01-01T00:02:00Z2001-01-28T00:08:00ZBartram, Jamie
<em>Bartram, Jamie</em>;
<br/><br/>
Health research systems: a framework for the futureS0042-968620030003000042016-01-01T00:02:00Z2001-01-28T00:08:00ZSadana, RituPang, Tikki
<em>Sadana, Ritu</em>;
<em>Pang, Tikki</em>;
<br/><br/>
Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern PakistanS0042-968620030003000052016-01-01T00:02:00Z2001-01-28T00:08:00ZNanan, D.White, F.Azam, I.Afsar, H.Hozhabri, S.
<em>Nanan, D.</em>;
<em>White, F.</em>;
<em>Azam, I.</em>;
<em>Afsar, H.</em>;
<em>Hozhabri, S.</em>;
<br/><br/>
OBJECTIVE: Inadequate water and sanitation services adversely affect the health and socioeconomic development of communities. The Water and Sanitation Extension Programme (WASEP) project, undertaken in selected villages in northern Pakistan between 1997 and 2001, was designed to deliver an integrated package of activities to improve potable water supply at village and household levels, sanitation facilities and their use, and awareness and practices about hygiene behaviour. METHODS: A case-control study was conducted during July-September 2001 to evaluate whether, after selected confounders were controlled for, children aged <6 years with diarrhoea were more or less likely to reside in villages that participated in the project than in villages that did not participate. Descriptive and logistic regression analyses were performed. FINDINGS: Children not living in WASEP villages had a 33% higher adjusted odds ratio for having diarrhoea than children living in WASEP villages (adjusted odds ratio, 1.331; P<0.049). Boys had 25% lower odds of having diarrhoea than girls (adjusted odds ratio, 0.748; P<0.049). A 2.6% decrease was found in the odds of diarrhoea for every yearly increase in the mother's age (adjusted odds ratio, 0.974; P<0.044) and a 1.4% decrease for every monthly increase in the child's age (adjusted odds ratio, 0.986; P<0.001). CONCLUSIONS: The findings in this study may help refine the approach to future water, sanitation, and hygiene initiatives in northern Pakistan. The integrated approach taken by WASEP, which incorporates engineering solutions with appropriate education to maximize facility usage and improve hygiene practices, is a useful example of how desired health benefits can be obtained from projects of this type.Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospitalS0042-968620030003000062016-01-01T00:02:00Z2001-01-28T00:08:00ZEnglish, MikeBerkley, JamesMwangi, IsiahMohammed, ShebbeAhmed, MaimunaOsier, FaithMuturi, NeemaOgutu, BernhardsMarsh, KevinNewton, Charles R.J.C.
<em>English, Mike</em>;
<em>Berkley, James</em>;
<em>Mwangi, Isiah</em>;
<em>Mohammed, Shebbe</em>;
<em>Ahmed, Maimuna</em>;
<em>Osier, Faith</em>;
<em>Muturi, Neema</em>;
<em>Ogutu, Bernhards</em>;
<em>Marsh, Kevin</em>;
<em>Newton, Charles R.j.c.</em>;
<br/><br/>
OBJECTIVE: To investigate whether the outpatient, syndrome-based approach of the Integrated Management of Childhood Illness (IMCI) protocol could be extended to the inpatient arena to give clear and simple minimum standards of care for poorly resourced facilities. METHODS: A prospective, one-year admission cohort retrospectively compared hypothetical performance of syndrome-based management with paediatrician-defined final diagnosis. Admission syndrome definitions were based on local adaptations to the IMCI protocol that encompassed 20 clinical features, measurement of oxygen saturation, and malaria microscopy. FINDINGS: After 315 children with clinically obvious diagnoses (e.g. sickle cell disease and burns) were excluded, 3705 admission episodes were studied. Of these, 2334 (63%) met criteria for at least one severe syndrome (mortality 8% vs <1% for "non-severe" cases), and half of these had features of two or more severe syndromes. No cases of measles were seen. Syndrome-based treatment would have been appropriate (sensitivity >95%) for severe pneumonia, severe malaria, and diarrhoea with severe dehydration, and probably for severe malnutrition (sensitivity 71%). Syndrome-directed treatment suggested the use of broad-spectrum antibiotics in 75/133 (56% sensitivity) children with bacteraemic and 63/71 (89% sensitivity) children with meningitis. CONCLUSIONS: Twenty clinical features, oxygen saturation measurements, and results of malaria blood slides could be used for inpatient, syndrome-based management of acute paediatric admissions. The addition of microscopy of the cerebrospinal fluid and haemoglobin measurements would improve syndrome-directed treatment considerably. This approach might rationalize admission policy and standardize inpatient paediatric care in resource-poor countries, although the clinical detection of bacteraemia remains a problem.Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trialS0042-968620030003000072016-01-01T00:02:00Z2001-01-28T00:08:00ZFu, DongboFu, HuaMcGowan, PatrickShen, Yi-eZhu, LizhenYang, HuiqinMao, JianguoZhu, ShitaiDing, YongmingWei, Zhihua
<em>Fu, Dongbo</em>;
<em>Fu, Hua</em>;
<em>Mcgowan, Patrick</em>;
<em>Shen, Yi-E</em>;
<em>Zhu, Lizhen</em>;
<em>Yang, Huiqin</em>;
<em>Mao, Jianguo</em>;
<em>Zhu, Shitai</em>;
<em>Ding, Yongming</em>;
<em>Wei, Zhihua</em>;
<br/><br/>
OBJECTIVE: To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program (CDSMP). METHODS: A randomized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment (waiting-list controls) in five urban communities in Shanghai, China. Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately; those in the control group received the same education and book six months later. FINDINGS: In total, 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension, heart disease, chronic lung disease, arthritis, stroke, or diabetes who lived in communities were assigned randomly to treatment (n = 526) and control (n = 428) groups. Overall, 430 (81.7%) and 349 (81.5%) patients in the treatment and control groups completed the six-month study. Patients who received treatment had significant improvements in weekly minutes of aerobic exercise, practice of cognitive symptom management, self-efficacy to manage own symptoms, and self-efficacy to manage own disease in general compared with controls. They also had significant improvements in eight indices of health status and, on average, fewer hospitalizations. CONCLUSION: When implemented in Shanghai, the CDSMP was acceptable culturally to Chinese patients. The programme improved participants' health behaviour, self-efficacy, and health status and reduced the number of hospitalizations six months after the course. The locally based delivery model was integrated into the routine of community government organizations and community health services. Chinese lay leaders taught the CDSMP courses as successfully as professionals.Management of acute respiratory infections by community health volunteers: experience of Bangladesh Rural Advancement Committee (BRAC)S0042-968620030003000082016-01-01T00:02:00Z2001-01-28T00:08:00ZHadi, Abdullahel
<em>Hadi, Abdullahel</em>;
<br/><br/>
OBJECTIVE: To assess the role of management practices for acute respiratory infections (ARIs) in improving the competency of community health volunteers in diagnosing and treating acute respiratory infections among children. METHODS: Data were collected by a group of research physicians who observed the performance of a sample of 120 health volunteers in 10 sub-districts in Bangladesh in which Bangladesh Rural Advancement Committee (BRAC) had run a community-based ARI control programme since mid-1992. Standardized tests were conducted until the 95% interphysician reliability on the observation of clinical examination was achieved. FINDINGS:The sensitivity, specificity, and overall agreement rates in diagnosing and treating ARIs were significantly higher among the health volunteers who had basic training and were supervised routinely than among those who had not. CONCLUSION: Diagnosis and treatment of ARIs at the household level in developing countries are possible if intensive basic training and the close supervision of service providers are ensured.Efficacy of oxamniquine and praziquantel in the treatment of Schistosoma mansoni infection: a controlled trialS0042-968620030003000092016-01-01T00:02:00Z2001-01-28T00:08:00ZFerrari, M.L.A.Coelho, P.M.Z.Antunes, C.M.F.Tavares, C.A.P.Cunha, A.S. da
<em>Ferrari, M.l.a.</em>;
<em>Coelho, P.m.z.</em>;
<em>Antunes, C.m.f.</em>;
<em>Tavares, C.a.p.</em>;
<em>Cunha, A.s. Da</em>;
<br/><br/>
OBJECTIVE: To evaluate the therapeutic efficacy of oxamniquine and praziquantel, the two most clinically important schistosomicide drugs, and to compare the accuracy of faecal examination with the accuracy of oogram in testing for Schistosoma mansoni infection. METHODS: In a triple-masked and randomized controlled trial, 106 patients infected with S. mansoni were randomly allocated to one of three statistically homogeneous groups. One group was given 60 mg/kg praziquantel per day for three consecutive days, another was given two daily doses of 10 mg/kg oxamniquine, and the placebo group received starch. Faecal examinations (days 15, 30, 60, 90, 120, 150, and 180 after treatment) and biopsy of rectal mucosa by quantitative oogram (days 30, 60, 120, and 180) were used for the initial diagnosis and for evaluating the degree of cure. The chi2 test and the Kruskal-Wallis test were used to compare variables in the three groups. Survival analysis (Kaplan-Meier) and the log-rank test were used to evaluate the efficacy of the treatments. FINDINGS: The sensitivity of stool examinations ranged from 88.9% to 94.4% when patients presented with >5000 S. mansoni eggs per gram of tissue (oogram); when the number of eggs dropped to <1000 eggs per gram, sensitivity was reduced (range, 22.7-34.0%). When cure was evaluated by stool examination, oxamniquine and praziquantel had cure rates of 90.3% and 100%, respectively. However, when the oogram was used as an indicator of sensitivity, the oxamniquine cure rate dropped dramatically (to 42.4%), whereas the rate for praziquantel remained high, at 96.1%. CONCLUSIONS: Praziquantel was significantly more effective than oxamniquine in treating S. mansoni infection. The oogram was markedly more sensitive than stool examinations in detecting S. mansoni eggs and should be recommended for use in clinical trials with schistosomicides.The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000S0042-968620030003000102016-01-01T00:02:00Z2001-01-28T00:08:00ZKosek, MargaretBern, CarynGuerrant, Richard L.
<em>Kosek, Margaret</em>;
<em>Bern, Caryn</em>;
<em>Guerrant, Richard L.</em>;
<br/><br/>
Current estimates of the global burden of disease for diarrhoea are reported and compared with previous estimates made using data collected in 1954-79 and 1980-89. A structured literature review was used to identify studies that characterized morbidity rates by prospective surveillance of stable populations and studies that characterized mortality attributable to diarrhoea through active surveillance. For children under 5 years of age in developing areas and countries, there was a median of 3.2 episodes of diarrhoea per child-year. This indicated little change from previously described incidences. Estimates of mortality revealed that 4.9 children per 1000 per year in these areas and countries died as a result of diarrhoeal illness in the first 5 years of life, a decline from the previous estimates of 13.6 and 5.6 per 1000 per year. The decrease was most pronounced in children aged under 1 year. Despite improving trends in mortality rates, diarrhoea accounted for a median of 21% of all deaths of children aged under 5 years in these areas and countries, being responsible for 2.5 million deaths per year. There has not been a concurrent decrease in morbidity rates attributable to diarrhoea. As population growth is focused in the poorest areas, the total morbidity component of the disease burden is greater than previously.Analysis of the effects of malaria chemoprophylaxis in children on haematological responses, morbidity and mortalityS0042-968620030003000112016-01-01T00:02:00Z2001-01-28T00:08:00ZGeerligs, Paul D. PrinsenBrabin, Bernard J.Eggelte, Teunis A.
<em>Geerligs, Paul D. Prinsen</em>;
<em>Brabin, Bernard J.</em>;
<em>Eggelte, Teunis A.</em>;
<br/><br/>
This paper reviews the evidence for beneficial effects of malaria chemoprophylaxis on haematological responses, morbidity, mortality, health service utilization and rebound immunity in children. As anaemia may play an important role in childhood mortality, it is important to assess evidence from controlled trials of the potential of chemoprophylaxis to reduce childhood anaemia. An analysis of trials found good evidence that malaria chemoprophylaxis improves mean haemoglobin levels and reduces severe anaemia, clinical malaria attacks, parasite and spleen rates. Significant reductions in outpatient attendance and hospital admissions have been achieved, and substantial evidence from Gambian studies shows reductions in mortality. Chemoprophylaxis in children does not seem to produce any sustained impairment of immunity to malaria, although rebound effects may be greater in children who receive prophylaxis during infancy. Short periods of targeted prophylaxis are likely to be preferable to continuous drug administration. Evidence of the protective efficacy of malaria chemoprophylaxis in children shows that this strategy could be considered within integrated health programmes for specific time periods. Intermittent routine combination therapy early in childhood may be appropriate for those living under holoendemic conditions. Large-scale studies over a number of years are needed to address this issue and the impact of this approach on health service utilization, mortality, and the emergence of drug-resistant parasites.The Singapore Tuberculosis Elimination Programme: the first five yearsS0042-968620030003000122016-01-01T00:02:00Z2001-01-28T00:08:00ZChee, Cynthia B.E.James, Lyn
<em>Chee, Cynthia B.e.</em>;
<em>James, Lyn</em>;
<br/><br/>
The Singapore Tuberculosis Elimination Programme (STEP) was launched in 1997 because the incidence of the disease had remained between 49 and 56 per 100 000 resident population for the preceding 10 years. STEP involves the following key interventions: directly observed therapy (DOT) in public primary health care clinics; monitoring of treatment progress and outcome for all cases by means of a National Treatment Surveillance Registry; and preventive therapy for recently infected close contacts of infectious tuberculosis cases. Among other activities are the revamping of the National Tuberculosis Notification Registry, the discontinuation of BCG revaccination for schoolchildren, the tightening up of defaulter tracing, and the education of the medical community and the public. Future plans include an outreach programme for specific groups of patients who are unable to attend their nearest public primary care clinics for DOT, the detention of infectious recalcitrant defaulters for treatment under the Infectious Diseases Act, the molecular fingerprinting of tuberculosis isolates, and targeted screening of high-risk groups. The incidence of tuberculosis fell from 57 per 100 000 population in 1998 to 48 per 100 000 in 1999 and continued to decline to 44 per 100 000 in 2001. With political will and commitment and the support of the medical community and the public it is hoped that STEP will achieve further progress towards the elimination of tuberculosis in Singapore.The Healthy Cities approach: reflections on a framework for improving global healthS0042-968620030003000132016-01-01T00:02:00Z2001-01-28T00:08:00ZAwofeso, Niyi
<em>Awofeso, Niyi</em>;
<br/><br/>
Advancing the state of the world's newbornsS0042-968620030003000142016-01-01T00:02:00Z2001-01-28T00:08:00ZDarmstadt, Gary L.Lawn, Joy E.Costello, Anthony
<em>Darmstadt, Gary L.</em>;
<em>Lawn, Joy E.</em>;
<em>Costello, Anthony</em>;
<br/><br/>
Unknow titleS0042-968620030003000152016-01-01T00:02:00Z2001-01-28T00:08:00ZSaxena, ShekharMaulik, Pallab K.
<em>Saxena, Shekhar</em>;
<em>Maulik, Pallab K.</em>;
<br/><br/>
Environmental change, climate and health: issues and research methodsS0042-968620030003000162016-01-01T00:02:00Z2001-01-28T00:08:00ZGosselin, Pierre
<em>Gosselin, Pierre</em>;
<br/><br/>
Internally displaced people: a global surveyS0042-968620030003000172016-01-01T00:02:00Z2001-01-28T00:08:00ZAvery, Ann Harrison
<em>Avery, Ann Harrison</em>;
<br/><br/>
Can international public health law help to prevent war?S0042-968620030003000182016-01-01T00:02:00Z2001-01-28T00:08:00ZWhite, Franklin
<em>White, Franklin</em>;
<br/><br/>
Two new reports conclude that the health costs of war are unaffordableS0042-968620030003000192016-01-01T00:02:00Z2001-01-28T00:08:00ZAvery, Desmond
<em>Avery, Desmond</em>;
<br/><br/>
Brazil mobilizes for a war to save livesS0042-968620030003000202016-01-01T00:02:00Z2001-01-28T00:08:00ZHealth standards plummet on occupied farms in ZimbabweS0042-968620030003000212016-01-01T00:02:00Z2001-01-28T00:08:00ZSithole, Innocent
<em>Sithole, Innocent</em>;
<br/><br/>
Avian influenza virus reappears in Hong Kong Special Administrative RegionS0042-968620030003000222016-01-01T00:02:00Z2001-01-28T00:08:00ZEbola virus confirmed as cause of outbreakS0042-968620030003000232016-01-01T00:02:00Z2001-01-28T00:08:00ZWHO and motorists' federation plan to improve road safetyS0042-968620030003000242016-01-01T00:02:00Z2001-01-28T00:08:00ZFund launched to enhance food safety and qualityS0042-968620030003000252016-01-01T00:02:00Z2001-01-28T00:08:00ZWHO launches annual Move for Health DayS0042-968620030003000262016-01-01T00:02:00Z2001-01-28T00:08:00Z