Bulletin of the World Health Organizationhttps://scielosp.org/feed/bwho/2007.v85n1/2016-01-01T00:02:00ZUnknown authorVol. 85 No. 1 - 2007WerkzeugIn this month's BulletinS0042-968620070001000012016-01-01T00:02:00Z2001-01-28T00:08:00ZLeprosy: what is being "eliminated"?S0042-968620070001000022016-01-01T00:02:00Z2001-01-28T00:08:00ZFine, Paul E M
<em>Fine, Paul E M</em>;
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Ten years of fighting bird fluS0042-968620070001000032016-01-01T00:02:00Z2001-01-28T00:08:00ZParry, Jane
<em>Parry, Jane</em>;
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Dilemma over live-donor transplantationS0042-968620070001000042016-01-01T00:02:00Z2001-01-28T00:08:00ZGarwood, Paul
<em>Garwood, Paul</em>;
<br/><br/>
Polio will soon be historyS0042-968620070001000052016-01-01T00:02:00Z2001-01-28T00:08:00ZRecent news from WHOS0042-968620070001000062016-01-01T00:02:00Z2001-01-28T00:08:00ZAdverse birth outcomes in United Republic of Tanzania: impact and prevention of maternal risk factorsS0042-968620070001000072016-01-01T00:02:00Z2001-01-28T00:08:00ZWatson-Jones, DeborahWeiss, Helen AChangalucha, John MTodd, JamesGumodoka, BalthazarBulmer, JudithBalira, RebeccaRoss, DavidMugeye, KokungozaHayes, RichardMabey, David
<em>Watson-Jones, Deborah</em>;
<em>Weiss, Helen A</em>;
<em>Changalucha, John M</em>;
<em>Todd, James</em>;
<em>Gumodoka, Balthazar</em>;
<em>Bulmer, Judith</em>;
<em>Balira, Rebecca</em>;
<em>Ross, David</em>;
<em>Mugeye, Kokungoza</em>;
<em>Hayes, Richard</em>;
<em>Mabey, David</em>;
<br/><br/>
OBJECTIVE: To determine risk factors for poor birth outcome and their population attributable fractions. METHODS: 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. FINDINGS: At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. CONCLUSION: Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority.Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN StudyS0042-968620070001000082016-01-01T00:02:00Z2001-01-28T00:08:00ZKelishadi, RoyaArdalan, GelayolGheiratmand, RiazGouya, Mohammad MehdiRazaghi, Emran MohammadDelavari, AlirezaMajdzadeh, RezaHeshmat, RaminMotaghian, MoloukBarekati, HamedMahmoud-Arabi, Minou SadatRiazi, Mohammad Mehdi
<em>Kelishadi, Roya</em>;
<em>Ardalan, Gelayol</em>;
<em>Gheiratmand, Riaz</em>;
<em>Gouya, Mohammad Mehdi</em>;
<em>Razaghi, Emran Mohammad</em>;
<em>Delavari, Alireza</em>;
<em>Majdzadeh, Reza</em>;
<em>Heshmat, Ramin</em>;
<em>Motaghian, Molouk</em>;
<em>Barekati, Hamed</em>;
<em>Mahmoud-Arabi, Minou Sadat</em>;
<em>Riazi, Mohammad Mehdi</em>;
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OBJECTIVE: To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children. METHODS: A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran. PA and dietary pattern were assessed by self-administered validated questionnaires. FINDINGS: Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day. The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families). The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students. Among boys, the frequency of consumption of vegetables and plant proteins (R² = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI (R² = 0.57). Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight. When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups. CONCLUSION: Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life. When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered.Assessing the burden of injury in six European countriesS0042-968620070001000092016-01-01T00:02:00Z2001-01-28T00:08:00ZPolinder, SuzanneMeerding, Willem JanMulder, SaakjePetridou, Elenivan Beeck, Ed
<em>Polinder, Suzanne</em>;
<em>Meerding, Willem Jan</em>;
<em>Mulder, Saakje</em>;
<em>Petridou, Eleni</em>;
<em>Van Beeck, Ed</em>;
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OBJECTIVE: To assess injury-related mortality, disability and disability-adjusted life years (DALYs) in six European countries. METHODS: Epidemiological data (hospital discharge registers, emergency department registers, mortality databases) were obtained for Austria, Denmark, Ireland, Netherlands, Norway, and the United Kingdom (England and Wales). For each country, the burden of injury was estimated in years lost due to premature mortality (YLL), years lived with disability (YLD), and DALYs (per 1000 persons). FINDINGS: We observed marked differences in the burden of injury between countries. Austria lost the largest number of DALYs (25 per 1000 persons), followed by Denmark, Norway and Ireland (17-20 per 1000 persons). In the Netherlands and United Kingdom, the total burden due to injuries was relatively low (12 per 1000 persons). The variation between countries was attributable to a high variation in premature mortality (YLL varied from 9-17 per 1000 persons) and disability (YLD varied from 2-8 per 1000 persons). In all countries, males aged 25-44 years represented one third of the total injury burden, mainly due to traffic and intentional injuries. Spinal cord injury and skull-brain injury resulted in the highest burden due to permanent disability. CONCLUSION: The burden of injury varies considerably among the six participating European countries, but males aged 15-24 years are responsible for a disproportionate share of the assessed burden of injury in all countries. Consistent injury control policy is supported by high-quality summary measures of population health. There is an urgent need for standardized data on the incidence and functional consequences of injury.Human immunodeficiency virus (HIV) infection patterns and risk behaviours in different population groups and provinces in Viet NamS0042-968620070001000102016-01-01T00:02:00Z2001-01-28T00:08:00ZTuan, Nguyen AnhFylkesnes, KnutThang, Bui DucHien, Nguyen TranLong, Nguyen ThanhVan Kinh, NguyenThang, Pham HongManh, Pham DucO'Farrell, Nigel
<em>Tuan, Nguyen Anh</em>;
<em>Fylkesnes, Knut</em>;
<em>Thang, Bui Duc</em>;
<em>Hien, Nguyen Tran</em>;
<em>Long, Nguyen Thanh</em>;
<em>Van Kinh, Nguyen</em>;
<em>Thang, Pham Hong</em>;
<em>Manh, Pham Duc</em>;
<em>O'farrell, Nigel</em>;
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OBJECTIVE: To study patterns and determinants of HIV prevalence and risk-behaviour characteristics in different population groups in four border provinces of Viet Nam. METHODS: We surveyed four population groups during April-June 2002. We used stratified random-cluster sampling and collected data concomitantly on HIV status and risk behaviours. The groups included were female sex workers (n = 2023), injecting drug users (n = 1391), unmarried males aged 15-24 years (n = 1885) and different categories of mobile groups (n = 1923). FINDINGS: We found marked geographical contrasts in HIV prevalence, particularly among female sex workers (range 0-24%). The HIV prevalence among injecting drug users varied at high levels in all provinces (range 4-36%), whereas lower prevalences were found among both unmarried young men (range 0-1.3%) and mobile groups (range 0-2.5%). All groups reported sex with female sex workers. Less than 40% of the female sex workers had used condoms consistently. The strongest determinants of HIV infection among female sex workers were inconsistent condom use (adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 2.4-11.8), history of injecting drug use and mobility, and, among injecting drug users, sharing of injection equipment (adjusted OR, 7.3; 95% CI, 2.3-24.0) and sex with non-regular partners (adjusted OR 3.4; 95% CI 1.4-8.5). CONCLUSION: The finding of marked geographical variation in HIV prevalence underscores the value of understanding local contexts in the prevention of HIV infection. Although lacking support from data from all provinces, there would appear to be a potential for sex work to drive a self-sustaining heterosexual epidemic. That the close links to serious injecting drug use epidemics can have an accelerating effect in increasing the spread of HIV merits further study.Diarrhoea case management in low- and middle-income countries: an unfinished agendaS0042-968620070001000112016-01-01T00:02:00Z2001-01-28T00:08:00ZForsberg, Birger CarlPetzold, Max GTomson, GöranAllebeck, Peter
<em>Forsberg, Birger Carl</em>;
<em>Petzold, Max G</em>;
<em>Tomson, Göran</em>;
<em>Allebeck, Peter</em>;
<br/><br/>
OBJECTIVE: To ascertain whether diarrhoea management improved during 1986-2003, a period when significant efforts were made to promote effective case management in children. METHODS: We analysed household data from 107 Demographic and Health Surveys in 40 low- and middle-income countries from 1986 to 2003 and assessed trends in indicators of rehydration, fluid quantity and food intake in children with diarrhoea. A statistical analysis was made of the overall trend for each indicator. FINDINGS: Modest progress was made with regard to the use of oral rehydration therapy (ORT) (0.39% per year) and increased fluid intake (1.02% per year), and use rates remained low in 2003, when compared with desired full coverage. Although use rates improved in the majority of countries, no progress was made in several countries. We estimate that, annually, 307 million children in low- and middle-income countries did not receive ORT, 356 million did not get increased amounts of fluids, and at the beginning of the 21st century, 227 million children got neither ORT nor increased amounts of fluids. CONCLUSION: The finding that many children in low- and middle-income countries do not receive proper treatment for diarrhoea points to the urgency in addressing this unfinished agenda in child survival. The effectiveness of diarrhoea control needs to be improved after critical review of established approaches and activities to reach caregivers of children at risk of dying from diarrhoeal diseases. Significant efforts must be made to scale up activities to improve case management and reduce childhood deaths from diarrhoea.A proposal for measuring the degree of public health-sensitivity of patent legislation in the context of the WTO TRIPS AgreementS0042-968620070001000122016-01-01T00:02:00Z2001-01-28T00:08:00ZChaves, Gabriela CostaOliveira, Maria Auxiliadora
<em>Chaves, Gabriela Costa</em>;
<em>Oliveira, Maria Auxiliadora</em>;
<br/><br/>
OBJECTIVE: This study aims to propose a framework for measuring the degree of public health-sensitivity of patent legislation reformed after the World Trade Organization's TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement entered into force. METHODS: The methodology for establishing and testing the proposed framework involved three main steps:(1) a literature review on TRIPS flexibilities related to the protection of public health and provisions considered "TRIPS-plus"; (2) content validation through consensus techniques (an adaptation of Delphi method); and (3) an analysis of patent legislation from nineteen Latin American and Caribbean countries. FINDINGS: The results show that the framework detected relevant differences in countries' patent legislation, allowing for country comparisons. CONCLUSION: The framework's potential usefulness in monitoring patent legislation changes arises from its clear parameters for measuring patent legislation's degree of health sensitivity. Nevertheless, it can be improved by including indicators related to government and organized society initiatives that minimize free-trade agreements' negative effects on access to medicines.Ensuring access to HPV vaccines through integrated services: a reproductive health perspectiveS0042-968620070001000132016-01-01T00:02:00Z2001-01-28T00:08:00ZPollack, Amy EBalkin, MirandaEdouard, LindsayCutts, FelicityBroutet, Nathalie
<em>Pollack, Amy E</em>;
<em>Balkin, Miranda</em>;
<em>Edouard, Lindsay</em>;
<em>Cutts, Felicity</em>;
<em>Broutet, Nathalie</em>;
<br/><br/>
In 2006, a quadrivalent human papillomavirus (HPV) vaccine was licensed, and another vaccine may be licensed soon. Little is known about the practical considerations involved in designing and implementing cervical cancer prevention programmes that include vaccination as a primary means of prevention. Although the vaccine may ultimately be indicated for both males and females, young girls, or girls and women aged 9-25 years, will be the initial candidates for the vaccine. This paper describes avenues for service delivery of HPV vaccines and critical information gaps that must be bridged in order to inform future sexual and reproductive health programming. It proposes the role that the sexual and reproductive health community, together with immunization and cancer control programmes, could have in supporting the introduction of HPV vaccines within the context of current health systems.Using a fingerprint recognition system in a vaccine trial to avoid misclassificationS0042-968620070001000142016-01-01T00:02:00Z2001-01-28T00:08:00Z
PROBLEM: The potential for misidentification of trial participants, leading to misclassification, is a threat to the integrity of randomized controlled trials. The correct identification of study subjects in large trials over prolonged periods is of vital importance to those conducting clinical trials. Currently used means of identifying study participants, such as identity cards and records of name, address, name of household head and demographic characteristics, require large numbers of well-trained personnel, and still leave room for uncertainty. APPROACH: We used fingerprint recognition technology for the identification of trial participants. This technology is already widely used in security and commercial contexts but not so far in clinical trials. LOCAL SETTING: A phase 2 cholera vaccine trial in SonLa, Viet Nam. RELEVANT CHANGES: An optical sensor was used to scan fingerprints. The fingerprint template of each participant was used to verify his or her identity during each of eight follow-up visits. LESSONS LEARNED: A system consisting of a laptop computer and sensor is small in size, requires minimal training and on average six seconds for scanning and recognition. All participants' identities were verified in the trial. Fingerprint recognition should become the standard technology for identification of participants in field trials. Fears exist, however, regarding the potential for invasion of privacy. It will therefore be necessary to convince not only trial participants but also investigators that templates of fingerprints stored in databases are less likely to be subject to abuse than currently used information databases.Improving the use of confidential enquiries into maternal deaths in developing countriesS0042-968620070001000152016-01-01T00:02:00Z2001-01-28T00:08:00ZHussein, Julia
<em>Hussein, Julia</em>;
<br/><br/>