Bulletin of the World Health Organizationhttps://scielosp.org/feed/bwho/2010.v88n2/2016-01-01T00:02:00ZUnknown authorVol. 88 No. 2 - 2010WerkzeugIn this month's bulletinS0042-968620100002000012016-01-01T00:02:00Z2001-01-28T00:08:00ZShort-sightedness in sight-saving: half a strategy will not eliminate blinding trachomaS0042-968620100002000022016-01-01T00:02:00Z2001-01-28T00:08:00ZMontgomery, Maggie ABartram, Jamie
<em>Montgomery, Maggie A</em>;
<em>Bartram, Jamie</em>;
<br/><br/>
WHO Framework Convention on Tobacco Control: a key milestoneS0042-968620100002000032016-01-01T00:02:00Z2001-01-28T00:08:00ZNikogosian, Haik
<em>Nikogosian, Haik</em>;
<br/><br/>
Thailand: health care for all, at a priceS0042-968620100002000042016-01-01T00:02:00Z2001-01-28T00:08:00ZThe weight of affluenceS0042-968620100002000052016-01-01T00:02:00Z2001-01-28T00:08:00ZCorrigendumS0042-968620100002000062016-01-01T00:02:00Z2001-01-28T00:08:00ZHuman rights and health go hand-in-handS0042-968620100002000072016-01-01T00:02:00Z2001-01-28T00:08:00ZRecent news from WHOS0042-968620100002000082016-01-01T00:02:00Z2001-01-28T00:08:00ZHousehold-wide ivermectin treatment for head lice in an impoverished community: randomized observer-blinded controlled trialS0042-968620100002000092016-01-01T00:02:00Z2001-01-28T00:08:00ZPilger, DanielHeukelbach, JorgKhakban, AdakOliveira, Fabiola AraujoFengler, GernotFeldmeier, Hermann
<em>Pilger, Daniel</em>;
<em>Heukelbach, Jorg</em>;
<em>Khakban, Adak</em>;
<em>Oliveira, Fabiola Araujo</em>;
<em>Fengler, Gernot</em>;
<em>Feldmeier, Hermann</em>;
<br/><br/>
OBJECTIVE: To generate evidence on the effectiveness of household-wide treatment for preventing the transmission of pediculosis capitis (head lice) in resource-poor communities. METHODS: We studied 132 children without head lice who lived in a slum in north-eastern Brazil. We randomized the households of the study participants into an intervention and a control group and prospectively calculated the incidence of infestation with head lice among the children in each group. In the intervention group, all of the children's family members who lived in the household were treated with ivermectin; in the control group, no family member was treated. We used the χ2 test with continuity correction or Fisher's exact test to compare proportions. We performed survival analysis using Kaplan-Meier estimates with log rank testing and the Mann-Whitney U test to analyse the length of lice-free periods among sentinel children, and we used Cox regression to analyse survival data on a multivariate level. We also carried out a subgroup analysis based on gender. FINDINGS: Children in the intervention group remained free from infestation with head lice significantly longer than children in the control group. The median infestation-free period in the intervention group was 24 days (interquartile range, IQR: 11-45), as compared to 14 days (IQR: 11-25) in the control group (P = 0.01). Household-wide treatment with ivermectin proved significantly more effective among boys than among girls (P = 0.005). After treatment with ivermectin, the estimated number of annual episodes of head lice infestation was reduced from 19 to 14 in girls and from 15 to 5 in boys. Female sex and extreme poverty were independent risk factors associated with a shortened disease-free period. CONCLUSION: In an impoverished community, girls and the poorest of the poor are the population groups that are most vulnerable for head lice infestation. To decrease the number of head lice episodes per unit of time, control measures should include the treatment of all household contacts. Mass treatment with ivermectin may reduce the incidence of head lice infestation and associated morbidity in resource-poor communities.Effectiveness of planning and management interventions for improving age-appropriate immunization in rural IndiaS0042-968620100002000102016-01-01T00:02:00Z2001-01-28T00:08:00ZPrinja, ShankarGupta, MadhuSingh, AmarjeetKumar, Rajesh
<em>Prinja, Shankar</em>;
<em>Gupta, Madhu</em>;
<em>Singh, Amarjeet</em>;
<em>Kumar, Rajesh</em>;
<br/><br/>
OBJECTIVE: To study the effectiveness of planning and management interventions for ensuring children in India are immunized at the appropriate age. METHODS: The study involved children aged less than 18 months recruited from Haryana, India, in 2005-2006: 4336 in a pre-intervention cohort and 5213 in a post-intervention cohort. In addition, immunization of 814 hospitalized children from outside the study area was also assessed. Operational barriers to age-appropriate immunization with diphtheria, pertussis and tetanus (DPT) vaccine were investigated by monitoring vaccination coverage, observing immunization sessions and interviewing parents and health-care providers. An intervention package was developed, with community volunteers playing a pivotal role. Its effectiveness was assessed by monitoring the ages at which the three DPT doses were administered. FINDINGS: The main reasons for delayed immunization were staff shortages, non-adherence to plans and vaccine being out of stock. In the post-intervention cohort, 70% received a third DPT dose before the age of 6 months, significantly more than in the pre-intervention cohort (62%; P = 0.002). In addition, the mean age at which the first, second and third DPT doses were administered decreased by 17, 21 and 34 days, respectively, in the study area over a period of 18 months (P for trend < 0.0001). No change was observed in hospitalized children from outside the study area. CONCLUSION: An intervention package involving community volunteers significantly improved age-appropriate DPT immunization in India. The Indian Government's intention to recruit village-based volunteers as part of a health sector reform aimed at decentralizing administration could help increase timely immunization.Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in BangladeshS0042-968620100002000112016-01-01T00:02:00Z2001-01-28T00:08:00ZLeFevre, AmnestyShillcutt, Samuel DSaha, Samir KAhmed, ASM Nawshad UddinAhmed, SaifuddinChowdhury, MAK AzadLaw, Paul ABlack, RobertSantosham, MathuramDarmstadt, Gary L
<em>Lefevre, Amnesty</em>;
<em>Shillcutt, Samuel D</em>;
<em>Saha, Samir K</em>;
<em>Ahmed, Asm Nawshad Uddin</em>;
<em>Ahmed, Saifuddin</em>;
<em>Chowdhury, Mak Azad</em>;
<em>Law, Paul A</em>;
<em>Black, Robert</em>;
<em>Santosham, Mathuram</em>;
<em>Darmstadt, Gary L</em>;
<br/><br/>
OBJECTIVE: To evaluate the cost-effectiveness of topical emollients, sunflower seed oil (SSO) and synthetic Aquaphor, versus no treatment, in preventing mortality among hospitalized preterm infants (< 33 weeks gestation) at a tertiary hospital in Bangladesh. METHODS: Evidence from a randomized controlled efficacy trial was evaluated using standard Monte Carlo simulation. Programme costs were obtained from a retrospective review of activities. Patient costs were collected from patient records. Health outcomes were calculated as deaths averted and discounted years of life lost (YLLs) averted. Results were deemed cost-effective if they fell below a ceiling ratio based on the per capita gross national income of Bangladesh (United States dollars, US$ 470). FINDINGS: Aquaphor and SSO were both highly cost-effective relative to control, reducing neonatal mortality by 26% and 32%, respectively. SSO cost US$ 61 per death averted and US$ 2.15 per YLL averted (I$6.39, international dollars, per YLL averted). Aquaphor cost US$ 162 per death averted and US$ 5.74 per YLL averted (I$ 17.09 per YLL averted). Results were robust to sensitivity analysis. Aquaphor was cost-effective relative to SSO with 77% certainty: it cost an incremental US$ 26 more per patient treated, but averted 1.25 YLLs (US$ 20.74 per YLL averted). CONCLUSION: Topical therapy with SSO or Aquaphor was highly cost-effective in reducing deaths from infection among the preterm neonates studied. The choice of emollient should be made taking into account budgetary limitations and ease of supply. Further research is warranted on additional locally available emollients, use of emollients in community-based settings and generalizability to other geographic regions.Maternal near miss and maternal death in the World Health Organization's 2005 global survey on maternal and perinatal healthS0042-968620100002000122016-01-01T00:02:00Z2001-01-28T00:08:00ZSouza, João PauloCecatti, Jose GuilhermeFaundes, AnibalMorais, Sirlei SianiVillar, JoseCarroli, GuillermoGulmezoglu, MetinWojdyla, DanielZavaleta, NellyDonner, AllanVelazco, AlejandroBataglia, VicenteValladares, ElietteKublickas, MariusAcosta, Arnaldo
<em>Souza, João Paulo</em>;
<em>Cecatti, Jose Guilherme</em>;
<em>Faundes, Anibal</em>;
<em>Morais, Sirlei Siani</em>;
<em>Villar, Jose</em>;
<em>Carroli, Guillermo</em>;
<em>Gulmezoglu, Metin</em>;
<em>Wojdyla, Daniel</em>;
<em>Zavaleta, Nelly</em>;
<em>Donner, Allan</em>;
<em>Velazco, Alejandro</em>;
<em>Bataglia, Vicente</em>;
<em>Valladares, Eliette</em>;
<em>Kublickas, Marius</em>;
<em>Acosta, Arnaldo</em>;
<br/><br/>
OBJECTIVE: To develop an indicator of maternal near miss as a proxy for maternal death and to study its association with maternalfactors and perinatal outcomes. METHODS: In a multicenter cross-sectional study, we collected maternal and perinatal data from the hospital records of a sample of women admitted for delivery over a period of two to three months in 120 hospitals located in eight Latin American countries. We followed a stratified multistage cluster random design. We assessed the intra-hospital occurrence of severe maternal morbidity and the latter's association with maternal characteristics and perinatal outcomes. FINDINGS: Of the 97 095 women studied, 2964 (34 per 1000) were at higher risk of dying in association with one or more of the following: being admitted to the intensive care unit (ICU), undergoing a hysterectomy, receiving a blood transfusion, suffering a cardiac or renal complication, or having eclampsia. Being older than 35 years, not having a partner, being a primipara or para > 3, and having had a Caesarean section in the previous pregnancy were factors independently associated with the occurrence of severe maternal morbidity. They were also positively associated with an increased occurrence of low and very low birth weight, stillbirth, early neonatal death, admission to the neonatal ICU, a prolonged maternal postpartum hospital stay and Caesarean section. CONCLUSION: Women who survive the serious conditions described could be pragmatically considered cases of maternal near miss. Interventions to reduce maternal and perinatal mortality should target women in these high-risk categories.Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of AmericaS0042-968620100002000132016-01-01T00:02:00Z2001-01-28T00:08:00ZCapewell, SimonFord, Earl SCroft, Janet BCritchley, Julia AGreenlund, Kurt JLabarthe, Darwin R
<em>Capewell, Simon</em>;
<em>Ford, Earl S</em>;
<em>Croft, Janet B</em>;
<em>Critchley, Julia A</em>;
<em>Greenlund, Kurt J</em>;
<em>Labarthe, Darwin R</em>;
<br/><br/>
OBJECTIVE: To examine the potential for reducing cardiovascular risk factors in the United States of America enough to cause age-adjusted coronary heart disease (CHD) mortality rates to drop by 20% (from 2000 baseline figures) by 2010, as targeted under the Healthy People 2010 initiative. METHODS: Using a previously validated, comprehensive CHD mortality model known as IMPACT that integrates trends in all the major cardiovascular risk factors, stratified by age and sex, we calculated how much CHD mortality would drop between 2000 and 2010 in the projected population of the United States aged 25-84 years (198 million). We did this for three assumed scenarios: (i) if recent risk factor trends were to continue to 2010; (ii) success in reaching all the Healthy People 2010 risk factor targets, and (iii) further drops in risk factors, to the levels already seen in the low-risk stratum. FINDINGS: If age-adjusted CHD mortality rates observed in 2000 remained unchanged, some 388 000 CHD deaths would occur in 2010. First scenario: if recent risk factor trends continued to 2010, there would be approximately 19 000 fewer deaths than in 2000. Although improved total cholesterol, lowered blood pressure in men, decreased smoking and increased physical activity would account for some 51 000 fewer deaths, these would be offset by approximately 32 000 additional deaths from adverse trends in obesity and diabetes and in blood pressure in women. Second scenario: If Healthy People 2010 cardiovascular risk factor targets were reached, approximately 188 000 CHD deaths would be prevented. Scenario three: If the cardiovascular risk levels of the low-risk stratum were reached, approximately 372 000 CHD deaths would be prevented. CONCLUSION: Achievement of the Healthy People 2010 cardiovascular risk factor targets would almost halve the predicted CHD death rates. Additional reductions in major risk factors could prevent or postpone substantially more deaths from CHD.Self-reported health assessments in the 2002 World Health Survey: how do they correlate with education?S0042-968620100002000142016-01-01T00:02:00Z2001-01-28T00:08:00ZSubramanian, SVHuijts, TimAvendano, Mauricio
<em>Subramanian, Sv</em>;
<em>Huijts, Tim</em>;
<em>Avendano, Mauricio</em>;
<br/><br/>
OBJECTIVE: To assess the value of self-rated health assessments by examining the association between education and self-rated poor health. METHODS: We used the globally representative population-based sample from the 2002 World Health Survey, composed of 219 713 men and women aged 25 and over in 69 countries, to examine the association between education and self-rated poor health. In a binary regression model with a logit link function, we used self-rated poor health as the binary dependent variable, and age, sex and education as the independent variables. FINDINGS: Globally, there was an inverse association between years of schooling and self-rated poor health (odds ratio, OR: 0.929; 95% confidence interval, CI: 0.926-0.933). Compared with the individuals in the highest quintile of years of schooling, those in the lowest quintile were twice as likely to report poor health (OR: 2.292; 95% CI: 2.165-2.426). We found a dose-response relationship between quintiles of years of schooling and the ORs for reporting poor health.This association was consistent among men and women; low-, middle- and high-income countries; and regions. CONCLUSION: Our findings suggest that self-reports of health may be useful for epidemiological investigations within countries, even in low-income settings.Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in indigenous infants in AustraliaS0042-968620100002000152016-01-01T00:02:00Z2001-01-28T00:08:00ZO'Grady, KFCarlin, JBChang, ABTorzillo, PJNolan, TMRuben, AAndrews, RM
<em>O'grady, Kf</em>;
<em>Carlin, Jb</em>;
<em>Chang, Ab</em>;
<em>Torzillo, Pj</em>;
<em>Nolan, Tm</em>;
<em>Ruben, A</em>;
<em>Andrews, Rm</em>;
<br/><br/>
OBJECTIVE: To evaluate the effectiveness of the 7-valent pneumococcal conjugate vaccine (PCV7) in preventing pneumonia, diagnosed radiologically according to World Health Organization (WHO) criteria, among indigenous infants in the Northern Territory of Australia. METHODS: We conducted a historical cohort study of consecutive indigenous birth cohorts between 1 April 1998 and 28 February 2005. Children were followed up to 18 months of age. The PCV7 programme commenced on 1 June 2001. All chest X-rays taken within 3 days of any hospitalization were assessed. The primary endpoint was a first episode of WHO-defined pneumonia requiring hospitalization. Cox proportional hazards models were used to compare disease incidence. FINDINGS: There were 526 pneumonia events among 10 600 children - an incidence of 3.3 per 1000 child-months; 183 episodes (34.8%) occurred before 5 months of age and 247 (47.0%) by 7 months. Of the children studied, 27% had received 3 doses of vaccine by 7 months of age. Hazard ratios for endpoint pneumonia were 1.01 for 1 versus 0 doses; 1.03 for 2 versus 0 doses; and 0.84 for 3 versus 0 doses. CONCLUSION: There was limited evidence that PCV7 reduced the incidence of radiologically confirmed pneumonia among Northern Territory indigenous infants, although there was a non-significant trend towards an effect after receipt of the third dose. These findings might be explained by lack of timely vaccination and/or occurrence of disease at an early age. Additionally, the relative contribution of vaccine-type pneumococcus to severe pneumonia in a setting where multiple other pathogens are prevalent may differ with respect to other settings where vaccine efficacy has been clearly established.What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countriesS0042-968620100002000162016-01-01T00:02:00Z2001-01-28T00:08:00ZCross, SuzanneBell, Jacqueline SGraham, Wendy J
<em>Cross, Suzanne</em>;
<em>Bell, Jacqueline S</em>;
<em>Graham, Wendy J</em>;
<br/><br/>
The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.Expiry of medicines in supply outlets in UgandaS0042-968620100002000172016-01-01T00:02:00Z2001-01-28T00:08:00ZNakyanzi, Josephine KatabaaziKitutu, Freddy EricOria, HusseinKamba, Pakoyo Fadhiru
<em>Nakyanzi, Josephine Katabaazi</em>;
<em>Kitutu, Freddy Eric</em>;
<em>Oria, Hussein</em>;
<em>Kamba, Pakoyo Fadhiru</em>;
<br/><br/>
PROBLEM: The expiry of medicines in the supply chain is a serious threat to the already constrained access to medicines in developing countries. APPROACH: We investigated the extent of, and the main contributing factors to, expiry of medicines in medicine supply outlets in Kampala and Entebbe, Uganda. A cross-sectional survey of six public and 32 private medicine outlets was done using semi-structured questionnaires. LOCAL SETTING: The study area has 19 public medicine outlets (three non-profit wholesalers, 16 hospital stores/pharmacies), 123 private wholesale pharmacies and 173 retail pharmacies, equivalent to about 70% of the country's pharmaceutical businesses. Our findings indicate that medicines prone to expiry include those used for vertical programmes, donated medicines and those with a slow turnover. RELEVANT CHANGES: Awareness about the threat of expiry of medicines to the delivery of health services has increased. We have adapted training modules to emphasize management of medicine expiry for pharmacy students, pharmacists and other persons handling medicines. Our work has also generated more research interest on medicine expiry in Uganda. LESSONS LEARNED: Even essential medicines expire in the supply chain in Uganda. Sound coordination is needed between public medicine wholesalers and their clients to harmonize procurement and consumption as well as with vertical programmes to prevent duplicate procurement. Additionally, national medicine regulatory authorities should enforce existing international guidelines to prevent dumping of donated medicine. Medicine selection and quantification should be matched with consumer tastes and prescribing habits. Lean supply and stock rotation should be considered.Pakistan, politics and polioS0042-968620100002000182016-01-01T00:02:00Z2001-01-28T00:08:00ZNishtar, Sania
<em>Nishtar, Sania</em>;
<br/><br/>