Bulletin of the World Health Organizationhttps://scielosp.org/feed/bwho/2011.v89n1/2016-01-01T00:02:00ZUnknown authorVol. 89 No. 1 - 2011WerkzeugIn this month's bulletin10.2471/BLT.11.0001112016-01-01T00:02:00Z2001-01-28T00:08:00ZViolence against women: an urgent public health priority10.2471/BLT.10.0852172016-01-01T00:02:00Z2001-01-28T00:08:00ZGarcia-Moreno, ClaudiaWatts, Charlotte
<em>Garcia-Moreno, Claudia</em>;
<em>Watts, Charlotte</em>;
<br/><br/>
Systematic reviews in the Bulletin10.2471/BLT.10.0849702016-01-01T00:02:00Z2001-01-28T00:08:00ZClark, Maria LuisaThapa, Shyam
<em>Clark, Maria Luisa</em>;
<em>Thapa, Shyam</em>;
<br/><br/>
Public health round-up10.2471/BLT.11.0101112016-01-01T00:02:00Z2001-01-28T00:08:00ZCampaigns against acid violence spur change10.2471/BLT.11.0201112016-01-01T00:02:00Z2001-01-28T00:08:00ZAre antibiotics still "automatic" in France?10.2471/BLT.11.0301112016-01-01T00:02:00Z2001-01-28T00:08:00ZLearning to outwit malaria10.2471/BLT.11.0401112016-01-01T00:02:00Z2001-01-28T00:08:00ZMaternal mortality estimation at the subnational level: a model-based method with an application to Bangladesh10.2471/BLT.10.0768512016-01-01T00:02:00Z2001-01-28T00:08:00ZAhmed, SaifuddinHill, Kenneth
<em>Ahmed, Saifuddin</em>;
<em>Hill, Kenneth</em>;
<br/><br/>
OBJECTIVE: To provide a model-based method of estimating maternal mortality at the subnational level and illustrate its use in estimating maternal mortality rates (MMrates) and maternal mortality ratios (MMRs) in all 64 districts of Bangladesh. METHODS: Knowing that mortality is more pronounced among the poorer segments of a population, in rural areas and in areas with poor availability and utilization of maternal care, we used an empirical Bayesian prediction method to estimate maternal mortality at the subnational level from the spatial distribution of such factors. FINDINGS: MMRs varied significantly by district in Bangladesh, from 158 maternal deaths per 100 000 live births at Dhaka district to 782 in the northern coastal regions. Maternal mortality was consistently higher in the eastern and northern regions, which are known to be culturally conservative and to have poor transportation systems. CONCLUSION: Bangladesh has made noteworthy strides in reducing maternal mortality since 1990, even though the utilization of skilled birth attendants has increased very little. However, several areas still show alarmingly high maternal mortality figures and need to be prioritized and targeted by health administrators and policy-makers.Progress towards millennium development goal 1 in Latin America and the Caribbean: the importance of the choice of indicator for undernutrition10.2471/BLT.10.0786182016-01-01T00:02:00Z2001-01-28T00:08:00ZLutter, Chessa KChaparro, Camila MMuñoz, Sergio
<em>Lutter, Chessa K</em>;
<em>Chaparro, Camila M</em>;
<em>Muñoz, Sergio</em>;
<br/><br/>
OBJECTIVE: To assess the effect of using stunting versus underweight as the indicator of child undernutrition for determining whether countries in Latin America and the Caribbean are on track to meet the component of Millennium Development Goal (MDG) 1 pertaining to the eradication of hunger, namely to reduce undernutrition by half between 1990 and 2015. METHODS: The prevalence of underweight and stunting among children less than 5 years of age was calculated for 13 countries in Latin America and the Caribbean by applying the WHO Child Growth Standards to nationally-representative, publicly available anthropometric data. The predicted trend (based on the trend in previous years) and the target trend (based on MDG 1) for stunting and underweight were estimated using linear regression. FINDINGS: The choice of indicator affects the conclusions regarding which countries are on track to reach MDG 1. All countries are on track when underweight is used to assess progress towards the target prevalence, but only 6 of them are on track when stunting is used instead. Another two countries come within 2 percentage points of the target prevalence of stunting. CONCLUSION: Whether countries are determined to be on track to meet the nutritional component of MDG 1 or not depends on the choice of stunting versus underweight as the indicator. Unfortunately, underweight is the indicator officially used to monitor progress towards MDG 1. In Latin America and the Caribbean, the use of underweight for this purpose will fail to take account of the large remaining burden of stunting.Validity of verbal autopsy for ascertaining the causes of stillbirth10.2471/BLT.10.0768282016-01-01T00:02:00Z2001-01-28T00:08:00ZAggarwal, Arun KJain, VanitaKumar, Rajesh
<em>Aggarwal, Arun K</em>;
<em>Jain, Vanita</em>;
<em>Kumar, Rajesh</em>;
<br/><br/>
OBJECTIVE: To validate the verbal autopsy tool for stillbirths of the World Health Organization (WHO) by using hospital diagnosis of the underlying cause of stillbirth (the gold standard) and to compare the fraction of stillbirths attributed to various specific causes through hospital assessment versus verbal autopsy. METHODS: In a hospital in Chandigarh, we prospectively studied all stillbirths occurring from 15 April 2006 to 31 March 2008 whose cause was diagnosed within 2 days. All mothers had to be at least 24 weeks pregnant and live within 100 km of the hospital. For verbal autopsy, field workers visited mothers 4 to 6 weeks after the stillbirth. Autopsy results were reviewed by two independent obstetricians and disagreements were resolved by engaging a third expert. Causes of stillbirths as determined by hospital assessment and verbal autopsy were compared in frequency. FINDINGS: Hospital assessment and verbal autopsy yielded the same top five underlying causes of stillbirth: pregnancy-induced hypertension (30%), antepartum haemorrhage (16%), underlying maternal illness (12%), congenital malformations (12%) and obstetric complications (10%). Overall diagnostic accuracy of verbal autopsy diagnosis versus hospital-based diagnosis for all five top causes of stillbirth was 64%. The areas under the receiver operator characteristic curve (ROC) were, for congenital malformations, 0.91 (95% confidence interval, CI: 0.83-0.97); pre-gestational maternal illness, 0.75 (95% CI: 0.65-0.84); pregnancy-induced hypertension, 0.76 (95% CI: 0.69-0.81); antepartum haemorrhage, 0.76 (95% CI: 0.67-0.84) and obstetric complication, 0.82 (95% CI: 0.71-0.93). CONCLUSION: The WHO verbal autopsy tool for stillbirth can provide reasonably good estimates of common underlying causes of stillbirth in resource-limited settings where a medically certified cause of stillbirth may not be available.Comparing road traffic mortality rates from police-reported data and death registration data in China10.2471/BLT.10.0803172016-01-01T00:02:00Z2001-01-28T00:08:00ZHu, GuoqingBaker, TimothyBaker, Susan P
<em>Hu, Guoqing</em>;
<em>Baker, Timothy</em>;
<em>Baker, Susan P</em>;
<br/><br/>
OBJECTIVE: To compare death rates from road traffic injuries in China in 2002-2007 when derived from police-reported data versus death registration data. METHODS: In China, police-recorded data are obtained from police records by means of a standardized, closed-ended data collection form; these data are published in the China statistical yearbook of communication and transportation. Official death registration data, on the other hand, are obtained from death certificates completed by physicians and are published in the China health statistics yearbook. We searched both sources for data on road traffic deaths in 2002-2007, used the χ2 test to compare the mortality rates obtained, and performed linear regression to look for statistically significant trends in road traffic mortality over the period. FINDINGS: For 2002-2007, the rate of death from road traffic injuries based on death registration data was about twice as high as the rate reported by the police. Linear regression showed a significant decrease of 27% (95% confidence interval, CI: 35-19) in the death rate over the period according to police sources but no significant change according to death registration data. CONCLUSION: The widely-cited recent drop in road traffic mortality in China, based on police-reported data, may not reflect a genuine decrease. The quality of the data obtained from police reports, which drives decision-making by the Government of China and international organizations, needs to be investigated, monitored and improved.Blood sample volumes in child health research: review of safe limits10.2471/BLT.10.0800102016-01-01T00:02:00Z2001-01-28T00:08:00ZHowie, Stephen RC
<em>Howie, Stephen Rc</em>;
<br/><br/>
OBJECTIVE: To determine paediatric blood sample volume limits that are consistent with physiological "minimal risk." METHODS: A literature review was performed to search for evidence concerning the adverse effects of blood sampling in children and for guidelines on sampling volume in paediatric research. The search included Medline, EMBASE, other web-based and non-web-based sources and the bibliographies of the sources identified. Experts were also consulted. FINDINGS: Five studies and nine guidelines were identified. Existing guidelines specify paediatric blood sample volume limits ranging from 1% to 5% of total blood volume (TBV) over 24 hours and up to 10% of TBV over 8 weeks. The evidence available is limited and includes findings from non-randomized studies showing a minimal risk with one-off sampling of up to 5% of TBV. CONCLUSION: The evidence available is consistent with the conclusion that all identified guidelines are within the limits of "minimal risk." However, more and better evidence is required to draw firmer conclusions. Researchers and institutional review boards need to take into account the total sampling volume needed for both clinical care and research rather than for each alone. The child's general state of health should be considered and extra caution should be observed particularly with children whose illness can deplete blood volume or haemoglobin or hinder their replenishment. Local policies must also address the appropriateness and local acceptability of collection procedures and of the blood volumes drawn.Evidence summaries tailored to health policy-makers in low- and middle-income countries10.2471/BLT.10.0754812016-01-01T00:02:00Z2001-01-28T00:08:00ZRosenbaum, Sarah EGlenton, ClaireWiysonge, Charles SheyAbalos, EdgardoMignini, LucianoYoung, TarynAlthabe, FernandoCiapponi, AgustínMarti, Sebastian GarciaMeng, QingyueWang, JianBradford, Ana Maria De la HozKiwanuka, Suzanne NRutebemberwa, ElizeusPariyo, George WFlottorp, SigneOxman, Andrew D
<em>Rosenbaum, Sarah E</em>;
<em>Glenton, Claire</em>;
<em>Wiysonge, Charles Shey</em>;
<em>Abalos, Edgardo</em>;
<em>Mignini, Luciano</em>;
<em>Young, Taryn</em>;
<em>Althabe, Fernando</em>;
<em>Ciapponi, Agustín</em>;
<em>Marti, Sebastian Garcia</em>;
<em>Meng, Qingyue</em>;
<em>Wang, Jian</em>;
<em>Bradford, Ana Maria De La Hoz</em>;
<em>Kiwanuka, Suzanne N</em>;
<em>Rutebemberwa, Elizeus</em>;
<em>Pariyo, George W</em>;
<em>Flottorp, Signe</em>;
<em>Oxman, Andrew D</em>;
<br/><br/>
OBJECTIVE: To describe how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs). METHODS: We carried out 21 user tests in six countries to explore users' experiences with the summary format. We modified the summaries based on the results and checked our conclusions through 13 follow-up interviews. To solve the problems uncovered by the user testing, we also obtained advisory group feedback and conducted working group workshops. FINDINGS: Policy-makers liked a graded entry format (i.e. short summary with key messages up front). They particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally-relevant detail in the original review. Some struggled to understand the text and numbers. Three issues made redesigning the summaries particularly challenging: (i) participants had a poor understanding of what a systematic review was; (ii) they expected information not found in the systematic reviews and (iii) they wanted shorter, clearer summaries. Solutions included adding information to help understand the nature of a systematic review, adding more references and making the content clearer and the document quicker to scan. CONCLUSION: Presenting evidence from systematic reviews to policy-makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. They should also explain the nature of the information provided by systematic reviews and its relevance for policy decisions.Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa10.2471/BLT.10.0797982016-01-01T00:02:00Z2001-01-28T00:08:00ZDoherty, TanyaSanders, DavidGoga, AmeenaJackson, Debra
<em>Doherty, Tanya</em>;
<em>Sanders, David</em>;
<em>Goga, Ameena</em>;
<em>Jackson, Debra</em>;
<br/><br/>
The World Health Organization released revised principles and recommendations for HIV and infant feeding in November 2009. The recommendations are based on programmatic evidence and research studies that have accumulated over the past few years within African countries. This document urges national or subnational health authorities to decide whether health services should mainly counsel and support HIV-infected mothers to breastfeed and receive antiretroviral interventions, or to avoid all breastfeeding, based on estimations of which strategy is likely to give infants in those communities the greatest chance of HIV-free survival. South Africa has recently revised its clinical guidelines for prevention of mother-to-child HIV transmission, adopting many of the recommendations in the November 2009 World Health Organization's rapid advice on use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. However, one aspect of the new South African guidelines gives cause for concern: the continued provision of free formula milk to HIV-infected women through public health facilities. This paper presents the latest evidence regarding mortality and morbidity associated with feeding practices in the context of HIV and suggests a modification of current policy to prioritize child survival for all South African children.The movement of patients across borders: challenges and opportunities for public health10.2471/BLT.10.0766122016-01-01T00:02:00Z2001-01-28T00:08:00ZHelble, Matthias
<em>Helble, Matthias</em>;
<br/><br/>
In a globalizing world, public health is no longer confined to national borders. In recent years we have observed an increasing movement of patients across international borders. The full extent of this trend is yet unknown, as data are sparse and anecdotal. If this trend continues, experts are convinced that it will have major implications for public health systems around the globe. Despite the growing importance of medical travel, we still have little empirical evidence on its impact on public health, especially on health systems. This paper summarizes the most recent debates on this topic. It discusses the main forces that drive medical travel and its implications on health systems, in particular the impacts on access to health care, financing and the health workforce. This paper also offers guidance on how to define medical travel and how to improve data collection. It advocates for more scientific research that will enable countries to harness benefits and limit the potential risks to public health arising from medical travel.Indian approaches to retaining skilled health workers in rural areas10.2471/BLT.09.0708622016-01-01T00:02:00Z2001-01-28T00:08:00ZSundararaman, ThiagarajanGupta, Garima
<em>Sundararaman, Thiagarajan</em>;
<em>Gupta, Garima</em>;
<br/><br/>
PROBLEM: The lack of skilled service providers in rural areas of India has emerged as the most important constraint in achieving universal health care. India has about 1.4 million medical practitioners, 74% of whom live in urban areas where they serve only 28% of the population, while the rural population remains largely underserved. APPROACH: The National Rural Health Mission, launched by the Government of India in 2005, promoted various state and national initiatives to address this issue. Under India's federal constitution, the states are responsible for implementing the health system with financial support from the national government. LOCAL SETTING: The availability of doctors and nurses is limited by a lack of training colleges in states with the greatest need as well as the reluctance of professionals from urban areas to work in rural areas. Before 2005, the most common strategy was compulsory rural service bonds and mandatory rural service for preferential admission into post-graduate programmes. RELEVANT CHANGES: Initiatives under the National Rural Health Mission include an increase in sanctioned posts for public health facilities, incentives, workforce management policies, locality-specific recruitment and the creation of a new service cadre specifically for public sector employment. As a result, the National Rural Health Mission has added more than 82 343 skilled health workers to the public health workforce. LESSONS LEARNT: The problem of uneven distribution of skilled health workers can be solved. Educational strategies and community health worker programmes have shown promising results. Most of these strategies are too recent for outcome evaluation, although this would help optimize and develop an ideal mix of strategies for different contexts.Health and social justice10.2471/BLT.10.0823882016-01-01T00:02:00Z2001-01-28T00:08:00ZGostin, Lawrence O
<em>Gostin, Lawrence O</em>;
<br/><br/>