Bulletin of the World Health Organizationhttps://scielosp.org/feed/bwho/2011.v89n6/2016-01-01T00:02:00ZUnknown authorVol. 89 No. 6 - 2011WerkzeugIn this month's bulletin10.2471/BLT.11.0006112016-01-01T00:02:00Z2001-01-28T00:08:00ZEstablishing an evidence base for e-health: a call for papers10.2471/BLT.11.0902742016-01-01T00:02:00Z2001-01-28T00:08:00ZGeissbuhler, AntoineAl Shorbaji, Najeeb
<em>Geissbuhler, Antoine</em>;
<em>Al Shorbaji, Najeeb</em>;
<br/><br/>
Surgery as a public health intervention: common misconceptions versus the truth10.2471/BLT.11.0882292016-01-01T00:02:00Z2001-01-28T00:08:00ZBae, Jin YungGroen, Reinou SKushner, Adam L
<em>Bae, Jin Yung</em>;
<em>Groen, Reinou S</em>;
<em>Kushner, Adam L</em>;
<br/><br/>
Public health round-up10.2471/BLT.11.0106112016-01-01T00:02:00Z2001-01-28T00:08:00ZFetal alcohol syndrome: dashed hopes, damaged lives10.2471/BLT.11.0206112016-01-01T00:02:00Z2001-01-28T00:08:00ZFrom awareness to action10.2471/BLT.11.0306112016-01-01T00:02:00Z2001-01-28T00:08:00ZMaternal multiple micronutrient supplementation and pregnancy outcomes in developing countries: meta-analysis and meta-regression10.2471/BLT.10.0837582016-01-01T00:02:00Z2001-01-28T00:08:00ZKawai, KosukeSpiegelman, DonnaShankar, Anuraj HFawzi, Wafaie W
<em>Kawai, Kosuke</em>;
<em>Spiegelman, Donna</em>;
<em>Shankar, Anuraj H</em>;
<em>Fawzi, Wafaie W</em>;
<br/><br/>
OBJECTIVE: To systematically review randomized controlled trials comparing the effect of supplementation with multiple micronutrients versus iron and folic acid on pregnancy outcomes in developing countries. METHODS: MEDLINE and EMBASE were searched. Outcomes of interest were birth weight, low birth weight, small size for gestational age, perinatal mortality and neonatal mortality. Pooled relative risks (RRs) were estimated by random effects models. Sources of heterogeneity were explored through subgroup meta-analyses and meta-regression. FINDINGS: Multiple micronutrient supplementation was more effective than iron and folic acid supplementation at reducing the risk of low birth weight (RR:0.86, 95% confidence interval, CI:0.79-0.93) and of small size for gestational age (RR:0.85; 95% CI: 0.78-0.93). Micronutrient supplementation had no overall effect on perinatal mortality (RR:1.05; 95% CI:0.90-1.22), although substantial heterogeneity was evident (I²=58%; P for heterogeneity=0.008). Subgroup and meta-regression analyses suggested that micronutrient supplementation was associated with a lower risk of perinatal mortality in trials in which >50% of mothers had formal education (RR:0.93; 95% CI:0.82-1.06) or in which supplementation was initiated after a mean of 20 weeks of gestation (RR:0.88; 95% CI:0.80-0.97). CONCLUSION: Maternal education or gestational age at initiation of supplementation may have contributed to the observed heterogeneous effects on perinatal mortality. The safety, efficacy and effective delivery of maternal micronutrient supplementation require further research.Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries10.2471/BLT.10.0843272016-01-01T00:02:00Z2001-01-28T00:08:00ZCameron, AlexandraRoubos, IlseEwen, MargaretMantel-Teeuwisse, Aukje KLeufkens, Hubertus GMLaing, Richard O
<em>Cameron, Alexandra</em>;
<em>Roubos, Ilse</em>;
<em>Ewen, Margaret</em>;
<em>Mantel-Teeuwisse, Aukje K</em>;
<em>Leufkens, Hubertus Gm</em>;
<em>Laing, Richard O</em>;
<br/><br/>
OBJECTIVE: To investigate potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries. METHODS: Data on the availability of 30 commonly-surveyed medicines - 15 for acute and 15 for chronic conditions - were obtained from facility-based surveys conducted in 40 developing countries. Results were aggregated by World Bank country income group and World Health Organization region. FINDINGS: The availability of medicines for both acute and chronic conditions was suboptimal across countries, particularly in the public sector. Generic medicines for chronic conditions were significantly less available than generic medicines for acute conditions in both the public sector (36.0% availability versus 53.5%; P=0.001) and the private sector (54.7% versus 66.2%; P=0.007). Antiasthmatics, antiepileptics and antidepressants, followed by antihypertensives, were the drivers of the observed differences. An inverse association was found between country income level and the availability gap between groups of medicines, particularly in the public sector. In low- and lower-middle income countries, drugs for acute conditions were 33.9% and 12.9% more available, respectively, in the public sector than medicines for chronic conditions. Differences in availability were smaller in the private sector than in the public sector in all country income groups. CONCLUSION: Current disease patterns do not explain the significant gaps observed in the availability of medicines for chronic and acute conditions. Measures are needed to better respond to the epidemiological transition towards chronic conditions in developing countries alongside current efforts to scale up treatment for communicable diseases.Effect on road traffic injuries of criminalizing road traffic offences: a time-series study10.2471/BLT.10.0821802016-01-01T00:02:00Z2001-01-28T00:08:00ZNovoa, Ana MPérez, KatherineSantamariña-Rubio, ElenaBorrell, Carme
<em>Novoa, Ana M</em>;
<em>Pérez, Katherine</em>;
<em>Santamariña-Rubio, Elena</em>;
<em>Borrell, Carme</em>;
<br/><br/>
OBJECTIVE: To determine the effect of criminalizing some traffic behaviours, after the reform of the Spanish penal code in 2007, on the number of drivers involved in injury collisions and of people injured in traffic collisions in Spain. METHODS: This study followed an interrupted times-series design in which the number of drivers involved in injury collisions and of people injured in traffic collisions in Spain before and after the criminalization of offences were compared. The data on road traffic injuries in 2000-2009 were obtained from the road traffic collision database of the General Traffic Directorate. The dependent variables were stratified by sex, age, injury severity, type of road user, road type and time of collision. Quasi-Poisson regression models were fitted with adjustments for time trend, seasonality, previous interventions and national fuel consumption. FINDINGS: The overall number of male drivers involved in injury collisions dropped (relative risk, RR: 0.93; 95% confidence interval, CI: 0.89-0.97) after the reform of the penal code, but among women no change was observed (RR: 0.99; 95% CI: 0.95-1.03). In addition, 13 891 men (P < 0.01) were prevented from being injured. Larger reductions were observed among young male drivers and among male motorcycle or moped riders than among the drivers of other vehicles. CONCLUSION: The findings suggest that criminalizing certain traffic behaviours can improve road safety by reducing both the number of drivers involved in injury collisions and the number of people injured in such collisions.Socioeconomic inequalities in hospital births in China between 1988 and 200810.2471/BLT.10.0852742016-01-01T00:02:00Z2001-01-28T00:08:00ZFeng, Xing LinXu, LingGuo, YanRonsmans, Carine
<em>Feng, Xing Lin</em>;
<em>Xu, Ling</em>;
<em>Guo, Yan</em>;
<em>Ronsmans, Carine</em>;
<br/><br/>
OBJECTIVE: To assess trends in hospital births in China during 1988-2008 in an effort to determine if efforts to overcome financial barriers to giving birth in hospital have reduced the access gap between the rich and the poor. METHODS: Cross-sectional data obtained from four National Health Service Surveys were used to determine trends in hospital births during 1988-2008. Crude and adjusted annual rates were calculated by means of Poisson regression and were used to define trends across socioeconomic regions and households in different income quintiles. FINDINGS: In 2008 women throughout China were giving birth in hospital almost universally except in region IV, the most remote rural region, where the percentage of hospital births was only 60.8. Hospital births in this region had increased steadily before 2002, but after that year the upward trend slowed down. During 1988-2001 the average yearly increase had been 21%, but in 2002-2008 it dropped to 10% (P=0.0031). Inequalities between socioeconomic regions were greater than among individual households belonging to different income strata. By 2008 the difference between low- and high-income households in the proportion of hospital births had become very small (96.1% and 87.7% of high- and low-income households, respectively, gave birth in hospital that year). CONCLUSION: Most Chinese women now give birth in hospital, but the poorest rural region is still lagging behind. A more active and comprehensive approach will be needed to increase hospital births in these remote, hard-to-reach populations.Challenges in developing national HIV guidelines: experience from the eastern Mediterranean10.2471/BLT.10.0837902016-01-01T00:02:00Z2001-01-28T00:08:00ZDe Weggheleire, AnjaBortolotti, VeroniqueZolfo, MariaCrowley, SiobhanColebunders, RobertRiedner, GabrieleLynen, Lutgarde
<em>De Weggheleire, Anja</em>;
<em>Bortolotti, Veronique</em>;
<em>Zolfo, Maria</em>;
<em>Crowley, Siobhan</em>;
<em>Colebunders, Robert</em>;
<em>Riedner, Gabriele</em>;
<em>Lynen, Lutgarde</em>;
<br/><br/>
OBJECTIVE: To appraise the process of development and clinical content of national human immunodeficiency virus (HIV) clinical practice guidelines of countries in the eastern Mediterranean and to formulate recommendations for future guideline development and adaptation. METHODS: Twenty-three countries in the World Health Organization (WHO) Eastern Mediterranean and United Nations Children's Fund Middle East and North Africa regions were invited to submit national HIV clinical practice guidelines for review. The guideline development methodology was assessed using an adaptation of the Appraisal of Guidelines Research and Evaluation (AGREE) instrument and guideline content, using a checklist to evaluate concordance with WHO 2006 generic guidelines. FINDINGS: Twelve countries submitted 20 guidelines developed between 2004 and 2009. Median scores were poor (i.e. <0.6) for the methodological quality domains of rigour of development, stakeholder involvement and applicability and flexibility. Scores were better for the domains of scope and purpose (median: 0.82, interquartile range, IQR: 0.58-0.89) and clarity and presentation (median: 0.67, IQR: 0.50-0.78). Concerning guideline content, recommended first-line treatment and eligibility criteria for antiretroviral therapy (ART) in adults were in line with WHO recommendations in most guidelines. However, recommendations on antiretroviral prophylaxis for the prevention of vertical HIV transmission, diagnosis and treatment of HIV infection in infants, monitoring patients on ART, treatment failure and co-morbidities were often lacking. CONCLUSION: The large majority of national HIV clinical practice guidelines had methodological weaknesses and content inaccuracies. Countries require assistance with the adaptation process to ensure that guidelines are valid and up to date and accurately reflect WHO global clinical care recommendations for patients with HIV.Pharmacology and immuno-virologic efficacy of once-a-day HAART in African HIV-infected children: ANRS 12103 phase II trial10.2471/BLT.10.0816462016-01-01T00:02:00Z2001-01-28T00:08:00ZNacro, BoubacarZoure, EmmanuelleHien, HervéTamboura, HassaneRouet, FrançoisOuiminga, AdamaDrabo, AliYameogo, SouleymaneHien, AlainPeyriere, HélèneMathieu, OlivierHirt, DeborahTreluyer, Jean-MarcNicolas, JoëlleFoulongne, VincentSegondy, Michelvan de Perre, PhilippeDiagbouga, SergeMsellati, Philippe
<em>Nacro, Boubacar</em>;
<em>Zoure, Emmanuelle</em>;
<em>Hien, Hervé</em>;
<em>Tamboura, Hassane</em>;
<em>Rouet, François</em>;
<em>Ouiminga, Adama</em>;
<em>Drabo, Ali</em>;
<em>Yameogo, Souleymane</em>;
<em>Hien, Alain</em>;
<em>Peyriere, Hélène</em>;
<em>Mathieu, Olivier</em>;
<em>Hirt, Deborah</em>;
<em>Treluyer, Jean-Marc</em>;
<em>Nicolas, Joëlle</em>;
<em>Foulongne, Vincent</em>;
<em>Segondy, Michel</em>;
<em>Van De Perre, Philippe</em>;
<em>Diagbouga, Serge</em>;
<em>Msellati, Philippe</em>;
<br/><br/>
OBJECTIVE: To assess 12-month survival, pharmacokinetics, immunologic and virologic efficacy, tolerance, compliance and drug resistance in HIV-infected children in Bobo-Dioulasso, Burkina Faso, receiving once-daily highly-active antiretroviral therapy as a combination of didanosine (DDI), lamivudine (3TC) and efavirenz (EFV). METHODS: In the ANRS 12103 open phase II trial, HIV-infected children were examined at inclusion and monthly thereafter. CD4+ T-lymphocyte (CD4) count, plasma concentration of ribonucleic acid (RNA) of human immunodeficiency virus type 1 (HIV-1) and haematologic and biochemical parameters were measured at baseline and every trimester. HIV-1 resistance testing was performed in case of viral escape. Drug plasma concentrations were determined with high-performance liquid chromatography. FINDINGS: From February 2006 to November 2007, 51 children (39% girls) with a mean age of 6.8 years were enrolled and treated for 12 months. At baseline, Z scores for mean weight-for-age and mean height-for-age were -2.01 and -2.12, respectively. Mean CD4% was 9.0. Median plasma HIV-1 RNA viral load was 5.51 log10 copies per millilitre (cp/ml). Two children (3.9%) died and another 11 (22%) suffered 13 severe clinical events. At month 12, mean WAZ had improved by 0.63 (P < 0.001) and mean HAZ by 0.57 (P < 0.001). Mean CD4% had risen to 24 (P < 0.001). Viral load was below 300 RNA cp/ml in 81% of the children; HIV resistance mutations were detected in 11 (21.6%). CONCLUSION: The once-a-day combination of DDI + 3TC + EFV is an alternative first-line treatment for HIV-1-infected children. Dose adjustment should further improve efficacy.Spatial heterogeneity of haemoglobin concentration in preschool-age children in sub-Saharan Africa10.2471/BLT.10.0835682016-01-01T00:02:00Z2001-01-28T00:08:00ZMagalhães, Ricardo J SoaresClements, Archie CA
<em>Magalhães, Ricardo J Soares</em>;
<em>Clements, Archie Ca</em>;
<br/><br/>
OBJECTIVE: To determine whether blood haemoglobin concentration in preschool-age children (< 5 years of age) is geographically heterogeneous in sub-Saharan Africa and describe its association with environmental variables that drive anaemia of different etiologies. METHODS: Data were obtained on 24 277 preschool-age children in western Africa (2862 cluster sites) and 25 343 in eastern Africa (2999 cluster sites) from the 2001-2007 Demographic and Health Surveys (DHS) for sub-Saharan Africa. Cluster sites were linked to environmental information on distance to perennial water body, elevation, land surface temperature and normalized difference vegetation index (NDVI; a proxy for rainfall) in a geographical information system. Statistical associations with environmental variables were determined using multivariate regression models, and the spatial dependence of haemoglobin concentration unexplained by these factors was quantified using semivariograms. FINDINGS: In eastern Africa, the lowest haemoglobin concentrations (< 70 g/l) occurred in small clusters throughout the region; in western Africa, they occurred in a large cluster straddling the border between Burkina Faso and Mali. Our results show significant continent-wide associations between haemoglobin concentration and environmental variables, particularly in western Africa for land surface temperature and NDVI, and in eastern Africa for elevation. Residual spatial dependence was significant, and the magnitude was greater in western than in eastern Africa. CONCLUSION: The distribution of anaemia is driven by large-scale environmental factors, and the epidemiological drivers differ in western and eastern Africa. Strategies for anaemia control in preschool-age children in sub-Saharan Africa should be tailored to local conditions, taking into account the specific etiology and prevalence of anaemia.