Bulletin of the World Health Organizationhttps://scielosp.org/feed/bwho/2011.v89n8/2016-01-01T00:02:00ZUnknown authorVol. 89 No. 8 - 2011WerkzeugUnknow titleS0042-968620110008000012016-01-01T00:02:00Z2001-01-28T00:08:00ZDevelopment at risk: addressing noncommunicable diseases at the United Nations high-level meetingS0042-968620110008000022016-01-01T00:02:00Z2001-01-28T00:08:00ZAlwan, Ala DinGalea, GaudenStuckler, David
<em>Alwan, Ala Din</em>;
<em>Galea, Gauden</em>;
<em>Stuckler, David</em>;
<br/><br/>
Action on noncommunicable diseases: balancing priorities for prevention and careS0042-968620110008000032016-01-01T00:02:00Z2001-01-28T00:08:00ZMaher, DermotFord, Nathan
<em>Maher, Dermot</em>;
<em>Ford, Nathan</em>;
<br/><br/>
Public health round-upS0042-968620110008000042016-01-01T00:02:00Z2001-01-28T00:08:00ZEnd of a century-long scourge?S0042-968620110008000052016-01-01T00:02:00Z2001-01-28T00:08:00ZMalaria volunteers fight to protect the best weaponS0042-968620110008000062016-01-01T00:02:00Z2001-01-28T00:08:00ZFoodborne outbreaks: managing the risksS0042-968620110008000072016-01-01T00:02:00Z2001-01-28T00:08:00ZProvision of injectable contraceptives in Ethiopia through community-based reproductive health agentsS0042-968620110008000082016-01-01T00:02:00Z2001-01-28T00:08:00ZPrata, NdolaGessessew, AmanuelCartwright, AliceFraser, Ashley
<em>Prata, Ndola</em>;
<em>Gessessew, Amanuel</em>;
<em>Cartwright, Alice</em>;
<em>Fraser, Ashley</em>;
<br/><br/>
OBJECTIVE: To determine whether community-based health workers in a rural region of Ethiopia can provide injectable contraceptives to women with similar levels of safety, effectiveness and acceptability as health extension workers (HEWs). METHODS: This was a prospective non-randomized community intervention trial designed to test the provision of injectable contraceptives by community-based reproductive health agents (CBRHAs). Effectiveness, safety, acceptability and continuation rates were the outcomes of interest. The outcomes observed when injectable contraceptives were administered by HEWs in health posts and when they were administered by CBRHAs were compared by means of χ2 tests for association among categorical variables and t-tests for independent samples to determine differences between group means. FINDINGS: A total of 1062 women participated in the study. Compared with health post clients, the clients of CBRHAs were, on average, slightly older, less likely to be married and less educated, and they had significantly more living children. Women seeking services from CBRHAs were also significantly more likely to be using injectable contraceptives for the first time; health post clients were more likely to have used them in the past. In addition, clients of CBRHAs were less likely to discontinue using injectable contraceptives over three injection cycles than health post clients. CONCLUSION: Receiving injectable contraceptives from CBRHAs proved as safe and acceptable to this sample of Ethiopian women as receiving them in health posts from HEWs. These findings add to the growing body of evidence supporting the development, introduction and scale up of programmes to train community-based health workers such as CBRHAs to safely administer injectable contraceptives.Emergency, anaesthetic and essential surgical capacity in the GambiaS0042-968620110008000092016-01-01T00:02:00Z2001-01-28T00:08:00ZIddriss, AdamShivute, NestorBickler, StephenCole-Ceesay, RamouJargo, BakaryAbdullah, FizanCherian, Meena
<em>Iddriss, Adam</em>;
<em>Shivute, Nestor</em>;
<em>Bickler, Stephen</em>;
<em>Cole-Ceesay, Ramou</em>;
<em>Jargo, Bakary</em>;
<em>Abdullah, Fizan</em>;
<em>Cherian, Meena</em>;
<br/><br/>
OBJECTIVE: To assess the resources for essential and emergency surgical care in the Gambia. METHODS: The World Health Organization's Tool for Situation Analysis to Assess Emergency and Essential Surgical Care was distributed to health-care managers in facilities throughout the country. The survey was completed by 65 health facilities - one tertiary referral hospital, 7 district/general hospitals, 46 health centres and 11 private health facilities - and included 110 questions divided into four sections: (i) infrastructure, type of facility, population served and material resources; (ii) human resources; (iii) management of emergency and other surgical interventions; (iv) emergency equipment and supplies for resuscitation. Questionnaire data were complemented by interviews with health facility staff, Ministry of Health officials and representatives of nongovernmental organizations. FINDINGS: Important deficits were identified in infrastructure, human resources, availability of essential supplies and ability to perform trauma, obstetric and general surgical procedures. Of the 18 facilities expected to perform surgical procedures, 50.0% had interruptions in water supply and 55.6% in electricity. Only 38.9% of facilities had a surgeon and only 16.7% had a physician anaesthetist. All facilities had limited ability to perform basic trauma and general surgical procedures. Of public facilities, 54.5% could not perform laparotomy and 58.3% could not repair a hernia. Only 25.0% of them could manage an open fracture and 41.7% could perform an emergency procedure for an obstructed airway. CONCLUSION: The present survey of health-care facilities in the Gambia suggests that major gaps exist in the physical and human resources needed to carry out basic life-saving surgical interventions.Lives saved by tuberculosis control and prospects for achieving the 2015 global target for reducing tuberculosis mortalityS0042-968620110008000102016-01-01T00:02:00Z2001-01-28T00:08:00ZGlaziou, PhilippeFloyd, KatherineKorenromp, Eline LSismanidis, CharalambosBierrenbach, Ana LWilliams, Brian GAtun, RifatRaviglione, Mario
<em>Glaziou, Philippe</em>;
<em>Floyd, Katherine</em>;
<em>Korenromp, Eline L</em>;
<em>Sismanidis, Charalambos</em>;
<em>Bierrenbach, Ana L</em>;
<em>Williams, Brian G</em>;
<em>Atun, Rifat</em>;
<em>Raviglione, Mario</em>;
<br/><br/>
OBJECTIVE: To assess whether the global target of halving tuberculosis (TB) mortality between 1990 and 2015 can be achieved and to conduct the first global assessment of the lives saved by the DOTS/Stop TB Strategy of the World Health Organization (WHO). METHODS: Mortality from TB since 1990 was estimated for 213 countries using established methods endorsed by WHO. Mortality trends were estimated separately for people with and without human immunodeficiency virus (HIV) infection in accordance with the International classification of diseases. Lives saved by the DOTS/Stop TB Strategy were estimated with respect to the performance of TB control in 1995, the year that DOTS was introduced. FINDINGS: TB mortality among HIV-negative (HIV-) people fell from 30 to 20 per 100 000 population (36%) between 1990 and 2009 and could be halved by 2015. The overall decline (when including HIV-positive [HIV+] people, who comprise 12% of all TB cases) was 19%. Between 1995 and 2009, 49 million TB patients were treated under the DOTS/Stop TB Strategy. This saved 4.6-6.3 million lives, including those of 0.23-0.28 million children and 1.4-1.7 million women of childbearing age. A further 1 million lives could be saved annually by 2015. CONCLUSION: Improvements in TB care and control since 1995 have greatly reduced TB mortality, saved millions of lives and brought within reach the global target of halving TB deaths by 2015 relative to 1990. Intensified efforts to reduce deaths among HIV+ TB cases are needed, especially in sub-Saharan Africa.Trends in sociodemographic and health-related indicators in Bangladesh, 1993-2007: will inequities persist?S0042-968620110008000112016-01-01T00:02:00Z2001-01-28T00:08:00ZKhan, Md Mobarak HossainKrämer, AlexanderKhandoker, AklimunnessaPrüfer-Krämer, LuiseIslam, Anwar
<em>Khan, Md Mobarak Hossain</em>;
<em>Krämer, Alexander</em>;
<em>Khandoker, Aklimunnessa</em>;
<em>Prüfer-Krämer, Luise</em>;
<em>Islam, Anwar</em>;
<br/><br/>
OBJECTIVE: To assess levels, trends and gaps between the poorest and the richest in selected health and human development indicators in Bangladesh. METHODS: Data for selected indicators associated with sociodemographic characteristics among ever-married women, contraception use, child vaccination, antenatal care practices and health conditions were extracted from the Bangladesh Demographic and Health Surveys conducted in 1993-94, 1996-1997, 1999-2000, 2004 and 2007. Results for the whole sample and for the poorest and the richest wealth quintiles are presented. FINDINGS: Positive trends were noted in urbanization, availability of electricity, age at first marriage, use of modern contraception, access to skilled antenatal care, child vaccination, knowledge of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome and overweight and obesity. In contrast, negative trends were seen in factors such as literacy, infant and child mortality, fertility rate, home delivery and malnutrition and underweight. However, changes in these indicators differed between the poorest and richest quintiles. For instance, only the richest quintile experienced rapid urbanization, whereas illiteracy declined more among the poorest. Noteworthy gaps were found in almost all factors. Rich-poor gaps in urbanization, age at marriage, fertility, condom use, home delivery and overweight increased; in contrast, gaps in education, water and sanitation, use of contraception (except condoms) and child vaccination declined. CONCLUSION: Persistent inequities in Bangladesh endanger equitable and sustainable human development in the country. Pro-poor development strategies based on the principles of equity and quality should be implemented to narrow existing gaps and further promote holistic and equitable human development.Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokineticsS0042-968620110008000122016-01-01T00:02:00Z2001-01-28T00:08:00ZLazzerini, MarziaTickell, David
<em>Lazzerini, Marzia</em>;
<em>Tickell, David</em>;
<br/><br/>
OBJECTIVE: To systemically review the evidence in support of World Health Organization guidelines recommending broad-spectrum antibiotics for children with severe acute malnutrition (SAM). METHODS: CENTRAL, MEDLINE, EMBASE, LILACS, POPLINE, CAB Abstracts and ongoing trials registers were searched. Experts were contacted. Conference proceedings and reference lists were manually searched. All study types, except single case reports, were included. FINDINGS: Two randomized controlled trials (RCTs), one before-and-after study and two retrospective reports on clinical efficacy and safety were retrieved, together with 18 pharmacokinetic studies. Trial quality was generally poor and results could not be pooled due to heterogeneity. Oral amoxicillin for 5 days was as effective as intramuscular ceftriaxone for 2 days (1 RCT). For uncomplicated SAM, amoxicillin showed no benefit over placebo (1 retrospective study). The introduction of a standardized regimen using ampicillin and gentamicin significantly reduced mortality in hospitalized children (odds ratio, OR: 4.0; 95% confidence interval, CI: 1.7-9.8; 1 before-and-after study). Oral chloramphenicol was as effective as trimethoprim-sulfamethoxazole in children with pneumonia (1 RCT). Pharmacokinetic data suggest that normal doses of penicillins, cotrimoxazole and gentamicin are safe in malnourished children, while the dose or frequency of chloramphenicol requires adjustment. Existing evidence is not strong enough to further clarify recommendations for antibiotic treatment in children with SAM. CONCLUSION: Large RCTs are needed to define optimal antibiotic treatment in children with SAM with and without complications. Further research into gentamicin and chloramphenicol toxicity and into the pharmacokinetics of ceftriaxone and ciprofloxacin is also required.Maternal depression and early childhood growth in developing countries: systematic review and meta-analysisS0042-968620110008000132016-01-01T00:02:00Z2001-01-28T00:08:00ZSurkan, Pamela JKennedy, Caitlin EHurley, Kristen MBlack, Maureen M
<em>Surkan, Pamela J</em>;
<em>Kennedy, Caitlin E</em>;
<em>Hurley, Kristen M</em>;
<em>Black, Maureen M</em>;
<br/><br/>
OBJECTIVE: To investigate the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta-analysis. METHODS: Six databases were searched for studies from developing countries on maternal depression and child growth published up until 2010. Standard meta-analytical methods were followed and pooled odds ratios (ORs) for underweight and stunting in the children of depressed mothers were calculated using random effects models for all studies and for subsets of studies that met strict criteria on study design, exposure to maternal depression and outcome variables. The population attributable risk (PAR) was estimated for selected studies. FINDINGS: Seventeen studies including a total of 13 923 mother and child pairs from 11 countries met inclusion criteria. The children of mothers with depression or depressive symptoms were more likely to be underweight (OR: 1.5; 95% confidence interval, CI: 1.2-1.8) or stunted (OR: 1.4; 95% CI: 1.2-1.7). Subanalysis of three longitudinal studies showed a stronger effect: the OR for underweight was 2.2 (95% CI: 1.5-3.2) and for stunting, 2.0 (95% CI: 1.0-3.9). The PAR for selected studies indicated that if the infant population were entirely unexposed to maternal depressive symptoms 23% to 29% fewer children would be underweight or stunted. CONCLUSION: Maternal depression was associated with early childhood underweight and stunting. Rigorous prospective studies are needed to identify mechanisms and causes. Early identification, treatment and prevention of maternal depression may help reduce child stunting and underweight in developing countries.Transforming the global tuberculosis response through effective engagement of civil society organizations: the role of the World Health OrganizationS0042-968620110008000142016-01-01T00:02:00Z2001-01-28T00:08:00ZGetahun, HaileyesusRaviglion, Mario
<em>Getahun, Haileyesus</em>;
<em>Raviglion, Mario</em>;
<br/><br/>
Management of the HIV epidemic in Nicaragua: the need to improve information systems and access to affordable diagnosticsS0042-968620110008000152016-01-01T00:02:00Z2001-01-28T00:08:00ZEspinoza, HenrySequeira, MagdaDomingo, GonzaloAmador, Juan JoséQuintanilla, Margaritade los Santos, Tala
<em>Espinoza, Henry</em>;
<em>Sequeira, Magda</em>;
<em>Domingo, Gonzalo</em>;
<em>Amador, Juan José</em>;
<em>Quintanilla, Margarita</em>;
<em>De Los Santos, Tala</em>;
<br/><br/>