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Evidence behind the WHO guidelines: hospital care for children: what is the aetiology of pneumonia in HIV-infected children in developing countries?
Journal of Tropical Pediatrics. 2009 Aug; 55(4):219-24.This clinical review discusses the most common cause of pneumonia in HIV-infected children--bacterial pathogens and includes recommendations for the management of pneumonia in HIV-infected children from World Health Organization (WHO).
Journal of Tropical Pediatrics. 2006 Feb; 52(1):46-48.The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. The WHO guidelines, and more reviews are available at http://www.who.int/child-adolescenthealth/ publications/CHILD_HEALTH/PB.htm. This review addresses the question: ''What are the most appropriate empirical first-line antibiotics for children with septicaemia?'' The WHO Pocketbook of Hospital Care for Children states: Antibiotic therapy - Where blood cultures are available, obtain blood cultures before starting antibiotics - Give ampicillin (or penicillin) and gentamicin - Give cloxacillin (if available) instead of penicillin if extensive skin pustules or abscesses as these might be signs of Staphylococcus infection. (excerpt)
Geneva, Switzerland, WHO, Division of Family Health, Programme of Maternal and Child Health and Family Planning, 1991 Dec. , 122 p. (WHO/MCH/91.10)This WHO consultation on maternal and perinatal infections reviews the epidemiology of these infections, examines the effectiveness of known intervention strategies to prevent and treat these infections, notes gaps in current knowledge, and develops recommendations for implementation of appropriate control strategies. The report is geared toward maternal and child health professionals in developing countries where maternal and perinatal infections cause considerable morbidity and death. These countries have limited resources for health care (e.g., US $5-10/person), largely due to the worsening economic situation. The report centers on the feasibility, effectiveness, and cost of interventions to prevent, treat, and control the infections. It has summary cost-effective analyses of maternal and perinatal infections and proposed interventions using 3 different hypothetical country situations to help policymakers decide on priorities and policies on prevention, treatment, and control of these infections. The report dedicates a chapter to each infection (syphilis, neonatal tetanus, malaria, hepatitis, HIV infections, chlamydial infections, herpes simplex infection, Group B Streptococcal infections, and maternal genital infection causing premature birth and low birth weight). Each chapter addresses their clinical and public health significance; prevalence in pregnant women and transmission from mother to fetus/infant; clinical effects; prevention, treatment, and control; and cost effectiveness and feasibility of various interventions. Based on public health importance, feasibility, and affordability, the consultants agreed that national and international programs should place the highest priority on these perinatal infections: gonococcal ophthalmia neonatorum, maternal and congenital syphilis, neonatal tetanus, hepatitis B, and maternal puerperal infections.
Oxford, England, Oxford University Press, 1990. xix, 136 p.The Commission on Health Research for Development is an independent international consortium formed in 1987 to improve the health of people in developing countries by the power of research. This book is the result of 2 years of effort: 19 commissioned papers, 8 expert meetings, 8 regional workshops, case studies of health research activities in 10 developing countries and hundreds of individual discussions. A unique global survey examined financing, locations and promotion of health research. The focus of all this work was the influence of health on development. This book has 3 sections: a review of global health inequities and why health research is needed; findings of country surveys, health research financing, selection of topics and promotion; conclusions and recommendations. Some research priorities are contraception and reproductive health, behavioral health in developing countries, applied research on essential drugs, vitamin A deficiency, substance abuse, tuberculosis. The main recommendations are: that all countries begin essential national health research (ENHR), with international partnership; that larger and sustained international funding for research be mobilized; and that larger and sustained international funding for research be mobilized; and that international mechanisms for monitoring progress be established. The book is full of graphs and contains footnotes, a complete bibliography and an index.
In: Disease and mortality in Sub-Saharan Africa, edited by Richard G. Feachem, Dean T. Jamison. Oxford, England, Oxford University Press, 1991. 173-89.In Sub-Saharan Africa (SSA), 1% of all children die of neonatal tetanus, 9% of measles, 3% of tuberculosis (TB), and 4% of pertussis. Further, .6% acquire paralytic polio. 20% of the .6% who acquire diphtheria die. Even though vaccination can control these diseases, only 20% of children in SSA receive the complete course of vaccination against the 6 diseases targeted by WHO's Expanded Programme on Immunization (EPI). But high vaccine coverage is not always a cure-all. For example, in the Gambia coverage is high but high mortality levels persist. Of the EPI diseases, measles is the greatest threat since it kills 2 million people annually in developing countries. Measles related mortality is highest in the 9 months following the disease. Even though tetanus is a major cause of death in neonates, tetanus also kills adults such as those that work with the land. Further the tetanus vaccination is effective in adults, but no adult program operates in SSA. Trained midwives reduce neonatal tetanus mortality by 76.6% and vaccination of pregnant mothers with 2 doses of tetanus toxoid reduces mortality 93.3%. Lameness surveys in SSA countries show that, contrary to earlier beliefs, paralytic polio is quite common (range 0.7-13.2). Administration of the oral polio vaccine and improved sanitation are responsible for a real fall in polio cases in the Gambia, the Ivory Coast, and Cameroon. TB was introduced into SSA in the 19th century. It mainly occurs in adults. The estimated life long risk of developing smear positive TB in SSA is 63. The case fatality rate of pertussis in the 1st year of life is high (3.2) and infants do no acquire maternal immunity against it, so the best control measures are early vaccination and identifying secondary cases among young siblings. Of the EPI diseases, scientists know the least about diphtheria in SSA. Its case fatality rate is high (11-38%) yet it is treatable. Primary problems of adequate vaccination coverage for the EPI diseases are managerial problems rather than technological.
[Unpublished] 1987 Nov. , 19 p.Immunizations often involve injecting a needle into the skin and, if health personnel do not take appropriate precautions, they can transmit pathogens such as hepatitis B and HIV. The most difficult form of microbe to destroy is bacteria encased in spores, e.g. Clostridium tetani. The most common method in developing countries to disinfect immunization equipment is to boil them nonstop for 20 minutes. Based on some studies, key researchers believe that exposure to 100 degrees Celsius water for several minutes can actually destroy or inactivate essentially all vegetative bacteria, viruses, protozoa, yeasts, and molds. Yet there is no agreement on the amount of time and temperature needed to inactivate the hepatitis B virus since some evidence indicates that it is highly resistant to heat (60 minutes needed) whereas other evidence indicates it is not very resistant (2 minutes). Many researchers believe HIV can be inactivated at 80 degrees Celsius. Health workers must clean immunization equipment before boiling since organic materials and oils on the equipment prevent heat penetration and protect microbes. Further they should submerge all equipment at the same time and make sure that the water is at full boil continuously for the entire specified time. Indeed health workers in developing countries should adhere to the procedure listed in the WHO/EPI/UNICEF pamphlet entitled How to Boil Needles and Syringes Properly. Steam is by far the best method to sterilize immunization equipment, however. WHO/EPI is trying to introduce portable special pressure cookers which can attain a temperature of 121 degrees Celcius to act as autoclaves for needles and syringes. WHO/EPI and UNICEF are exploring disposable syringes as another means of preventing disease transmission. Researchers are also working on developing vaccines that do not require injection such as the oral polio vaccine.