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Bulletin of the World Health Organization. 2011 May 1; 89(5):390-2.This article focuses on antimicrobial resistance, which challenges the control of infectious diseases, jeopardizes progress on health outcomes by increasing morbidity and mortality, and imposes huge costs on societies. It discusses several aspects related to antimicrobial resistance including: the lack of commitment and data, un-assured drug quality, poor prevention and control of infections, and weaker research efforts. It concludes by outlining the World Health Organization's policy package to combat antimicrobial resistance, which reframes the critical actions to be taken by governments to stimulate change by all stakeholders.
WORLD HEALTH FORUM. 1994; 15(4):393-7.The fact that food safety is given a low priority in the health care systems of many countries despite an increase in food-borne diseases may be due to a lack of reliable quantitative data on incidence of disease. The World Health Organization (WHO) has linked this increase to intensive methods of livestock production which foster the spread of salmonella and other pathogens. By relying on legislation, regulations, and standards to monitor food commerce, policy-makers have failed to emphasize health education for food handlers and consumers. WHO has proposed a collaborative, intersectoral approach between governments, food industries, and consumers which will emphasize consumer education. WHO has also prepared 10 rules for safe food preparation. Governments can insure the education of consumers and food handlers by using the primary health care (PHC) mechanism for health education. To date, the most intensive involvement of the PHC community has been in efforts to avoid diarrheal diseases through hand-washing, sanitation, and safe storage of water. Insufficient cooking, faulty food storage, and improper reuse of leftovers have all been neglected topics. Food safety efforts at the local level should 1) identify specific food-related practices and behavior relevant to risk factors, 2) change risky behavior and practices through health education, 3) involve the community in making improvements related to food safety, 4) mobilize and coordinate relevant activities of other sectors, 5) report incidences of food-borne illnesses, 6) generate a strong public demand for food safety, and 7) research diseases and cultural practices related to food handling and safety. To achieve these objectives, PHC workers should be trained in the epidemiology of food-borne diseases and the sociocultural characteristics of their area, in health education and community involvement, and in research methodology.
AFRICA HEALTH. 1992 Jul; 14(5):10-1.An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
WORLD HEALTH. 1991 Jul-Aug; 18-9.90% of individual cases of foodborne illness in industrialized countries are unreported and as such do not appear in official morbidity statistics. This figure grows to 99% in non-industrialized countries, yet in developed countries the associated cost of these illnesses is estimated at US$10,000 million/year. Microbiological contaminants are responsible for 90% of the episodes of foodborne illness including: typhoid fever, non-typhoid salmonelloses, cholera, diarrhoeal diseases, bacterial and amoebic dysenteries, botulism, hepatitis A, and trichinellosis. In industrialized countries most of these illnesses have declined; however, salmonellosis and a few others have increased 10 to 20 fold in countries like Germany. Similar trends are present in the US. Canada, Finland, and the United Kingdom. In the Netherlands it was recently estimated that 1.5 million cases of foodborne, microbial diseases occurred in a population of 15 million. Contaminants are dangerous because their numbers can be so great that our normal defenses are overcome. Some can produce toxic chemicals that are not destroyed during cooking. The WHO has created 10 golden rules to follow in food preparation and storage. These rules were created to be practical for low-income economies and households.
INDIAN JOURNAL OF PEDIATRICS. 1990 Jan-Feb; 57(1):7-14.Problems facing the world's children, development goals for children, and strategies for meeting these goals in the 1990s are abstracted from a UNICEF publication "Strategies for Children in the 1990s". Children face poverty (45% of children under 5 outside China), mortality from diarrhea, preventable diseases, malaria, meningitis and others, disabling diseases, being unplanned, low birth weight, malnutrition, lack of sanitation and education, and 20% are in "especially difficult circumstances" i.e. war, disaster, abandonment of refugee status. Children should be the starting point of development strategy since human capital is the basis of national investment. The UN goals are to reduce infant mortality by 50% in all countries or to 50-70/1000; reduce maternal mortality by 50%, provide safe drinking water, sanitation and universal education and eliminate guinea worm by 1995. Specific goals in maternal and child health are listed. Emphasis should be placed on implementation with today's technology, reaching the hard to reach, giving preferential access to women.
Lancet. 1989 Feb 18; 1(8634):396.The World Health Organization (WHO) issued a consensus statement about AIDS and sexually transmitted diseases (STD) and partner notification for patients with HIV infection. Evidence that genital ulcer disease (GUD) is a risk factor and facilitator for HIV-1 infection in heterosexual people is strong, especially in developing countries. A few studies have shown an association of antibodies to herpes simplex virus type 2 (HSV-2) and Treponema pallidum (the chief cause of genital and anorectal ulcers in developing countries). A consistent relation between HIV-1 and HSV-2 and T. pallidum has been demonstrated in seroepidemiological studies. Data assessing the link between other STD pathogens and HIV-1 transmission are insufficient, but it is plausible that all STD pathogens that cause genital ulcers or inflammation are risk factors for increased susceptibility to HIV-1 infection. Investigating this possibility should be a research priority, as genital ulcer diseases intervention may help to prevent sexual transmission of HIV-1 infection. Partner notification programs, as part of a comprehensive AIDS prevention and control program, should be carefully designed. Because the notification procedure can cause individual and social harm and detract from other AIDS prevention and control activities, a careful assessment of medical, legal, logistic, social, and ethical issues needs to be made. Other variables, such as cost, local environment, and epidemiology need to be taken into account. Issues of patient referral, target populations, training of notification personnel, patient consent, diagnostic accuracy, and the logistics of notification need to be addressed. WHO suggests that the following criteria be monitored when assessing efficiency of partner notification activities: number of index persons; number of partners identified; number of partners notified and their seroprevalence; cost; satisfaction; compliance and acceptability; counseling and support; staff training; confidentiality; and adequacy of follow-up.
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 1986 Jan; 35(1):1-2.A paper by Hazlett et al. is of particular importance because it addresses the question of the role of acute respiratory infections (ARI) as a cause of morbidity and especially mortality in 3rd world children. Diarrheal disease and malnutrition are generally thought to be the major killers of these children, and until recently little attention was paid to ARI. Recent data suggest that ARI are more important than realized previously and almost certainly are the leading cause of death in children in developing countries. It is estimated that each year more than 15 million children less than 5 years old die, obviously most in socially and economically deprived countries. Since death usually is due to a combination of social, economic, and medical factors, it is impossible to obtain precise data on the causes of death. It has been estimated that 5 million of the deaths are due to diarrhea, over 3 million due to pneumonia, 2 million to measles, 1.5 million to pertussis, 1 million to tetanus, and the other 2.5 million or less to other causes. Since pertussis is an acute respiratory infection and measles deaths frequently are due to infections of the respiratory tract, it is becoming clear that ARI are associated with more deaths than any other single cause. The significance of this is emphasized when the mortality rates from ARI in developed and underdeveloped nations are compared. Depending on the countries compared, age group, and other factors, increases of 5-10-fold have been reported. These factors raise the question of why respiratory infections are so lethal for 3rd world children. The severity of pneumonia, which is the cause of most ARI deaths, seems to be the big difference. Data are accumulating which show that bacterial infections are associated with the majority of severe infections and "Streptococcus pneumoniae" and "Haemophilus influenzae," infrequent causes of pneumonia in developed world children, are the microorganisms incriminated in a large proportion of cases. The increase in severity of ARI in 3rd world children has been associated, at least in port, with malnutrition, diarrheal diseases, an increased parasite load, and more recently with air pollution. Crowding and other factors associated with poverty doubtless also play a role. How these various factors contribute to increased severity and lethality is not well understood. The increasing recognition of the important role played by ARI as causes of mortality in 3rd world children is encouraging. The UN International Children's Emergency Fund (UNICEF) has joined the World Health Organization in the battle against ARI in developing countries, and the 2 organizations recently issued a joint statement on the subject in which they pledged to collaborate to integrate an ARI component into the primary health care program.