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  1. 1
    Peer Reviewed

    WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study.

    Nadjm B; Amos B; Mtove G; Ostermann J; Chonya S; Wangai H; Kimera J; Msuya W; Mtei F; Dekker D; Malahiyo R; Olomi R; Crump JA; Whitty CJ; Reyburn H

    BMJ. British Medical Journal. 2010; 340:c1350.

    OBJECTIVES: To assess the performance of WHO's "Guidelines for care at the first-referral level in developing countries" in an area of intense malaria transmission and identify bacterial infections in children with and without malaria. DESIGN: Prospective study. SETTING: District hospital in Muheza, northeast Tanzania. PARTICIPANTS: Children aged 2 months to 13 years admitted to hospital for febrile illness. MAIN OUTCOME MEASURES: Sensitivity and specificity of WHO guidelines in diagnosing invasive bacterial disease; susceptibility of isolated organisms to recommended antimicrobials. RESULTS: Over one year, 3639 children were enrolled and 184 (5.1%) died; 2195 (60.3%) were blood slide positive for Plasmodium falciparum, 341 (9.4%) had invasive bacterial disease, and 142 (3.9%) were seropositive for HIV. The prevalence of invasive bacterial disease was lower in slide positive children (100/2195, 4.6%) than in slide negative children (241/1444, 16.7%). Non-typhi Salmonella was the most frequently isolated organism (52/100 (52%) of organisms in slide positive children and 108/241 (45%) in slide negative children). Mortality among children with invasive bacterial disease was significantly higher (58/341, 17%) than in children without invasive bacterial disease (126/3298, 3.8%) (P<0.001), and this was true regardless of the presence of P falciparum parasitaemia. The sensitivity and specificity of WHO criteria in identifying invasive bacterial disease in slide positive children were 60.0% (95% confidence interval 58.0% to 62.1%) and 53.5% (51.4% to 55.6%), compared with 70.5% (68.2% to 72.9%) and 48.1% (45.6% to 50.7%) in slide negative children. In children with WHO criteria for invasive bacterial disease, only 99/211(47%) of isolated organisms were susceptible to the first recommended antimicrobial agent. CONCLUSIONS: In an area exposed to high transmission of malaria, current WHO guidelines failed to identify almost a third of children with invasive bacterial disease, and more than half of the organisms isolated were not susceptible to currently recommended antimicrobials. Improved diagnosis and treatment of invasive bacterial disease are needed to reduce childhood mortality.
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  2. 2

    New developments in vaccinology.

    Andre FE

    ANALES ESPANOLES DE PEDIATRIA. 1992 Jun; 36 Suppl 48:189.

    New vaccine developments will reflect achievements of the World Health Organization's (WHO) Expanded Programme on Immunization (EPI), as well as resistance from the public toward increasing numbers of vaccines. WHO's EPI program has concentrated on tuberculosis, diphtheria, tetanus, whooping cough, polio, and measles. 35 countries are attempting to control hepatitis B with universal vaccination. Now some countries are also recommending vaccination against Haemophilus influenza, mumps, and rubella. The complexity of multiple injections has prompted new research on acellular vaccines for pertussis, hepatitis A and B, varicella, and malaria. Combined vaccines and new adjuvants are also targets of intense research. Vaccines are a priority, because they are among the most cost-effective of medical interventions.
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  3. 3

    Maternal care for the reduction of perinatal and neonatal mortality. A joint WHO/UNICEF statement.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 1986. 22 p.

    Maternal care is the most appropriate target for reducing the high perinatal and neonatal mortality typical of the least developed countries. The principles formulated by the 25th session of the WHO/UNICEF Joint Committee on Health Policy in 1985 are outlined here. Perinatal mortality is defined as infant death from 1000 g, even if intrauterine or stillborn, to 1 week of age. Neonatal mortality is that occurring in the 1st month of life. Half of infant mortality (up to 1 year of age) occurs in the 1st month, most of that during the 1st week, and these deaths are directly related to maternal care during pregnancy and delivery. They are caused by low birth weight, intrauterine or birth asphyxia, birth trauma, or infections, usually of the cord or amniotic fluid. Tetanus is the primary lethal infection. Tetanus can be prevented by immunizing women, or giving tetanus toxoid to pregnant women, but also very effectively by training birth assistants in hygiene. Traumatic deaths can best be prevented by training midwives and strengthening the support system for referral to clinics. The most cost-effective strategies for improving maternal health are nutritional intervention, malaria prevention, treatment of infections and of toxemia, reducing heavy workload of pregnant women, and family planning services. Points where community involvement is effective are discussed. WHO and UNICEF will increase support in health education, tetanus immunization, training of birth attendants, equipping birth facilities, appropriate technology, and operational research.
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