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Brief guide on tuberculosis control for primary health care providers for countries in the WHO European Region with a high and intermediate burden of tuberculosis.
Copenhagen, Denmark, World Health Organization [WHO], Regional Office for Europe, 2004.  p.Tuberculosis is an increasingly serious problem in the WHO European region, particularly in the countries of eastern Europe, the Baltic States, and the Commonwealth of Independent States (CIS). Primary health care providers can play an important role in tuberculosis control through early detection of the disease, referral for treatment, and involvement in directly observed treatment. This guide has been written with the aim of developing the knowledge, awareness and skills of primary health care providers regarding tuberculosis and its prevention and control. The guide is not intended as a complete source of information on tuberculosis, but rather a summary of general principles regarding prevention, detection and treatment. The guide does not reflect specific national guidelines on TB control, and is intended to be used in conjunction with the appropriate national regulations. A reference card containing key information is included with this guide. (author's)
[Geneva, Switzerland], WHO, 1991 Dec.  p. (WHO/GPA/IDS/HCS/91.6)Infections and tumours are the paramount clinical problems confronting health care providers caring for patients with HIV-related disease. Treatment of these infections and tumours is of great importance as it decreases suffering and prolongs life in the absence of effective and non-toxic antiretroviral drugs or immunotherapy against HIV itself. However, clear treatment guidelines are lacking in many parts of the world and health care workers have often not received training in the management of HIV-related disease. To respond to this situation, the WHO Global Programme on AIDS (GPA) has developed guidelines for the clinical management of HIV infection in adults. There are wide variations in the presentation of HIV-related diseases, availability of resources and health infrastructures. It is hoped that the guidelines will provide a model to assist all countries, but especially those in the developing world, to formulate national guidelines in accordance with their own particular needs and resources. Adaptation of these guidelines should take place through national/institutional workshops. The guidelines represent the consensus of a number of clinical experts working in this area, and will be revised from time to time in the light of experience. Comments are welcome and should be sent to the Global Programme on AIDS, World Health Organization, 1211 Geneva 27, Switzerland. (excerpt)
TDR NEWS. 1998 Feb; (55):5.Following the demonstration of onchocercal skin disease's (OSD) public health and social importance in 1994, the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) Task Force on Onchocerciasis Operational Research was asked to assess its economic impact. A multi-country study was subsequently undertaken in Ethiopia, Sudan, and Nigeria to measure the effect of OSD upon labor input and the effect of severe reactive skin disease in the household upon school attendance by children. Where the head-of-household had OSD, children were twice as likely to drop out of school compared to other children of the same age from the same community. The relationship was especially strong among girls, who were 2.6 times as likely to drop out of school if the head-of-household had OSD than if the head did not. It follows that onchocerciasis impedes educational development where OSD is highly prevalent. People with OSD spend US$20 more annually on health-related expenditures, 15% of their annual income, than do people without OSD. There are also significant time costs to having OSD. Another study was conducted in Uganda, Ghana, and Nigeria to assess the effect of ivermectin treatment upon OSD. Treatment led to a 40-50% decline in severe itching compared to placebo, sustained for up to 12 months after the first treatment. There was also a significant decline in the prevalence of reactive skin lesions following treatment compared to placebo.
In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 17-8.The World Health Organization (WHO) was selected as the Executing Agency for the Onchocerciasis Control Programme (OCP) in West Africa, and The World Bank agreed to mobilize funds from the donors and the beneficiary African governments. Because of the severity and spread of the disease and the flight range of the vector, Simulium damnosum, a large area was demarcated for vector control activities. Most of the vector breeding sites were inaccessible to land-based vehicles, and the only control tool available was aerial larviciding. Work started in 1975. By 1986, the original 7-country treatment area was expanded to include 11 countries with a total population of 30 million. Weekly larvicide treatments were continuing in 1987, when chemotherapy with Mectizan was added. As a result of intensive research, today there are 6 pesticides and Mectizan, a microfilaricide suitable for mass distribution. In the original program area, OCP has been ahead of schedule in removing the disease as a public health and socioeconomic development problem: a) None of the 30 million people living in the OCP area risk getting onchocerciasis; over 150,000 cases of blindness have been prevented. b) 25 million hectares of fertile land have been liberated and, in many areas, production of cereal, animals, and fish has increased. More than 400 indigenous scientists and health workers have been formally trained, and over 98% of OCP staff are Africans. Merck & Co. tested Mectizan in large-scale clinical trials that were conducted in association with OCP and WHO. By 1986, about 1200 patients had been treated and, of those, over 1000 were in the OCP region. In October 1987, Mectizan was registered for human use, and Merck & Co. donated the drug to all patients. Since then, OCP has used over 3 million tablets. Mectizan is well accepted by the patients; it controls the disease, and, in combination with larviciding, it dramatically affects transmission.
WORLD HEALTH FORUM. 1994; 15(3):293-4.Recent data show that some 1.2 million Ugandans are infected with the parasite that causes onchocerciasis (river blindness). Similar figures are emerging from other countries in Africa (which accounts for more than 99% of cases). In Equatorial Guinea, 60,000 are now infected, 5 times as many as previous estimates. These new figures were disclosed by the World Health Organization (WHO) Expert Committee on Onchocerciasis Control, which met in Geneva in December, 1993. The widening availability of a drug to cure the disease, ivermectin, has spurred countries to carry out more thorough surveys. River blindness is endemic in large areas of Sub-Saharan Africa and in isolated areas of Latin America and Yemen. The Expert Committee estimated that some 270,000 people are blind today as a result of the disease and that an equal number are severely visually impaired. Hundreds of thousands also suffer from skin lesions. Onchocerciasis is caused by infective larvae of the Onchocerca volvulus parasite, which are transmitted by the bite of Simulium blackflies. Over the years, as the burden of worms increases, severe skin damage and blindness ensue. Ivermectin (Mectizan) kills the microfilariae but not the adult worms. The UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases in conjunction with the Onchocerciasis Control Programme in West Africa proved that a single tablet once a year stops the onset of blindness, reverses minor eye damage, and reduces the unpleasant skin problems. In many countries, WHO rapid assessment techniques should be urgently applied, and national programs to treat the disease with ivermectin should be established in every affected country. Onchocerciasis has been eliminated in 11 countries in Sub-Saharan Africa by the spraying of insecticides against the blackflies. In Burkina Faso in 1975, some 600,000 people were infected and blindness rates were extremely high. Now hardly anyone is infected and transmission has been completely halted.
AFRICA HEALTH. 1992 Jan; 14(2):31, 34-5.10-12 million people in the world have leprosy. India claims about 4 million of these cases. Overall at least 20% of the cases are children. In the 1940s, dapsone was the only drug used to treat leprosy. By the early 1970s, dapsone did not perform as expected and Mycobacterium leprae were beginning to exhibit resistance to dapsone. In 1982, WHO published results of its study which recommended fixed and relatively short duration regimens of multiple drug therapy (MDT) for all people with leprosy. It also listed recommendations on diagnosis, classification, and distribution of patients to either pauci or multibacillary groups. MDT depends on what type of leprosy patients have. For example, patients with multibacillary leprosy receive rifampicin, clofazimine, and dapsone whereas those with paucibacillary leprosy receive only rifampicin. In many African countries, however, MDT is not used. Yet cases of leprosy exist in 94% of Africa's countries. Moreover 37% have highly prevalent leprosy and the lowest percentage of patients on MDT (18% vs. world average of 56%). In fact, Nigeria is included in the group of 5 countries with 84% of all cases. Until the various countries in Africa can satisfy the ideal requirements for establishing a MDT program, they should begin MDT at least on a small scale. They do need, however, an adequate supply of the drugs. The other requirements include a good plan of action, laboratory facilities, transport, and referral centers. If the period of time needed to meet these requirements is long, then physicians should conduct pre MDT screenings to diagnose cases and determine who needs chemotherapy. The best way to diagnose cases is from clinical experience and paying particular attention to dermatological and neurological findings. Early identification is needed since leprosy cases are stigmatized. This article includes MDT dosages in adults and children.
Bulletin of the World Health Organization. 1979; 57(2):167-177.Recent epidemiological surveys have demonstrated the association between malnutrition and infectious diseases. Parasitic infections, diarrhea, pneumonia, hepatitis and tuberculosis are more frequent and most serious in undernourished people and in infants with low birth weight. Data suggest an increased susceptibility to infectious diseases in individuals with protein-energy malnutrition and with iron-deficiency anemia; circulating lymphocytes and intraepithelial lymphocytes are also reduced in cases of malnutrition. Due to impaired immunological response, the effectiveness of prophilactic vaccination is doubtful in undernourished people; there have been, for example, reports of geographical variations in the response of children to polio virus vaccine. A whole series of strategies must be taken into consideration to break the vicious circle of malnutrition-infection; some of these are: breastfeeding; an improved schedule of vaccinations; nutritional supplement, especially for hospitalized patients; and prevention of low birth weight.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 253-282This review of combined oral contraceptive (OC) preparations presents formulations, pregnancy rates, biochemical parameter changes, morbidity, and OC indications in 15 tables. The OC preparations are based on 2 different estrogens and 14 progestagens. Though steroid content differs among products, all act primarily to inhibit ovulation by suppression of midcycle release of pituitary gonadotropins. Variable-dose products are associated with higher pregnancy rates than fixed-dose preparations. Side effects of OCs, while difficult to identify, fall into 2 categories: 1) common adverse associations similar to responses to inert placeboes; and 2) serious biochemical and physiological alterations. There is no evidence of any increase in morbidity due to OC use, whereas avoidance of risks associated with pregnancy is beneficial. No convincing evidence of carcinogenic hazard is presented. Some evidence of reduced systemic side effects by lower-dose products is presented, though gynecological side effects, such as irregular bleeding, may increase. Drug interaction with OCs is described; rifampicin causes the most serious of these. OCs induce wide-ranging metabolic changes in many organ systems. These may relate to undesirable side effects (psychological or neurological signs, skin disorders, and blood pressure changes).
REVIEWS OF INFECTIOUS DISEASES. 1982 Sep-Oct; 4(5):916-30.The successful world eradication of smallpox is analyzed with respect to the biological factors that facilitated this effort, and the solutions of specific and localized problems that forced final eradication. Smallpox has several biological features favoring disease eradication: 1) a severe disease, fatal in as many as 30% and disfiguring or worse in survivors. 2) Subclinical smallpox infection does not occur. 3) Infectivity accompanies, rather than precedes, the rash. 4) Carrier states do not exist. 5) Although related pox viruses do exist, only 1 serotype of smallpox has been identified. 6) A cheap, heat-stable vaccine was available. 7) Seasonal fluctuations enhanced control programs. 8) There is no wild animal host. In addition, smallpox exclusion in variola-free countries was so expensive, that these nations were willing to pay the costs of eradication worldwide. Some of the specific methods that WHO finally resorted to were extensive "surveillance and containment" in difficult areas such as rural India and Ethiopia. In both countries, 24-hour guards were posted on infected households. Health workers spread out to every village, by helicopter if necessary in Ethiopia, Rewards were given for finding a case. "Search weeks" were conducted in every village in endemic areas. After the last cases were recorded in India in 1975 and Ethiopia in 1976, worldwide certification was begun, checking every case of chickenpox, or suspect fever with rash, possibly caused by the related virus variola minor, by laboratory methods. The excellent leadership of WHO project directors was an important factor in the successful eradication.