Your search found 285 Results

  1. 1
    392915
    Peer Reviewed

    Prescription drug use during pregnancy in Southern Tigray region, North Ethiopia.

    Molla F; Assen A; Abrha S; Masresha B; Gashaw A; Wondimu A; Belete Y; Melkam W

    BMC Pregnancy and Childbirth. 2017 Jun 5; 17(1):170.

    BACKGROUND: Judicious utilization of drugs rescues the fetus from the harmful effects while treating the health problems of the pregnant women. This study aimed at evaluating drug utilization pattern and its associated factors among pregnant women in Southern Tigray, Ethiopia. METHOD: Institution based cross-sectional study was conducted among 647 pregnant women who had been attending obstetrics-gynecology and antenatal care units in different health facilities of Southern Tigray region. The study participants were selected using multistage sampling technique. Data collection was done using pre-tested semi-structured questionnaires and by reviewing antenatal follow-up cards. Descriptive and inferential statistics were analyzed, to assess drug utilization pattern and its associated factors among pregnant women, using SPSS version 20 software. RESULTS: Of 647 pregnant women, 87.5% were prescribed with at least one medication. As per the United States Food and Drug Administration (US-FDA) risk classification system, 87.7, 7.9, 3.9, and 0.5% of the prescribed drug were from category A, B, C and D, respectively. Prescription drug use was more likely among gynecology ward visitors [AOR = 8.97, 95% Cl (2.69-29.88)] and among those who visited health facilities for the first time during their first [AOR =2.65, 95% Cl (1.44-4.84)] and second [AOR = 2.50, 95% Cl (1.36-4.61)] trimesters. CONCLUSION: Majority of the study population used safe and appropriate medications according to US-FDA risk classification system, with the exception of low proportion (0.5%) of medication with potential risk for the fetus. The average number of drug prescribed per pregnant women was in the recommended range of WHO drug use indicators guideline.
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  2. 2
    391126
    Peer Reviewed

    Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews.

    Nurse-Findlay S; Taylor MM; Savage M; Mello MB; Saliyou S; Lavayen M; Seghers F; Campbell ML; Birgirimana F; Ouedraogo L; Newman Owiredu M; Kidula N; Pyne-Mercier L

    PLoS Medicine. 2017 Dec; 14(12):e1002473.

    BACKGROUND: Benzathine penicillin G (BPG) is the only recommended treatment to prevent mother-to-child transmission of syphilis. Due to recent reports of country-level shortages of BPG, an evaluation was undertaken to quantify countries that have experienced shortages in the past 2 years and to describe factors contributing to these shortages. METHODS AND FINDINGS: Country-level data about BPG shortages were collected using 3 survey approaches. First, a survey designed by the WHO Department of Reproductive Health and Research was distributed to 41 countries and territories in the Americas and 41 more in Africa. Second, WHO conducted an email survey of 28 US Centers for Disease Control and Prevention country directors. An additional 13 countries were in contact with WHO for related congenital syphilis prevention activities and also reported on BPG shortages. Third, the Clinton Health Access Initiative (CHAI) collected data from 14 countries (where it has active operations) to understand the extent of stock-outs, in-country purchasing, usage behavior, and breadth of available purchasing options to identify stock-outs worldwide. CHAI also conducted in-person interviews in the same 14 countries to understand the extent of stock-outs, in-country purchasing and usage behavior, and available purchasing options. CHAI also completed a desk review of 10 additional high-income countries, which were also included. BPG shortages were attributable to shortfalls in supply, demand, and procurement in the countries assessed. This assessment should not be considered globally representative as countries not surveyed may also have experienced BPG shortages. Country contacts may not have been aware of BPG shortages when surveyed or may have underreported medication substitutions due to desirability bias. Funding for the purchase of BPG by countries was not evaluated. In all, 114 countries and territories were approached to provide information on BPG shortages occurring during 2014-2016. Of unique countries and territories, 95 (83%) responded or had information evaluable from public records. Of these 95 countries and territories, 39 (41%) reported a BPG shortage, and 56 (59%) reported no BPG shortage; 10 (12%) countries with and without BPG shortages reported use of antibiotic alternatives to BPG for treatment of maternal syphilis. Market exits, inflexible production cycles, and minimum order quantities affect BPG supply. On the demand side, inaccurate forecasts and sole sourcing lead to under-procurement. Clinicians may also incorrectly prescribe BPG substitutes due to misperceptions of quality or of the likelihood of adverse outcomes. CONCLUSIONS: Targets for improvement include drug forecasting and procurement, and addressing provider reluctance to use BPG. Opportunities to improve global supply, demand, and use of BPG should be prioritized alongside congenital syphilis elimination efforts.
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  3. 3
    369330
    Peer Reviewed

    Influences on participant reporting in the World Health Organisation drugs exposure pregnancy registry; a qualitative study.

    Allen EN; Gomes M; Yevoo L; Egesah O; Clerk C; Byamugisha J; Mbonye A; Were E; Mehta U; Atuyambe LM

    BMC Health Services Research. 2014; 14:525.

    BACKGROUND: The World Health Organisation has designed a pregnancy registry to investigate the effect of maternal drug use on pregnancy outcomes in resource-limited settings. In this sentinel surveillance system, detailed health and drug use data are prospectively collected from the first antenatal clinic visit until delivery. Over and above other clinical records, the registry relies on accurate participant reports about the drugs they use. Qualitative methods were incorporated into a pilot registry study during 2010 and 2011 to examine barriers to women reporting these drugs and other exposures at antenatal clinics, and how they might be overcome. METHODS: Twenty-seven focus group discussions were conducted in Ghana, Kenya and Uganda with a total of 208 women either enrolled in the registry or from its source communities. A question guide was designed to uncover the types of exposure data under- or inaccurately reported at antenatal clinics, the underlying reasons, and how women prefer to be asked questions. Transcripts were analysed thematically. RESULTS: Women said it was important for them to report everything they had used during pregnancy. However, they expressed reservations about revealing their consumption of traditional, over-the-counter medicines and alcohol to antenatal staff because of anticipated negative reactions. Some enrolled participants' improved relationship with registry staff facilitated information sharing and the registry tools helped overcome problems with recall and naming of medicines. Decisions about where women sought care, which influenced medicines used and antenatal clinic attendance, were influenced by pressure within and outside of the formal healthcare system to conform to conflicting behaviours. Conversations also reflected women's responsibilities for producing a healthy baby. CONCLUSIONS: Women in this study commonly take traditional medicines in pregnancy, and to a lesser extent over-the-counter medicines and alcohol. The World Health Organisation pregnancy registry shows potential to enhance their reporting of these substances at the antenatal clinic. However, more work is needed to find optimal techniques for eliciting accurate reports, especially where the detail of constituents may never be known. It will also be important to find ways of sustaining such drug exposure surveillance systems in busy antenatal clinics.
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  4. 4
    365812

    OS032. Pharmacotherapy for pre-eclampsia in low and middle income countries: An analysis of essential medicines lists (EMLS).

    Lalani S; Firoz T; Magee LA; Lowe R; Sawchuck D; Payne B; Gordon R; Vidler M; Dadelszen Pv And Community Level

    Pregnancy Hypertension. 2012 Jul; 2(3):193-4.

    INTRODUCTION: Pre-eclampsia is the second leading cause of maternal mortality in low and middle income countries (LMIC). Pharmacological management of pre-eclampsia has five major components including antihypertensive therapy for severe and non-severe hypertension, magnesium sulphate for prevention or treatment of eclampsia, treatment of pre-eclampsia-related end-organ complications, antenatal corticosteroids for acceleration of fetal pulmonary maturity given iatrogenic preterm delivery for maternal and/or fetal indications, and labour induction for such indicated deliveries. Essential medicines are defined by the World Health Organization (WHO) as "drugs that satisfy the health care needs of the majority of the population". Essential Medicines Lists (EMLs) detail these essential medicines within an individual country and support the argument that the medication should be routinely available. OBJECTIVES: To determine how many drugs required for comprehensive pre-eclampsia management are listed in national EMLs of LMIC. METHODS: We conducted a descriptive analysis of relevant drug prevalence on identified EMLs. We searched for the national EMLs of the 144 LMIC identified by the World Bank. EMLs were collected by broad based internet searches and in collaboration with the WHO. The EMLs were surveyed for therapies for the different aspects of pre-eclampsia management: hypertension (non-severe and severe with oral or parenteral agents), eclampsia, pre-eclampsia complications (e.g., pulmonary oedema, thrombosis), preterm birth, and labour induction. RESULTS: EMLs were located and reviewed for 58(40.3%) of LMIC. One or more parenteral antihypertensive agents were listed in 51(87.9%) EMLs. The most common agents were: hydralazine (67.2%), verapamil (58.6%), propranolol (39.7%) and sodium nitroprusside (37.9%); parenteral labetalol was listed by only 19.0% of EMLs. The most prevalent oral antihypertensive therapies listed were: nifedipine (96.6%, usually 10 or 20mg intermediate-acting tablets), methyldopa (94.8%), propranolol (89.7%), and atenolol (87.9%). Captopril, enalapril, hydrochlorothiazide and spironolactone were commonly listed. Magnesium sulphate for prevention and management of eclampsia was present in 86.2% of EMLs (and its antidote, calcium gluconate in 82.8%). To manage complications of pre-eclampsia, oral frusemide was listed in 94.8% of EMLs and parenteral heparin in 91.4%. Most EMLs listed parenteral dexamethasone (91.4%) for acceleration of fetal pulmonary maturity and oxytocin (98.3%) or a prostanoid (usually misoprostol, 39.7%) for labour induction. CONCLUSION: EMLs of LMIC provide comprehensive coverage of all aspects of recommended pre-eclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country. Copyright (c) 2012. Published by Elsevier B.V.
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  5. 5
    337624

    Medical eligibility criteria for contraceptive use. Fifth edition 2015. Executive summary.

    World Health Organization [WHO]. Department of Reproductive Health and Research

    Geneva, Switzerland, WHO, 2015. [14] p. (WHO/RHR/15.07)

    This executive summary contains all the new recommendations that will be incorporated into the fifth edition of the Medical eligibility criteria for contraceptive use. In addition to the recommendations themselves, the summary provides an introduction to the guideline, a description of the methods used to develop the recommendations for this fifth edition, and a summary of changes (from the fourth edition to the fifth edition of the MEC). It is anticipated that the Medical eligibility criteria for contraceptive use, fifth edition will be available online by 1 July 2015. In the interim, the fourth edition of the guideline, along with this summary of new recommendations provides the complete set of WHO recommendations on medical eligibility criteria for contraceptive use.
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  6. 6
    335403

    Scaling up lifesaving commodities for women, children, and newborns. An advocacy toolkit.

    Kade K; Kingshott E; Latimer A; Nieuwenhuyus BJ; Pacque M; Fox S; Lias N

    Washington, D.C., Program for Appropriate Technology in Health [PATH], 2013. [91] p.

    This toolkit provides information about the UN Commission on Life-Saving Commodities (the Commission), 13 priority commodities, and examples of how its ten recommendations to improve access and availability are being applied globally and within countries. It also provides advocacy resources for utilizing the Commission platform to raise awareness and engage stakeholders in addressing commodity-related gaps in policy.
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  7. 7
    335234

    The global partnership for development: A review of MDG 8 and proposals for the post-2015 development agenda.

    Kenny C; Dykstra S

    Washington, D.C., Center for Global Development, 2013 Jul. [49] p. (CGD Policy Paper No. 026)

    The eighth Millennium Development Goal (MDG 8) covered a ‘global partnership for development’ in areas including aid, trade, debt relief, drugs and ICTs. We have seen progress as well as gaps in the areas which were covered: more aid, but with quality lagging and a link to progress in MDG areas that was weak; a better rich world performance on tariffs but one that misses increasingly important parts of trade; broadly successful debt relief but an agenda on the support for private investment left uncovered; mixed progress on drugs access and absence of a broader global public health agenda; and a global ICT revolution with weak links to the MDGs or a global partnership. Migration, non-ICT technologies, the global environment, and global institutional issues were all completely unaddressed in MDG 8. Looking forward, by 2030, a global compact on development progress linking OECD DAC aid and policy reform to low income countries as target beneficiaries (the implicit model of MDG 8) would be irrelevant to three quarters of the world. Half of the rich world will be in non-DAC countries and the share of aid in global transfers will continue to shrink. Global public goods provision will increasingly require the active participation of (at least) the G20 nations. A post-2015 global partnership agenda should involve a mixed approach to compact and partnership issues: binding ‘global compact’ targets under specific post-2015 sectoral goals focused on the role for aid alongside a standalone global public goods goal with time bound, numerical targets covering trade, investment, migration, technology, the environment and global institutions.
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  8. 8
    335019

    UN Commission on Life-Saving Commodities for Women and Children: Commissioners' report.

    United Nations. Commission on Life-Saving Commodities for Women and Children

    New York, New York, United Nations Commission on Life-Saving Commodities for Women and Children, 2012 Sep. [25] p.

    The United Nations Commission on Life-Saving Commodities for Women and Children presents a new plan and set of recommendations to improve the supply and access of life-saving health supplies.
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  9. 9
    334472

    Promoting access to medical technologies and innovation. Intersections between public health, intellectual property and trade.

    Bartels HG; Beyer P; Kampf R; Krattiger A; Mirza Z; Taubman A; Watal J

    Geneva, Switzerland, World Health Organization [WHO], 2012. [253] p.

    Medical technologies -- medicines, vaccines and medical devices -- are essential for public health. Access to essential medicines and the lack of research to address neglected diseases have been a major concern for many years. More recently, the focus of health policy debate has broadened to consider how to promote innovation and how to ensure equitable access to all vital medical technologies. Today’s health policy-makers need a clear understanding both of the innovation processes that lead to new technologies and of the ways in which these technologies are disseminated in health systems. This study captures a broad range of experience and data in dealing with the interplay between intellectual property, trade rules and the dynamics of access to, and innovation in, medical technologies. The study is intended to inform ongoing technical cooperation activities undertaken by the three organizations (World Trade Organization, World Intellectual Property Organization and World Health Organization) and to support policy discussions. Based on many years of field experience in technical cooperation, the study has been prepared to serve the needs of policymakers who seek a comprehensive presentation of the full range of issues, as well as lawmakers, government officials, delegates to international organizations, non-governmental organizations and researchers.
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  10. 10
    333681

    Research and development to meet health needs in developing countries: Strengthening global financing and coordination. Report of the Consultative Expert Working Group on Research and Development: Financing and Coordination.

    World Health Organization [WHO]. Consultative Expert Working Group on Research and Development: Financing and Coordination

    Geneva, Switzerland, WHO, 2012 Apr. [226] p.

    The Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) was established by the World Health Assembly (WHA) in 2010 by resolution WHA63.28 with the principal task of deepening the analysis and taking forward the work done by the previous Expert Working Group on Research and Development: Coordination and Financing (EWG) which reported in 2010. Underlying both expert groups was the objective set out in the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPA-PHI): “to examine current financing and coordination of research and development, as well as proposals for new and innovative sources of financing to stimulate research and development related to Type II and Type III diseases and the specific research and development needs of developing countries in relation to Type I diseases.” In undertaking our work we were mindful of the request that we “observe scientific integrity and be free from conflict of interest” in our work and we also decided to be as open and transparent as possible by providing an open forum during our first meeting, calling for submissions, providing open briefings after each of our meetings, and publishing as much as possible on our web site. (Excerpt)
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  11. 11
    352117

    Essential medicines for reproductive health: developing evidence based interagency list.

    Logez S; Jayasekar S; Moller H; Ahmed K; Patel MU

    Southern Med Review. 2011 Dec; 4(2):15-21.

    Objectives: Although poor reproductive health constitutes a significant proportion of the disease burden in developing countries, essential medicines for reproductive health are often not available to the population. The objective was to analyze the guiding principles for developing national Essential Medicines Lists (EML). The second objective was to compare the reproductive health medicines included on these EMLs to the 2002 WHO/UNFPA list of essential drugs and commodities for reproductive health. Another objective was to compare the medicines included in existing international lists of medicines for reproductive health. Methods: The authors calculated the average number of medicines per clinical groups included in 112 national EMLs and compared these average numbers with the number of medicines per clinical group included on the WHO/UNFPA List. Additionally, they compared the content of the lists of medicines for reproductive health developed by various international agencies. Results: In 2003, the review of the 112 EMLs highlighted that medicines for reproductive health were not consistently included. The review of the international lists identified inconsistencies in their recommendations. The reviews' outcomes became the catalyst for collaboration among international agencies in the development of the first harmonized Interagency List of Essential Medicines for Reproductive Health. Additionally, WHO, UNFPA and PATH published guidelines to support the inclusion of essential medicines for reproductive health in national medicine policies and EMLs. The Interagency List became a key advocacy tool for countries to review their EMLs. In 2009, a UNFPA/WHO assessment on access to reproductive health medicines in six countries demonstrated that the major challenge was that the Interagency List had not been updated recently and was inconsistently used. Conclusion: The addition of cost-effective medicines for reproductive health to EMLs can result in enhanced equity in access to and cost containment of these medicines, and improve quality of care. Action is required to ensure their inclusion in national budget lines, supply chains, policies and programmatic guidance.
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  12. 12
    333309

    Millennium Development Goal 8, The Global Partnership for Development: Time to deliver. MDG Gap Task Force Report 2011.

    United Nations. MDG Gap Task Force

    New York, New York, United Nations, 2011. [98] p.

    The objective of MDG 8 is to assist all developing countries in achieving the goals through a strengthened global partnership for international development cooperation. The present report describes how that partnership is producing significant results on many fronts, but notes that many important gaps between expectations and delivery remain. (Excerpt)
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  13. 13
    332957

    The USAID | DELIVER project improves patient access to essential medicines in Zambia. Success story.

    John Snow [JSI]. DELIVER

    Arlington, Virginia, JSI, DELIVER, 2011 Feb. [2] p.

    Success story on a logistics system pilot project in Zambia that set out to cost-effectively improve the availability of lifesaving drugs and other essential products at health facilities.
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  14. 14
    345013

    Essential medicines for mothers and children: a key element of health systems. Access to medicines and public pharmaceutical policy.

    Joncheere K

    Entre Nous. 2009; (68):14-15.

    Medicines, when used appropriately, are one of the most cost effective interventions in health care. European countries spend an important part of their health budget on medicines, from 12% on average for the EU countries to more than 30% for the Newly Independent States (NIS) countries. Whereas in EU countries the larger part of the medicines expenditures are publicly funded through taxes and/or social health insurance, in the NIS and in the south eastern European countries it is often the patients who have to pay directly for the drugs themselves. This means that many patients simply do not get the drugs they need because they cannot afford them, and also may force families to incur enormous expenses as they sell their belongings in order to pay for their drugs and their health care.
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  15. 15
    342775
    Peer Reviewed

    Keeping evidence-based recommendations up to date: the World Health Organization's global guidance for family planning.

    Curtis KM; Peterson HB; d'Arcangues C

    Contraception. 2009 Oct; 80(4):323-4.

    This editorial explains the different tools that the World Health Organization's (WHO) Department of Reproductive Health and Research in collaboration with international partners have been creating and updating as global guidance for family planning. It discusses that the tools are based on the best scientific evidence and stresses the importance of updating the recommendations in the tools.
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  16. 16
    342377
    Peer Reviewed

    Improving control of African schistosomiasis: towards effective use of rapid diagnostic tests within an appropriate disease surveillance model.

    Stothard JR

    Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Apr; 103(4):325-32.

    Contemporary control of schistosomiasis is typically reliant upon large-scale administration of praziquantel (PZQ) to school age children. Whilst PZQ treatment of each child is inexpensive, the direct and indirect costs of preventive chemotherapy for the whole school population are more substantive and, at the national level where many schools are targeted, maximising cost effectiveness and the health impact are essential requirements for ensuring longer-term sustainability (i.e. >5 years). To this end, the WHO has issued a set of treatment guidelines, inclusive of re-treatment schedules, such that, where possible, treatment decisions by school are based upon local disease prevalence as determined by parasitological and/or questionnaire methods. As each diagnostic method has known shortcomings, presumptive treatment of at-risk schools may initially be preferred, especially if the existing infrastructure for disease surveillance is poor. It is against this background of school-based preventive chemotherapy that a rapid diagnostic test (RDT) for schistosomiasis is most urgently needed, not only to improve initial disease surveillance but also to focus drug delivery better through time. In this paper, the development, evaluation and application of selected diagnostic tests are reviewed to identify barriers that impede progress, foremost of which is that a new disease surveillance and evaluation model is required where the in-country price of each RDT ideally needs to be less than US$1 to be cost effective both in the short- and long-term perspective.
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  17. 17
    331506

    How to be reasonably sure a client is not pregnant. [Checklist].

    Family Health International [FHI]

    Research Triangle Park, North Carolina, FHI, 2008. [2] p.

    In order to help nonmenstruating clients safely initiate their method of choice, Family Health International (FHI) developed a simple checklist for use by family planning providers. Although originally the Pregnancy Checklist was developed for use by family planning providers, it can also be used by other health care providers who need to determine whether a client is not pregnant. For example, pharmacists may use this checklist when prescribing certain medications that should be avoided during pregnancy (e.g., certain antibiotics or anti-seizure drugs). The checklist is endorsed by the World Health Organization (WHO) and is based on criteria established by WHO for determining with reasonable certainty that a woman is not pregnant. Evaluation of the checklist in family planning clinics has demonstrated that the tool is very effective in correctly identifying women who are not pregnant. Furthermore, recent studies in Guatemala, Mali, and Senegal have shown that use of the checklist by family planning providers significantly reduced the proportion of clients being turned away due to menstrual status and improved women's access to contraceptive services.
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  18. 18
    324063

    Evidence for interventions included in the Minimum Package of Maternal and Newborn Interventions.

    Mridha MK

    MotherNewBorNews. 2006 Aug-Dec; 2(1):[15] p.

    In 2006, USAID and several of its partners agreed to the implementation of a minimum set of evidence-based interventions in maternal and newborn programs. These included a number of community-based and facility-based interventions that could be phased in to improve the survival and well being of mothers and newborns. These interventions have been tested in various operations research studies and have also been provided as an integrated package of services as described in subsequent sections of this newsletter. Below is a summary of evidence for each of the interventions. In the interest of brevity and simplicity, we have limited the evidence to just a few key studies. To keep the document consistent with the MAMAN framework described in the previous article, the evidence for MAMAN interventions has been described under three broad categories: I) Minimum maternal and newborn care, II) Other essential interventions, and III) Context specific interventions. (excerpt)
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  19. 19
    322663
    Peer Reviewed

    Inferiority of single-dose sulfadoxine-pyrimethamine intermittent preventive therapy for malaria during pregnancy among HIV-positive Zambian women.

    Gill CJ; MacLeod WB; Mwanakasale V; Chalwe V; Mwananyanda L

    Journal of Infectious Diseases. 2007 Dec 1; 196(11):1577-1584.

    The World Health Organization advocates 2-3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (SP IPTp). The optimal number of doses and the consequences of singledose therapy remain unclear. Data were from a randomized, controlled study of human immunodeficiency virus-positive Zambian women comparing monthly versus 2-dose SP IPTp. We compared maternal and neonatal birth outcomes as a function of how many doses the mothers received (1 to >/= 4 doses). Of 387 deliveries, 34 received 1 dose of SP. Single-dose SP was significantly associated with higher proportions of maternal anemia, peripheral and cord blood parasitemia, infant prematurity, and low birth weight. SP conferred dose-dependent benefits, particularly in the transition from 1 to 2 doses of SP. Women randomized to the standard 2-dose regimen were much more likely to receive only 1 dose than were women randomized to monthly IPT (relative risk, 16.4 [95% confidence interval, 4.0-68.3]). Single-dose SP was a common result of trying to implement the standard 2-dose regimen and was inferior to all other dosing regimens. At a programmatic level, this implies that monthly SP IPTp may ultimately be more effective than the standard regimen by reducing the risk of inadvertently underdosing mothers. (author's)
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  20. 20
    322021

    Handbook of supply management at first-level health care facilities. 1st version for country adaptation.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2006. 73 p. (WHO/HIV/2006.03)

    All first-level health care facilities, namely primary health care clinics and outpatient departments based in district hospitals, use medicines and related supplies. It takes a team effort to manage these supplies, involving all health care facility staff: doctors, nurses, health workers and storekeepers. This is especially true in small facilities with only one or two health workers. Each staff member should know how to manage all supplies at the health care facility correctly. Each staff member has an important role. The Handbook of Supply Management at First-Level Health Care Facilities describes all major medicines and supply management tasks, known as the standard procedures of medicines supply management at first-level health care facilities. Each chapter covers one major task, explains how the task fits into the process of maintaining a consistent supply of medicines, and recommends which standard procedures to use. Annexes at the back of the handbook contain various checklists and examples of forms which can be introduced as needed at your health care facility. This handbook is part of a package used in an integrated training and capacity-building course targeted at first-level health care facilities. It can be used in conjunction with the existing Integrated Management of Adult and Adolescent Illness (IMAI) strategy developed by WHO. It can also be used for basic training activities independent of IMAI training courses. (excerpt)
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  21. 21
    321814

    Delay in tuberculosis care: One link in a long chain of social inequities [editorial]

    Allebeck P

    European Journal of Public Health. 2007 Oct; 17(5):409.

    In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
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  22. 22
    321302
    Peer Reviewed

    Management of acute diarrhoea in primary care in Bahrain: Self-reported practices of doctors.

    Ismaeel AY; Al Khaja KA; Damanhori AH; Sequeira RP; Botta GA

    Journal of Health, Population and Nutrition. 2007 Jun; 25(2):205-211.

    This nationwide study was conducted to assess the extent of adherence of primary-care physicians to the World Health Organization (WHO)-recommended guidelines on the use of oral rehydration therapy (ORT), antimicrobials, and prescribing of other drugs used in treating symptoms of acute diarrhoea in Bahrain. A questionnaire-based, cross-sectional survey was carried out in primary-care health centres. During a six-week survey period (15 August-30 September 2003), 328 (25.2%) completed questionnaires were returned from 17 of 20 health centres. In a sample of 300 patients, oral rehydration salts (ORS) solution was prescribed to 89.3% (n=268) patients; 12.3% received ORS alone, whereas 77% received ORS in combination with symptomatic drugs. Antimicrobials were prescribed to 2% of the patients. In 11.4% of the cases, rehydration fluids and other drugs were given parenterally. The mean number of drugs was 2.2+0.87 per prescription. In approximately one-third of the patients, three or more drugs were used. Primary-care physicians almost always adhered to the WHO guidelines with respect to ORT and antimicrobials. However, in several instances, ORT was prescribed along with polypharmacy, including irrational use of drugs for symptomatic relief. Effective health policies are needed to reduce the unnecessary burden on the healthcare system. (author's)
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  23. 23
    320894

    Studies of the systemwide effects of the Global Fund to Fight AIDS, TB and Malaria.

    Abt Associates. Partners for Health Reform Plus

    Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, [2004]. [2] p. (USAID Contract No. HRN-C-00-00-00019-00)

    The Global Fund to Fight AIDS, TB and Malaria aims to attract, manage, and disburse resources that will make a significant and sustainable impact on the three focal diseases. The Global Fund has also stated its commitment to support programs that address the three diseases "in ways that contribute to the strengthening of health systems." The Global Fund is likely to have a variety of direct and indirect effects upon health care systems that could be positive or negative in nature. To be effective and sustainable in the long run, interventions will depend upon well-functioning health systems. This is true not only for the Global Fund, but also for other initiatives, such as the World Bank Multisectoral AIDS Program (MAP), the President's Emergency Plan for AIDS Relief, and others that aim to substantially increase the scale of response to specific diseases, particularly HIV/ AIDS. (excerpt)
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  24. 24
    319932

    Setting standards for essential children's medicines [editorial]

    Hill SR; Gray A; Weber M

    Bulletin of the World Health Organization. 2007 Sep; 85(9):650.

    The WHO Model List of Essential Medicines, used by many countries to guide drug procurement and supply, has been a global standard for 30 years. Although this list has included some paediatric medicines, a children's list has not been systematically developed until now. To address this shortcoming, a subcommittee of the WHO Expert Committee on Selection and Use of Essential Medicines met in July 2007, to develop a list of essential medicines for children. In May 2007, the 60th World Health Assembly passed a resolution on Better Medicines for Children (WHA60.20) that described several strategies to improve access to essential medicines of adequate quality for children. As has been described in several reviews, the main causes of mortality in children can be treated by essential medicines such as antibiotics for infections or oral rehydration solution and zinc for diarrhoea. To apply this knowledge effectively requires that these medicines be available; yet suitable zinc tablets, for example, are still not included in many national essential medicines lists. (excerpt)
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  25. 25
    316980

    Drug resistance in tuberculosis [editorial]

    Ebrahim GJ

    Journal of Tropical Pediatrics. 2007 Jun; 53(3):147-149.

    Tuberculosis (TB) kills about 2 million adults and around 100 000 children every year. One-third of the world's population are currently infected with Mycobacterium tuberculosis and many have active disease. In Europe TB emerged as a major disease in the latter part of the 14th century. The industrial revolution saw rapid growth of urban centres where overcrowding with poor living conditions provided ideal circumstances for the spread of the disease. Great impact was made by streptomycin and isoniazid, so that by the 1970s TB was no longer being considered a problem in the developed world. But beginning in the 1980s the number of new cases of TB in USA and across Europe rose sharply. The pattern was repeated in many countries and worldwide throughout the 1990s and into the new millennium. The incidence of TB climbed to over 9 million cases every year. In 1993 the World Health Organization (WHO) declared TB as a global emergency. During the 1990s multidrug resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, emerged as a threat to TB control. MDR-TB requires the use of second line drugs that are less effective, more toxic and costlier. In a global survey of 17 690 TB isolates during 2000-04, 20% were MDR and 2% were extremely drug resistant (XDR). XDR-TB is defined as MDR plus resistance to any fluoroquinolones and at least one of three injectable second line drugs kanamycin and amikacin, or capreomycin or both. Currently one in ten new infections is resistant to at least one antituberculosis drug. (excerpt)
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