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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)
Geneva, Switzerland, WHO, Division of Diarrhoeal and Acute Respiratory Disease Control, 1994 Nov. 3 p. (Update No. 18)If diarrhoea in children is to be managed correctly, there is need to look beyond public sector health facilities. Good management has to be promoted in the home, and there is also a need to improve the practices of all providers of care, particularly in the private sector. Retail drug businesses are particularly important providers of care because: in most countries, pharmacies and over-the-counter drug stores are widely distributed geographically; they are the most frequently visited of all health-related facilities; for purposes of training, drug retail outlets are relatively easy to reach; products sold and advice given to customers for treating diarrhoea are generally inappropriate and, in some cases, dangerous. (excerpt)
[Unpublished] 1991 Apr 24. , 28 p. (SEA/DD/43; Project: ICP CDD 001)Physicians collected data on 4319 households and 3766 0-5 year old children living in rural areas of Dhaka Division in Bangladesh to determine the prevalence of diarrhea among the children, the percentage of diarrhea cases treated with various forms of oral rehydration therapy and with drugs, and caretaker awareness of when to refer children with diarrhea to a health facility. 60.3% received no treatment at all. The 24-hour point prevalence of diarrhea stood at 5.2%. Blood accompanied the diarrhea of 22.3% of these children. Yet only 12% of bloody diarrhea cases received appropriate antibiotic therapy. 13.4% of the children had experienced a diarrheal episode during the 2 weeks before the interview. Mean duration was 7 days, but 22.4% of the children had diarrhea for at least 14 days. The adjusted annual diarrhea incidence rate was 2.3 episodes/child. 33.7% of caretakers asked others for help in treating diarrhea. The advisers tended to be village doctors or quacks (21%), government health workers (17%), and homeopaths (17%). 75% of advisors, except family and friends, suggested drugs. Only 27% and 16% recommended administering oral rehydration solution (ORS) and various home fluids, respectively. Only 22% and 17% suggested caretakers to continue feeding and breast feeding, respectively. The ORS use rate during the previous 24 hours was only 11.9% and just 3.6% of cases drank properly prepared ORS. Yet 93.8% knew about ORS. Most caretakers did not use enough water or all the contents of the ORS packet. Use rate for home fluids was 16.5%. 97.5% of lactating mothers continued to breast feed during the diarrhea episode. 36.1% of children received drugs compared with 25.8% for use of oral rehydration therapy. 70.7% of caretakers gave ill children at least the same amount of solid or semisolid foods during the episode. 70% of caretakers preferred ORS to drugs. The leading reasons for referring cases to a health facility included too many stools (79.7%), failure to improve (28.3%), and fever (26.7%). The researchers deemed only 23.5% to have adequate referral knowledge (=or> 3 reasons).
BMJ (CLINICAL RESEARCH ED.). 1996 Oct 26; 313(7064):1085.Jacqui Wise reports that artemether, the active ingredient of a traditional Chinese remedy for fever, has been found to be as effective as quinine in severe malaria. She states that most deaths from malaria occur in Africa and then quotes Dr. Peter Trigg, a scientist with the World Health Organization's malaria unit, as saying that the WHO appreciates the operational advantages of the new drug in the field but will not "recommend its introduction into Africa because of fears that ... resistance would spread." This decision by the WHO is unethical and unprofessional. The organization is condemning African patients with malaria to the possibility of death even while it is announcing that a new drug has shown better outcomes than occur with quinine. It is incredible that an organization that is part of the United Nations and that is charged with implementing health for all in the world by 2000 should decide to abandon patients to possible death from malaria on the basis of the lame excuse that resistant strains might develop if a new drug was introduced. Would this kind of trial be approved by an ethics committee? Rather than deprive African patients of the benefits of a new drug, the WHO should use its influence and resources to educate the governments and people in Africa about the dangers of misuse of drugs and the emergence of resistant strains of malaria. (full text)
Social Science and Medicine. 1996 Apr; 42(7):1011-9.Inappropriate drug use is a major problem in the control of diarrheal diseases. Addressing the problem, the World Health Organization's (WHO) Program for the Control of Diarrheal Diseases reviewed the literature on the most commonly used antidiarrheal agents, and distributed the resulting document widely in 1990. Individual and group campaigns against the registration and use of antidiarrheal drugs also brought considerable attention to the issue in the popular media. This article evaluates the actions taken against antidiarrheal drugs by national drug regulators during and after these events, January 1989 through December 1993. Information on regulatory actions was requested from countries and extracted from published and unpublished sources. 16 countries reported regulatory actions on 21 occasions during the period of study, with the majority of actions taken against antimotility drugs. Few were against adsorbents, antidiarrheal drugs containing antimicrobials, or adult formulae. Six countries took action against large and heterogenous groups of antidiarrheal drugs, with most actions occurring within two years of the distribution of the WHO review and the attention in the media. Many more antidiarrheal drugs may lose their register in the future through a passive deregistration process. The deregistration of inappropriate drugs, however, will probably take quite a while, with widespread deregistrations unlikely. Moreover, regulatory actions alone are probably not enough to achieve a more appropriate use of drugs. Greater effect can be expected from simultaneous regulatory, managerial, and educational interventions directed at providers, combined with communication to the general public.
BMJ. British Medical Journal. 1993 Nov 27; 307(6916):1375-6.The World Health Organization (WHO), at a meeting in Geneva in November 1993, launched a campaign that will coordinate efforts of the pharmaceutical industry, academic research institutes, and drug regulatory bodies to find a vaginal antiviral agent that will either inactivate the human immunodeficiency virus (HIV) or prevent its attachment to vaginal cells, without harming the genital tract or killing sperm. Spermicides, such as nonoxynol 9, which kill HIV in test tubes may increase HIV transmission by harming the vaginal lining. However, this may be due to the carrier substance. Clinical research, using a protocol designed by the WHO and international regulatory authorities, will begin examining existing vaginal microbicides. Other candidates include sulphated polysaccharides and reverse transcriptase inhibitors. Included are comments by Dr. Michael Merson and Prof. Don Jefferies. The meeting was organized by the United Kingdom's Medical Research Council and Department of Health.