Your search found 12 Results
Population and Development Review. 2015 Sep 15; 41(3):507-532.Chronic noncommunicable diseases (NCDs) in low- and middle-income countries have recently provoked a surge of public interest. This article examines the policy literature-notably the archives and publications of the World Health Organization (WHO), which has dominated this field-to analyze the emergence and consolidation of this new agenda. Starting with programs to control cardiovascular disease in the 1970s, experts from Eastern and Western Europe had by the late 1980s consolidated a program for the prevention of NCD risk factors at the WHO. NCDs remained a relatively minor concern until the collaboration of World Bank health economists with WHO epidemiologists led to the Global Burden of Disease study that provided an “evidentiary breakthrough” for NCD activism by quantifying the extent of the problem. Soon after, WHO itself, facing severe criticism, underwent major reform. NCD advocacy contributed to revitalizing WHO's normative and coordinative functions. By leading a growing advocacy coalition, within which The Lancet played a key role, WHO established itself as a leading institution in this domain. However, ever-widening concern with NCDs has not yet led to major reallocation of funding in favor of NCD programs in the developing world.
Lancet. 2007 Mar 3; 369(9563):715-798.South Africa is struggling to contain an outbreak of extensively drug-resistant tuberculosis, which has now spread to all the country's provinces, according to the Department of Health, and threatens to hamper HIV/AIDS treatment plans. Clare Kapp reports from South Africa. WHO is sending a permanent staff member to be based in South Africa to advise authorities struggling with an outbreak of extensively drug-resistant (XDR) tuberculosis. The Department of Health says there have now been 269 confirmed cases of XDR tuberculosis and that it has spread from the province of KwaZulu-Natal, where it was first confirmed, to all parts of South Africa. But Karin Weyer, tuberculosis research director at the Medical Research Council (MRC), said nobody really knows the true number of cases because of laboratory and diagnostics constraints and inconsistencies in reporting. So far there have been no reported cases in neighbouring southern African countries, but Weyner believes that this is because they simply do not have the laboratory testing facilities. (excerpt)
PLoS Medicine. 2007 Jan; 4(1):e44.The HIV/AIDS area has always been highly politically and emotionally charged, and we wrote a controversial and provocative piece. Most of the responses to it were unreasoned. The most cogent response came from UNAIDS (the Joint United Nations Programme on HIV/AIDS), and it generally restated an already well articulated position. We disagree with a number of the points for the reasons discussed in our original essay, and applaud one point. First, a brief restatement of our argument is warranted. There is good evidence that HIV-related stigma adversely affects the lives of people living with HIV/AIDS. There is little or no evidence, however, to support the notion that HIV-related stigma is one of the determinants of the global HIV epidemic. Furthermore, an argument could be made for why stigma might slow or contain the spread of infection in the general population. Given the very different effect the two positions would have on policy and the significance of the HIV epidemic, they deserve investigation. Among epidemiologists, two competing hypotheses, for which there is no strong evidence either way, would constitute a position of equipoise. (excerpt)
PLoS Medicine. 2007 Jan; 4(1):e51.In their essay "HIV, Stigma, and Rates of Infection: A Rumour without Evidence", Daniel Reidpath and Kit Yee Chan rightly underscore the insufficient body of research on the relationship between stigma and discrimination and HIV transmission . Increased scientific attention and effective programming against stigma and discrimination are both sorely needed. But the Joint United Nations Programme on HIV/AIDS (UNAIDS) does not accept a number of points made in the essay. Discrimination based on health status, including HIV, is a human rights violation, and stigma is the social form of this violation. HIV stigma and discrimination are wrong in and of themselves, and should be stopped for that reason alone. Reidpath and Chan suggest, as "an alternative hypothesis to the UNAIDS position", that stigma against certain groups, including people living with HIV, may have a public health value because it "could reduce opportunities for contact between high- and low-risk groups". UNAIDS cannot endorse a hypothesis that bases a public health goal on a human rights violation; nor do we believe it is either right, or necessary, to pit the public health against human rights. (excerpt)
Geneva, Switzerland, UNAIDS, 2000 Jul. 47 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/00.28E)Surveillance is the radar of public health. Nevertheless, its precise contours and justifications remain a matter of contention. Although the World Health Organization (WHO) Epidemiological Surveillance Unit in the Division of Communicable Diseases has defined disease surveillance quite broadly, most public health authorities, such as the United States Centers for Disease Prevention and Control (CDC) and the World Health Assembly, typically identify three key elements of surveillance. Surveillance involves the ongoing, systematic collection of health data, the evaluation and interpretation of these data for the purpose of shaping public health practice and outcomes, and the prompt dissemination of the results to those responsible for disease prevention and control. Surveillance, then, encompasses more than just disease reporting. "The critical challenge in public health surveillance today," conclude two prominent figures who have helped to define surveillance in the United States, "remains the ensurance of its usefulness." Two issues emerge from this understanding of surveillance. The first entails a question of efficacy. The second involves matters of privacy. Although conceptually distinct, the two are nevertheless intimately related. While the necessities of surveillance may justifiably limit some elements of privacy, such limitations are only justifiable to the extent that they in fact benefit the public's health. (excerpt)
AIDS Bulletin. 2005 Jun; 14(2):3-4.What we do now and how we choose to do it will affect Africa’s future and future generations. It seems a clear and obvious truism – yet not always one easy to live by in a world of instant need and gratification. UNAIDS has recently released a new report entitled AIDS in Africa: Three scenarios to 2025 which sketches three very different scenarios for AIDS in Africa and points out that our actions today determine our future tomorrow in terms of this epidemic and our continent. UNAIDS is quick to point out that the scenarios are not predictions rather they are stories about our possible futures and how the epidemic may develop. The aim is to highlight the various choices that will face African governments and societies in the coming decades, and to unpack the many broader factors that fuel the epidemic and examine how these interact. What is very stark is that depending on our actions today up to 43 million infections could be averted over the next 20 years – roughly equal to the population of South Africa. The report faces up the reality that the death toll will rise no matter what, but it is still possible to influence how much it rises. The scenarios, presented as stories, were developed by a team of people over a two-year period and involved collaboration with the African Union, the African Development Bank, the UN Economic Commission for Africa, the United Nations Development Programme, the World Bank and Royal Dutch Shell. They look at the possible course of the epidemic by 2025 when “no one under the age of 50 will remember a time without AIDS”. The stories are intended to be provocative and to stimulate debate and thus more informed decision making. (excerpt)
Lancet. 2005 Mar 5; 365:891-900.The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week—the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10–15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century. (author's)
Emerging Infectious Diseases. 2004 Nov; 10(11):1979-1983.The mechanisms, techniques, and data sources used to monitor and evaluate global AIDS prevention and treatment services may vary according to gender. The Joint United Nations Programme on HIV/AIDS has been charged with tracking the response to the pandemic by using a set of indicators developed as part of the Declaration of Commitment endorsed at the U.N. General Assembly Special Session on AIDS in 2001. Statistics on prevalence and incidence indicate that the pandemic has increasingly affected women during the past decade. Women’s biologic, cultural, economic, and social status can increase their likelihood of becoming infected with HIV. Since 2000, global financial resources have increased to allow expansion of both prevention and treatment services through a number of new initiatives, such as the Global Fund to Fight AIDS, TB and Malaria; the U.S. President’s Emergency Plan for AIDS Relief; and the World Bank MAP program. Programs should be monitored and evaluated to ensure these investments are used to maximum effect. Different types of data should be included when assessing the status of the HIV/AIDS epidemic and effectiveness of the response. Each of these “data streams” provides information to enhance program planning and implementation. (excerpt)
Lancet. 2003 Sep 13; 362(9387):917.I find reassuring the fact that the Child survival series could constitute a renaissance in child-health matters, as suggested by Boniface Kalanda in the accompanying Debate section online. To remain quiet while 10 million children die every year, mostly in developing countries, is certainly unacceptable. (excerpt)
AIDS Reader. 2003 Jan; 13(1):5-6.In a special session of the United Nations, held from June 25 to 27, 2001, access to medications was recognized as one of the fundamental elements ensuring the innate right of all persons to enjoy the highest attainable standard of health. The prevention and treatment of HIV/AIDS were emphasized as "mutually reinforcing elements" of an effective health response. Yet, of the 43 million people currently living with HIV/AIDS, fewer than 1 million have access to and are treated with antiretrovirals. That fact has become part of a new public service campaign to increase awareness of this issue in the United States. (author's)
AIDS BULLETIN. 1999 Jul; 8(2):4-5.AIDS notification is not believed by many to provide enough data concerning the epidemiology of AIDS. Cases were cited to show inconsistency in information gathered. Notifications with identifications will only reduce the level of reporting. It was further argued that the data gathered by the notification system would not be very useful for surveillance purposes. Since AIDS surveillance data reports are about risk factors for an infection acquired during the last 5-10 years, the results of current intervention programs will only impact AIDS case numbers in the next 5-10 years time. In addition, the notification figures derived from HIV testing would reflect more on the increasing number of tests done rather than in the number of HIV/AIDS cases. Meanwhile, surveillance conducted at selected sentinel sites is proposed as being the most viable method of determining the clinical features of AIDS and evaluating the impact of HIV/AIDS on the health care system. In contrast to AIDS notification, which seeks to gather data on every single case of AIDS in the country, this approach aims to provide high-quality, reliable data from a manageable number of sites.
TUBERCLE AND LUNG DISEASE. 1994 Jun; 75(3):163-7.Poor management of tuberculosis (TB) control is responsible for resistance to antituberculosis drugs. It leads to treatment failure, relapse, transmission of resistant TB, and multi-drug resistant TB. In developing countries, where resources are already limited, an epidemic of multi-drug resistant TB would jeopardize TB control. The effect of HIV infection is likely to worsen drug resistance-related problems. Specifically, streptomycin injections pose a risk of HIV transmission. It appears that withdrawal of thiacetazone from HIV infected TB patients causes resistance to more powerful drugs. If these 2 antibiotics cannot be used to treat TB patients, the armamentarium available to control TB in high HIV prevalence countries is reduced, which could foster resistance to the fewer remaining antibiotics. Good management and supervision is needed to prevent resistance to antituberculosis drugs. Surveillance of drug resistance is also needed to monitor the current level and characteristics of the drug resistance problem and to identify effective solutions. Specifically, at the national level, a TB surveillance system can assess the TB control program's performance and assess the need to modify the current treatment policy. It can identify districts or health centers with high levels of drug resistance and determine the risk factors for resistance. WHO will assist developing countries in developing their own surveillance systems. WHO and the International Union Against Tuberculosis and Lung Disease plan on setting up a network of supranational reference laboratories to determine the quality control and standardization of susceptibility testing needed for international comparison. WHO also plans on supporting national reference laboratories in developing countries.