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Guideline: Managing possible serious bacterial infection in young infants when referral is not feasible.
Geneva, Switzerland, WHO, 2015.  p.This guideline, developed by a panel of international experts and informed by a thorough review of existing evidence, contains a number of recommendations on the use of antibiotics for neonates (0–28 days old) and young infants (0–59 days old) with PSBI in order to reduce young infant mortality rates. The guideline is intended for use in resource-limited settings in situations when families do not accept or cannot access referral care. The goal of the guideline is to provide clinical guidance on the simplest antibiotic regimens that are both safe and effective for outpatient treatment of clinical severe infections and fast breathing (pneumonia) in children 0–59 days old. In addition, the guideline seeks to provide programmatic guidance on the role of CHWs and home visits in identifying signs of serious infections in neonates and young infants.
Geneva, Switzerland, WHO, 2013 Oct.  p.The postnatal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time. Yet, this is the most neglected period for the provision of quality care. WHO guidelines on postnatal care have been recently updated based on all available evidence. The guidelines focus on postnatal care of mothers and newborns in resource-limited settings in low- and middle-income countries. The guidelines address timing, number and place of postnatal contacts, and content of postnatal care for all mothers and babies during the six weeks after birth. The primary audience for these guidelines is health professionals who are responsible for providing postnatal care to women and newborns, primarily in areas where resources are limited. The guidelines are also expected to be used by policy-makers and managers of maternal and child health programmes, health facilities, and teaching institutions to set up and maintain maternity and newborn care services. The information in these guidelines is expected to be included in job aids and tools for both pre- and in-service training of health professionals to improve their knowledge, skills and performance in postnatal care. These recommendations will be regularly updated as more evidence is collated and analysed on a continuous basis, with major reviews and updates at least every five years. The next major update will be considered in 2018 under the oversight of the WHO Guidelines Review Committee.
Postnatal care for mothers and newborns: Highlights from the World Health Organization 2013 guidelines.
[Geneva, Switzerland], World Health Organization [WHO], 2015 Apr.  p. (WHO/RHR/15.05; USAID Leader with Associates Cooperative Agreement No. GHS-A-00-08-00002-00; USAID Cooperative Agreement No. AID-OAA-A-14-00028)This evidence brief provides highlights and key messages from World Health Organization’s 2013 Guidelines on Postnatal Care for Mothers and Newborns. These updated guidelines address the timing and content of postnatal care for mothers with a special focus on resource-limited settings in low- and middle-income countries. This brief is intended for policy-makers, programme managers, educators and providers who care for women and newborns after birth.
Report of the Director General of the World Health Organization. Implementation of General Assembly resolution 66/289 on consolidating gains and accelerating efforts to control and eliminate malaria in developing countries, particularly in Africa, by 2015.
[New York, New York], United Nations, General Assembly, 2013 Apr 5.  p. (A/67/825)The present report is submitted in response to General Assembly resolution 66/289. It provides a review of progress in the implementation of that resolution, focusing on the adoption and scaling-up of interventions recommended by the World Health Organization in 99 countries with ongoing malaria transmission and key challenges impeding progress, including a shortfall in financing for malaria control globally. It provides an assessment of progress towards the 2015 global malaria targets, including Millennium Development Goal 6, targets set through the African Union and the World Health Assembly and goals set through the Global Malaria Action Plan of the Roll Back Malaria Partnership. It elaborates on the challenges limiting the full achievement of the targets and provides recommendations to ensure that progress is accelerated up to and beyond 2015.
Challenges and priorities in the management of HIV/HBV and HIV/HCV coinfection in resource-limited settings.
Seminars In Liver Disease. 2012 May; 32(2):147-57.Liver disease due to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is now emerging as an increasing cause of morbidity and mortality in human immunodeficiency virus- (HIV-) infected persons in resource-limited settings (RLS). Existing management guidelines have generally focused on care in tertiary level facilities in developed countries. Less than half of low-income countries have guidance, and in those that do, there are important omissions or disparities in recommendations. There are multiple challenges to delivery of effective hepatitis care in RLS, but the most important remains the limited access to antiviral drugs and diagnostic tests. In 2010, the World Health Assembly adopted a resolution calling for a comprehensive approach for the prevention, control, and management of viral hepatitis. We describe activities at the World Health Organization (WHO) in three key areas: the establishment of a global hepatitis Program and interim strategy; steps toward the development of global guidance on management of coinfection for RLS; and the WHO prequalification program of HBV and HCV diagnostic assays. We highlight key research gaps and the importance of applying the lessons learned from the public health scale-up of ART to hepatitis care. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Geneva, Switzerland, WHO, 2011.  p.In June 2010, the UNAIDS Secretariat and WHO launched Treatment 2.0, an initiative designed to achieve and sustain universal access and maximize the preventive benefits of antiretroviral therapy (ART). Treatment 2.0 builds on '3 by 5' and the programmatic and clinical evidence and experience over the last 10 years to expand access to HIV diagnosis, treatment and care through a series of innovations in five priority work areas: drugs, diagnostics, costs, service delivery and community mobilization. The principles and priorities of Treatment 2.0 address the need for innovation and efficiency gains in HIV programmes, in greater effectiveness, intervention coverage and impact in terms of both HIV-specific and broader health outcomes. Since the launch of Treatment 2.0, the UNAIDS Secretariat and WHO have worked with other UNAIDS co-sponsoring organizations, technical experts and global partners to further elaborate and begin implementing Treatment 2.0. The Treatment 2.0 Framework for Action outlines the five priority work areas which comprise the core elements of the initiative and establishes a strategic framework to guide action within each of them over the next decade. The Framework for Action reflects commitments outlined in Getting to Zero: 2011 - 2015 Strategy, UNAIDS and the WHO Global Health-Sector Strategy on HIV, 2011 - 2015, the guiding strategies for the multi-sectoral and health-sector responses to the HIV pandemic. (Excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2007.  p.Since the advent of penicillin, syphilis is not only preventable but also treatable. Despite this, it remains a global problem with an estimated 12 million people infected each year. Pregnant women who are infected with syphilis can transmit the infection to their fetus, causing congenital syphilis with serious adverse effects on the pregnancy in up to 80% of the cases. Yet simple, cost-effective screening and treatment options could prevent and eventually eliminate congenital syphilis. With the current international focus on the Millennium Development Goals (MDGs), there exists a unique opportunity to mobilize action to prevent, and subsequently eliminate, congenital syphilis. Congenital syphilis is a serious but preventable disease, which can be eliminated through effective screening of pregnant women for syphilis and treatment of those infected. More newborn infants are affected by congenital syphilis than by any other neonatal infection, including human immunodeficiency virus (HIV) infection and tetanus, which are currently receiving global attention. Yet the burden of congenital syphilis is still under-appreciated at both international and national levels. Unlike many neonatal infections, congenital syphilis can be effectively prevented by testing and treatment of pregnant women, which also provides immediate benefits to the mother and allows potentially infected partners to be traced and offered treatment. It has been clearly shown that screening of pregnant women for reactive syphilis serology, followed by treatment of seropositive women, is a cost-effective, inexpensive and feasible intervention for the prevention of congenital syphilis and improvement of child health. In 1995, the Pan American Health Organization (PAHO) began a regional campaign to reduce the rate of congenital syphilis in the Americas to less than 50 cases per 100 000 live births. The strategy was to: (1) increase the availability of antenatal care; (2) establish routine serological testing for syphilis during antenatal careand at delivery; and (3) promote the rapid treatment of infected pregnant women. (excerpt)
Antiretroviral therapy for HIV infection in infants and children: towards universal access. Recommendations for a public health approach.
Geneva, Switzerland, WHO, 2007.  p.These stand-alone treatment guidelines serve as a framework for selecting the most potent and feasible first-line and second-line ARV regimens as components of expanded national responses for the care of HIV-infected infants and children. Recommendations are provided on: diagnosing HIV infection in infants and children; when to start ART, including situations where severe HIV disease in children less than 18 months of age has been presumptively diagnosed; clinical and laboratory monitoring of ART; substitution of ARVs for toxicities. The guidelines consider ART in different situations, e.g. where infants and children are coinfected with HIV and TB or have been exposed to ARVs either for the prevention of MTCT (PMTCT) or because of breastfeeding from an HIV-infected mother on ART. They address the importance of nutrition in the HIV-infected child and of severe malnutrition in relation to the provision of ART. Adherence to therapy and viral resistance to ARVs are both discussed with reference to infants and children. A section on ART in adolescents briefly outlines key issues related to treatment in this age group. (excerpt)
A research agenda for childhood tuberculosis. Improving the management of childhood tuberculosis within national tuberculosis programmes: research priorities based on a literature review.
Geneva, Switzerland, World Health Organization [WHO], 2007.  p. (WHO/HTM/TB/2007.381; WHO/FCH/CAH/07.02)Childhood TB is a neglected aspect of the TB epidemic, despite constituting 20% or more of the TB case-load in many countries with high TB incidence. This "orphan disease" exists in the shadow of adult TB and is a significant child health problem, but is neglected because it is usually smear-negative and is thus considered to make a relatively minor contribution to the spread of TB. In order to redress this neglect and integrate childhood TB into the mainstream of TB control activities, research priorities are identified that will assist in improving the prevention and management of childhood TB as a part of national TB programmes (NTPs). The proposed research agenda seeks to better define childhood TB, to optimize the treatment of childhood TB and to identify the best management practices by which childhood TB can be accurately documented and recorded, and efficiently managed within NTPs. (excerpt)
Seminars in Pediatric Infectious Diseases. 2006 Apr; 17(2):80-98.The Integrated Management of Childhood Illness (IMCI) strategy has helped strengthen the application and expand coverage of key child survival interventions aimed at preventing deaths from infectious disease, respiratory illness, and malnutrition, whether at the health services, in the community, or at home. IMCI covers the prevention, treatment, and follow-up of the leading causes of mortality, which are responsible for at least two-thirds of deaths of children younger than 5 years in the countries of the Americas. The IMCI clinical guidelines take an evidence-based, syndrome approach to case management that supports the rational, effective, and affordable use of drugs and diagnostic tools. When clinical resources are limited, the syndrome approach is a more realistic and cost-effective way to manage patients. Careful and systematic assessment of common symptoms and well-selected clinical signs provide sufficient information to guide effective actions. (author's)
Geneva, Switzerland, World Health Organization [WHO], 2006.  p. (WHO/HTM/ TB/2006.371; WHO/FCH/CAH/2006.7)This document complements existing national and international guidelines and standards for managing TB, many of which include guidance on children. It fills the gaps in the existing materials and provides current recommendations based on the best available evidence. National and regional TB control programmes may wish to revise and adapt this guidance according to local circumstances. This document reflects two important recent policy changes. Firstly, NTPs should record and report two age groups for children (0--4 years and 5--14 years) using the quarterly reporting form. Routine reporting of these two age groups has considerable benefits. Enumerating children with TB is a key step in bringing their management into the mainstream of the Stop TB Strategy as part of routine NTP activities. This age breakdown is crucial in ordering drugs (since child-friendly formulations are particularly important in children aged 0--4 years) and in monitoring of trends in these two distinct age groups (since children aged 0--4 years are the most vulnerable and infection at these early ages indicates recent transmission). In addition, routine NTP data collection will provide valuable and sustainable information on market needs concerning child-friendly formulations of anti-TB drugs. Secondly, the revised recommended dose of ethambutol is now 20 mg/kg (range 15--25 mg/kg) daily. Although ethambutol was previously often omitted from treatment regimens for children, due in part to concerns about toxicity (particularly optic neuritis), a literature review indicates that it is safe in children at this dose. (excerpt)
Geneva, Switzerland, WHO, Special Programme for Research and Training in Tropical Diseases [TDR], 2006. 25 p. (TDR/SDI/06.1.)Syphilis is a curable infection caused by a bacterium called Treponema pallidum. This infection is sexually transmitted, and can also be passed on from a mother to her fetus during pregnancy. As a cause of genital ulcer disease, syphilis has been associated with an increased risk of HIV transmission and acquisition. Most persons with syphilis tend to be unaware of their infection and they can transmit the infection to their sexual contacts or, in the case of a pregnant woman, to her unborn child. If left untreated, syphilis can cause serious consequences such as stillbirth, prematurity and neonatal deaths. Adverse outcomes of pregnancy are preventable if the infection is detected and treated before mid-second trimester. Early detection and treatment is also critical in preventing severe long term complications in the patient and onward transmission to sexual partners. Congenital syphilis kills more than one million babies a year worldwide but is preventable if infected mothers are identified and treated appropriately as early as possible. (excerpt)
The WHO dengue classification and case definitions: time for a reassessment. [Clasificación del dengue y definición de casos de la OMS: tiempo de una nueva evaluación]
Lancet. 2006 Jul 8; 368(9530):170-173.Dengue is the most prevalent mosquito-borne viral disease in people. It is caused by four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4), of the genus Flavivirus, and transmitted by Aedes aegypti mosquitoes. Infection provides life-long immunity against the infecting viral serotype, but not against the other serotypes. Although most of the estimated 100 million dengue virus infections each year do not come to the attention of medical staff , of those that do, the most common clinical manifestation is non-specific febrile illness or classic dengue fever. About 250 000--500 000 patients developing more severe disease. The risk of severe disease is several times higher in sequential than in primary dengue virus infections. Despite the large numbers of people infected with the virus each year, the existing WHO dengue classification scheme and case definitions have some drawbacks. In addition, the widely used guidelines are not always reproducible in different countries--a quality that is crucial to effective surveillance and reporting as well as global disease comparisons. And, as dengue disease spreads to different parts of the globe, several investigators have reported difficulties in using the system, and some have had to create new categories or new case definitions to represent the observed patterns of disease more accurately. (excerpt)
Bulletin of the World Health Organization. 2006 Jun; 84(6):428.Tuberculosis care, a clinical function consisting of diagnosis and treatment of persons with the disease, is the core of tuberculosis control, which is a public health function comprising preventive interventions, monitoring and surveillance, as well as incorporating diagnosis and treatment. Thus, for tuberculosis control to be successful in protecting the health of the public, tuberculosis care must be effective in preserving the health of individuals. There are three broad mechanisms through which tuberculosis care is delivered: public sector tuberculosis control programmes, private sector practitioners having formal links to public sector programmes (the public--private mix), and private providers having no connection with formal activities. In most countries, programmes in both the public sector and the public--private mix are guided by international and national recommendations based on the DOTS tuberculosis control strategy -- a systematic approach to diagnosis, standardized treatment regimens, regular review of outcomes, assessment of effectiveness and modification of approaches when problems are identified. (excerpt)
The Global Plan to Stop TB: a unique opportunity to address poverty and the Millennium Development Goals.
Lancet. 2006 Mar 18; 367(9514):955-957.The Millennium Development Goals (MDGs) provide the guiding framework within which the Stop TB Partnership's Second Global Plan to Stop TB has been conceived, and poverty is rightly recognised as a key cross-cutting issue for tuberculosis control. This explicit pro-poor focus, although important in itself, will only make a difference to the individual lives of the poor if practical steps are taken to address the obstacles that these people face in accessing good tuberculosis services, and if programme implementation takes account of the distribution of poverty within target communities as a whole. That the Plan goes beyond the rhetoric and lays out the practical steps that tuberculosis programmes can take to address poverty is encouraging (panel). (excerpt)
Lancet. 2006 Mar 18; 367(9514):952-955.Government commitment, diagnosis through microscopy, standardised and supervised treatment, uninterrupted drug supply, and regular monitoring, which together constitute DOTS--the WHO recommended tuberculosis control strategy--are all essential for controlling tuberculosis. DOTS has helped make remarkable progress in global control of the disease over the past decade. The gain is evident: nearly 20 million patients have been cured of tuberculosis. However, global statistics suggest that DOTS alone is not sufficient to achieve the 2015 tuberculosis-related Millennium Development Goals (MDG) and the Stop TB Partnership targets. The need for a new strategy that builds on, and goes beyond, DOTS has also been recognised by the Second Ad-hoc Committee on the Global TB Epidemic and the 2005 World Health Assembly. (excerpt)
Lancet. 2006 Mar 18; 367(9514):951-952.In the early 1990s, the global public-health community woke up to the reality that despite the availability of effective diagnostic and therapeutic tools, tuberculosis was one of the world's leading killers. The strategy that was subsequently devised, DOTS, was based on decades-old principles and technologies, but was engendered by new energy and political will (panel); the aim, to achieve 70% case detection and 85% cure rate by 2005. Although these goals were not achieved on a global scale and implementation of the programme has been patchy and sporadic in places, overall its roll-out has been rapid and effective. That said, DOTS can only be the foundation for global tuberculosis control; to truly contain the disease, much more is needed in the control of multidrug-resistant tuberculosis (MDR-TB) and the development of drugs, diagnostics, and vaccines. (excerpt)
Lancet. 2006 Mar 18; 367(9514):942-943.The lack of accurate, robust, and rapid diagnostics for tuberculosis impedes management of patients and disease control. For individual patients, the cost, complexity, and potential toxicity of 6 months of standard treatment demands certainty in diagnosis. For communities, the risk of transmission from undetected cases requires widespread access to diagnostic services and early detection. Unfortunately, diagnostic services in most places where tuberculosis is endemic fail both the individual and the community. Patients are often diagnosed after weeks to months of waiting, at substantial cost to themselves, and at huge cost to society. Many patients are never diagnosed, and contribute to the astonishing number of yearly deaths from tuberculosis worldwide. (excerpt)
Seminars in Pediatric Infectious Diseases. 2004 Jul; 15(3):150-154.Although accurate data are scarce for children, tuberculosis (TB) represents one of the most common infectious causes of morbidity and mortality worldwide. TB case rates have declined among children in the United States in the last decade, but they remain high among children from low-income countries and racial or ethnic minorities. Establishing the definitive diagnosis of TB in a child remains difficult and frequently relies on a constellation of history, clinical findings, and bacteriology. Recently, updated national and international treatment recommendations have been published. Contact investigation and treatment using directly observed therapy are important components of the optimal case detection and management of TB in children. (author's)
Geneva, Switzerland, WHO, Division of Child Health and Development, 2002 Sep 3. 34 p.CHECK FOR GENERAL DANGER SIGNS: ASK: Is the child able to drink or breastfeed? Does the child vomit everything? Has the child had convulsions? LOOK: See if the child is lethargic or unconscious. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 2004. 19 p. (USAID Development Experience Clearinghouse DocID / Order No: PN-ADC-611)Misdiagnosis of malaria results in significant morbidity and mortality. Rapid, accurate and accessible detection of malaria parasites has an important role in addressing this, and in promoting more rational use of increasingly costly drugs, in many endemic areas. Rapid diagnostic tests (RDTs) offer the potential to provide accurate diagnosis to all at risk populations for the first time, reaching those unable to access good quality microscopy services. The success of RDTs in malaria control will depend on good quality planning and implementation. This booklet is designed to assist those involved in malaria management in this task. While this new diagnostic tool is finding its place in management of this major global disease, there is a window of opportunity in which good practices can be established by health services and become the norm. (excerpt)
Estimation of the incidence and prevalence of sexually transmitted infections. Report of a WHO consultation, Treviso, Italy, 27 February - 1 March 2002.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2002. 26 p. (WHO/HIV/2002.14; WHO/CDS/CSR/NCS/2002.7)WHO in collaboration with the Office of International and Social Health at the Department of Health, Veneto Region, Italy organized a consultation on the estimation of STI prevalence and incidence on 27 February– 1 March 2002 in Treviso, Italy with the following objectives : to determine the strengths, weaknesses and appropriateness of the current WHO approach to estimating the prevalence and incidence of STIs; to identify the STIs or syndromes that are most appropriate for surveillance and the most appropriate methods for deriving estimates of their incidence and prevalence; to identify structural surveillance needs within countries; to determine the utility and feasibility of using specific STI data as indicators of HIV risk behaviour within the concept of second-generation HIV surveillance; and to make recommendations for how the data collected can best be used to prevent STIs and to improve the care of individuals with STIs or their outcomes. (excerpt)
Rehabilitation after cardiovascular diseases, with special emphasis on developing countries. Report of a WHO Expert Committee.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1993; 831:i-viii, 1-122.In October 1991, a WHO expert committee met to discuss rehabilitation after cardiovascular diseases, with special emphasis on developing countries. Cardiovascular diseases cause most of the premature mortality in developed countries and have emerged as a major public health problem in developing countries in the mid 1970s. Recommendations for rehabilitative care depend on the risk status of cardiac patients experiencing an early recurrence of cardiovascular events (high, intermediate, and low). Committee members have developed recommendations for functional assessment of patients and for physical activity components of care based on the levels of care facilities are equipped to provide (basic, intermediate, and advanced). Committee recommendations are directed to medical practitioners from a variety of fields (e.g., primary care, pediatric cardiology, and geriatrics) and to other health professionals involved in rehabilitative care. Implementation of cardiac rehabilitation in developing countries follows the introduction of the report, which provides guidelines for determining when patients can return to work and program requirements for basic, intermediate, and advanced facilities. The 3rd chapter is entitled exercise testing and training in rehabilitation of children and young adults with cardiovascular disease, e.g., Kawasaki disease and ventricular septic defect. Chapter 4 covers rehabilitation of severely disabled, medically complex cardiac cases, e.g., heart transplants and hypertrophic cardiomyopathy. The report also discusses existing and upcoming methods for education in the rehabilitation of patients with cardiovascular disease. After overall conclusions and recommendations, the report has 12 annexes, ranging in topics from a light exercise program to contraindications and special considerations for exercise testing.
World Health Organization Technical Report Series. 1985; 1-67.This report was prepared by a World Health Organization (WHO) Scientific Group on the Future Use of New Imaging Technologies in Developing Countries, which met in Geneva in 1984 to consider the use of ultrasound and computed tomography. There is increasing demand for both techniques, necessitating careful examination of the costs, medical indications, and types of equipment needed. The primary need in diagnostic imaging is conventional radiology. It is stressed that the use of ultrasound or computed tomography should be considered only when conventional radiology is already available. In addition, neither technique should be considered unless the appropriate specialist physicians are well trained and the resources and manpower are available to provide the necessary treatment and care. Ultrasound is the method of choice for imaging during obstetric examinations, and has almost replaced radiography in this area. This document aims to delineate the conditions under which these 2 new imaging technologies will be of use in developing countries. Toward this end, it outlines the major clinical indications for the use of these techniques and specifies the particular areas where the most benefit can be obtained from their use. The Scientific Group concluded that use of these 2 technical advances confers definite advantages, as long as proper planning and education precede their purchase. In particular, it is noted that purchase of computed tomography equipment will have a significant effect on the total health budget of many countries. Finally, the document reviews all aspects of the specifications and choice of equipment, as well as the type of buildings, education, and maintenance that are essential.
AIDS ACTION. 1993 Mar-May; (20):6-8.The US Centers for Disease Control in 1982 listed conditions and infections then associated with AIDS. That case definition, used as a model for many countries, was designed primarily for epidemiologic surveillance and now includes more than 20 conditions. The definition, however, requires diagnostic and laboratory technologies which are not always available in developing countries. The World Health Organization (WHO) therefore published the Bangui definition in 1985 which uses clinical criteria alone. Many developing countries have adapted this definition to the types of pathogens they encounter domestically. According to the AIDS clinical definition, the presence of generalized Kaposi sarcoma or cryptococcal meningitis is sufficient for the diagnosis of AIDS. AIDS is also diagnosed if at least two major signs and one minor sign are present in the absence of known causes of immunosuppression such as malnutrition. Major signs are fever for more than one month, loss of more than 10% of body weight, and diarrhea for more than one month. Minor signs include cough for more than one month, generalized pruritic dermatitis, recurrent herpes zoster or shingles, oropharyngeal candidiasis or thrush, chronic or aggressive ulcerative herpes simplex, and persistent generalized lymphadenopathy. WHO has also developed criteria for diagnosing symptomatic HIV infection as an aid to individual case management. These criteria, however, are not intended to replace the Bangui AIDS case definitions developed for epidemiological purposes. The diagnosis of symptomatic HIV infection is made through physical examination and the taking of a very detailed case history. In so doing, there may be cardinal, characteristic, and/or associated findings. Cardinal findings of HIV infection are Kaposi sarcoma, oesophageal candidiasis, cytomegalovirus retinitis, Pneumocystis carinii pneumonia, and Toxoplasma encephalitis. Characteristic findings include oral thrush in a patient not taking antibiotics; hairy leukoplakia; cryptococcal meningitis; miliary, extrapulmonary,, or non-cavity pulmonary tuberculosis; current or past herpes zoster or shingles; severe prurigo; Kaposi sarcoma of a less than generalized or rapidly progressive nature; and high-grade B-cell extranodal lymphoma. Finally, associated findings in the absence of any other obvious cause of immunosuppression are recent and/or explained weight loss of more than 10% of body weight; fever for more than one month; diarrhea for more than one month; ulcers for more than one month; cough for more than one month; neurological complaints or findings, peripheral neuropathy, dementia, and progressively worsening headache; generalized lymphadenopathy; previously unseen drug reactions; and severe or recurrent skin infections. A person has symptomatic HIV infection if there are one or more cardinal findings, two or more characteristics findings, one characteristic finding and two or more associated findings, three or more associated findings together with any risk factors, or two associated findings together with a positive HIV test result. Malawi, Zambia, Thailand, and the English-speaking Caribbean are adapting these criteria for national use.