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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.
Confirmed malaria cases among children under five with fever and history of fever in rural western Tanzania.
BMC Research Notes. 2011 Sep 13; 4(1):359-364.Background: The World Health Organization recommends that malaria treatment should begin with parasitological diagnosis. This will help to control misuse of anti-malarial drugs in areas with low transmission. The present study was conducted to assess the prevalence of parasitologically confirmed malaria among children under five years of age presenting with fever or history of fever in rural western Tanzania. A finger prick blood sample was obtained from each child, and thin and thick blood smears were prepared, stained with 10% Giemsa and examined under the light microscope. A structured questionnaire was used to collect each patient's demographic information, reasons for coming to the health center; and a physical examination was carried out on all patients. Fever was defined as axillary temperature = 37.5°C. Findings: A total of 300 children with fever or a history of fever (1 or 2 weeks) were recruited, in which 54.3% (163/300, 95%CI, 48.7-59.9) were boys. A total of 76 (76/300, 25.3%, 95%CI, 22.8 - 27.8) of the children had fever. Based on a parasitological diagnosis of malaria, only 12% (36/300, 95%CI, 8.3-15.7) of the children had P. falciparum infection. Of the children with P. falciparum infection, 52.7% (19/36, 95%CI, 47.1-58.3) had fever and the remaining had no fever. The geometrical mean of the parasites was 708.62 (95%CI, 477.96-1050.62) parasites/µl and 25% (9/36, 95%CI, 10.9 -39.1) of the children with positive P. falciparum had = 1001 parasites/µl. On Univariate (OR = 2.13, 95%CI, 1.02-4.43, P = 0.044) and multivariate (OR = 2.15, 95%CI, 1.03-4.49) analysis, only children above one year of age were associated with malaria infections. Conclusion: Only a small proportion of the children under the age of five with fever had malaria, and with a proportion of children having non-malaria fever. Improvement of malaria diagnostic and other causes of febrile illness may provide effective measure in management of febrile illness in malaria endemic areas.
Expert Opinion On Pharmacotherapy. 2009 Aug; 10(11):1783-91.BACKGROUND: Treating HIV-infected children remains a challenge due to a lack of treatment options, appropriate drug formulations and, in countries with limited resources, insufficient access to diagnostic tests and treatment. OBJECTIVE: To summarize current data concerning new opportunities to improve the treatment of HIV-infected children. METHODS: This review includes data from the most recently published peer-reviewed publications, guidelines or presentations at international meetings concerning new ways to treat HIV-infected children. RESULTS/CONCLUSIONS: New WHO guidelines recommend starting combination antiretroviral treatment in all infants aged < 1 year. Although this is common practice in some high-income countries, implementation of these recommendations in countries with limited resources is still a challenge. There is still an important gap between the availability of licensed drugs in children compared with adults. There remains a need for further pharmacokinetic studies, and for more pediatric formulations of antiretroviral drugs with improved palatability.
Indian Pediatrics. 2007 Nov 17; 44(11):814-816.Globally, 9.7 million children died last year, about 3.6 million of them during the neonatal period (WHO mortality database). Because of its large population and relatively high neonatal mortality rate, India contributes about a quarter of all neonatal deaths in the world. It is particularly important to note that more than two thirds of these neonatal deaths occur in the first week of life. It is well known that majority of neonatal deaths can be prevented with low-technology, low-cost interventions delivered across two continua of care-the first from pregnancy, birth, through neonatal period and childhood, and the second from home, through primary health facilities to hospitals. It has been estimated that optimal treatment of neonatal illness can avert up to half of all preventable neonatal deaths. (excerpt)
IAP Guidelines 2006 on hospital based management of severely malnourished children (adapted from the WHO guidelines).
Indian Pediatrics. 2007 Jun 17; 44(6):443-461.Malnutrition in children is widely prevalent in India. It is estimated that 57 million children are underweight (moderate and severe). More than 50% of deaths in 0-4 years are associated with malnutrition. The median case fatality rate is approximately 23.5% in severe malnutrition, reaching 50% in edematous malnutrition. There is a need for standardized protocol-based management to improve the outcome of severely malnourished children. In 2006, Indian Academy of Pediatrics undertook the task of developing guidelines for the management of severely malnourished children based on adaptation from the WHO guidelines. We summarize below the revised consensus recommendations (and wherever relevant the rationale) of the group. (excerpt)
Journal of the Pakistan Medical Association. 2006 Sep; 56(9):390-391.Tuberculosis, one of the oldest and deadliest infectious diseases had a dramatic comeback in the last quarter of the century. WHO declared Tuberculosis (TB) as a global emergency in 1993. Though no nation was immune from the disease, the main brunt of the disease was found in the developing countries. The escalating incidence of tuberculosis in Pakistan is due to persistence of poor socio-political conditions, inadequate health care infrastructure, undernutrition, overcrowded living conditions, influx of refugees, rising incidence of HIV/AIDS, and a general apathy towards health and related problems. Pakistan is identified as sixth among the 22 countries of the EMRO region with the highest burden of TB. In 2001, the Government of Pakistan declared Tuberculosis as a National Emergency. In 2002 the National Tuberculosis Control Programme (NTP) a project of Ministry of Health (MoH), Government of Pakistan, adopted and initiated the implementation of DOTS programme. The objective of the NTP was to provide 100 percent DOTS coverage by 2005, detecting 70% of all cases and successfully treating 85% of them by 2005 and reducing the prevalence and deaths due to tuberculosis by 50% by 2010. (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)
Interim WHO clinical staging of HIV / AIDS and HIV / AIDS case definitions for surveillance. African region.
Geneva, Switzerland, WHO, 2005.  p. (WHO/HIV/2005.02)With a view to facilitating the scale-up of access to antiretroviral therapy (ART) in the African Region the present document outlines recent revisions made by WHO to the clinical staging of HIV/AIDS and to case definitions for HIV/AIDS disease surveillance. These interim guidelines are based on an international drafting meeting held in Saas Fee in June 2004 and on recommendations made by experts from African countries at a meeting held in Nairobi in December of the same year. The revisions to the clinical staging target professionals ranging from senior consultants in teaching and referral hospitals to surveillance officers and first-level health care providers, all of whom have important roles in caring for people living with HIV and AIDS (PLWHA), including children. It is proposed that countries review, adapt and repackage the guidelines as appropriate for specific tasks at different levels of health service delivery. It is hoped that national HIV/ AIDS programmes in African countries will thus be assisted to develop, revise or strengthen their ART guidelines, patient monitoring and surveillance efforts. The interim clinical staging and revised definitions for surveillance are currently being reviewed in the other WHO regions and will be finalized at a global meeting to be held in September 2005. (excerpt)
Effectiveness of clinical guidelines for the presumptive treatment of streptococcal pharyngitis in Egyptian children.
Lancet. 1997 Sep 27; 350(9082):918-21.In developing country settings without access to bacterial culture and rapid diagnostic tests, the prevention of acute rheumatic fever depends on clinicians' presumptive treatment of streptococcal pharyngitis. This study evaluated the effectiveness of World Health Organization (WHO) acute respiratory infection guidelines in a large pediatric clinic (Abu Reesh Children's Hospital) in Cairo, Egypt. 451 children 2-13 years of age with sore throat and pharyngeal erythema were enrolled, 107 (24%) of whom had group A beta-hemolytic streptococci on throat culture. Purulent exudate, present in 99 (22%) of these children, was 31% sensitive and 81% specific for a positive culture. The WHO guidelines, which recommend treatment for pharyngeal exudate plus enlarged and tender cervical node, were 12% sensitive and 94% specific. Based on these guidelines, 13 of 107 children with a positive throat culture would correctly receive antibiotics and 323 of 344 with a negative culture would not receive antibiotics. A modified guideline in which exudate or large cervical nodes would indicate antibiotic treatment would be 84% sensitive and 40% specific. With this modification, 90 of 107 children with a positive throat culture would correctly receive antibiotics and 138 out of 344 with a negative culture would not receive treatment. However, additional prospective studies from other regions of Egypt are necessary before modified guidelines are implemented.
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