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Journal of Obstetrics and Gynaecology. 1994 Mar; 14(2): p..In order to find a simple screening test to assess tubal patency among infertile women, comparison was made between the data provided by complete hysterosalpingography and that given by taking a single follow up film after 15 minutes of walking about at the end of the procedure. There was a good correlation between the follow up film and the complete hysterosalpingography. There was also a positive relationship between the follow up film and the outcome in terms of pregnancy rate. (excerpt)
JOURNAL OF COMMUNICABLE DISEASES. 1994 Dec; 26(4):231-2.The World Health Organization (WHO) criteria for HIV clinical disease were tested among individuals with high-risk behavior in northern India. A questionnaire, based upon history and physical examination alone, standardized by the WHO to include both major and minor signs necessary for the clinical diagnosis of AIDS in adults was applied to 165 consecutive patients attending the STD clinic of Dr. R.M.L. Hospital, New Delhi. All patients were screened for the presence of STDs by the dermatologist in charge of the clinic, with patients fulfilling two major and at least two minor WHO criteria eventually classified as having clinical AIDS based upon the WHO case definition. Each of those patients was subjected to serological confirmation of the clinical suspicion using ELISA and Western blot commercial tests. Of the 165 patients screened, a definite diagnosis of STD was possible in 85. These patients were 20-45 years old (mean age, 30.59 years). All were male and chancroid was the most common STD in the cohort. Of the 85, only one satisfied the WHO clinical criteria for AIDS. Serological investigations, ELISA, and Western blot confirmed the subject's HIV-seropositive status. These results indicate that in northern India, clinical HIV disease remains rare even among individuals with high-risk behavior. The low prevalence of clinical HIV disease in that part of the country makes it difficult to assess the specificity and sensitivity of the WHO clinical criteria for AIDS.
In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 281-6.The World Health Organization (WHO) and UNICEF are collaborating in the development of an integrated approach to the management of the sick child. Acute respiratory infections, diarrhea, malaria, measles, and malnutrition cause 7 out of 10 deaths in children under 5 years of age in developing countries. Integrated management means effective, simple, and affordable treatments for all the leading killers of young children. Health workers using such guidelines can prevent serious disabilities resulting from measles and vitamin A deficiency. The integrated clinical guidelines rely on detection of cases based on simple clinical signs and empirical treatment without laboratory tests. They are based on a few essential drugs for outpatient use: oral rehydration salts, an antibiotic (co-trimoxazole), an oral antimalarial, vitamin A, iron tablets, and oral antipyretic (paracetamol), an antibiotic eye ointment, and gentian violet. Parenteral antibiotic and antimalarial drugs and intravenous fluids are needed for severely ill children before referral to hospital. The integrated clinical guidelines for sick children 2 months to 5 years old are summarized on 3 case management charts: 1) assess and classify the sick child 2 months to 5 years old; 2) treat the child; and 3) advise the mother. The implementation of case management will entail the use of several key preventive interventions: immunization, promotion of breast feeding, improved infant feeding, and vitamin A. All children with measles are given vitamin A. Those with severe pneumonia, stridor when calm, corneal clouding, or severe malnutrition are referred to hospital. Mothers are taught to manage mouth ulcers and conjunctivitis at home and to administer antibiotics for otitis media and pneumonia. Wherever Plasmodium falciparum is sensitive to sulfadoxine-pyrimethamine, fast breathing and fever can be treated with co-trimoxazole alone. The WHO prepared a report in 1993 demonstrating that management of the sick child in low-income countries averts 14% of the disease burden at only $ 1.60 per capita annually.
WHO case definitions for AIDS surveillance in adults and adolescents. Definitions OMS du cas de SIDA aux fins de surveillance, pour les adultes et les adolescents.
WEEKLY EPIDEMIOLOGICAL RECORD. 1994 Sep 16; 69(37):273-5.HIV and AIDS case surveillance is needed to monitor the course of the HIV pandemic and plan appropriate public health responses. The World Health Organization (WHO) recommends HIV sentinel surveillance to monitor HIV infection. This is a method in which the prevalence of HIV is measured in specific populations whose blood has been obtained in the health care setting for other purposes and then tested for antibody to HIV only after the removal of all patient identifiers. For the surveillance of AIDS cases, WHO recommends the systematic reporting of AIDS cases using an appropriate national AIDS surveillance case definition. In light of developments in the understanding of the spectrum of severe HIV-related illness in both developed and developing countries, and the increased availability of laboratory diagnostic methods, however, a meeting was convened in Geneva by the WHO Global Program on AIDS to review the current case definitions for AIDS surveillance in adults and adolescents, and to make recommendations for their modification and application. The meeting recommended modifying the 1985 provisional WHO clinical case definition for AIDS, now to be referred to as the WHO AIDS surveillance case definition; and introducing an expanded WHO AIDS surveillance case definition. These two case definitions for AIDS surveillance are recommended for use in adults and adolescents in countries with generally limited clinical and laboratory diagnostic capabilities. They should therefore not be confused with clinical staging systems for HIV infection, which are useful for the clinical management of patients and for clinical research purposes. Case definitions for AIDS surveillance in children remain unchanged for now. The WHO case definition for AIDS surveillance, the expanded WHO case definition for AIDS surveillance, and comments are presented.
[Unpublished] 1994 Sep. Presented at the 122nd Annual Meeting of the American Public Health Association [APHA], Washington, D.C., 1994. iii, 28 p.Tuberculosis (TB) is the leading cause of morbidity and mortality from an infectious disease and is responsible for 3.9 million deaths/year. The incidence and severity of TB are exacerbated by the rapid spread of HIV infections. In 1993, a USAID task force presented a report on the TB situation in less developed countries and recommended agency actions (no policy decisions have been made). The World Health Organization (WHO) subsequently requested USAID assistance for a broad range proposal to tackle the problem of TB and implied that WHO had developed a cost effective TB strategy. USAID requested the country evaluations WHO referred to in its proposal, and this report is based on a review of those data. The country reports reviewed are from Burundi, Comoros, Ethiopia, Guinea, Rwanda, Somalia, Tanzania, Malawi, Mozambique, Afghanistan, China, India, the Philippines, Brazil, Cuba, Nicaragua, Algeria. A summary is presented for each country report (except Afghanistan), overall findings are discussed, and unmet needs are identified. In general, the reports summarized from a variety of authors indicate that TB can be controlled through an extraordinary devotion of resources. Only Cuba treats TB as a socioeconomic problem; most of the other reviewers were entirely concerned with the medical aspects of the complex multidrug therapy approach and almost ignored that fact that patient compliance averaged only 30% unless there was massive donor support. It is concluded that the following needs must be met to address TB: 1) political commitment to TB control must be strong; 2) the cost of TB to economic security must be established; 3) the public understanding of TB must be enhanced; 4) the serious barriers to treatment must be addressed; 5) the health care delivery systems in developing countries must be strengthened; and 6) the capacities to support TB control must be increased. It was recommended that existing projects could be supplemented by a program which would cost US $2-5 million/year in order to address some unmet needs in the technical areas of training, research, and advocacy in developing countries.
AIDS BULLETIN. 1994 Apr; 3(1):12-3, 15.Poor laboratory facilities and lack of clinical expertise in many developing countries often make it difficult to definitively diagnose individual cases of sexually transmitted diseases (STD). The World Health Organization (WHO) therefore recommends a syndromic approach to managing STDs in such settings. It involves categorizing STD patients according to commonly presenting syndromes which include vaginal discharge, urethral discharge, genital ulceration, lower abdominal pain, inguinal bubo, balanitis, and scrotal swelling. The WHO has developed STD management protocols for each syndrome comprised of algorithms or flowcharts outlining the actions which should be taken by health care providers. This syndromic approach combined with standardized treatment protocols constitutes a simple and practical method to manage STDs and can be used by health workers with limited clinical experience. Sections of the paper briefly discuss the adaptation of protocols to local conditions, advantages of the syndromic approach and standardized protocols, prerequisites for the development of protocols, and protocols for STD management in South Africa.