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Geneva, Switzerland, World Health Organization [WHO], 2018. 458 p.Girls and women who have been subjected to female genital mutilation (FGM) need high quality, empathetic and appropriate health care to meet their specific needs. This handbook is for health care providers involved in the care of girls and women who have been subjected to any form of FGM. This includes obstetricians and gynaecologists, surgeons, general medical practitioners, midwives, nurses and other country-specific health professionals. Health-care professionals providing mental health care, and educational and psychosocial support – such as psychiatrists, psychologists, social workers and health educators – will also find this handbook helpful. It includes advice on how to: 1) communicate effectively and sensitively with girls and women who have developed health complications due to FGM; 2) communicate effectively and sensitively with the husbands or partners and family members of those affected; 3) provide quality health care to girls and women who have health problems due to FGM, including immediate and short-term urogynaecological or obstetric complications; 4) provide support to women who have mental health and sexual health complications caused by FGM; 5) make informed decisions on how and when to perform deinfibulation; 6) identify when and where to refer patients who need additional support and care; and 7) work with patients and families to prevent the practice of FGM.
Symptom-based screening of child tuberculosis contacts: improved feasibility in resource-limited settings.
Pediatrics. 2008 Jun; 121(6):e1646-52.OBJECTIVE: National tuberculosis programs in tuberculosis-endemic countries rarely implement active tracing and screening of child tuberculosis contacts, mainly because of resource constraints. We aimed to evaluate the safety and feasibility of applying a simple symptom-based approach to screen child tuberculosis contacts for active disease. METHODS: We conducted a prospective observational study from January through December 2004 at 3 clinics in Cape Town, South Africa. All of the children <5 years old in household contact with an adult tuberculosis source case were assessed by documenting current symptoms and tuberculin skin test and chest radiograph results. RESULTS: During the study period, 357 adult tuberculosis cases were identified; 195 cases (54.6%) had sputum smear and/or culture positive results and were in household contact with children aged <5 years. Complete information was available for 252 of 278 children; 176 (69.8%) were asymptomatic at the time of screening. Tuberculosis treatment was administered to 33 (13.1%) of 252; 27 were categorized as radiologically "certain tuberculosis," the majority (n = 22) of which had uncomplicated hilar adenopathy. The negative predictive value of symptom-based screening varied according to the case definition used, with 95.5% including all of the children treated for tuberculosis and 97.1% including only those with radiologically "certain tuberculosis." CONCLUSIONS: Our findings support current World Health Organization recommendations, demonstrating that symptom-based screening of child tuberculosis contacts should improve feasibility in resource-limited settings and seems to be safe.
Acta Obstetricia et Gynecologica Scandinavica. 2008; 87(7):693-6.Malarial infestation in pregnancy is a major public health concern in endemic countries and ranks high amongst the commonest complications of pregnancy, especially in large areas of Africa and Asia. It is an important preventable cause of significant maternal morbidity and mortality with associated fetal as well as perinatal wastage. The burden of malaria is greatest in sub-Saharan Africa where it contributes directly or indirectly to maternal and perinatal morbidity and mortality. The need for prompt and accurate diagnosis as well as prevention and treatment of malaria during pregnancy cannot, therefore, be overemphasized. This commentary focuses on the challenges of diagnosis and treatment of malaria in pregnancy.
WHO HIV clinical staging or CD4 cell counts for antiretroviral therapy eligibility assessment? An evaluation in rural Rakai district, Uganda [letter]
AIDS. 2007 May 31; 21(9):1208-1210.The ability of WHO clinical staging to predict CD4 cell counts of 200 cells/µl or less was evaluated among 1221 patients screened for antiretroviral therapy (ART). Sensitivity was 51% and specificity was 88%. The positive predictive value was 64% and the negative predictive value was 81%. Clinical criteria missed half the patients with CD4 cell counts of 200 cells/µl or less, highlighting the importance of CD4 cell measurements for the scale-up of ART provision in resource-limited settings. (author's)
Diagnostic accuracy comparison between clinical signs and hemoglobin color scale as screening methods in the diagnosis of anemia in children.
Revista Brasileira de Saude Materno Infantil. 2006 Apr-Jun; 6(2):183-189.The objectives were to compare the validity and reproducibility of clinical signs with the World Health Organization hemoglobin color scale. Two hundred six children in the age range of 6-23 months, at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP, were assessed. Two examiners evaluated the clinical signs and the hemoglobin color scale of each child at the different times. The hemoglobin value was used as a standard for validation. In more than 90% of cases the agreement between the values of the color scale and the laboratorial hemoglobin was <2 g/dL. Between the clinical signs the highest sensitivity level for diagnosing Hb<11 g/dL was presented by the hemoglobin color scale (75.7%). For moderate/severe anemia Hb<9g/dL the highest sensitivity was shown by combined palmar or conjunctival pallor (74.3%) and by the color scale (52.5%), according to the first and second observer, respectively. The highest specificity level for Hb<11 g/dL was presented by palmar pallor in comparison with the mother's palm and conjunctival pallor (100%). For Hb<9 g/dL the highest specificity was presented by the hemoglobin color scale (91.9%). This study suggests that moderate/ severe anemia can be diagnosed either by clinical signs or by the color scale, while, in cases of mild anemia, the better diagnosis tool appears to be the color scale. (author's)
Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study.
BMJ. British Medical Journal. 2006 Jul 15; 333(7559):124.The objective was to assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification. Design: Cross sectional study. Settings: One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4. Participants: 255 girls aged 4-9 and 282 women aged 17-35. Main outcome measures: The women's reports of FGM the actual anatomical extent of the mutilation, and the corresponding types according to the WHO classification. All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM were found to have it. Many said to have undergone "sunna circumcision" (excision of prepuce and part or all of clitoris, equivalent to WHO type I) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type III varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types II and III. The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct and interpretation of epidemiological and clinical studies. WHO should revise its classification. (author's)
Additional markers to refine the World Health Organization algorithm for diagnosis of pneumonia. [Marcadores adicionales para mejorar el algoritmo de diagnóstico de neumonía de la Organización Mundial de la Salud]
Indian Pediatrics. 2005 Aug 17; 42(8):773-781.WHO guidelines for primary care of children with tachypnea indicate that all should receive antibiotics for presumed pneumonia. These guidelines have led to excessive antibiotic use. The objective was to examine the value of history of previous respiratory distress, chest indrawing and fever, and response to bronchodilator(BD) to refine these guidelines. Design: Prospective study. Setting: Urban tertiary care hospital. Subjects: Children, between the ages of 6 and 59 months, presenting with cough and tachypnea. Methods: 182 children were enrolled. Each child had a chest X-ray that was read by two blinded, independent radiologists. Discordance between the two radiologists led to excluding 17 patients. The remaining 165 children were examined for fever and/or chest indrawing, and if they had a history of previous respiratory distress, challenge with a BD. The association of persistent tachypnea after BD and presence of pulmonary infiltrates was recorded. The median age was 22 months (mean 25.1 ± 14.5mo) and 75.8% were aged = 1 year. There were 58.8% males. Previous respiratory distress occurred in 65.0% and 79.2% of children aged < 1 year and = 1 year, respectively. Pneumonia was radiologically diagnosed in 26/165 (15.8%). 2/40 (5%) of children without a history of previous respiratory distress had pneumonia diagnosed. Of 125 children with history of previous respiratory distress, pneumonia was identified in 24 (19.2%). Persistence of tachypnea after BD was associated with pulmonary infiltrate in 14/24 (58.3%), whereas, tachypnea persisted in 32/101 (31.7%) children without pulmonary infiltrates (P = 0.02). The negative predictive value of resolution of tachypnea was 87.3% (95% CI 77.5-93.4). BD nonresponse was most useful in children without fever and/or with chest indrawing to indicate pneumonia as the cause of the tachypnea. This study indicates that by adding the simple procedures of a history of previous respiratory distress, recording of fever and chest indrawing, and observing the response to bronchodilators, pneumonia can be reliably identified in children presenting with tachypnea and cough. It is probable that this approach to management of children with cough and tachypnea could reduce unnecessary use of antibiotics. (author's)
Geneva, Switzerland, WHO, 2003.  p.Sexual violence is ubiquitous; it occurs in every culture, in all levels of society and in every country of the world. Data from country and local studies indicate that, in some parts of the world at least, one woman in every five has suffered an attempted or completed rape by an intimate partner during her lifetime. Furthermore, up to one-third of women describe their first sexual experience as being forced. Although the vast majority of victims are women, men and children of both sexes also experience sexual violence. Sexual violence can thus be regarded as a global problem, not only in the geographical sense but also in terms of age and sex. Sexual violence takes place within a variety of settings, including the home, the workplace, schools and the community. In many cases, it begins in childhood or adolescence. High rates of forced sexual initiation have been reported in population-based studies conducted in such diverse locations as Cameroon, the Caribbean, Peru, New Zealand, South Africa and Tanzania. According to these studies, between 9% and 37% of adolescent females, and between 7% and 30% of adolescent males, have reported sexual coercion at the hands of family members, teachers, boyfriends or strangers. Sexual violence has a significant negative impact on the health of the population. The potential reproductive and sexual health consequences are numerous – unwanted pregnancy, sexually transmitted infections (STIs), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) and increased risk for adoption of adoption of risky sexual behaviours (e.g. early and increased sexual involvement, and exposure to older and multiple partners). The mental health consequences of sexual violence can be just as serious and long lasting. Victims of child sexual abuse, for example, are more likely to experience depression, substance abuse, post-traumatic stress disorder (PTSD) and suicide in later life than their non-abused counterparts. Worldwide child sexual abuse is a major cause of PTSD, accounting for an estimated 33% of cases in females and 21% of cases in males. (excerpt)
Brief guide on tuberculosis control for primary health care providers for countries in the WHO European Region with a high and intermediate burden of tuberculosis.
Copenhagen, Denmark, World Health Organization [WHO], Regional Office for Europe, 2004.  p.Tuberculosis is an increasingly serious problem in the WHO European region, particularly in the countries of eastern Europe, the Baltic States, and the Commonwealth of Independent States (CIS). Primary health care providers can play an important role in tuberculosis control through early detection of the disease, referral for treatment, and involvement in directly observed treatment. This guide has been written with the aim of developing the knowledge, awareness and skills of primary health care providers regarding tuberculosis and its prevention and control. The guide is not intended as a complete source of information on tuberculosis, but rather a summary of general principles regarding prevention, detection and treatment. The guide does not reflect specific national guidelines on TB control, and is intended to be used in conjunction with the appropriate national regulations. A reference card containing key information is included with this guide. (author's)
Geneva, Switzerland, WHO, Department of Immunization, Vaccines and Biologicals, 2004.  p. (WHO/EPI/TRAM/93.5 (updated 2004); WHO/PBL/93.31)This teaching aid is about measles, and its potentially harmful effects on the eyes of children.1 Understanding the risks of damage to the eye from measles is the first step before learning what action to take to save sight. Measles causes a great amount of unnecessary death and blindness in children, especially in Africa and parts of Asia. Death and loss of sight due to measles are health care disasters that simply should not occur. Measles is a highly infectious disease preventable by immunization. Reducing deaths due to measles is a global health priority. Immunized children rarely get measles and the cost of immunization is low. The road to good health is also the road to good vision. Since the eye problems due to measles are especially dangerous in children who eat less well, this teaching aid also presents good feeding habits and how to improve the diet for the malnourished child. Protein-energy malnutrition is the most widespread form of malnutrition. It is not easily preventable in poor communities or where there is serious shortage of food as in famine situations and civil strife. (excerpt)
WHO background paper: Obstacles to women accessing forensic medical exams in cases of sexual violence.
New York, New York, Human Rights Watch, 2001 Jun 25. 22 p.Despite the success of the women’s human rights movement in highlighting the issue of violence against women, many countries have yet to implement the necessary criminal justice system reform to ensure that, at the very least, wo men can pursue redress through the criminal justice system. This work must happen in the larger context of dismantling de jure and de facto discrimination against women. It is women’s second class status that makes them vulnerable to violence and bars them from receiving effective redress through the criminal justice system. Women’s rights activists all over the world are doing extensive work training police, prosecutors and judges to address pervasive bias and ignorance. A group of professionals largely untouched by this advocacy are doctors or other health professionals responsible for collecting, analyzing and testifying about forensic evidence in cases of sexual and gender based violence. In this paper, we call on the World Health Organization (WHO) to establish minimum standards for the collection of evidence in cases of sexual and domestic violence. We also call on WHO to draft a policy paper to support the effective implementation of the minimum standards. This paper should explore obstacles to the successful implementation of these standards such as discriminatory rules of evidence and procedure; the failure of states to criminalize specific conduct such as marital rape; and, the belief that only virgins can be raped. (excerpt)
Clinical diagnosis and assessment of severity of confirmed dengue infections in Vietnamese children: is the World Health Organization classification system helpful?
American Journal of Tropical Medicine and Hygiene. 2004; 70(2):172-179.Classification of dengue using the current World Health Organization (WHO) system is not straightforward. In a large prospective study of pediatric dengue, no clinical or basic laboratory parameters clearly differentiated between children with and without dengue, although petechiae and hepatomegaly were independently associated with the diagnosis. Among the 712 dengue-infected children there was considerable overlap in the major clinical features. Mucosal bleeding was observed with equal frequency in those with dengue fever and dengue hemorrhagic fever (DHF), and petechiae, thrombocytopenia, and the tourniquet test differentiated poorly between the two diagnostic categories. Fifty-seven (18%) of 310 with shock did not fulfill all four criteria considered necessary for a diagnosis of DHF by the WHO, but use of the WHO provisional classification scheme resulted in considerable over-inflation of the DHF figures. If two separate entities truly exist rather than a continuous spectrum of disease, it is essential that some measure of capillary leak is included in any classification system, with less emphasis on bleeding and a specific platelet count. (author's)
New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization / Nutrition for Health and Development Iodine Deficiency Study Group Report.
American Journal of Clinical Nutrition. 2004 Feb; 79(2):231-237.Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children. The study aim was to establish international reference values for Tvol by ultrasound in 6–12-y-old children that could be used to define goiter in the context of IDD monitoring. Tvol was measured by ultrasound in 6–12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)–specific 97th percentiles for Tvol were calculated for boys and girls. The sample included 3529 children evenly divided between boys and girls at each year (x ± SD age: 9.3 ± 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 µg/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references. These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring. (author's)
The hospital in rural and urban districts. Report of a WHO Study Group on the Functions of Hospitals at the First Referral Level.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (819):i-vii, 1-74.In 1992, the WHO Study Group on the Functions of Hospitals at the First Referral Level compiled a report on the functions of the hospital in rural and urban districts. It advocates that the 1st referral level hospital should be integrated into the district health care system, which is administered by a district health council. This approach strengthens primary health care and uses hospital resources to promote health. The most pressing need for this approach to work is changing people's attitudes and motivation. Various obstacles invariably slow this integration process such as resistance by central and local government officials and inadequate funding. The district hospital should help people to find health rather than just cure disease. Further it must accept the fact that it is not the center of the health system. This means a redistribution of both finance and effort. Governments need to improve the decentralization process to facilitate integration. The study group proposes a step by step methodology to integrate the health system. The 1st step is creating a district health council with representatives from the district health office, the hospital, other sectors of the health care system, and the community. The council determines the community diagnosis including population trends, patterns of morbidity and mortality, and disease and risk distribution by age and location. It also needs to review health services in the district. The council can divide these services into preventive, promotional, curative, rehabilitative, and organizational services. It also must reassess distribution of resources including people, buildings, equipment, and materials. The council must draft a plan and deliberate on implementing the plan. Once the council has taken these steps, it can then implement, monitor, and evaluate the plan and its results.
Geneva, Switzerland, WHO, 1990 Oct. ix, 72 p. (WHO/MCH/GPA/90.2)Guidelines for medical professionals in supervisory, managerial and administrative positions in Maternal-Child Health/Family Planning programs (MCH/FP) in developing countries have been developed by the Division of Family Health, Programme of Maternal and Child Health including Family Planning and the Global Programme on AIDS of the World Health Organization (WHO) with the UN Population Fund (UNFPA). MCH/FP programmes occupy a unique position to help stop the spread of AIDS because they comprise the largest pool of health personnel already experienced in counseling, education and training in sexuality, contraception and STD prevention. The booklet begins with a review of HIV facts, with a few additions specifically for developing areas, such as a discussion of the possible increased risk to those who have undergone female circumcision. HIV prevention during pregnancy is as usual, with additional recommendations of measures to prevent the need for blood transfusions, e.g., iron and folic acid supplements, and malaria treatment. Recommendations for HIV containment in labor and delivery wards are the usual universal cautions for health workers, with additional suggestions for sterilization and disposal of materials in areas without conventional western waste facilities. Diagnosis of HIV infected newborns is based on a special WHO clinical case definition for pediatric AIDS, since laboratory tests are not accurate on infants. Treatment and care should be supportive since many HIV infected children can have months of years of quality life. HIV prevention in women and adolescents in terms of men, condoms and family planning is reviewed: no unique information is available for MCH programs. A section covering logistics and supplies suggests solutions to maximize the efficient use of condoms, plastic aprons, and particularly sterile and nonsterile gloves, by strict management at the local level. Suggestions include provision of a set number of paris for each delivering woman, and providing heavy work gloves semi-annually for cleaning staff. The chapter on training MCH staff in use of guidelines has specific curricula, and that on how to evaluate the implementation of these guidelines has several detailed questionnaires. The traditional services of MCH/FP are vital and must be expanded to include information, education and counseling on safer sex related to STD and HIV prevention.
[Unpublished] 1988. 32 p. (WHO/MCH/88.4)The partograph is a graph in which cervical dilatation in centimeters is plotted against time in hours to identify abnormally slow labor, which may lead to obstructed labor due to cephalopelvic disproportion. In addition to cervical dilatation, a record is charted on the partograph of descent of fetal head; frequency and duration of contractions, fetal heart rate, color and amount of amniotic fluid, molding of fetal skull; and maternal vital signs, urinalysis, fluid and drug intake, and oxytocin regimen. In the latent phase of labor the cervix dilates slowly from 0-3 cm; in the active phase it dilates faster, from 3-10 cm at the rate of 1 cm/hour. Vaginal examinations should be made every 4 hours. The latent phase should last no longer than 8 hours. Descent of the fetal head takes place at about 7 cm dilatation and is measured abdominally in 5ths above the pelvic brim. Abdominal examination should always be done before a vaginal examination is done. Frequency of uterine contractions is recorded as number of contractions per 10 minutes of time; duration of contractions is recorded by shading the squares. Fetal heart rate is recorded every 1/2 hour, after a contraction; a heart rate higher than 160 beats/minute or lower than 120 beats/minute indicates fetal distress. Fetal membranes are recorded as intact or ruptured, and if ruptured, the amount and color of the liquor is recorded. The molding of the fetal head is recorded; overlapping bones are an indication of cephalopelvic disproportion. Maternal vital signs; urine volume, protein, and acetone; drugs and intravenous fluids, and oxytocin titration are also recorded. Labor in the latent phase longer than 8 hours or to the right of the action line in active phase is cause to transfer the woman to a hospital with facilities for obstetric intervention. When cervical dilatation reaches the action line, one may have to terminate labor or augment it with oxytocin infusion. If the membranes have ruptured for more than 12 hours without delivery, antibiotics should be administered. If there is evidence of fetal distress, oxytocin should be stopped and fluids and oxygen administered after vaginal examination to exclude cord presentation or uterine prolapse.
[Unpublished] 1988. 14 p. (WHO/MCH/88.3)In developing countries 450 women die for every 100,000 live births. Prolonged labor due to cephalopelvic disproportion resulting in obstructed labor is responsible for many of these deaths, especially among primagravidas. The partograph is a graphic recording of the progress of labor in centimeters of cervical dilatation plotted against time in hours. It therefore acts as an early warning system for labor that is not progressing normally. It has been used since 1970 in a number of countries, including Zimbabwe, Malawi, the Cameroon, and Papua-New Guinea, and has been shown to be effective in preventing prolonged labor and reducing operative intervention. It is based on the principles that: the active phase of labor starts at 3 cm cervical dilatation; the latent phase should not last more than 8 hours; during active labor, the cervical dilatation should not be slower than 1 cm/hour; a lag time of 4 hours between slowing of labor and need for intervention is acceptable; vaginal examinations should be done no more often than every 4 hours; and a partograph with preset lines is best for constructing alert and action lines. If cervical dilatation moves to the right of the alert line, the woman should be transferred to hospital and observed closely. If cervical dilatation crosses the action line (4 hours to the right of the alert line), intervention may be necessary. The partogram is also used to record the fetal heart rate, descent of the fetal head, quality of uterine activity, and vital signs. Use of the partogram implies an adequate referral system and trained midwives who can perform vaginal examinations in labor and plot cervical dilatation accurately.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1987; 65(5):601-6.The 3rd meeting of the WHO Collaborating Centres on AIDS, held 6 June 1987, updated Centre representatives on the activities of WHO's Special Programme on AIDS and discussed technical matters such a definition, testing and diagnosis of AIDS. The special program is concentrating on the African and American regions, visiting countries, and holding workshops on topics such as training, case management and epidemiological surveillance. There will be 20 professional staff at WHO headquarters and 16 in the field. An advisory group on behavioral research met to establish social and behavioral priorities. A protocol for studies of seroprevalence is being developed. The technical topics discussed included widening the definition of AIDS cases to include wasting syndrome and dementia, as well as diagnosis of presumptive AIDS without availability of standardized tests. 3 Consensus statements were adopted, on HIV transmission, HIV infection in health workers, and on present and future status of laboratory tests for HIV. HIV should be continually isolated in various regions of the world to ensure that diagnostic tests reflect local virus strains. An agenda was proposed, including the next meeting to be held in Stockholm in June, 1988.
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.
[Study of the prevalence of STDs among pregnant Tunisian women, and a validation of the clinical algorithm proposed by the World Health Organization (WHO) for managing STDs] Etude de la prevalence des MST chez les femmes tunisiennes enceintes et validation de l'algorithme clinique propose par l'OMS pour la prise en charge des MST.
Contraception, Fertilite, Sexualite. 1999 Nov; 27(11):785-90.Sexually transmitted diseases (STDs) are public health problems in most of the world s countries because of their growing prevalence and their role as cofactors in HIV transmission. Results are presented from a study conducted on a sample of 409 pregnant Tunisian women during April-July 1996. These women underwent clinical and bacteriological exams as part of an assessment of the most frequently encountered STDs in the country. 1.7% of the women were under 20 years old and 6.6% were over age 40 years, although 30.1% of the women were 30-34 years old. 91% of the women were married, while 6.3% were divorced or unmarried. 65.7% were consulting health services to request an abortion. 42.3% of blood samples drawn were seropositive for the presence of STDs. The most often seen sexually transmitted agents were Trichomonas vaginalis with a prevalence of 5.6%, and Chlamydia trachomatis with a prevalence of 1.7%. No case of gonococcal infection was observed. Since this sample of women was comprised of pregnant women without any particular risk factors, these study results can be extrapolated to the general population. The WHO syndromic approach to STD management was also validated as a less than ideal tool, but one which is nonetheless highly useful when laboratory facilities are unavailable. The WHO approach also allows the diagnosis and treatment of the patient from the initial consultation.
Geneva, Switzerland, WHO, Action Programme for the Elimination of Leprosy, . vi, 106 p. (WHO/LEP/97.7)Elimination of leprosy by the year 2000--a goal set at the 1991 World Health Assembly--is a realistic possibility as a result of 10 years of successful experience with multidrug therapy. Almost all major endemic countries have implemented action programs to eliminate the disease. Key to leprosy elimination is making the World Health Organization (WHO)-recommended antileprosy drugs accessible to all patients, including those living in remote areas. This guide was prepared by WHO's Action Program for the Elimination of Leprosy to enable health workers in endemic countries (especially field workers) to contribute to this goal. It can be used for self-learning or for training courses. The pocket-sized guide includes information on the leprosy elimination strategy, diagnosis, classification of leprosy, organizing diagnostic services, treatment, management of complications, patient care and referral activities, and organizing multidrug therapy services.
[Children in poor countries also have a right to good health care. A new health care program will reduce child mortality] Aven barn v fattiga lander har ratt till god vard. Nytt omvardnadsprogram skall minska barnadodligheten.
LAKARTIDNINGEN. 1997 Oct 8; 94(41):3637-41.This article discusses the integrated management of childhood illness (IMCI) approach, developed by WHO and UNICEF based on international experience, which allows the care and treatment of sick children in countries with limited resources. It is estimated that every year 12 million children die in low-income countries before age 5. 70% of these deaths are related to common diseases: respiratory infections, diarrhea, measles, malaria, and malnutrition. The guidelines were developed for local health workers. Two flowcharts were designed for presenting the guidelines: one for children aged 1 week to 2 months and one for children aged 2 months to 5 years. For infants, the treatment of bacterial infections, diarrhea and feeding, and low weight are paramount. Fever and breathing difficulty may be the expression of severe general infection. The care of children aged 2 months to 5 years should consider four general warning symptoms: cramps, loss of consciousness, inability to drink or suckle, and constant vomiting. The presence of one of these symptoms indicates serious illness and the need for immediate care. Coughing and breathing difficulties are signs of severe pneumonia or serious respiratory illness, which requires transfer to a hospital after administering a dose of antibiotics. The use of trimethoprim-cotrimoxazole is recommended for treatment of pneumonia, while trimethoprim-sulfamethoxazole is indicated for malaria. The diagnosis, classification, and treatment of diarrhea is performed according to earlier WHO guidelines. General erythema and either coughing, a cold, or red eyes are the signs of measles.
SYNOPSIS. 1998 Jan; (2):1-8.The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
Integrated management of childhood illness: conclusions. WHO Division of Child Health and Development.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1997; 75 Suppl 1:119-28.Studies have helped improve the guidelines for the integrated management of childhood illness (IMCI) as well as the WHO/UNICEF training course for teaching those guidelines to health workers in first-level health facilities. Those guidelines can lead to the appropriate management of sick children by health workers in first-level facilities. Field studies' results on the effectiveness of the guidelines are presented and important issues to address are identified. The paper also describes the process for adapting program guidelines to specific country situations and presents the broader IMCI strategy and the status of its implementation in several countries as of May 1997. The following issues in need of further attention are discussed: the performance of lower chest wall indrawing as a sign for referral, the specificity of the clinical signs of malaria in settings of low malaria prevalence, the performance of clinical signs in detecting anemia, and the performance of the guidelines in identifying children in need of referral. Program strategy objectives are to reduce the levels of child morbidity and mortality in developing countries, and to enhance child growth and development. IMCI activities are therefore organized to improve health workers' skills, health systems, and family and community practices.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1997; 75 Suppl 1:65-75.Findings are presented from a study conducted to evaluate and improve the integrated management of childhood illness (IMCI) training program guidelines on identifying young infants and children who need to be referred to hospitals in an area of low malaria prevalence. 234 infants aged 1 week to 2 months and 668 children aged 2 months to 5 years were prospectively sampled from patients who presented at a children's hospital in Dhaka, Bangladesh. Pediatricians obtained standardized histories from the patients and conducted a physical examination. The IMCI's sensitivity relative to a pediatrician's assessment in favor of hospital admission was 84% for young infants and 86% for children, while specificities were 54% and 64%, respectively. 25% or more of both young infants and children were provisionally diagnosed with pneumonia. The IMCI's specificity increased without reducing sensitivity by changing the respiratory signs demanding referral. Study findings indicate that the IMCI is sensitive enough to result in the proper referral of young infants and children in need of hospital admission in a developing country setting with a low prevalence of malaria.