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2016 Oct; New York, New York, UNICEF, 2016 Oct. 100 p.This report looks at how children, particularly the most disadvantaged, are affected by air pollution. It points out that around 300 million children live in areas where the air is toxic – exceeding international limits by at least six times – and that children are uniquely vulnerable to air pollution, breathing faster than adults on average and taking in more air relative to their body weight. The report also notes that air pollution is a major contributing factor in the deaths of around 600,000 children under age 5 every year and threatens the health, lives and futures of millions more. It concludes with a set of concrete steps to take so that children can breathe clean, safe air.
Performance of the new WHO diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV prevalent settings: a multisite study in Uganda.
Tropical Medicine and International Health. 2012 Jul; 17(7):884-95.OBJECTIVE: To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03). METHODS: A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum community-based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV-infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints. RESULTS: WHO07 reduced the time to diagnosis of smear-negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear-negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 vs. 28.5 days, P = 0.003). Diagnostic specificity and sensitivity [95% confidence intervals (CIs)] for smear-negative PTB were higher at the rural hospital compared with the urban ASO: [98% (93-100%) vs. 86% (77-92%), P = 0.001] and [95% (72-100%) vs. 90% (54-99%), P > 0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow-up appointments and poor adherence by healthcare workers to algorithms. CONCLUSION: At both sites, WHO07 expedited diagnosis of smear-negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource-limited settings. (c) 2012 Blackwell Publishing Ltd.
[Clinical, epidemiological and microbiological characteristics of a cohort of pulmonary tuberculosis patients in Cali, Colombia] Caracteristicas clinicas, epidemiologicas y microbiologicas de una cohorte de pacientes con tuberculosis pulmonar en Cali, Colombia.
Biomedica. 2010 Oct-Dec; 30(4):482-91.INTRODUCTION: The World Health Organization recommended strategy for global tuberculosis control is a short-course, clinically administered treatment, This approach has approximately 70% coverage in Colombia. OBJECTIVE: The clinical, epidemiological and microbiological characteristics along with drug therapy outcomes were described in newly diagnosed, pulmonary tuberculosis patients. MATERIALS AND METHODS: This was a descriptive study, conducted as part of a multicenter clinical trial of tuberculosis treatment. A cohort of 106 patients with pulmonary tuberculosis were recruited from several public health facilities in Cali between April 2005 and June 2006. Sputum smear microscopy, culture, drug susceptibility tests to first-line anti-tuberculosis drugs, chest X- ray and HIV-ELISA were performed. Clinical and epidemiological information was collected for each participant. Treatment was administered by the local tuberculosis health facility. Food and transportation incentives were provided during a 30 month follow-up period. RESULTS: The majority of patients were young males with a diagnostic delay longer than 9 weeks and a high sputum smear grade (2+ or 3+). The initial drug resistance was 7.5% for single drug treatment and 1.9% for multidrug treatments. The incidence of adverse events associated with treatment was 8.5%. HIV co-infection was present in 5.7% of the cases. Eighty-six percent of the patients completed the treatment and were considered cured. The radiographic presentation varied within a broad range and differed from the classic progression to cavity formation. CONCLUSION: Delay in tuberculosis diagnosis was identified as a risk factor for treatment compliance failure. The study population had similar baseline epidemiologic characteristics to those described in other cohort studies.
The World Health Organization / International Union against Tuberculosis and Lung Disease Global Project on Surveillance for Anti-Tuberculosis Drug Resistance: a model for other infectious diseases.
Clinical Infectious Diseases. 2005; 41 Suppl 4:S258-S262.Tuberculosis remains a global epidemic, with one-third of the population infected and 9 million active cases. Mono- and multidrug resistance in 6 World Health Organization (WHO) regions have been assessed in 40% of the global cases diagnosed by positive results of sputum testing. The 2004 report of the WHO Global Project on Anti-Tuberculosis Drug Resistance Surveillance confirms earlier findings that drug-resistant tuberculosis is ubiquitous and that multidrug-resistant tuberculosis has increased alarmingly. Control of tuberculosis, which is undermined by the human immunodeficiency virus (HIV) epidemic, is seriously jeopardized by multidrug resistant strains, for which treatment is complex, more costly, and less successful. Challenges for high-burden countries include implementation of the DOTS strategy and management of identified multidrug resistance with DOTS-Plus. Strengthening of the laboratory network in conjunction with improvement of surveillance, elucidation of the impact of HIV on transmission of tuberculosis and on amplification of resistance at individual and population levels, and implementation of private sector policies on drug resistance are imperative. New diagnostic tools and drugs are needed to expedite early detection and cure of multiresistant strains. (author's)
[Geneva, Switzerland], WHO, 1991 Dec.  p. (WHO/GPA/IDS/HCS/91.6)Infections and tumours are the paramount clinical problems confronting health care providers caring for patients with HIV-related disease. Treatment of these infections and tumours is of great importance as it decreases suffering and prolongs life in the absence of effective and non-toxic antiretroviral drugs or immunotherapy against HIV itself. However, clear treatment guidelines are lacking in many parts of the world and health care workers have often not received training in the management of HIV-related disease. To respond to this situation, the WHO Global Programme on AIDS (GPA) has developed guidelines for the clinical management of HIV infection in adults. There are wide variations in the presentation of HIV-related diseases, availability of resources and health infrastructures. It is hoped that the guidelines will provide a model to assist all countries, but especially those in the developing world, to formulate national guidelines in accordance with their own particular needs and resources. Adaptation of these guidelines should take place through national/institutional workshops. The guidelines represent the consensus of a number of clinical experts working in this area, and will be revised from time to time in the light of experience. Comments are welcome and should be sent to the Global Programme on AIDS, World Health Organization, 1211 Geneva 27, Switzerland. (excerpt)
DOTS versus self administered therapy (SAT) for patients of pulmonary tuberculosis: a randomised trial at a tertiary care hospital.
Indian Journal of Medical Sciences. 2002 Jan; 56(1):19-21.Tuberculosis is a major public health problem in India, and it is being made worse by poor adherence to and frequent interruption of antitubercular treatment. Directly observed therapy short course (DOTS), is one of the key elements in the WHO global tuberculosis control programme strategy and has been widely publicized as a breakthrough and strongly promoted globally by WHO. However little or no randomised data exists of comparison between DOTS versus self administered therapy (SAT). The present study is an effort in this direction to compare adherence and outcome after random allocation of patients to directly observed therapy (DOTS) or self administered therapy (SAT). (author's)
The World Health Organization guidelines for air quality. Part 2: Air-quality management and the role of the guidelines. [Recomendaciones sobre calidad del aire de la Organización Mundial de la Salud. Parte 2: Manejo de la calidad de aire y papel de las recomendaciones]
EM. The Urban Environment. 2000 Aug; 23-27.In Part 1 of this article (July 2000, pp 29-34), the revised and updated guidelines for air pollutants were presented. It was emphasized that the guideline values and exposure-response relationships should be considered in the framework of air-quality management. Air-quality management is important for several reasons, which become particularly clear if one is looking at the estimated global burden of disease caused by air pollution. Recent estimates of mortality and morbidity caused by indoor and ambient air pollutions are reproduced in Figures 1 and 2. Figure 1 illustrates the daily mortality for urban ambient air exposure, urban indoor air exposure, and rural indoor air exposure as potentially caused by particulate matter in eight regions: Established Market Economies (EME); Eastern Europe (EE); China; India; SoutheastAsia/Western Pacific (SEAWP); Eastern Mediterranean (EM); Latin America (LA); and SubSaharan Africa (SSA). On a global scale, air-pollution-related mortality accounts for 4% to 8% of the total death rate of 52.2 million annually. Figure 2 estimates the number of people with respiratory diseases potentially caused, or exacerbated by, exposure to suspended particulate matter (SPM). Accordingly, between 20% and 30% of 760 million cases of respiratory diseases recorded annually may be affected by suspended particulate matter. These estimates, when viewed along with the existing information on the health effects of air pollution, lead to the conclusion that controlling sources of ambient and indoor air pollution is necessary to avoid a significant increase in the burden of disease it can cause. This issue is addressed in the World Health Organization 19996 Guidelines for Air Quality (hereafter referred to as Guidelines). In Part 2 of this article, we describe the main statements in the Guidelines with respect to ambient and indoor air management. (excerpt)
The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective.
Bulletin of the World Health Organization. 2002; 80(6):471-6.The development of WHOs directly observed treatment, short course (DOTS) strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation, and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multi-country projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programs. In 1998, an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multi-drug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. The authors discuss the prerequisites for success, the shortcomings of this WHO-supported program, and future challenges and needs. (author's)
CLINICAL INFECTIOUS DISEASES. 1995 Dec; 21 Suppl 3:S213-7.Pneumonia is one of the leading causes of morbidity and mortality among children in many developing countries. To address this public health problem, the World Health Organization developed a standard case management program for pediatric pneumonia. Clinical diagnosis involves mainly an evaluation of chest movement and a determination of respiratory rate. Mild pneumonia is treated with trimethoprim-sulfamethoxazole, procaine penicillin, ampicillin, or amoxicillin. Severe pneumonia with chest indrawing is treated for at least 3 days with either benzylpenicillin or ampicillin. After clinical improvement of the child with severe pneumonia, therapy is changed to intramuscular procaine penicillin, oral ampicillin, or oral amoxicillin, in the dosages given for mild pneumonia, for at least 5 days. Antimicrobials are then given for 3 days after the child is well. This paper summarizes the implementation and efficacy of the World Health Organization's standard case management program for pediatric pneumonia in three counties in China and in the Western Division of Fiji. Information provided through the program was simple enough to be understood by parents and health care workers with a basic educational background. The program reduced mortality from pneumonia even when implemented through the existing health care system in a relatively poor county in China. Parents' improved recognition of the signs of childhood pneumonia, the earlier presentation of children with those signs to health care facilities, the availability of antimicrobial agents at the primary health care level, and rational decision making by health care workers about treatment were important factors in program success.
In: Health care of women and children in developing countries, [edited by] Helen M. Wallace, Kanti Giri. Oakland, California, Third Party Publishing, 1990. 349-63.Acute Respiratory Infections (ARI) are a major health problem for children throughout the world. This problem is particularly serious in developing countries where the mortality due to ARI may reach 1000 or more/100,000 live-births. Several reasons are given for the high rate of mortality from ARI in developing countries including poverty, malnutrition, ignorance, lack of and underutilization of health facilities, and predominance of bacterial etiology of pneumonia. the World Health Organization (WHO) has proposed that ARI be classified on the basis of clinical severity as mild, moderate, or severe. The 3 clinical manifestations are respiratory rate greater then 50/minute, presence of chest indrawing, and inability to drink. The 1st section of this chapter provides information about the etiology and clinical management of ARI. Table 1 provides a list of the viral and bacterial etiologic agents of common ARI. Recommendations for the clinical management of the common cold, acute otitis media, acute sinusitis, sore throat, infectious croup, pertussis, bronchiolitis, and pneumonia are provided. Measles is also discussed because of the fatality rate due to post-measles pneumonia. The authors state that there is an urgent need for systematic studies to identify the causative bacteria responsible for post-measles pneumonia. They identify Staph aureus as the most common recognizable bacterial invader in such patients. The 2nd section in the chapter is about supportive therapy in ARI. According to the authors, the effectiveness of supportive therapy has not been tested by controlled trials. Steam, cough suppressants, expectorants, nasal decongestants, mucolytics, and anti-histamines are listed as ineffective supportive measures that need not be encouraged. It is advised that fluid intake be adequate and breast feeding is continued. Nursing should take place in a neutral environmental temperature. If axillary temperature exceeds 38.5 degrees celsius, Paracetamol (10-15 mg/kg/dose orally) should be given every 6 hours. Oxygen is recommended if respiratory rate is more than 70/minute, or if the child has a wheeze or cyanosis. The third section describes the WHO standard case management protocol and the ARI programs. The major emphasis of the program is the prevention of death from pneumonia. The WHO and UNICEF recommend that ARI control programs have health education, standard case management, and immunization. Standard case management involves the discrimination of severity, use of antimicrobials on the village level, and referral of severe cases. Table 3 provides the specific symptoms associated with mild, moderate, and severe ARI and the appropriate treatment intervention. In the area of prevention, the benefits of diphtheria, pertussis, and measles immunization is well established. Efforts to promote breast feeding, reduce the incidence of low birth weight, and keep children away from crowded areas may also help prevent ARI.
MEDICAL JOURNAL OF AUSTRALIA. 1990 Dec 3-17; 153(11-12):635-7.While most infant-related health problems in the Third World can be attributed to commonplace diseases, the lack of resources necessary to implement Western styles of medicine suggests the need for new strategies -- those that rely less on technology and more on grass roots efforts. Most illnesses in the developing world are the result of the top 5-10 diseases. Of the 4 million deaths from pneumonia each year, 97% take place in the Third World. Measles causes the yearly deaths of 1.6 million. Many of these diseases have been eradicated in the West; the others can be easily treated. But in the 3rd World, health problems are compounded by the fact that attention is often sought late, as well as the lack of doctors and nurses. Most of those with Western-style medical training rarely practice in rural or urban slum areas. One strategy to meet these difficulties is to train personnel on how to diagnose and treat these 5-10 common diseases without them having to go through Western-style training -- reminiscent of the famous "barefoot doctors" of China. These local health workers can more easily meet the health needs of isolated areas, since they can be trained to carry out immunization, and teach nutrition and family planning. Furthermore, this strategy does not rely on high technology, following instead the scheme laid out by acronym GOBI -- Growth monitoring. Oral rehydration therapy, Breast feeding, and Immunization. Developed nations can help in this effort by supporting WHO, UNICEF and other international organizations, as well as sending personnel to work in 3rd World countries. While individual 3rd World nations must confront these problems, worldwide social, political, and economic changes will be necessary.
[Arlington, Virginia], Management Sciences for Health, Technologies for Primary Health Care [PRITECH] Project, 1987. iii, 36 p. (USAID Contract No. AID/DPE-5927-C-00-3083-00; PN-AAY-O22)Children <5 years old comprise 18% of the population of Senegal yet >50% of all deaths include these children. The leading causes of death for them include diarrhea, respiratory infections, malaria, measles, and tetanus, all of which can be prevented or treated. However, the health system cannot deliver the needed services to the children when these services are needed. The Child Survival Strategy for Senegal, a planning document for developing an action plan, has been designed to improve the delivery of these interventions. For example, Senegal targeted the immunization of 75% of all children <2 years old by April 30, 1987. This accelerated program caused some areas of infrastructure to be overlooked, e.g., maintenance of equipment, however. The Strategy recommended that the country develop a mechanism to fund and repair equipment, and target all children <1 year old (those at highest risk) rather than those <2 years old. Senegal has a diarrhea control program which uses home mix sugar salt solution at home and oral rehydration salts at health facilities. Yet this program had not been evaluated, so the Strategy suggested that it be evaluated and that the program widen the use of oral rehydration therapy through increased training of all health providers. Since child spacing and antenatal care have a significant impact on infant mortality, the Strategy recommended that the Ministry of Health sensitize itself to this and to the very low prevalence of contraceptive use and operate accordingly. Another recommendation was for Senegal to formulate a strategy for dealing with the unavailability of chloroquine during the rainy season when malaria transmission is at its peak. Other interventions where USAID could make contributions to child survival included national direction and coordination, expansion of the Rural Health Services Project Model, and self-financing.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1988; 41(3-4):267-73.Because declining mortality from infectious diseases is accompanied by increasing mortality from noncommunicable diseases in both developed and developing countries, the World Health Organization (WHO) has initiated the Integrated Program for Community Health in Noncommunicable Diseases (Interhealth). Interhealth is based on the concepts that 1) noncommunicable diseases are related to a set of risk factors some of which can be controlled; 2) the entire community must be involved; 3) health promotion intervention strategies, such as population control, risk identification, screening and prevention strategies, must be integrated; 4) different categories of intervention (e.g., lifestyle changes, health care reorganization) must be coordinated; 5) social and environmental changes will be necessary; and 6) noncommunicable disease prevention and control strategies will be implemented through existing primary health care systems. The core program of Interhealth addresses heart diseases, stroke, diabetes, cancer, and respiratory diseases from the point of view of their common risk factors: diet, tobacco, physical activity, environment, oral hygiene, blood pressure, lipids, and glucose. The Interhealth program is being developed as a dynamic system, consisting of 4 main activities: experimental testing by means of demonstration projects (of which there are currently 18 in 15 countries); mathematical modeling of disease/risk factor interrelations; training; and research activities. These activities will be supported by organizational, financial and information activities at WHO headquarters and in the WHO Regional Offices.
DEVELOPMENT FORUM. 1988 Mar-Apr; 16(2):11, 14.Facts for Life is a 50-page compilation of priority messages focussed on infant and child health and designed to reach parents directly, so that they will have the facts they need to keep their children alive and healthy. The "Facts for Life" initiative is expected to reach the parents through a grand alliance of communicators -- nongovernmental organizations and individuals -- who come directly into contact with parents. The initiative has the backing of the World Health Organization (WHO) and the UN Children's Fund (UNICEF). It is also supported by nongovernmental networks such as the Children, Rotary, and Junior Chambers of Commerce as well as officials of the International Pediatrics Association, London University Institute of Child Health, and the Johns Hopkins University School of Hygiene and Public Health. Topics covered in the "Facts for Life" messages include safe motherhood, breast feeding, immunization, acute respiratory infections, malaria, timing births, promoting child growth, diarrhea, home hygiene, and AIDS. The booklet is available in English, French, Spanish, Portuguese and Arabic for 25 cents (US) a copy from UNICEF.