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Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia.
International Journal of Tuberculosis and Lung Disease. 2013 Dec; 17(12):1518-23.SETTING: Achieving the World Health Organization (WHO) target of zero paediatric tuberculosis (TB) deaths will require an understanding of the underlying risk factors for mortality. OBJECTIVE: To identify risk factors for mortality and assess the impact of human immunodeficiency virus (HIV) testing during anti-tuberculosis treatment in children in 13 TB-HIV programmes run by Medecins Sans Frontieres. DESIGN: In a retrospective cohort study, we recorded mortality and analysed risk factors using descriptive statistics and logistic regression. Diagnosis was based on WHO algorithm and smear microscopy. RESULTS: A total of 2451 children (mean age 5.2 years, SD 3.9) were treated for TB. Half (51.0%) lived in Asia, the remainder in sub-Saharan Africa; 56.0% had pulmonary TB; 6.4% were diagnosed using smear microscopy; 211 (8.6%) died. Of 1513 children tested for HIV, 935 (61.8%) were positive; 120 (12.8%) died compared with 30/578 (5.2%) HIV-negative children. Risk factors included being HIV-positive (OR 2.6, 95%CI 1.6-4.2), age <5 years (1.7, 95%CI 1.2-2.5) and having tuberculous meningitis (2.6, 95%CI 1.0-6.8). Risk was higher in African children of unknown HIV status than in those who were confirmed HIV-negative (1.9, 95%CI 1.1-3.3). CONCLUSIONS: Strategies to eliminate childhood TB deaths should include addressing the high-risk groups identified in this study, enhanced TB prevention, universal HIV testing and the development of a rapid diagnostic test.
Journal of the Pakistan Medical Association. 2004 Apr; 54(4):175-181.Objectives: There are two objectives: (a) to clearly articulate the Millennium Development Goals (MDGs) adopted by the United Nations in 2000 and their implications for developing countries like Pakistan; and (b) to critically review the challenges faced by Pakistan in achieving the health-related MDGs. Methods: A critical review of secondary data and information generated primarily by multilateral agencies and United Nations organizations. Results: The MDGs represent a global consensus on the broad goals of development to be achieved by 2015. Of the eight Millennium Development Goals, three are specifically health related - reducing infant (under-5) and maternal mortality; and combating HIV/AIDS, tuberculosis, malaria and other significant communicable diseases. According to various studies, many developing countries will not achieve the MDGs without concerted efforts and commitment of additional resources. Like many other developing countries, Pakistan is also faced with an enormous challenge in reaching the Millennium Development Goals and targets set by the United Nations. For Pakistan, perhaps the most challenging MDG is that of reducing "by three-quarters the maternal mortality ratio." Maternal mortality is so intertwined with other "social" factors - including the status of women - that a comprehensive holistic approach is required. Conclusion: In order to achieve the MDGs, Pakistan would require a fundamental shift in its policy and strategic directions. Along with allocation of significant additional resources for health, it needs to review and reprioritize the use of existing resources, focusing more on primary health care. Pakistan must also adopt a holistic integrated approach that views health, education, and other social sector development as intrinsically interrelated and interwoven. Without such an integrated approach, achieving the health-related MDGs is likely to remain illusive for Pakistan. There is a critical need to foster a healthy debate on the health-related Millennium Development Goals in Pakistan so as to inform and, hopefully influence, public policy. (author's)
Implementing the ICPD Plan of Action in Central Asian Republics and Kazakhstan (CARAK). Kyrgyzstan. Breast-feeding is best.
ENTRE NOUS. 1995 May; (28-29):11.The socioeconomic problems which began in Kyrgyzstan in 1990 have impacted on the health of the people living there. A major decline in income, living standards, and social security is reflected in the low fertility rate, high maternal and infant mortality, and shorter life expectancy. Tuberculosis, viral hepatitis, anemia, hypertrophy, and rachitis have become very common in young children. In order to remedy this situation, breast feeding has gained the importance of a national program. Other unresolved issues include the high neonatal mortality rate, and the increasing maternal mortality rate (from 76.4 per 100,000 live births in 1991 to 84.2 per 100,000 currently). There has been a functioning family planning service and a system of social patronage since 1989. In the latter system, a social worker takes charge of families at risk. One worker on average attends 30 families. The International Planned Parenthood Federation has financed 689 social patronage workers over the past year. International organizations have supported the supply of contraceptives through humanitarian aid. Because of this, the number of women accepting family planning is rising and the fertility rate is decreasing (from 28.2 per 1000 in 1991 to 26.9 in 1993).
[Unpublished] 1992. , 15 p. (WHO/GPA/RES/SFI/92.1)A summary of current state and future trends to HIV infections and AIDS cases in world regions prepared from the most recent information on file at the WHO Global Programme on AIDS as of January 1992. HIV infection and AIDS began in the 1980s or earlier in homosexual or bisexual men and intravenous drug users in urban Americas, Australia, and Western Europe, and in heterosexuals in East and Central Africa. There is another virus called HIV-2 with a lower virulence, but similar mode of transmission and clinical syndrome prevalent in West Africa. By 1992 450,000 AIDS cases were reported to WHO, but about 1.5 million AIDS cases are thought to have occurred, including 500,000 in children. About 9-11 million HIV infections, including 1 million in children, are estimated to exist. In Australia, North America, and Western Europe, spread of HIV to homosexuals has decreased, but growth in the intravenous drug-using population and heterosexuals may still occur. In Latin America prevalence is high in homosexual or bisexual men, injecting drug users, and prostitutes, and is increasing dramatically in women. In Africa heterosexual transmission is still the rule; infections from blood products account for about 10% of cases. In East and Central Africa 2/3 of the HIV cases are in 9 countries, where urban HIV prevalence reaches 25-33% in adults. In Africa there is also a growing problem of 750,000 pediatric AIDS so far, and possible 10 million orphans in the 1990s. Spread of HIV in high risk populations in South East Asia is rapid, notably in Bangkok, Thailand, in Yangon, Myanmar, and in Bombay and in northeastern India. The potential for spread in this region is a great concern. Areas of East Asia contiguous with South East Asia are also at risk. In Eastern Europe there are clusters of outbreaks related to improper use of blood products. WHO predicts that 4 million people have HIV and TB. WHO projects that global HIV infection will amount to 15-20 million by 2000. A major research topic and concern is estimation of when and at what level HIV prevalence will peak in world regions.
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.