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Lancet. 2010 Oct 30; 376(9751):1439-40.This commentary discusses how the pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria from countries, the private sector, and innovative funding sources have fallen short of the demand estimates, despite the pledged sum being the largest amount ever mobilized for global health. The US $11.7 billion pledge for the 2011-2013 time range is an increase of more than 20% over 2007-2010 and will go toward maintaining programs at their current scale and support further significant expansion of health services in many countries. It explains that the shortfall to meet the $13 billion will result in challenging decisions about which new programs to support and a slower rate of scale-up for new programs.
Obstetrics and Gynecology. 2007 Nov; 110(5):999-1002.Family planning plays a pivotal role in population growth, poverty reduction, and human development. Evidence from the United Nations and other governmental and nongovernmental organizations supports this conclusion. Failure to sustain family planning programs, both domestically and abroad, will lead to increased population growth and poorer health worldwide, especially among the poor. However, robust family planning services have a range of benefits, including maternal and infant survival, nutrition, educational attainment, the status of girls and women at home and in society, human immunodeficiency virus (HIV) prevention, and environmental conservation efforts. Family planning is a prerequisite for achievement of the United Nations' Millennium Development Goals and for realizing the human right of reproductive choice. Despite this well-documented need, the U.S. contribution to global family planning has declined in recent years. (author's)
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
Lancet. 2007 Feb 24; 369(9562):626-627.In today's Lancet, Longde Wang and colleagues report on many remarkable recent improvements in the control of tuberculosis in China. The progress is good news in view of the size and global importance of the tuberculosis burden in China and the faltering of control in the 1990s, as noted by Wang. The fruitful partnership with WHO, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and several governments and non-governmental organisations is also noteworthy, as is the commitment to transparent reporting and health-system reform in China today in the environment after the outbreak of severe acute respiratory syndrome. Better control of tuberculosis in China is also timely in view of the high rates of multidrug resistance, and the emergence of HIV infection in some population subgroups also at high risk of tuberculosis. One group of special concern are work migrants, most often poor young men, who leave the countryside to join the wage economy in towns and cities all over China. Some come from areas such as Henan Province where huge numbers of peasants were infected with HIV from scandalous plasma--donor practices in the 1990s. Many male migrants are at risk of unprotected sex when away from home. And men are also at higher risk of tuberculosis than women in China because the male-to-female ratio of adults with pulmonary tuberculosis is about 2:1 or more, reflecting a real risk excess rather than differential detection or notification. So several factors converge in young male migrant workers to put them at risk of both HIV and tuberculosis, and this convergence must be of great concern. (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)
Emerging Infectious Diseases. 2006 Sep; 12(9):1311-1318.Most high-income countries implement tuberculosis (TB) infection control programs to reduce the risk for nosocomial transmission. However, such control programs are not routinely implemented in India, the country that accounts for the largest number of TB cases in the world. Despite the high prevalence of TB in India and the expected high probability of nosocomial transmission, little is known about nosocomial and occupational TB there. The few available studies suggest that nosocomial TB may be a problem. We review the available data on this topic, describe factors that may facilitate nosocomial transmission in Indian healthcare settings, and consider the feasibility and applicability of various recommended infection control interventions in these settings. Finally, we outline the critical information needed to effectively address the problem of nosocomial transmission of TB in India. (author's)
IMPO NEWSLETTER. 1998 Dec; 3.Worldwide, 2-3 million people die annually from tuberculosis (TB). Unless concerted efforts are taken in Asia, the TB epidemic will continue to worsen, jeopardizing global control efforts. At a 4-day conference in Bangkok of more than 1500 lung disease experts, Dr. Heidi Larson, a senior World Health Organization official, noted that the economic crisis in southeast Asia has increased the risks of TB spreading throughout the region. The danger of a major resurgence of TB has been made worse by drug resistance developed as a result of haphazard treatment of the condition in poor countries. Malnutrition and generally worsening health problems caused by the economic crisis have increased the likelihood of people developing active TB because they have weakened immune systems. Interruptions of drug supplies also broaden the scope for the development of drug-resistant TB. The World Health Organization has identified China, India, and Indonesia as the countries which have experienced the most dramatic increases in cases of active TB. TB can be cured on a large scale, but both national and international political commitment are needed.
BMJ (CLINICAL RESEARCH ED.). 1998 Mar 28; 316(7136):957.The World Health Organization's (WHO) directly observed treatment short course (DOTS) strategy consists of health care or community workers who directly observe tuberculosis (TB) patients ingest their anti-TB treatment. Treatment, usually with 5 drugs, lasts for 6 months and costs about $11 per patient for the course. DOTS also involves the establishment of case detection and monitoring systems. DOTS is ranked by the World Bank as one of the most cost effective of all health interventions. The treatment success rate of TB cases in areas where DOTS is operating was 78% compared with 45% in areas which do not use the strategy. 22 countries account for 80% of TB cases worldwide. However, only 3 of the countries, Peru, Tanzania, and Vietnam, have made good progress in controlling TB by using DOTS, while Bangladesh, China, and Congo are making some progress. Brazil, Indonesia, Iran, Mexico, Philippines, Russia, South Africa, Thailand, Afghanistan, Ethiopia, India, Myanmar, Nigeria, Pakistan, Sudan, and Uganda have moved too slowly to implement the DOTS strategy and are making no progress against TB. These latter countries will play a major role in the world's failure to control TB by 2000. The failure to control TB is due not so much to a lack of finances as it is to a lack of political will and commitment.
WORLD HEALTH FORUM. 1997; 18(3-4):225-32.The Directly Observed Treatment, Short-course (DOTS) therapy against tuberculosis (TB) adopted by the World Health Organization (WHO) 5 years ago has proven to be highly effective in curing and controlling the spread of TB. DOTS now needs to be used worldwide on a much larger scale. More than 1.2 million people worldwide have been treated with DOTS since it was adopted by WHO 5 years ago as the preferred strategy against TB. Most patients have been young and middle-aged adults, of whom more than 900,000 had the infectious, smear-positive form of the disease. Had these patients had access to only the treatment previously available in their countries, many would have certainly died and many more would have become chronic cases, spreading the disease in their communities. Such chronic cases resulting from poor or interrupted treatment become the main source of drug-resistant TB strains. The following components must be in place in order to launch a successful DOTS program: a network of trained workers able to administer DOTS for at least the first 2 months; laboratories with personnel trained and equipped to recognize tubercle bacilli in sputum smear samples; a dependable supply of high-quality drugs; an accurate record-keeping and cohort analysis system for monitoring case-finding, treatment, and outcomes; and sustained political commitment and funding.
AFRICA HEALTH. 1997 Nov; 20(1):21-2.Directly observed treatment short course (DOTS) is the World Health Organization's (WHO) recommended strategy for eradicating tuberculosis (TB). Although DOTS involves 5 key elements, watching TB patients swallow their drugs is the core of the approach. WHO insists that patients, especially if smear positive, must have every dose observed, even those on ambulatory treatment. People should come to health facilities to have their treatment observed. Where that is not possible, a community health worker or community leader should observe. The WHO DOTS strategy is not easy to implement, but evidence suggests that it is a feasible, necessary, and effective strategy for controlling TB. It is, however, possible that good quality TB care including health education, microscopy, drugs, and follow-up can be made effective without direct observation. Operational research is needed to determine whether such observation is necessary. Every country needs to evaluate DOTS within its own context.
Lancet. 1997 Jul 12; 350(9071):149.The global incidence of tuberculosis (TB) is increasing even though the tubercle bacillus already kills more people than any other infectious agent. The World Health Organization (WHO) recently announced a way to control TB. The approach is called directly-observed therapy, short-course (DOTS), and involves a regimen of three or four drugs over the course of 6-9 months, with monitoring by a health worker or other volunteer to verify that each dose of medicine is taken. By ensuring that all patients with TB are provided appropriate treatment and supervision, WHO projects that the annual number of TB cases will be halved in the next decade. The WHO press release mentioned no need for better tools or further research into TB. However, while DOTS is the best currently available approach against TB and it can provide very high cure rates for most patients reached, biomedical research must continue and public awareness be kept high. Only 5-10% of patients are currently being reached by DOTS. The widest possible implementation of DOTS should be among the top priorities on the world's health care agenda.
ECONOMIST. 1993 Nov 13; 99-100.The World Health Organization (WHO) eradicated smallpox in 1977. This was the first time that an effective vaccine disseminated through a systematically organized inoculation program had been so successful. In the aftermath, WHO launched the Expanded Program on Immunization (EPI) with the objective of eradicating measles, diphtheria, whooping cough, tetanus, tuberculosis, and polio. These diseases were chosen because all caused major child mortality and effective vaccines existed against each. After 16 years, 80% of the world's children have been immunized and many lives have been saved, but only patchy geographical coverage of immunizations has been achieved and each targeted disease in still with us. In light of this situation, program critics saw the need to take an alternative approach and launched the Children's Vaccine Initiative (CVI) in 1990. EPI concentrated on increasing the effectiveness of bureaucracy to delivery vaccines, but 5 clinic visits in the first 15 months of the baby's life were nonetheless needed for a complete regimen of inoculations against all 6 target diseases. The WHO bureaucracy had trouble incorporating improved vaccines as they were developed and in maintaining the cold chain. The CVI, however, has only minority participation by WHO and the different strategy of focusing upon the development of simpler, more robust vaccines. The CVI is striving to develop a combined vaccine against all 6 diseases which would be affordable, unaffected by changing temperatures, and administered orally in 1 dose shortly after birth. The WHO chief, Nakajima, conceded to the flaws of EPI and agreed to merge the program and its resources with CVI in January, 1994. This move will bring a great deal of program money to CVI. Regarding specific technologies, Virogenetics of Troy, New York, is testing canary-pox-based vaccines on people with the goal of securing a vaccine capable of effectively carrying 7 different antigens. Timed-release capsules are being tested as a means of dealing with the need for repeated doses and it appears that using heavy water to make polio vaccine increases the latter's resistance to heat; researchers are trying to find out why.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(6):779-89.5-15% of all 3-15 year old children in the world are mentally impaired. In fact, 0.4-1.5% (10-30 million) are severely mentally retarded and an additional 60-80 million children are mildly or moderately mentally retarded. Birth asphyxia and birth trauma account for most cases of mental retardation in developing countries. >1.2 million newborns survive with severe brain damage and an equal number die from moderate or severe birth asphyxia. Other causes of mental retardation can also be prevented or treated such as meningitis or encephalitis associated with measles and pertussis; grave malnutrition during the 1st months of life, especially for infants of low birth weight; hyperbilirubinemia in neonates which occurs frequently in Africa and countries in the Pacific; and iodine deficiency. In addition, iron deficiency may even slow development in infants and young children. Current socioeconomic and demographic changes and a rise in the number of employed mothers may withhold the necessary stimulation for normal development from infants and young children. Primary health care (PHC) interventions can prevent many mental handicaps. For example, PHC involves families and communities who take control of their own care. Besides traditional birth attendants, community health workers, nurse midwives, physicians, and other parents must also participate in prevention efforts. For example, they should be trained in appropriate technologies including the risk approach, home risk card, partograph, mouth to mask or bag and mask resuscitation of the newborn, kick count, and ictometer. WHO has field tested all these techniques. These techniques not only prevent mental handicaps but can also be applied at home, health centers, and day-care centers.
USAID HIGHLIGHTS. 1991 Fall; 8(3):1-4.This article considers the epidemic proportion of AIDS in developing countries, and discusses the U.S. Agency for International Development's (USAID) reworked and intensified strategy for HIV infection and AIDS prevention and control over the next 5 years. Developing and launching over 650 HIV and AIDS activities in 74 developing countries since 1986, USAID is the world's largest supporter of anti-AIDS programs. Over $91 million in bilateral assistance for HIV and AIDS prevention and control have been committed. USAID has also been the largest supporter of the World Health Organization's Global Program on AIDS since 1986. Interventions have included training peer educators, working to change the norms of sex behavior, and condom promotion. Recognizing that the developing world will increasingly account for an ever larger share of the world's HIV-infected population, USAID announced an intensified program of estimated investment increasing to approximately $400 million over a 5-year period. Strategy include funding for long-term, intensive interventions in 10-15 priority countries, emphasizing the treatment of other sexually transmitted diseases which facilitate the spread of HIV, making AIDS-related policy dialogue an explicit component of the Agency's AIDS program, and augmenting funding to community-based programs aimed at reducing high-risk sexual behaviors. The effect of AIDS upon child survival, adult mortality, urban populations, and socioeconomic development in developing countries is discussed. Program examples are also presented.
Report of a technical advisory meeting on research on AIDS and tuberculosis, Geneva, 2-4 August 1988.
[Unpublished] 1989. 21 p. (WHO/GPA/BMR/89.3)A technical advisory meeting on research on AIDS and tuberculosis was held to review and prioritize ongoing and planned research in the field, suggesting essential studies and study design. Studies in need of international collaboration, as well as subjects not covered by ongoing and planned research were considered, with attention given to recommending frameworks for development. The final major objective of the meeting was to determine key areas of TB programs requiring strengthening to facilitate such research, and to suggest developmental steps for improvement. The report provides opening background information of tuberculosis, AIDS, and the relationship between the 2, then launches into a discussion of urgently needed research. Epidemiological, diagnostic, clinical presentation, prevention, and treatment studies are called for under this section heading, each sub-section providing objectives, justification, and specific research questions. Design examples for selected research studies constitute an annex following the main body of text. When planning for action on suggested research, the report acknowledges the need for resources, organizational structures, detailed plans and timetables, and collaborative arrangements. 7 areas in which WHO could provide assistance are offered, followed by discussion of strengthening tuberculosis control capacity in WHO, and at the country and local levels. Selection of research sites is considered at the close of the text.