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Report of a WHO Consultation on the Prevention of Human Immunodeficiency Virus and Hepatitis B Virus Transmission in the Health Care Setting, Geneva, 11-12 April 1991.
[Unpublished] 1991. , 8 p. (WHO/GPA/DIR/91.5)The transmission of both Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in health care settings causes concern among patients, health care workers, and national policymakers. This document reports recommendations from a consultative meeting on the issue organized by the World Health Organization Global Program on AIDS. The meeting was held at the request of member states to review risks of transmission of HBV and HIV in the health care setting, and to provide guidance on policies and strategies to minimize such risks. In order of declining incidence and likelihood, HBV and HIV may be transmitted from patient to patient, patient to worker, and worker to patient. The risk of infection depends on the prevalence of infected individuals in the population, the frequency of exposure to contaminated medical instruments, relative viral infectivity, and the concentration of virus in the blood. The risk of acquiring HBV from a needlestick exposure to blood of an infected patient is estimated at 7-30%, while less than 0.5% of health care workers exposed in similar fashion to HIV+ blood have become infected with HIV. General recommendations and specific measures for WHO and national authorities to adopt in the prevention of these infections are listed. Central to prevention is the adoption by health care workers of universal precautions which assume that all blood and certain bodily fluids are infectious. HBV vaccines for both health care workers and as a routine infant immunogen are recommended where appropriate. Routine and/or mandatory blood testing of workers or patients is not recommended, and is considered potentially counterproductive to AIDS control.
Washington, D.C., World Bank, 1991. x, 51 p. (World Bank Technical Paper No. 159)A World Bank report outlines the results of an empirical study. It lists institutional characteristics connected with successful tropical disease control programs, describes their importance, and extracts useful lessons for disease control specialists and managers. The study covers and compares 7 successful tropical disease control programs: the endemic disease program in Brazil; schistosomiasis control programs in China, Egypt, and Zimbabwe; and the malaria, schistosomiasis, and tuberculosis programs in the Philippines. All of these successful programs, as defined by reaching goals over a 10-15 year period, are technology driven. Specifically they establish a relevant technological strategy and package, and use operational research to appropriately adapt it to local conditions. Further they are campaign oriented. The 7 programs steer all features of organization and management to applying technology in the field. Moreover groups of expert staff, rather than administrators, have the authority to decide on technical matters. These programs operate both vertically and horizontally. Further when it comes to planning strategy they are centralized, but when it comes to actual operations and tasks, they are decentralized. Besides they match themselves to the task and not the task to the organization. Successful disease control programs have a realistic idea of what extension activities, e.g., surveillance and health education, is possible in the field. In addition, they work with households rather than the community. All employees are well trained. Program managers use informal and professional means to motivate then which makes the programs productive. The organizational structure of these programs mixes standardization of technical procedures with flexibility in applying rules and regulations, nonmonetary rewards to encourage experience based use of technological packages, a strong sense of public service, and a strong commitment to personal and professional development.
ENTRE NOUS. 1991 Dec; (19):15.About 8 million women use the long acting injectable contraceptive depot-medroxy-progesterone acetate (DMPA) and norethisterone enanthate (NET-EN). These progesterone only injectables are not dependent on sexual activity and are easy to administer. Yet they are not always well accepted since they can interfere with menstrual bleeding and often induce amenorrhea. Researchers find that adding estrogen to DMPA and NET-EN treats these irregularities. They must use esters with limited action to protect the endometrium from constant estrogens, however, which requires monthly injections. Thus bleeding occurs once a month just like the normal menstrual cycle. Clinical trials in China of Injectable No. 1 (250 mg 17-alpha-hydroxyprogesterone caproate and 5 mg estradiol valerate) show that it has few side effects and is acceptable. Other trials in China are evaluating monthly injectables with NET-EN or megestrol acetate. Numerous developing countries often as WHO's Special Programme of Research in Human Reproduction for effective, safe, and fully studied monthly injectables. WHO operates under a 2 part strategy: optimum improvement of HPR 102 (50 m NET-EN and 5 mg estradiol valerate) and Cyclofem (25 mg DMPA and 5 mg estradiol cypionate) resulting in a reduction of the dose of at least 1 of the hormones and results of a study of the efficacy and side effects of these 2 injectables. It hopes the study provides the impetus to introduce them into national family planning programs. It demonstrates that they are indeed efficacious, effect fewer changes in the menstrual cycle than the progesterone only injectables, and are well accepted, even though women must go to a clinic every 27-33 days for an injection. Other studies are determining their effects on lipid and glucose metabolism, coagulation, and fibrinolysis. They are also looking at the time needed for ovulation to return. 1 study shows that menstruation returned in all women by the 3rd cycle.
ESSENTIAL DRUGS MONITOR. 1991; (11):10-1.Most health professionals in developing and developed countries consider oral rehydration therapy (ORT) to be the most effective treatment for diarrhea. An estimated 1,500 million episodes of diarrhea occur annually and 3 million of these results in death of children <5 years old. Caretakers must give increased amounts of fluids (rice water, tea, and gruel) to children with diarrhea to prevent dehydration. If they become dehydrated, caretakers must take them to a health workers so he/she can assess and treat them with oral rehydration solution (ORS) or, in the case of severe dehydration, rehydrate them intravenously. Drugs should not be used to treat diarrhea cases. Nevertheless, surveys in 4 Asian nations indicated that drug use ranged from 22-68% of diarrhea episodes and ORS use ranged only from 9-21%. Drug use is very expensive. In fact, Peru spent >US$2 million on antidiarrheals in 1988- 1989. Further, drugs often make up >40% of health care costs in developing countries, so ORS use reduces these costs. Indeed drug us deflects from correct case management of diarrhea. In addition, drugs have no proven value for acute diarrhea. They do not decrease the fluid loss responsible for death and may even have serious side effects, such as central nerve depression and gastrointestinal toxicity. If health workers suspect cholera or dysentery, however, they can administer effective and relatively inexpensive antibiotics. Since the early 1980s, almost all developing countries had a national control of diarrheal disease program. In several countries, hospital admission rates for diarrhea fell 61% and the case fatality rate fell 71% after ORT introduction. Some hospitals have even saved as much as 60% in costs due to these declines. WHO has a book available which covers rational use of drugs in managing acute diarrhea in children.