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[Implementation of the Integrated Management of Childhood Illnesses strategy in Northeastern Brazil] Implementacao da estrategia Atencao Integrada as Doencas Prevalentes na Infancia no Nordeste, Brasil.
Revista De Saude Publica. 2008 Aug; 42(4):598-606.OBJECTIVE: The majority of child deaths are avoidable. The Integrated Management of Childhood Illnesses strategy, developed by the World Health Organization and the United Nations Children's Fund, aims to reduce child mortality by means of actions to improve performance of health professionals, the health system organization, and family and community practices. The article aimed to describe factors associated with the implementation of this strategy in three states of Northeastern Brazil. METHODS: Ecological study conducted in 443 municipalities in the states of Northeastern Brazil Ceara, Paraiba and Pernambuco, in 2006. The distribution of economic, geographic, environmental, nutritional, health service organization, and child mortality independent variables were compared between municipalities with and without the strategy. These factors were assessed by means of a hierarchical model, where Poisson regression was used to calculate the prevalence ratios, after adjustment of confounding factors. RESULTS: A total of 54% of the municipalities studied had the strategy: in the state of Ceara, 65 had it and 43 did not have it; in the state of Paraiba, 27 had it and 21 did not have it; and in the state of Pernambuco, 147 had it and 140 did not have it. After controlling for confounding factors, the following variables were found to be significantly associated with the absence of the strategy: lower human development index, smaller population, and greater distance from the capital. CONCLUSIONS: There was inequality in the development of the strategy, as municipalities with a higher risk to child health showed lower rates of implementation of actions. Health policies are necessary to help this strategy to be consolidated in the municipalities that are at a higher risk of child mortality.
How Brazil outpaced the United States when it came to AIDS: the politics of civic infiltration, reputation, and strategic internationalization.
Journal of Health Politics, Policy and Law. 2011 Apr; 36(2):317-52.Using a temporal approach dividing the reform process into two periods, this article explains how both Brazil and the United States were slow to respond to AIDS. However, Brazil eventually outpaced the United States in its response due to international rather than democratic pressures. Since the early 1990s, Brazil's success has been attributed to "strategic internationalization": the concomitant acceptance and rejection of global pressure for institutional change and antiretroviral treatment, respectively. The formation of tripartite partnerships among donors, AIDS officials, and nongovernmental organizations has allowed Brazil to avoid foreign aid dependency, while generating ongoing incentives for influential AIDS officials to incessantly pressure Congress for additional funding. Given the heightened international media attention, concern about Brazil's reputation has contributed to a high level of political commitment. By contrast, the United States' more isolationist relationship with the international community, its focus on leading the global financing of AIDS efforts, and the absence of tripartite partnerships have prevented political leaders from adequately responding to the ongoing urban AIDS crisis. Thus, Brazil shows that strategically working with the international health community for domestic rather than international influence is vital for a sustained and effective response to AIDS.
Geneva, Switzerland, UNAIDS, 2011 Aug.  p. (UNAIDS/ JC2112E)This report shows that these global commitments will be achieved only if the unique needs of young women and men are acknowledged, and their human rights fulfilled, respected, and protected. In order to reduce new HIV infections among young people, achieve the broader equity goals set out in the MDGs, and begin to reverse the overall HIV epidemic, HIV prevention and treatment efforts must be tailored to the specific needs of young people.
Measles outbreaks and progress towards meeting measles pre-elimination goals: WHO African Region, 2009-2010. Flambees de rougeole et progres accomplis en vue d'atteindre les objectifs de preelimination de la rougeole: Region africaine de l'OMS, 2009-2010.
Releve Epidemiologique Hebdomadaire. 2011 Apr 1; 86(14):129-36.This report summarizes the progress made during 2009-2010 towards meeting the pre-elimination goals after a historically low incidence of measles cases was reported in 2008. In addition, it provides information on measles outbreaks occurring during the same period which highlights the urgent need for renewed political will from governments and their partners to ensure that national multiyear vaccination plans, budgetary line-items and financial commitments exist for routine immunization services and measles-control activities. To assist countries in resonding to measles outbreaks, WHO guidelines were published in 2009.
Journal of the History of Medicine and Allied Sciences. 2010 Jul; 65(3):287-326.In 1971 Abdel R. Omran published his classic paper on the theory of epidemiologic transition. By the mid-1990s, it had become something of a citation classic and was understood as a theoretical statement about the shift from infectious to chronic diseases that supposedly accompanies modernization. However, Omran himself was not directly concerned with the rise of chronic disease; his theory was in fact closely tied to efforts to accelerate fertility decline through health-oriented population control programs. This article uses Omran's extensive published writings as well as primary and secondary sources on population and family planning to place Omran's career in context and reinterpret his theory. We find that "epidemiologic transition" was part of a broader effort to reorient American and international health institutions towards the pervasive population control agenda of the 1960s and 1970s. The theory was integral to the WHO's then controversial efforts to align family planning with health services, as well as to Omran's unsuccessful attempt to create a new sub-discipline of "population epidemiology." However, Omran's theory failed to displace demographic transition theory as the guiding framework for population control. It was mostly overlooked until the early 1990s, when it belatedly became associated with the rise of chronic disease.
PloS One. 2010; 5(1):e8796.BACKGROUND: The tight epidemiological coupling between HIV and its associated opportunistic infections leads to challenges and opportunities for disease surveillance. METHODOLOGY/PRINCIPAL FINDINGS: We review efforts of WHO and collaborating agencies to track and fight the TB/HIV co-epidemic, and discuss modeling--via mathematical, statistical, and computational approaches--as a means to identify disease indicators designed to integrate data from linked diseases in order to characterize how co-epidemics change in time and space. We present R(TB/HIV), an index comparing changes in TB incidence relative to HIV prevalence, and use it to identify those sub-Saharan African countries with outlier TB/HIV dynamics. R(TB/HIV) can also be used to predict epidemiological trends, investigate the coherency of reported trends, and cross-check the anticipated impact of public health interventions. Identifying the cause(s) responsible for anomalous R(TB/HIV) values can reveal information crucial to the management of public health. CONCLUSIONS/SIGNIFICANCE: We frame our suggestions for integrating and analyzing co-epidemic data within the context of global disease monitoring. Used routinely, joint disease indicators such as R(TB/HIV) could greatly enhance the monitoring and evaluation of public health programs.
Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response.
Geneva, Switzerland, WHO, 2010.  p.This new report on anti-tuberculosis (TB) drug resistance by the World Health Organization (WHO) updates "Anti-tuberculosis drug resistance in the world: Report No. 4" published by WHO in 2008. It summarizes the latest data and provides latest estimates of the global epidemic of multidrug and extensively drug-resistant tuberculosis (M/XDR-TB). For the first time, this report includes an assessment of the progress countries are making to diagnose and treat MDR-TB cases. (Excerpt)
Symposium proceedings. HPV Vaccines: New Tools in the Prevention of Cervical Cancer and Other HPV Disease in Asia and the Pacific, Bangkok, Thailand, 2 November 2006.
Bangkok, Thailand, Family Health International [FHI], Asia / Pacific Regional Office, 2007. 55 p.Cervical cancer -- the most preventable and treatable of all cancers -- is the most common cancer among women in developing countries. This report presents the proceedings of a November 2006 symposium organized by FHI in Bangkok, Thailand, that brought together leading specialists in immunization, cancer prevention, and other disciplines to start building consensus on a comprehensive approach to programming for the prevention and early detection of cervical cancers in the Asia region. Presentations covered such topics as improved screening methods for cervical cancer, the latest research on human papillomavirus (HPV) vaccines, and country and social perspectives related to HPV vaccination. Participants concluded that there is a need to 1) further educate health professionals, especially so they can influence policymakers and service planners, and 2) devise communication strategies that will shape debates on HPV vaccines.
Reproductive health surveillance in the US-Mexico border region: beyond the border (and into the future) [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A109.This editorial examines reproductive health surveillance in the US- Mexico border region. It offers improvements for reproductive health data system methods and recommendations for sustainability of the project. It also proposes revisions to the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP) in the following areas: maternal birthing experiences, women’s health over the life course, migration history, acculturation/cultural identity/border region identity, Latina reproductive health, and MCH policy relevance.
The past, present, and future of reproductive health surveillance in the US-Mexico border region [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A110.This editorial discusses reproductive health surveillance in the US- Mexico border region. It touches on past, present and future projects for that area including the United States- Mexico Border Health Commission (USMBHC) and the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP).
Sexually Transmitted Infections. 2008; 84(Suppl 1):i1-i4.This introductory article refers to the journal supplement that assembles important new data relating to several assumptions used for the new HIV and AIDS estimates. The collection of methodological papers in the supplement, aim to provide easy access to the scientific basis underlying the latest HIV and AIDS estimates for 2007.
Geneva, Switzerland, UNAIDS, . 13 p.For over 25 years, our world has been living with HIV. And in just this short time, AIDS has become one of the make-or-break global crises of our age, undermining not just the health prospects of entire societies but also their ability to reduce poverty, promote development, and maintain national security. And in too many regions AIDS continues to expand - every single day 11 000 people are newly infected with HIV, and nearly 8 000 people die from AIDS-related illnesses. Yet, despite the magnitude of the AIDS crisis, today we are at a time of great hope and great opportunity to get ahead of the epidemic. Our crisis-response tactics have led to real progress against AIDS. Funding for efforts against AIDS has risen from 'millions' to 'billions' in just a decade. Political commitment and leadership on AIDS is higher than ever before. In more and more countries - including some of the world's poorest - we are seeing real results in terms of lives saved because effective HIV prevention and treatment programmes are being made widely available. Leaders of both developing and rich countries have now committed themselves to working together so as to get close to universal access to HIV prevention, treatment, care and support by 2010 - a critical stepping stone to halting the epidemic by 2015, as set out in the Millennium Development Goals. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Dec. 50 p. (UNAIDS/07.27E; JC1322E)Every day, over 6800 persons become infected with HIV and over 5700 persons die from AIDS, mostly because of inadequate access to HIV prevention and treatment services. The HIV pandemic remains the most serious of infectious disease challenges to public health. Nonetheless, the current epidemiologic assessment has encouraging elements since it suggests: the global prevalence of HIV infection (percentage of persons infected with HIV) is remaining at the same level, although the global number of persons living with HIV is increasing because of ongoing accumulation of new infections with longer survival times, measured over a continuously growing general population; there are localized reductions in prevalence in specific countries; a reduction in HIV-associated deaths, partly attributable to the recent scaling up of treatment access; and a reduction in the number of annual new HIV infections globally. Examination of global and regional trends suggests the pandemic has formed two broad patterns: generalized epidemics sustained in the general populations of many sub-Saharan African countries, especially in the southern part of the continent; and epidemics in the rest of the world that are primarily concentrated among populations most at risk, such as men who have sex with men, injecting drug users, sex workers and their sexual partners. (excerpt)
Epidemiology and clinical features of pneumonia according to radiographic findings in Gambian children.
Tropical Medicine and International Health. 2007 Nov; 12(11):1377-1385.The objective was to assess the effect of vaccines against pneumonia in Gambian children. Data from a randomized, controlled trial of a 9-valent pneumococcal conjugate vaccine (PCV) were used. Radiographic findings, interpreted using WHO definitions, were classified as primary end point pneumonia, 'other infiltrates / abnormalities' pneumonia and pneumonia with no abnormality. We calculated the incidence of the different types of radiological pneumonia, and compared clinical and laboratory features between these groups. Among children who did not receive PCV, the incidence of pneumonia with no radiographic abnormality was about twice that of 'other infiltrates' pneumonia and three times that of primary endpoint pneumonia. Most respiratory symptoms, reduced feeding and vomiting occurred most frequently in children with primary endpoint pneumonia. These children were more likely to be malnourished, to have bronchial breath sounds or invasive bacterial diseases, and to die within 28 days of consultation than children in the other groups. Conversely, a history of convulsion, diarrhoea or fast breathing, malaria parasitaemia and isolation of salmonellae were commoner in children with pneumonia with no radiographic abnormality. Lower chest wall indrawing and rhonchi on auscultation were seen most frequently in children with 'other infiltrates / abnormalities' pneumonia. Primary endpoint pneumonia is strongly associated with bacterial aetiology and severe pneumonia. Since this category of pneumonia is significantly reduced after vaccination with Hib and pneumococcal vaccines, the risk-benefit of antimicrobial prescription for clinical pneumonia for children with increased respiratory rate may warrant re-examination once these vaccines are in widespread use. (author's)
Geneva, Switzerland, UNAIDS, 2007.  p. (UNAIDS/07.07E; JC1274E)These Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access are designed to provide policy makers and planners with practical guidance to tailor their national HIV prevention response so that they respond to the epidemic dynamics and social context of the country and populations who remain most vulnerable to and at risk of HIV infection. They have been developed in consultation with the UNAIDS cosponsors, international collaborating partners, government, civil society leaders and other experts. They build on Intensifying HIV Prevention: UNAIDS Policy Position Paper and the UNAIDS Action Plan on Intensifying HIV Prevention. In 2006, governments committed themselves to scaling up HIV prevention and treatment responses to ensure universal access by 2010. While in the past five years treatment access has expanded rapidly, the number of new HIV infections has not decreased - estimated at 4.3 (3.6-6.6) million in 2006 - with many people unable to access prevention services to prevent HIV infection. These Guidelines recognize that to sustain the advances in antiretroviral treatment and to ensure true universal access requires that prevention services be scaled up simultaneously with treatment. (excerpt)
Bulletin of the World Health Organization. 2007 Aug; 85(8):586-592.WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004. In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003). In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11%) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P< 0.01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%). In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness. (author's)
Journal of Infectious Diseases. 2007 Aug 15; 196 Suppl 1:S5-S14.Tuberculosis (TB) and human immunodeficiency virus (HIV) infection make each other's control significantly more difficult. Coordination in addressing this "cursed duet" is insufficient at both global and national levels. However, global policy for TB/HIV coordination has been set, and there is consensus around this policy from both the TB and HIV control communities. The policy aims to provide all necessary care for the prevention and management of HIV-associated TB, but its implementation is hindered by real technical difficulties and shortages of resources. All major global-level institutions involved in HIV care and prevention must include TB control as part of their corporate policy. Country-level decision makers need to work together to expand both TB and HIV services, and civil society and community representatives need to hold those responsible accountable for their delivery. The TB and HIV communities should join forces to address the health-sector weaknesses that confront them both. (author's)
Recent experiences in infectious diseases: strengthening public health infrastructure in disease surveillance.
Contact. 2005 Jan; (179):29-31.In the past century there have been remarkable achievements in the prevention and treatment of infectious diseases. Bacteria and viruses have been identified; laboratory techniques have greatly advanced; the pathogenesis and epidemiology have been defined for most diseases; and antibiotics and vaccines have been developed to treat and prevent a host of discusses. Examples are everywhere. We have eradicated smallpox and come close to doing the same for polio. Inexpensive treatments such as Oral Rehydration Therapy (ORT) for diarrhoea have greatly reduced mortality and morbidity among children. Improvements in water and sanitation helped to reduce expose to certain pathogens. Yet, despite these great successes in controlling and treating infectious diseases, they remain a serious medical burden in both developing and industrialized in countries. It is estimated that about 15 million of the 57 million annual deaths (about 26%) are directly related to infectious diseases. This estimate does not include deaths due to the consequences of past infections (for example, rheumatic heart disease) or from complications of chronic infections (for example, hepatocellular carcinoma from hepatitis B infection). (excerpt)
Lancet. 2007 Mar 3; 369(9563):715-798.South Africa is struggling to contain an outbreak of extensively drug-resistant tuberculosis, which has now spread to all the country's provinces, according to the Department of Health, and threatens to hamper HIV/AIDS treatment plans. Clare Kapp reports from South Africa. WHO is sending a permanent staff member to be based in South Africa to advise authorities struggling with an outbreak of extensively drug-resistant (XDR) tuberculosis. The Department of Health says there have now been 269 confirmed cases of XDR tuberculosis and that it has spread from the province of KwaZulu-Natal, where it was first confirmed, to all parts of South Africa. But Karin Weyer, tuberculosis research director at the Medical Research Council (MRC), said nobody really knows the true number of cases because of laboratory and diagnostics constraints and inconsistencies in reporting. So far there have been no reported cases in neighbouring southern African countries, but Weyner believes that this is because they simply do not have the laboratory testing facilities. (excerpt)
Strategic and technical meeting on intensified control of neglected tropical diseases: a renewed effort to combat entrenched communicable diseases of the poor. Report of an international workshop, Berlin, 18-20 April 2005.
Geneva, Switzerland, World Health Organization [WHO], Department of Control of Neglected Tropical Diseases, 2006.  p. (WHO/CDS/NTD/2006.1)Throughout the developing world, socioeconomic progress is impeded by ancient and entrenched infectious diseases that permanently diminish human potential in very large populations. These diseases have largely vanished from affluent nations but continue to flourish in tropical and subtropical climates under the living conditions that surround impoverished populations -- the people left behind by socioeconomic development. These neglected tropical diseases thrive in areas where water supply, housing and sanitation are inadequate, nutrition is poor, literacy rates are low, health systems are rudimentary and insects and other disease vectors are constant household and occupational companions. Neglected tropical diseases continue to permanently maim or otherwise impair the lives of millions of people every year, frequently with adverse effects starting early in life. They anchor affected populations in poverty and also compromise the effectiveness of efforts made by other sectors to improve socioeconomic development. For example, there is ample evidence that children heavily infected with intestinal worms will not fully benefit from educational opportunities and are more likely to suffer poor nutritional status. Adults permanently disabled by blindness or limb deformities may be a burden in rural agricultural communities that eke out a living from subsistence farming. In addition, the stigma attached to many of these diseases closes options for a normal family and social life, especially for women. Efforts to control these diseases thus free people to develop their potential unimpeded by disabling disease and, in so doing, increase the chances that efforts in other sectors, such as education and agriculture, will be successful. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006.  p.There is thus an increased awareness of the problem of child maltreatment and growing pressure on governments to take preventive action. At the same time, the paucity of evidence for the effectiveness of interventions raises concerns that scarce resources may be wasted through investment in well-intentioned but unsystematic prevention efforts whose effectiveness is unproven and which may never be proven. For this reason, the main aim of this guide is to provide technical advice for setting up policies and programmes for child maltreatment prevention and victim services that take into full account existing evidence on the effectiveness of interventions and that use the scientific principles of the public health approach. This will encourage the implementation of scientifically testable interventions and their evaluation. It is hoped that, in this way, the guide will contribute to a geographical expansion of the evidence base to include more evaluations of interventions from low-income and middle-income countries, and a greater variety of evaluated interventions. The long-term aim is to be able to prepare evidence-based guidelines on interventions for child maltreatment. (excerpt)
Beijing, China, National Center for AIDS / STD Prevention and Control, 2006 Jan 24.  p.Over the past two years, the response to HIV/AIDS across China has intensified, and the Chinese government has strengthened leadership on HIV/AIDS. Effective measures have been launched in each key area of HIV/AIDS prevention, treatment and care work, and the environment for comprehensive work in these areas has improved considerably. This report was jointly prepared by the Ministry of Health of the People's Republic of China, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) to describe the current status of China's HIV/AIDS epidemic, progress made over the past year in China's HIV/AIDS response, and key challenges that need to be addressed to stop the spread of AIDS. (excerpt)
Progress in Reproductive Health Research. 2005; (71):1-8.The WHO Department of Reproductive Health and Research (RHR) has two initiatives aimed at promoting evidence-based sexual and reproductive health care. One is devoted to Implementing Best Practices (IBP), the other to mapping the best sexual and reproductive health practices. In the latter case, the WHO Reproductive Health Library (RHL) is used as a key instrument for documenting and disseminating the best practices. Both initiatives provide health-care practitioners with information to help them choose which methods, techniques, interventions, medications and other tools work in a given set of circumstances and settings, and which don't. That information, in current health parlance, is "evidence-based". To the extent that practitioners put the evidence to use in their practices, the members of the communities they serve can be confident that they are receiving the best advice and treatment that current scientific knowledge can provide. Both the IBP and RHL take advantage of the global "information networks" that the scientific and health communities have developed over the years and that, with the advent of electronic communication, have become increasingly "virtual". In this respect, what is known as the "scientific literature" has become a global network for distributing and sharing information. IBP initiative, for example, uses two tools, the Knowledge Gateway and a virtual library, that foster rapid access to the evidence and its continuous enrichment and updating through a sharing of information and experience. The RHL compresses into an Internet web site (as well as a single compact disc) a wealth of information based on evidence validated by peer review and commented on by experts. (excerpt)
PLoS Medicine. 2007 Jan; 4(1):e44.The HIV/AIDS area has always been highly politically and emotionally charged, and we wrote a controversial and provocative piece. Most of the responses to it were unreasoned. The most cogent response came from UNAIDS (the Joint United Nations Programme on HIV/AIDS), and it generally restated an already well articulated position. We disagree with a number of the points for the reasons discussed in our original essay, and applaud one point. First, a brief restatement of our argument is warranted. There is good evidence that HIV-related stigma adversely affects the lives of people living with HIV/AIDS. There is little or no evidence, however, to support the notion that HIV-related stigma is one of the determinants of the global HIV epidemic. Furthermore, an argument could be made for why stigma might slow or contain the spread of infection in the general population. Given the very different effect the two positions would have on policy and the significance of the HIV epidemic, they deserve investigation. Among epidemiologists, two competing hypotheses, for which there is no strong evidence either way, would constitute a position of equipoise. (excerpt)
PLoS Medicine. 2007 Jan; 4(1):e51.In their essay "HIV, Stigma, and Rates of Infection: A Rumour without Evidence", Daniel Reidpath and Kit Yee Chan rightly underscore the insufficient body of research on the relationship between stigma and discrimination and HIV transmission . Increased scientific attention and effective programming against stigma and discrimination are both sorely needed. But the Joint United Nations Programme on HIV/AIDS (UNAIDS) does not accept a number of points made in the essay. Discrimination based on health status, including HIV, is a human rights violation, and stigma is the social form of this violation. HIV stigma and discrimination are wrong in and of themselves, and should be stopped for that reason alone. Reidpath and Chan suggest, as "an alternative hypothesis to the UNAIDS position", that stigma against certain groups, including people living with HIV, may have a public health value because it "could reduce opportunities for contact between high- and low-risk groups". UNAIDS cannot endorse a hypothesis that bases a public health goal on a human rights violation; nor do we believe it is either right, or necessary, to pit the public health against human rights. (excerpt)