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  1. 26
    342819
    Peer Reviewed

    Pediatric HIV: new opportunities to treat children.

    Van der Linden D; Callens S; Brichard B; Colebunders R

    Expert Opinion On Pharmacotherapy. 2009 Aug; 10(11):1783-91.

    BACKGROUND: Treating HIV-infected children remains a challenge due to a lack of treatment options, appropriate drug formulations and, in countries with limited resources, insufficient access to diagnostic tests and treatment. OBJECTIVE: To summarize current data concerning new opportunities to improve the treatment of HIV-infected children. METHODS: This review includes data from the most recently published peer-reviewed publications, guidelines or presentations at international meetings concerning new ways to treat HIV-infected children. RESULTS/CONCLUSIONS: New WHO guidelines recommend starting combination antiretroviral treatment in all infants aged < 1 year. Although this is common practice in some high-income countries, implementation of these recommendations in countries with limited resources is still a challenge. There is still an important gap between the availability of licensed drugs in children compared with adults. There remains a need for further pharmacokinetic studies, and for more pediatric formulations of antiretroviral drugs with improved palatability.
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  2. 27
    342377
    Peer Reviewed

    Improving control of African schistosomiasis: towards effective use of rapid diagnostic tests within an appropriate disease surveillance model.

    Stothard JR

    Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Apr; 103(4):325-32.

    Contemporary control of schistosomiasis is typically reliant upon large-scale administration of praziquantel (PZQ) to school age children. Whilst PZQ treatment of each child is inexpensive, the direct and indirect costs of preventive chemotherapy for the whole school population are more substantive and, at the national level where many schools are targeted, maximising cost effectiveness and the health impact are essential requirements for ensuring longer-term sustainability (i.e. >5 years). To this end, the WHO has issued a set of treatment guidelines, inclusive of re-treatment schedules, such that, where possible, treatment decisions by school are based upon local disease prevalence as determined by parasitological and/or questionnaire methods. As each diagnostic method has known shortcomings, presumptive treatment of at-risk schools may initially be preferred, especially if the existing infrastructure for disease surveillance is poor. It is against this background of school-based preventive chemotherapy that a rapid diagnostic test (RDT) for schistosomiasis is most urgently needed, not only to improve initial disease surveillance but also to focus drug delivery better through time. In this paper, the development, evaluation and application of selected diagnostic tests are reviewed to identify barriers that impede progress, foremost of which is that a new disease surveillance and evaluation model is required where the in-country price of each RDT ideally needs to be less than US$1 to be cost effective both in the short- and long-term perspective.
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  3. 28
    342347
    Peer Reviewed

    Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test.

    Peltier CA; Omes C; Ndimubanzi PC; Ndayisaba GF; Stulac S; Arendt V; Courteille O; Muganga N; Kayumba K; Van den Ende J

    PloS One. 2009; 4(4):e5312.

    INTRODUCTION: All infants born to HIV-positive mothers have maternal HIV antibodies, sometimes persistent for 18 months. When Polymerase Chain Reaction (PCR) is not available, August 2006 World Health Organization (WHO) recommendations suggest that clinical criteria may be used for starting antiretroviral treatment (ART) in HIV seropositive children <18 months. Predictors are at least two out of sepsis, severe pneumonia and thrush, or any stage 4 defining clinical finding according to the WHO staging system. METHODS AND RESULTS: From January 2005 to October 2006, we conducted a prospective study on 236 hospitalized children <18 months old with a positive HIV serological test at the national reference hospital in Kigali. The following data were collected: PCR, clinical signs and CD4 cell count. Current proposed clinical criteria were present in 148 of 236 children (62.7%) and in 95 of 124 infected children, resulting in 76.6% sensitivity and 52.7% specificity. For 87 children (59.0%), clinical diagnosis was made based on severe unexplained malnutrition (stage 4 clinical WHO classification), of whom only 44 (50.5%) were PCR positive. Low CD4 count had a sensitivity of 55.6% and a specificity of 78.5%. CONCLUSION: As PCR is not yet widely available, clinical diagnosis is often necessary, but these criteria have poor specificity and therefore have limited use for HIV diagnosis. Unexplained malnutrition is not clearly enough defined in WHO recommendations. Extra pulmonary tuberculosis (TB), almost impossible to prove in young children, may often be the cause of malnutrition, especially in HIV-affected families more often exposed to TB. Food supplementation and TB treatment should be initiated before starting ART in children who are staged based only on severe malnutrition.
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  4. 29
    326313

    The global elimination of congenital syphilis: rationale and strategy for action.

    Meredith S; Hawkes S; Schmid G; Broutet N

    Geneva, Switzerland, World Health Organization [WHO], 2007. [45] p.

    Since the advent of penicillin, syphilis is not only preventable but also treatable. Despite this, it remains a global problem with an estimated 12 million people infected each year. Pregnant women who are infected with syphilis can transmit the infection to their fetus, causing congenital syphilis with serious adverse effects on the pregnancy in up to 80% of the cases. Yet simple, cost-effective screening and treatment options could prevent and eventually eliminate congenital syphilis. With the current international focus on the Millennium Development Goals (MDGs), there exists a unique opportunity to mobilize action to prevent, and subsequently eliminate, congenital syphilis. Congenital syphilis is a serious but preventable disease, which can be eliminated through effective screening of pregnant women for syphilis and treatment of those infected. More newborn infants are affected by congenital syphilis than by any other neonatal infection, including human immunodeficiency virus (HIV) infection and tetanus, which are currently receiving global attention. Yet the burden of congenital syphilis is still under-appreciated at both international and national levels. Unlike many neonatal infections, congenital syphilis can be effectively prevented by testing and treatment of pregnant women, which also provides immediate benefits to the mother and allows potentially infected partners to be traced and offered treatment. It has been clearly shown that screening of pregnant women for reactive syphilis serology, followed by treatment of seropositive women, is a cost-effective, inexpensive and feasible intervention for the prevention of congenital syphilis and improvement of child health. In 1995, the Pan American Health Organization (PAHO) began a regional campaign to reduce the rate of congenital syphilis in the Americas to less than 50 cases per 100 000 live births. The strategy was to: (1) increase the availability of antenatal care; (2) establish routine serological testing for syphilis during antenatal careand at delivery; and (3) promote the rapid treatment of infected pregnant women. (excerpt)
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  5. 30
    322939
    Peer Reviewed

    WHO global strategy for the prevention and control of sexually transmitted infections: Time for action.

    Lewis DA; Latif AS; Ndowa F

    Sexually Transmitted Infections. 2007; 83:508-509.

    Worldwide, sexually transmitted infections (STIs) continue to be a major cause of morbidity and mortality. Global estimates suggest that more than 340 million new cases of syphilis, gonorrhoea, chlamydial infection and trichomoniasis occurred throughout the world in 1999. Congenital syphilis, prevention of which is relatively easy and cost-effective, may still be responsible for as many as 14% of neonatal deaths. Up to 10% of those women who are untreated, or inadequately treated, for chlamydial and gonococcal infections may become infertile as a consequence. On a global scale, up to 4000 newborn babies each year may become blind because of gonococcal and chlamydial ophthalmia neonatorum. There is evidence that STIs may enhance both the transmission and acquisition of HIV infection, and that improved control of STIs may slow down HIV transmission. The prevention and control of STIs is not an easy task. Epidemiological patterns of STIs vary geographically and are influenced by cultural, political, economical and social forces. Many affected by STIs are in marginalised vulnerable groups. The asymptomatic nature of some STIs remains a challenge to healthcare providers in areas of the world where laboratory screening tests are unaffordable. (excerpt)
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  6. 31
    322825

    Simple clinical signs to identify severe neonatal illness [editorial]

    Bahl R

    Indian Pediatrics. 2007 Nov 17; 44(11):814-816.

    Globally, 9.7 million children died last year, about 3.6 million of them during the neonatal period (WHO mortality database). Because of its large population and relatively high neonatal mortality rate, India contributes about a quarter of all neonatal deaths in the world. It is particularly important to note that more than two thirds of these neonatal deaths occur in the first week of life. It is well known that majority of neonatal deaths can be prevented with low-technology, low-cost interventions delivered across two continua of care-the first from pregnancy, birth, through neonatal period and childhood, and the second from home, through primary health facilities to hospitals. It has been estimated that optimal treatment of neonatal illness can avert up to half of all preventable neonatal deaths. (excerpt)
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  7. 32
    322522
    Peer Reviewed

    Epidemiology and clinical features of pneumonia according to radiographic findings in Gambian children.

    Enwere G; Cheung YB; Zaman SM; Akano A; Oluwalana C

    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)
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  8. 33
    322017

    Antiretroviral therapy for HIV infection in infants and children: towards universal access. Recommendations for a public health approach.

    World Health Organization [WHO]. Department of HIV / AIDS

    Geneva, Switzerland, WHO, 2007. [147] p.

    These stand-alone treatment guidelines serve as a framework for selecting the most potent and feasible first-line and second-line ARV regimens as components of expanded national responses for the care of HIV-infected infants and children. Recommendations are provided on: diagnosing HIV infection in infants and children; when to start ART, including situations where severe HIV disease in children less than 18 months of age has been presumptively diagnosed; clinical and laboratory monitoring of ART; substitution of ARVs for toxicities. The guidelines consider ART in different situations, e.g. where infants and children are coinfected with HIV and TB or have been exposed to ARVs either for the prevention of MTCT (PMTCT) or because of breastfeeding from an HIV-infected mother on ART. They address the importance of nutrition in the HIV-infected child and of severe malnutrition in relation to the provision of ART. Adherence to therapy and viral resistance to ARVs are both discussed with reference to infants and children. A section on ART in adolescents briefly outlines key issues related to treatment in this age group. (excerpt)
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  9. 34
    320903

    Developing and testing a generic job aid for malaria rapid diagnostic tests (RDTs). Field report.

    Rennie W; Harvey SA

    Bethesda, Maryland, University Research Company, Quality Assurance Project, 2004 Dec. 47 p. (QAP / WHO Field Report)

    The traditional approach to malaria diagnosis has been examination by microscope of a thick blood smear from the individual suspected of being infected. In an attempt to provide a more rapid alternative, companies worldwide have developed malaria rapid diagnostic tests (RDTs). Although RDTs can be effectively used in clinical settings by trained personnel, their greatest potential use is in rural areas with limited access to health and laboratory facilities. Using RDTs for diagnosis at the community level will shorten the delay between the onset of symptoms and the beginning of appropriate treatment. It will also slow development of resistance and lead to significant cost savings by avoiding unnecessary use of antimalarials. However, achieving a high level of sensitivity and specificity with RDTs in this context will require a product designed, labelled, and explained so that community health workers (CHWs) can use it accurately with minimal formal training and supervision. In partnership with theWHO Regional Office for the Western Pacific, the Quality Assurance Project (QAP) carried out quality-design research in the Philippines and the Lao People's Democratic Republic to develop and test a generic RDT job aid, mainly pictorial, that could be adapted with little modification for use with different RDT products and in different cultural settings by health workers with low literacy skills and with little or no prior training in product use. (author's)
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  10. 35
    319155
    Peer Reviewed

    IAP Guidelines 2006 on hospital based management of severely malnourished children (adapted from the WHO guidelines).

    Bhatnagar S; Lodha R; Choudhury P; Sachdev HP; Shah N

    Indian Pediatrics. 2007 Jun 17; 44(6):443-461.

    Malnutrition in children is widely prevalent in India. It is estimated that 57 million children are underweight (moderate and severe). More than 50% of deaths in 0-4 years are associated with malnutrition. The median case fatality rate is approximately 23.5% in severe malnutrition, reaching 50% in edematous malnutrition. There is a need for standardized protocol-based management to improve the outcome of severely malnourished children. In 2006, Indian Academy of Pediatrics undertook the task of developing guidelines for the management of severely malnourished children based on adaptation from the WHO guidelines. We summarize below the revised consensus recommendations (and wherever relevant the rationale) of the group. (excerpt)
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  11. 36
    318283

    A research agenda for childhood tuberculosis. Improving the management of childhood tuberculosis within national tuberculosis programmes: research priorities based on a literature review.

    Donald P; Maher D; Qazi S

    Geneva, Switzerland, World Health Organization [WHO], 2007. [123] p. (WHO/HTM/TB/2007.381; WHO/FCH/CAH/07.02)

    Childhood TB is a neglected aspect of the TB epidemic, despite constituting 20% or more of the TB case-load in many countries with high TB incidence. This "orphan disease" exists in the shadow of adult TB and is a significant child health problem, but is neglected because it is usually smear-negative and is thus considered to make a relatively minor contribution to the spread of TB. In order to redress this neglect and integrate childhood TB into the mainstream of TB control activities, research priorities are identified that will assist in improving the prevention and management of childhood TB as a part of national TB programmes (NTPs). The proposed research agenda seeks to better define childhood TB, to optimize the treatment of childhood TB and to identify the best management practices by which childhood TB can be accurately documented and recorded, and efficiently managed within NTPs. (excerpt)
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  12. 37
    316237
    Peer Reviewed

    Planning to improve global health: the next decade of tuberculosis control.

    Maher D; Dye C; Floyd K; Pantoja A; Lonnroth K

    Bulletin of the World Health Organization. 2007 May; 85(5):325-420.

    The Global Plan to Stop TB 2006-2015 is a road map for policy-makers and managers of national programmes. It sets out the key actions needed to achieve the targets of the Millennium Development Goals relating to tuberculosis (TB): to halve the prevalence and deaths by 2015 relative to 1990 levels and to save 14 million lives. Developed by a broad coalition of partners, the plan presents a model approach combining interventions that can feasibly be supplied on the ground. The main areas of activity set out in the plan are: scaling up interventions to control tuberculosis; promoting the research and development of improved diagnostics, drugs and vaccines; and engaging in related activities for advocacy, communications and social mobilization. Scenarios for the planning process were developed; these looked at issues both globally and in seven epidemiological regions. The scenarios made ambitious but realistic assumptions about the pace of scale-up and implementation coverage of the activities. A mathematical model was used to estimate the impact of scaling up current interventions based on data from studies of tuberculosis biology and from experience with tuberculosis control in diverse settings. The estimated costs of the activities set out in the Global Plan were based on implementing interventions and researching and developing drugs, diagnostics and vaccines; these costs were US$ 56 billion over 10 years. When translated into cost per disability adjusted life year averted, these costs compare favourably with those of other public health interventions. This approach to planning for global tuberculosis control is a valuable example of developing plans to improve global health that has relevance for other health issues. (author's)
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  13. 38
    316012

    Integrated management of childhood illness: An emphasis on the management of infectious diseases.

    Benguigui Y; Stein F

    Seminars in Pediatric Infectious Diseases. 2006 Apr; 17(2):80-98.

    The Integrated Management of Childhood Illness (IMCI) strategy has helped strengthen the application and expand coverage of key child survival interventions aimed at preventing deaths from infectious disease, respiratory illness, and malnutrition, whether at the health services, in the community, or at home. IMCI covers the prevention, treatment, and follow-up of the leading causes of mortality, which are responsible for at least two-thirds of deaths of children younger than 5 years in the countries of the Americas. The IMCI clinical guidelines take an evidence-based, syndrome approach to case management that supports the rational, effective, and affordable use of drugs and diagnostic tools. When clinical resources are limited, the syndrome approach is a more realistic and cost-effective way to manage patients. Careful and systematic assessment of common symptoms and well-selected clinical signs provide sufficient information to guide effective actions. (author's)
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  14. 39
    312718

    The Stop TB Partnership in South Africa: a review.

    Barr D; Padarath A; Salt L

    Durban, South Africa, Health Systems Trust, 2004. 61 p.

    This case study presents an overview of the Stop TB Partnership operating in the South African context. It offers an analysis of the activities and impact of the Partnership in South Africa. Its overarching objective is to collect a set of baseline data on the functioning and operational aspects of the Partnership and to assess whether such initiatives contribute to the development of equitable health services in the public health sector. Tuberculosis is a priority disease in South Africa: the cure rate for new patients of 64% is still way below the World Health Organization (WHO) target of 85%. In some provinces, the cure rate is as low as 40%. The estimated incidence of TB per 100 000 population is 526, and an estimated 60% of adults with TB are also HIV positive. South Africa is ranked third in the WHO AFRO region by the number of TB cases, and ninth globally. Funded by WEMOS, this review is part of a multi-country study. It aims to augment the existing body of knowledge on Global Public Private Initiatives in Health (GPPIs) and to generate a body of country-based evidence relating to the effect of GPPIs on health policies and health systems. (excerpt)
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  15. 40
    312290

    Guidance for national tuberculosis programmes on the management of tuberculosis in children.

    Bjune G; Cotton M; El Sony A; Gie R; Graham S

    Geneva, Switzerland, World Health Organization [WHO], 2006. [49] p. (WHO/HTM/ TB/2006.371; WHO/FCH/CAH/2006.7)

    This document complements existing national and international guidelines and standards for managing TB, many of which include guidance on children. It fills the gaps in the existing materials and provides current recommendations based on the best available evidence. National and regional TB control programmes may wish to revise and adapt this guidance according to local circumstances. This document reflects two important recent policy changes. Firstly, NTPs should record and report two age groups for children (0--4 years and 5--14 years) using the quarterly reporting form. Routine reporting of these two age groups has considerable benefits. Enumerating children with TB is a key step in bringing their management into the mainstream of the Stop TB Strategy as part of routine NTP activities. This age breakdown is crucial in ordering drugs (since child-friendly formulations are particularly important in children aged 0--4 years) and in monitoring of trends in these two distinct age groups (since children aged 0--4 years are the most vulnerable and infection at these early ages indicates recent transmission). In addition, routine NTP data collection will provide valuable and sustainable information on market needs concerning child-friendly formulations of anti-TB drugs. Secondly, the revised recommended dose of ethambutol is now 20 mg/kg (range 15--25 mg/kg) daily. Although ethambutol was previously often omitted from treatment regimens for children, due in part to concerns about toxicity (particularly optic neuritis), a literature review indicates that it is safe in children at this dose. (excerpt)
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  16. 41
    312289

    The use of rapid syphilis tests.

    World Health Organization [WHO]. Special Programme for Research and Training in Tropical Diseases. Sexually Transmitted Diseases Diagnostics Initiative

    Geneva, Switzerland, WHO, Special Programme for Research and Training in Tropical Diseases [TDR], 2006. 25 p. (TDR/SDI/06.1.)

    Syphilis is a curable infection caused by a bacterium called Treponema pallidum. This infection is sexually transmitted, and can also be passed on from a mother to her fetus during pregnancy. As a cause of genital ulcer disease, syphilis has been associated with an increased risk of HIV transmission and acquisition. Most persons with syphilis tend to be unaware of their infection and they can transmit the infection to their sexual contacts or, in the case of a pregnant woman, to her unborn child. If left untreated, syphilis can cause serious consequences such as stillbirth, prematurity and neonatal deaths. Adverse outcomes of pregnancy are preventable if the infection is detected and treated before mid-second trimester. Early detection and treatment is also critical in preventing severe long term complications in the patient and onward transmission to sexual partners. Congenital syphilis kills more than one million babies a year worldwide but is preventable if infected mothers are identified and treated appropriately as early as possible. (excerpt)
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  17. 42
    310830
    Peer Reviewed

    Assessment of ultrasound morbidity indicators of schistosomiasis in the context of large-scale programs illustrated with experiences from Malian children.

    Koukounari A; Sacko M; Keita AD; Gabrielli AF; Landoure A

    American Journal of Tropical Medicine and Hygiene. 2006 Dec; 75(6):1042-1052.

    We assessed morbidity indicators for both Schistosoma haematobium and Schistosoma mansoni infections and evaluated the appropriateness of the World Health Organization (WHO) guidelines for ultrasound in schistosomiasis in the context of large-scale control interventions. Abdominal and urinary tract ultrasonography was performed on 2,247 and 2,822 school children, respectively, from 29 randomly selected schools in Mali before the implementation of mass anthelminthic drug administration. Using two-level logistic regression models, we examined associations of potential factors with the risk of having a positive ultrasound global score (morbidity indicative of S. haematobium infection), abnormal image pattern scores, dilatation of the portal vein, and/or enlarged liver (morbidity indicative of S. mansoni infection). The WHO protocol was found useful for detection of S. haematobium pathology but overestimated the risk of portal vein dilatation and left liver lobe enlargement associated with S. mansoni infection. We conclude that ultrasonography should be included in large-scale control interventions, where logistics allow, but cautiously. (author's)
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  18. 43
    310375
    Peer Reviewed

    Health professionals must confront HIV / AIDS. From the World Health Organization.

    Brundtland GH

    JAMA. 2001 Sep 26; 286(12):1444.

    The 20th anniversary of the first diagnosis of HIV infection has come and gone. So has the razzmatazz surrounding the UN General Assembly's Special Session on AIDS in June. Headlines made when UN Secretary-General Kofi Annan appealed for the world to act on the global emergency AIDS represents have been superseded by other events. It's back to business as usual. Or is it? It must not be. The AIDS crisis is as real now as a few months ago, and it will continue to grow unless the world is constantly reminded of it and plans to stem the epidemic are turned into action. The recent focus on AIDS among the poorest countries of the world--in particular in Africa--may have given an impression that those who live in countries with stable or declining infection rates no longer need to worry. Recent infection figures in the United States showing disturbing increases in some population groups prove this is not so. And the effects of globalization mean that there no longer is such a thing as a localized health problem. The HIV/AIDS epidemic is a global emergency and it calls for global commitment and action. UN Secretary-General Annan recently asserted that "AIDS can no longer do its deadly work in the dark. The world has started to wake up." Frighteningly, it has taken 22 million deaths and 13 million orphaned children to act as a global alarm clock. Today, there are 36 million people living with HIV/AIDS. (author's)
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  19. 44
    307809

    Tuberculosis in children [editorial]

    Mehnaz A

    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)
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  20. 45
    306526
    Peer Reviewed

    Nosocomial tuberculosis in India.

    Pai M; Kalantri S; Aggarwal AN; Menzies D; Blumberg HM

    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)
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  21. 46
    303739

    HIV testing methods: UNAIDS technical update.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 1997 Nov. 7 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)

    Since 1985, HIV testing has been essential in securing the safety of blood supplies, monitoring the progress of the epidemic and diagnosing individuals infected with the virus. Various assays are now available, allowing testing strategies to be tailored to the epidemiological conditions and budgets of national health systems. New techniques -- including simple tests giving instant results -- hold great promise, but also raise some serious issues for governments and for individuals. HIV infection is most frequently diagnosed by detecting antibodies which the body produces as it tries to resist the virus. These antibodies usually begin to be produced within 3 to 8 weeks after the time of infection. The period following infection but before the antibodies become detectable is known as the .window period.. Antibodies are much easier to detect than the virus itself. It is sometimes possible to detect HIV antigen during the window period if, by coincidence, an individual is tested during the short peak of high levels of circulating virus particles. After this peak, the level of p24 antigen steeply declines to the point where it is no longer detectable. It fluctuates or rises steeply again, usually years later, when the clinical situation of the patient starts to deteriorate with the onset of AIDS. (excerpt)
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  22. 47
    303426
    Peer Reviewed

    The WHO dengue classification and case definitions: time for a reassessment. [Clasificación del dengue y definición de casos de la OMS: tiempo de una nueva evaluación]

    Deen JL; Harris E; Wills B; Balmaseda A; Hammond SN

    Lancet. 2006 Jul 8; 368(9530):170-173.

    Dengue is the most prevalent mosquito-borne viral disease in people. It is caused by four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4), of the genus Flavivirus, and transmitted by Aedes aegypti mosquitoes. Infection provides life-long immunity against the infecting viral serotype, but not against the other serotypes. Although most of the estimated 100 million dengue virus infections each year do not come to the attention of medical staff , of those that do, the most common clinical manifestation is non-specific febrile illness or classic dengue fever. About 250 000--500 000 patients developing more severe disease. The risk of severe disease is several times higher in sequential than in primary dengue virus infections. Despite the large numbers of people infected with the virus each year, the existing WHO dengue classification scheme and case definitions have some drawbacks. In addition, the widely used guidelines are not always reproducible in different countries--a quality that is crucial to effective surveillance and reporting as well as global disease comparisons. And, as dengue disease spreads to different parts of the globe, several investigators have reported difficulties in using the system, and some have had to create new categories or new case definitions to represent the observed patterns of disease more accurately. (excerpt)
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  23. 48
    303117

    Mass treatment of syphilis in an Indian province.

    Cutler JC; Kvittingen J; Rose E; McCullough JC

    Bulletin of the World Health Organization. 1952; 5:377-439.

    This report deals with some of the experiences of the World Health Organization Venereal Disease Demonstration Team assigned to the Government of India to establish a suitable system of control in both an urban and rural area and to give instruction in those methods of diagnosis and treatment which could best be adapted to local resources. The WHO Expert Committee on Venereal Diseases believed that the method of control developed in the United States of America could be applied usefully in many areas of the world, if suitably adapted to local conditions and requirements. The committee suggested that the team's activities should embrace both rural and urban populations. The importance of working in rural areas is particularly evident in India where, in 1941, 87% of the population was rural and a serious shortage of medical care prevailed. The expert committee believed that proved techniques could be adapted to provide venereal-disease care for this rural group within the budgetary and personnel limitations of the medical services of the country. (excerpt)
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  24. 49
    301999

    Tuberculosis care and control [editorial]

    Hopewell PC; Migliori GB; Raviglione MC

    Bulletin of the World Health Organization. 2006 Jun; 84(6):428.

    Tuberculosis care, a clinical function consisting of diagnosis and treatment of persons with the disease, is the core of tuberculosis control, which is a public health function comprising preventive interventions, monitoring and surveillance, as well as incorporating diagnosis and treatment. Thus, for tuberculosis control to be successful in protecting the health of the public, tuberculosis care must be effective in preserving the health of individuals. There are three broad mechanisms through which tuberculosis care is delivered: public sector tuberculosis control programmes, private sector practitioners having formal links to public sector programmes (the public--private mix), and private providers having no connection with formal activities. In most countries, programmes in both the public sector and the public--private mix are guided by international and national recommendations based on the DOTS tuberculosis control strategy -- a systematic approach to diagnosis, standardized treatment regimens, regular review of outcomes, assessment of effectiveness and modification of approaches when problems are identified. (excerpt)
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  25. 50
    298767
    Peer Reviewed

    The Global Plan to Stop TB: a unique opportunity to address poverty and the Millennium Development Goals.

    Squire SB; Obasi A; Nhlema-Simwaka B

    Lancet. 2006 Mar 18; 367(9514):955-957.

    The Millennium Development Goals (MDGs) provide the guiding framework within which the Stop TB Partnership's Second Global Plan to Stop TB has been conceived, and poverty is rightly recognised as a key cross-cutting issue for tuberculosis control. This explicit pro-poor focus, although important in itself, will only make a difference to the individual lives of the poor if practical steps are taken to address the obstacles that these people face in accessing good tuberculosis services, and if programme implementation takes account of the distribution of poverty within target communities as a whole. That the Plan goes beyond the rhetoric and lays out the practical steps that tuberculosis programmes can take to address poverty is encouraging (panel). (excerpt)
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