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ETHIOPIAN MIDWIVES MAGAZINE. 1995; (10):13.The Global Program on Acquired Immunodeficiency Syndrome (AIDS), known as GPA, has established a new organization composed of several UN agencies (i.e., WHO, UNICEF, UNDP, UNESCO, UNDFP, and the World Bank). GPA estimates for human immunodeficiency infection (HIV) indicate an increase of 3 million over the last year. Over half of the new infections occurred in women. The sharpest rise has been in the number of AIDS cases; during the last 6 months, the estimated cumulative number has risen from 1 million to 4 million globally. Since the beginning of the pandemic, over 16 million men, women, and children have become infected with HIV. One in every 15 people infected is a child. Almost one-fourth of the total, about 4 million, have developed AIDS. The GPA Management Committee Meeting (GMC) in May released the following information: 1) every day 5000 more people are infected with HIV; 2) sub-Saharan Africa remains the most heavily affected with two-thirds of the total infections; 3) the epidemic is spreading most rapidly in India, Thailand, Vietnam, and Cambodia; 4) there has been an increase, from 30,000 to 250,000, in the number of AIDS cases in the past year in south and southeast Asia; and 5) prevalence rates as high as 25% among military recruits, and 8% among pregnant women, are being reported in parts of northern Thailand. Once the epidemics in African countries have matured, over two-thirds of the new infections occur in persons under 24 years of age; almost half of the new adult cases are women. Unless action is taken at least 30-40 million people will be infected by the end of the decade.
Geneva, Switzerland, World Health Organization [WHO], 1991. vi, 96 p.WHO published this manual on the prevention and control of hookworm infection and anemia primarily for community health workers. The manual addresses the epidemiology, diagnosis, and management of these conditions. Its annexes provide details of appropriate examination techniques for hookworm and hookworm anemia surveys and sample survey considerations. It emphasizes the importance of thorough population surveys. The worldwide prevalence of infection with Ancylostoma duodenale and Necator americanus is about 25%. It occurs predominantly in developing countries, where prevalence may be as high as 80% in some areas. It is a major cause of iron deficiency anemia. Its presence indicates deficiencies in sanitation and health education. Many persons, including public health officials, are not interested in national control of hookworm infection, probably because it induces low mortality and it is technically difficult to measure and quantify hookworm-related morbidity. Control of hookworm infection and hookworm-related anemia is uncomplicated and effective. It consists of health education, effective sanitation, and treatment with antihelminthics and iron supplements. The manual's seven chapters cover the following: hookworms infecting humans; clinical pathology of hookworm infection; hookworm infection as a cause of anemia; epidemiology of hookworm infection; principles of prevention and control; assessing the situation; and practical prevention and control.
Epidemiology of an outbreak of cholera in Senegal (West Africa) in 1985: modes of transmission and mortality.
[Unpublished] . 24,  p.A cholera outbreak in villages under demographic surveillance by a team of ORSTOM researchers in the center part of Senegal during the first three months of 1985 is described. Health authorities started a vaccination campaign and disinfection of the wells. The ORSTOM team helped to treat cholera cases and a house-to-house survey of the area was started immediately. All cases of cholera-like diarrhea and vomiting that occurred during January-March 1985 in the villages were recorded on special forms. Most cases (63%) and most deaths occurred in January. The epidemic reached a peak during the fourth week of January, then plunged. Interventions started at the end of the third week with a mass vaccination campaign, chlorinization of wells, treatment of cases with oral rehydration therapy (ORT) and tetracycline (4 x 500 mg per day for 2 days), and chemoprophylaxis of cholera patient contacts with sulfadoxine. The pattern of the disease transmission was clearly identified from retrospective interviews in 4% of all cases. Among the 102 identified cases, 56% showed evidence of primary contamination at a funeral ceremony and 44% were secondary cases within the household caused by person-to-person cholera transmission. 70% of adults were contaminated at a burial ceremony and 82% of children inside the compound. 31% of all cholera patients were below 15 years of age (more than 44% of the total population), while 28% of all cholera cases were among the population aged over 50 (14% of the population). During these 3 months, 235 cases of cholera with 44 deaths were recorded. The overall attack rate was 1.9/100 population, and the global lethality rate was 18.7%. However, below age 50 the case-fatality rate was 10%, and after age 50 it rose to 40%. 24.7% of males vs. 14.5% of females were at risk of dying. The drop from a peak of 43% lethality to less than 10% a week later was most probably attributable to ORT and tetracycline treatment.
WORLD HEALTH. 1995 Jan-Feb; 48(1):10-1.The World Health Organization has established a network of more than 60 national virology laboratories to perform the surveillance necessary to insure the eradication of poliovirus. These laboratories work with epidemiologists to determine the cause of cases of acute flaccid paralysis. Their work is supported by 15 regional reference laboratories and 5 specialized global laboratories. As the number of polio-free countries increases, researchers at the US Centers for Disease Control are engaging in "molecular epidemiology" to determine if the indigenous strains of wild polio have really disappeared. These studies examine the mutations which occur at a rate of approximately 2% of a selected portion of the genome each year to determine the relationship between viruses of the same type. Differences of more than 10% indicate different families of viruses. Analysis of many strains has allowed the mapping of the "homelands," or geographical areas, of various genotypes. Such molecular epidemiology will allow coordinated eradication activities to be directed at eliminating genotypes from homelands which extend beyond national borders. Until global eradication is achieved, all countries remain at risk.
TUBERCLE AND LUNG DISEASE. 1994 Jun; 75(3):163-7.Poor management of tuberculosis (TB) control is responsible for resistance to antituberculosis drugs. It leads to treatment failure, relapse, transmission of resistant TB, and multi-drug resistant TB. In developing countries, where resources are already limited, an epidemic of multi-drug resistant TB would jeopardize TB control. The effect of HIV infection is likely to worsen drug resistance-related problems. Specifically, streptomycin injections pose a risk of HIV transmission. It appears that withdrawal of thiacetazone from HIV infected TB patients causes resistance to more powerful drugs. If these 2 antibiotics cannot be used to treat TB patients, the armamentarium available to control TB in high HIV prevalence countries is reduced, which could foster resistance to the fewer remaining antibiotics. Good management and supervision is needed to prevent resistance to antituberculosis drugs. Surveillance of drug resistance is also needed to monitor the current level and characteristics of the drug resistance problem and to identify effective solutions. Specifically, at the national level, a TB surveillance system can assess the TB control program's performance and assess the need to modify the current treatment policy. It can identify districts or health centers with high levels of drug resistance and determine the risk factors for resistance. WHO will assist developing countries in developing their own surveillance systems. WHO and the International Union Against Tuberculosis and Lung Disease plan on setting up a network of supranational reference laboratories to determine the quality control and standardization of susceptibility testing needed for international comparison. WHO also plans on supporting national reference laboratories in developing countries.
Surveillance of acquired immunodeficiency syndrome in Africa: an analysis of evaluations of the World Health Organization and other clinical definitions.
EPIDEMIOLOGIC REVIEWS. 1994; 16(2):403-17.In order to improve public health efforts to combat the HIV pandemic, a system for surveillance of HIV and AIDS is needed. Definitions used for case reporting are at the heart of such a system. In many parts of Africa, however, facilities for diagnosing HIV infection and its subsequent complications are unavailable, and the definition developed by the US Centers for Diseases Control and Prevention (CDC) for use in developed countries is often impractical in Africa. The World Health Organization (WHO) in early 1985 therefore proposed using a provisional case definition of AIDS based principally upon clinical criteria. Developing a clinical definition of AIDS in Africa, however, is also complicated. The nonspecific nature of many of the signs and symptoms of HIV infection as well as the clinical redundancy between HIV and other epidemic health problems make definitive identification of any single disease problematic. Evaluation of the surveillance definition of AIDS in Africa is complicated by the lack of an accepted standard for comparison. Most studies in the field have used HIV serology as the standard, while others have employed the CDC definition for AIDS, giving the evaluations a certain relativity. This paper reviews available information on the WHO definition and other clinical definitions for AIDS in Africa in order to analyze their various field evaluations and explore the use of such definitions in the African context. Sections discuss surveillance clinical case definitions for African AIDS in adult and pediatric populations, clinical case definitions of African AIDS in adult and pediatric populations, sensitivity and specificity, the WHO clinical case definition for HIV epidemiologic survey, clinical definitions for AIDS in clinical practice, and working toward the improvement of the clinical definition of AIDS.
SANTE-SALUD. 1993 Summer; (2):5-6.The World Health Organization (WHO) has coordinated and supported the eradication of malaria in various countries of the world since 1957. Unlike some countries in the temperate zone which have been successful in eradicating the disease, malaria remains endemic in tropical and subtropical countries. In 1969 WHO recommended that, although eradication should remain an ultimate goal, malaria control operations may form a transitional phase in countries where eradication does not appear feasible. Malaria control, however, remains an impossible goal in many countries where the disease is endemic. Plasmodium falciparum is the predominant malaria pathogen responsible for severe disease and death. It is estimated that 90% of all malaria cases worldwide occur in Africa, where the majority of people live in highly endemic or endemic prone areas. Only about 12% of the population lives in risk-free or low-risk areas. Between one-third and two-thirds of all cases of fever among children are associated with malaria, and in some parts of Africa the case-fatality rate is as high 31.9% for infants and 20.4% for children. The malaria situation in the African continent is rapidly changing due to variants of P. falciparum that are resistant to chloroquine; mosquitoes that are resistant to insecticides; movement of nonimmune individuals to endemic areas; increasing short-term travel patterns; and ecological reasons. Malaria is also appearing in previously free areas because of technological (agricultural) advances. Adult and pediatric dosages of antimalarial drugs are suggested for the treatment and prevention of P. falciparum malaria.
WORLD HEALTH FORUM. 1994; 15(1):43-7.The results of a survey initiated in May, 1991, are reported, in which members of the World Health Organization (WHO) Global Environmental Epidemiology Network (GEENET) were queried with the aim of compiling an inventory of free-standing environmental and occupational epidemiology courses that were offered or planned for 1991-93 in English, French, or Spanish for professionals (physicians, environmental health officers, public health inspectors, safety officers, sanitation officers, toxicologists, urban planners, and public health administrators) living both in and outside the countries concerned. 1221 persons on the mailing list were contacted. GEENET was established in 1987 with the aim of integrating approaches to hazard recognition, risk assessment, and pollution control. By June, 1992, GEENET had about 1700 members in 110 countries. Its objectives are to target WHO materials for distribution, form a panel of experts, and exchange information. In 1990, GEENET members in developing countries reported serious problems pertaining to sanitation and sewage disposal, housing, contaminated food and water, traffic accidents, exposure to pesticides, and indoor air pollution. In developed countries, traffic accidents ranked first, followed by air pollution, and pollution from toxic waste disposal sites. The inventory was printed in July, 1992, from database files. Of the 126 courses on which information was received. 72 were open to health professionals from more than 1 discipline. The duration of courses ranged from 2 days to 4 academic years, and 15 courses lasted 1 year. Communicable diseases were included in only 29% of 42 courses in the Americas, compared to 56% of 43 courses in Europe. The control of environmental hazards was taught in 93% of courses in Africa, 94% in the western Pacific, only but 71% and 58%, respectively, of course in the Americas and in Europe. Epidemiological principles, statistical methods, principles of outbreak investigation, and risk assessment were less frequently mentioned in the courses of the Americas than in those of Europe. The tutors should review course content to verify the satisfaction of educational objectives.