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American Journal of Tropical Medicine and Hygiene. 2006 Feb; 74(2):187-188.Accurate measurement of malaria incidence is of great importance to malaria control, but it is very hard to achieve in most circumstances. Robert Snow and colleagues recently reported the results of a method to determine the case incidences of Plasmodium falciparum malaria around the world. For non-African P. falciparum malaria, they estimated three times more cases than in recent WHO figures. They suggested that the WHO estimates were lower due to the use of passively reported national malaria records. We, who prepared the WHO estimates of non-African malaria cases and published the method used to derive them, discuss here the suggestion by Snow and colleagues that, because of the data and methods used, the WHO estimates must be an under-representation of the true incidence of malaria cases. (excerpt)
Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings.
Journal of Acquired Immune Deficiency Syndromes. 2006 Apr 15; 41(5):632-641.The objective was to estimate the potential impact of antiretroviral therapy on the heterosexual spread of HIV-1 infection and AIDS mortality in resource-limited settings. A mathematic model of HIV-1 disease progression and transmission was used to assess epidemiologic outcomes under different scenarios of antiretroviral therapy, including implementation of World Health Organization guidelines. Implementing antiretroviral therapy at 5% HIV-1 prevalence and administering it to 100% of AIDS cases are predicted to decrease new HIV-1 infections and cumulative deaths from AIDS after 10 years by 11.2% (inter-quartile range [IQR]: 1.8%-21.4%) and 33.4% (IQR: 26%-42.8%), respectively. Later implementation of therapy at endemic equilibrium (40% prevalence) is predicted to be less effective, decreasing new HIV-1 infections and cumulative deaths from AIDS by 10.5% (IQR: 2.6%-19.3%) and 27.6% (IQR: 20.8%-36.8%), respectively. Therapy is predicted to benefit the infected individual and the uninfected community by decreasing transmission and AIDS deaths. The community benefit is greater than the individual benefit after 25 years of treatment and increases with the proportion of AIDS cases treated. Antiretroviral therapy is predicted to have individual and public health benefits that increase with time and the proportion of infected persons treated. The impact of therapy is greater when introduced earlier in an epidemic, but the benefit can be lost by residual infectivity or disease progression on treatment and by sexual disinhibition of the general population. (author's)
WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity.
BMC Public Health. 2006 Jul 6; 6:177.Health care planning for chronic pelvic pain (CPP), an important cause of morbidity amongst women is hampered due to lack of clear collated summaries of its basic epidemiological data. We systematically reviewed worldwide literature on the prevalence of different types of CPP to assess the geographical distribution of data, and to explore sources of variation in its estimates. We identified data available from Medline (1966 to 2004), Embase (1980 to 2004), PsycINFO (1887 to 2003), LILACS (1982 to 2004), Science Citation index, CINAHL (January 1980 to 2004) and hand searching of reference lists. Two reviewers extracted data independently, using a piloted form, on participants' characteristics, study quality and rates of CPP. We considered a study to be of high quality (valid) if had at least three of the following features: prospective design, validated measurement tool, adequate sampling method, sample size estimation and response rate > 80%. We performed both univariate and multivariate meta-regression analysis to explore heterogeneity of results across studies. There were 178 studies (459975 participants) in 148 articles. Of these, 106 studies were (124259 participants) on dysmenorrhoea, 54 (35973 participants) on dyspareunia and 18 (301756 participants) on noncyclical pain. There were only 19/95 (20%) less developed and 1/45 (2.2%) least developed countries with relevant data in contrast to 22/43 (51.2%) developed countries. Metaregression analysis showed that rates of pain varied according to study quality features. There were 40 (22.5%) high quality studies with representative samples. Amongst them, the rate of dysmenorrhoea was 16.8 to 81%, that of dyspareunia was 8 to 21.8%, and that for noncyclical pain was 2.1 to 24%. There were few valid population based estimates of disease burden due to CPP from less developed countries. The variation in rates of CPP worldwide was due to variable study quality. Where valid data were available, a high disease burden of all types of pelvic pain was found. (author's)
Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis.
Lancet. 2006 Dec 16; 368(9553):2142-2154.The burden of tuberculosis is compounded by drug-resistant forms of the disease. This study aimed to analyse data on antituberculosis drug resistance gathered by the WHO and International Union Against Tuberculosis and Lung Disease Global Project on Anti-tuberculosis Drug Resistance Surveillance. Data on drug susceptibility testing for four antituberculosis drugs--isoniazid, rifampicin, ethambutol, and streptomycin--were gathered in the third round of the Global Project (1999-2002) from surveys or ongoing surveillance in 79 countries or geographical settings. These data were combined with those from the first two rounds of the project and analyses were done. Countries that participated followed a standardised set of guidelines to ensure comparability both between and within countries. The median prevalence of resistance to any of the four antituberculosis drugs in new cases of tuberculosis identified in 76 countries or geographical settings was 10.2% (range 0.0-57.1). The median prevalence of multidrug resistance in new cases was 1.0% (range 0.0-14.2). Kazakhstan, Tomsk Oblast (Russia), Karakalpakstan (Uzbekistan), Estonia, Israel, the Chinese provinces Liaoning and Henan, Lithuania, and Latvia reported prevalence of multidrug resistance above 6.5%. Trend analysis showed a significant increase in the prevalence of multidrug resistance in new cases in Tomsk Oblast (p < 0.0001). Hong Kong (p = 0.01) and the USA (p = 0.0002) reported significant decreasing trends in multidrug resistance in new cases of tuberculosis. Multidrug resistance represents a serious challenge for tuberculosis control in countries of the former Soviet Union and in some provinces of China. Gaps in coverage of the Global Project are substantial, and baseline information is urgently required from several countries with high tuberculosis burden to develop appropriate control interventions. (author's)
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)
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)
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)
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)
Promoting behavior change in Botswana: an assessment of the Peer Education HIV / AIDS Prevention Program at the workplace.
Journal of Health Communication. 2003 May-Jun; 8(3):267-281.Botswana has the highest rate of HIV prevalence in the world and AIDS has now reached crisis proportions in the country. Among the initiatives implemented as a response, to promote sexual behavior change, is the Peer Education HIV/AIDS Prevention Program (PEHAPP) at the workplace. This paper assesses the impact and outcome of the PEHAPP. It concludes that the PEHAPP is having a measurable positive impact in the key areas of improving knowledge, attitudes, and practices related to risky sexual behavior which, in turn, should reduce the incidence of transmission of HIV/AIDS and other STDs over the long-term. (author's)
Epidemiology of measles in the central region of Ghana: a five-year case review in three district hospitals.
East African Medical Journal. 2003 Jun; 80(6):312-317.Objective: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. Design: A descriptive survey was carried out on retrospective cases of measles. Setting: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. Subjects: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles eases in all health facilities in the three study, districts were also analysed. Main outcome measures: The distribution of measles eases in person (age and sex), time (weekly, or monthly, trends) anti place (residence), the relative frequency, of eases, and the outcome of treatment. Results: There was an overall decline in reported eases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%- 52% of the reported 1508 eases in the hospitals. The median age of patients was 36 months. Eleven percent of eases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly eases. Conclusion: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns. (author's)
Transmission intensity index to monitor filariasis infection pressure in vectors for the evaluation of filariasis elimination programmes.
Tropical Medicine and International Health. 2003 Sep; 8(9):812-819.We conducted longitudinal studies on filariasis control in Villupuram district of Tamil Nadu, south India, between 1995 and 2000. Overall, 23 entomological (yearly) data sets were available from seven villages, on indoor resting collections [per man hour (PMH) density and transmission intensity index (TII)] and landing collections on human volunteers [PMH and annual transmission potential (ATP)]. All four indices decreased or increased hand-in-hand with interventions or withdrawal of inputs and remained at high levels without interventions under varied circumstances of experimental design. The correlation coefficients between parameters [PMH: resting vs. landing (r = 0.77); and TII vs. ATP (r = 0.81)] were highly significant (P < 0.001). The former indices from resting collections stand a chance of replacing the latter from landing collections in the evaluation of global filariasis elimination efforts. The TII would appear to serve the purpose of a parameter that can measure infection pressure per unit time in the immediate household surroundings of human beings and can reflect the success or otherwise of control/elimination efforts along with human infection parameters. Moreover, it will not pose any additional risk of new infection(s) and avoids infringement of human rights concerns by the experimental procedures of investigators, unlike ATP that poses such a risk to volunteers. (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)
AIDS Alert. 2003 Feb; 18(2):22.HIV prevention continues to offer the world's best hope in stopping the AIDS epidemic, and recent success stories in South Africa and Uganda prove that these work, according to the recent AIDS Epidemic Update report by UNAIDS and the World Health Organization (WHO) in Geneva, Switzerland. (excerpt)
Lancet. 2003 Sep 13; 362(9387):917.I find reassuring the fact that the Child survival series could constitute a renaissance in child-health matters, as suggested by Boniface Kalanda in the accompanying Debate section online. To remain quiet while 10 million children die every year, mostly in developing countries, is certainly unacceptable. (excerpt)
Clinical Infectious Diseases. 2003 Jan 15; 36 Suppl 1:S24-S30.Resistance to antituberculosis drugs has been a problem since the era of chemotherapy began. After dramatic outbreaks of multidrug-resistant tuberculosis (MDR-TB) in the early 1990s, resistance became recognized as a global problem. MDR-TB now threatens the inhabitants of countries in Europe, Asia, Africa, and the Americas. An understanding of the molecular basis of drug resistance may contribute to the development of new drugs. Management of MDR-TB relies on prompt recognition and treatment with at least 3 drugs to which an isolate is susceptible. (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)
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 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)
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.
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)
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.
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.
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.
[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.
Bulletin of the World Health Organization. 2010 Mar; 88(3):232-4.Add to my documents.