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  1. 1

    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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  2. 2

    Acquired immune deficiency syndrome (AIDS)--recommendations of IMAP.

    International Planned Parenthood Federation [IPPF]. International Medical Advisory Panel [IMAP]

    IPPF MEDICAL BULLETIN. 1986 Jun; 20(3):3-4.

    This statement was prepared by the IPPF Medical Department in response to requests from family planning associations for clear and accurate information about the acquired immunodeficiency syndrome (AIDS) and the precautions needed to avoid AIDS infection. It summarizes current knowledge on the epidemiology, transmission, diagnosis, symptoms, and prevention of AIDS. Transmission of human lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) occurs through sexual contact with an infected person, transfusion of infected blood or blood products, injection with a needle contaminated with the virus, or artificial insemination with infected semen. Transmission also can occur perinatally from an infected mother to her infant. At present, persons who have antibody to HTLV-III/LAV are believed to harbor the virus and are considered infectious. Recommendations for the prevention of sexually acquired AIDS include avoidance of casual sex, especially with those from high risk groups (homosexual or bisexual men, intravenous drug users, prostitutes), and condom use. Transmission by nonsexual means can be controlled by refusing to accept blood, semen, organ, or tissue donations from persons in high risk groups; avoidance of illicit use of intravenous drugs or use of nonsterile needles; awareness on the part of health workers involved in providing artificial insemination services or blood and blood products of the risk of HTLV-III/LAV infection; and screening of semen donors for antibody at the time of donation and after 3 months. In terms of prevention of perinatal transmission, it should be noted that women with HTLV-III/LAV infection who become pregnant are at increased risk of developing AIDS and have a 50% chance of transmitting infection to their infant. Women with HTLV-III/LAV infection should be advised of the need for a highly efficient type of contraception to prevent pregnancy. Since AIDS is an uncommon disease of low infectivity, family planning workers are not considered to be at greater risk than the broader population.
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  3. 3

    Guidelines for the prevention and control of infection with LAV/HTLV III.

    World Health Organization [WHO]

    [Unpublished] 1986 May. [17] p. (WHO/CDS/AIDS/86.1)

    These guidelines, prepared by WHO, address the prevention and control of the acquired immunodeficiency syndrome (AIDS) infection with lymphadenopathy associated virus/human T-lymphotropic virus Type III (LAV/HTLV-III) and are suitable for international application. The Introduction sets forth case definitions of AIDS and discusses the virus, its transmission and clinical features, laboratory methods for detection, and notification and confidentiality. The chapter on recommendations for health care workers proposes precautions for specific personnel such as laboratory staff, providers of home care, dental care personnel, and eye examiners. Also included are considerations relevant to non-health-care workers such as personal service workers and food service workers. Procedures for the handling of blood and blood products and disinfection and sterilization are set forth, and means of avoiding sexual and parenteral transmission of LAV/HTLV-III infection are suggested. Another chapter focuses on screening, diagnostic testing, and counseling of seropositive individuals. The strategies outlined are anchored in fundamental public health concepts and utilize the best available knowledge on the laboratory, clinical, and epidemiologic aspects of LAV/HTLV-III infection. The guidelines are directed toward public health authorities and health professionals who have the responsibility of adapting the general guidelines to meet the diverse requirements of different populations and settings. The document is not complete at this time; several sections are currently under development and will be made available as soon as they are finished.
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  4. 4

    AIDS: diagnosis and control [letter]

    Deinhardt F; Domok P; Smithies A; Leparski E; Bytchenko B; Mann J

    Lancet. 1987 Apr 18; 1(8538):930.

    At a meeting convened by the World Health Organization (WHO) regional office for Europe in March 1987 and attended by representatives of 27 member states, it was agreed that human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) pose a major threat to the health of all nations in the world. The most effective means of reducing the transmission of the virus remains intensive, frank education for the entire population about the nature of HIV infection, its modes of transmission, and the precautionary measures available. More epidemiologic data on the distribution of HIV infection and the development of AIDS within the population are needed, but should be obtained, wherever possible, by voluntary, targeted surveys rather than through compulsory testing or mandatory reporting by name. In addition, there was recognition of the need for further improvement in diagnostic tests for HIV infection to make them simple, less expensive, and more specific. Tests are also needed to detect HIV or its antigen directly during the early period after infection. Epidemiologic models can be helpful in making short-term predictions, but cannot at present be used for the long-term since they are dependent on inaccessible or unreliable data about prevalence and shifts in life-style. Finally, there was strong support at the meeting for AIDS research to be identified as a national priority. Funding should be provided to increase the number of basic and clinical research institutes, to develop cooperation among scientists from different regions, and to establish a collaborative network for clinical trials.
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  5. 5

    HIV-1 seroprevalence and AIDS diagnostic criteria in Central African Republic [letter]

    Georges AJ; Martin PM; Gonzalez JP; Salaun D; Mathiot CC; Grezenguet G; Georges-Courbot MC

    Lancet. 1987 Dec 5; 2(8571):1332-3.

    Serological surveys and recording of acquired immunodeficiency syndrome (AIDS) cases have been conducted in Bangui since 1985 to monitor the spread of HIV-1 in the Central African Republic. 2.1% in 1985, 3.8% in 1986, and 7.8% of sera in the completed period of 1987 had antibodies to HIV-1--a striking increase. The expected number of new cases of AIDS from January 1986 to March 1987 was calculated to be 734. During that period only 99 cases of AIDS defined by Centers for Disease Control (CDC) criteria were reported to the authors' Bangui institute. However 587 cases (including the 99) were recorded using WHO Bangui workshop criteria. Thus the provisional clinical case definition of AIDS developed in Bangui detected 80% of predicted cases compared with only 13.5% when CDC criteria were used. These differences could at least partly explain the small number of AIDS cases reported from certain countries with high HIV seroprevalence rates.
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  6. 6
    Peer Reviewed

    Smallpox and its post-eradication surveillance.

    Jezek Z; Khodakevich LN; Wickett JF


    Since May 1980 when the 33rd World Health Assembly declared the global eradication of smallpox, WHO has been developing a comprehensive system of surveillance aimed at maintaining the world permanently free from this disease. By 1984, all countries had ceased vaccinating the general public against smallpox, and had withdrawn the requirement for smallpox vaccination certificates from international travellers. A number of countries had also discontinued the vaccinating of military personnel. Until now WHO has maintained a stock of smallpox vaccine sufficient to vaccinate 300 million persons, but considering that 10 years have elapsed since the last endemic case of smallpox, maintenance of this reserve is no longer indicated. WHO continues to monitor rumors and coordinate the investigation of suspected cases, all of which have actually been misdiagnosed chickenpox or some other skin disease, or other errors in recording or reporting. Variola virus is now kept in only 2 WHO Collaborating Centers which possess high security containment laboratories. Since the variola virus gene pool has been cloned in bacterial plasmids which provide sufficient material to solve future research and diagnostic problems, there is no need to retain stocks of viable variola virus any longer. The results of a special program for the surveillance of human monkeypox have confirmed that the disease does not pose any significant health problem. In addition to testing human and animal specimens, WHO collaborating laboratories have made progress in the analysis of DNA of orthopoxviruses and in the development of reliable serological tests. (author's modified)
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  7. 7
    Peer Reviewed

    Evaluation of a clinical case: definition of AIDS in African children.

    Colebunders RL; Greenberg A; Nguyen-Dinh P; Francis H; Kabote N; Izaley L; Davachi F; Quinn TC; Piot P

    AIDS. 1987; 1:151-3.

    In July 1986, a provisional clinical case definition of AIDS in children, developed by the WHO for surveillance purposes in Africa, was tested on 159 patients hospitalized in the Department of Pediatrics at Mama Yemo Hospital, Kinshasa, Zaire. 21 (13%) of these children were seropositive for HIV. In this population, the clinical case definition of pediatric AIDS was found to be fairly specific (87%) but lacked sensitivity (35%). The positive predictive value for HIV seropositivity was 25%. This study suggests that it is more difficult to define AIDS clinically in children than in adults and that the utility of the proposed WHO clinical case definition for pediatric AIDs for surveillance of children's AIDS in Africa is limited. (author's)
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  8. 8

    Report of the WHO Meeting on Criteria for HIV Screening Programmes, Geneva, 20-21 May 1987.

    World Health Organization [WHO]. Special Programme on AIDS

    [Unpublished] 1987. 12 p. (WHO/SPA/GLO/87.2)

    The usefulness of proposed screening programs for human immunodeficiency virus (HIV) infection must be weighed carefully against potential harmful effects. Because of complex social and ethical issues and the lack of any specific intervention against acquired immunodeficiency syndrome (AIDS), screening programs may be intrusive and divert resources from educational programs. 21 participants from 17 countries attended a special meeting in May 1987 convened by the WHO Special Program on AIDS to discuss criteria for HIV screening programs. There was general consensus among participants that readily accessible counseling and testing for antibody to HIV, provided on a voluntary basis, are more likely to result in behavior changes that reduce the spread of AIDS than are mandatory screening initiatives. There was also agreement that mandatory screening of targeted populations is less likely than a voluntary approach to reach effectively those persons whose behavior can be influenced to reduce the risk of infection. To facilitate awareness of the complexities inherent in mandatory screening of at risk populations such as drug abusers and prostitutes, this report includes a list of criteria that must be considered and resolved in the planning process. These criteria are: what is the rationale of the proposed program, what population is to be screened, what test method is to be used, where is the laboratory testing to be done, what is the intended disposition of data obtained from testing, what plan will be used for communicating results to the person tested, how is counseling to be accomplished, what is the social impact of screening, and what legal and ethical considerations are raised by the proposed screening program?
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  9. 9

    Cost-effectiveness of screening to reduce transfusion-related AIDS in developing areas. Overheads.

    Shepard DS; Eichner J

    [Unpublished] 1988. Presented at the 116th Annual Meeting of the American Public Health Association [APHA], Boston, Massachusetts, November 13-17, 1988. [14] p.

    98 countries responded to the World Health Organization (WHO) survey to gather data on screening of blood for Acquired Immune Deficiency Syndrome (AIDS) antibody. 35 of the 98 countries reported screening. Nonlaboratory means of excluding high-risk donors includes donor group selection, information and education for donor self-deferral, donor history, and physical examination. On the basis of the survey, the following conclusions were reached: screening and testing of blood virtually eliminates transfusion-related AIDS in the long run; the impact on hospital costs is evident only after 5 years; screening and testing blood reduces AIDS cases and deaths and saves money; testing and screening are worthwhile even if the test or technique is imperfect; and a model can estimate impact of improvements in utilization and accuracy of testing and screening.
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  10. 10
    Peer Reviewed

    Third meeting of the WHO Collaborating Centres on AIDS: memorandum from a WHO meeting.

    World Health Organization [WHO]. Collaborating Centres on AIDS


    The 3rd meeting of the WHO Collaborating Centres on AIDS, held 6 June 1987, updated Centre representatives on the activities of WHO's Special Programme on AIDS and discussed technical matters such a definition, testing and diagnosis of AIDS. The special program is concentrating on the African and American regions, visiting countries, and holding workshops on topics such as training, case management and epidemiological surveillance. There will be 20 professional staff at WHO headquarters and 16 in the field. An advisory group on behavioral research met to establish social and behavioral priorities. A protocol for studies of seroprevalence is being developed. The technical topics discussed included widening the definition of AIDS cases to include wasting syndrome and dementia, as well as diagnosis of presumptive AIDS without availability of standardized tests. 3 Consensus statements were adopted, on HIV transmission, HIV infection in health workers, and on present and future status of laboratory tests for HIV. HIV should be continually isolated in various regions of the world to ensure that diagnostic tests reflect local virus strains. An agenda was proposed, including the next meeting to be held in Stockholm in June, 1988.
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  11. 11

    Research in family planning: 2.

    WHO Chronicle. 1982; 36(5):179-85.

    The World Health Organization (WHO) Special Programme of Research, Development and Research Training in Human Reproduction supports investigations on the safety and efficacy in developing countries of oral contraceptive (OC) methods and provides advice on the best preparations or devices for particular groups and the safety of controversial products such as injectable progestins. Comparative studies on OC dosages and preparations, interaction of OCs with parasitic diseases such as malaria, timing of IUD insertion, comparison of available types of IUDs, clinical and epidemiological studies of the safety and dosage levels of long acting progestin preparations, and a comparison of surgical sterilization techniques have been carried out. High priority is given to the development of better methods of fertility control. A simplified questionnaire to determine prevalence of primary and secondary infertility, pregnancy wastage, and infant and child mortality has disclosed some very high rates of infertility, particularly in Africa. Other studies seek to standardize the protocol for diagnosis and investigation of infertility and to evaluate commonly used treatment and evaluation procedures for infertility. The Special Programme seeks to strengthen the capability of institutions in developing countries to conduct research and collaborate in projects. 250 research and visiting scientist grants were awarded in 1980-81, and 20 research training courses were organized. A major effort was made in the standardization and quality control of laboratory procedures, and 142 laboratories in 48 countries now participate.
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  12. 12

    The eastern Mediterranean region.

    Baasher T

    In: Bannerman RH, Burton J, Ch'en Wen-Chieh. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva, Switzerland, World Health Organization, 1983. 253-62.

    This article describes the present state of traditional medicine in the Eastern Mediterranean Region and its future prospects with special emphasis on the role of WHO in the promotion and development of research activities. Attitude and the official policy towards traditional medicine vary from country to country. In practically all the countries 2 systems of health care are in operation--allopathic or modern medicine, which comes under official regulations by the State, and traditional medicine, which is community-related and generally self-developed. Professional and community attitudes, official policies, the categories of traditional practitioners, and techniques used in diagnosis and treatment are discussed. The diagnosis is essentially based on general observations and history taking. Usually no resort is had to medical instruments or to laboratory tests to establish a diagnosis. The techniques used in treatment can be grouped under physical remedies, social and psychotherapeutic practices. The physical remedies are mainly the prescription of certain diets, the use of drugs and chemicals, cautery, simple surgical operations, bonesetting, massage, hydrotherapy, cupping, and bloodletting. The psychotherapeutic devises may be simple practices for protection or may entail a complex group interaction and abreactive measures. The ancient Zar cult, for example, is a psychodramatic technique based on musical therapy and group activity. The only available statistical data are for the traditional birth attendants (TBA), and even these are limited. TBA's attend about 99% of mothers in Pakistan, 80% in Iraq, 60% in Iran and 50% in Egypt. Although some countries have no organized training for traditional practitioners, others have a long and rich background in the field of training. Innovative approaches in Sudan and Pakistan are mentioned and significant contributions to traditional pharmacopoeia and research activities in traditional medicine are discussed. WHO has played a major role in the development programs to promote traditional medicine and to investigate its optimal utilization in modern medical health services.
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  13. 13

    Annual report 83/84.

    Family Planning Association of Hong Kong

    Hong Kong, Family Planning Association of Hong Kong, 1984. [108] p.

    This 1983-84 Annual Report of the Family Planning Association of Hong Kong lists council and executive members as well as subcommittee members and volunteers for 1983 and provides information on the following: administration of the Association; clinical services; education; information; International Planned Parenthood Federation (IPPF) activities; laboratory services; library service; motivation; personnel resource development and production; the Sexually Assualted Victims Service; studies and evaluation; subfertility service; surgical service; training; the Vietnamese Refugees Project; women's clubs; the Youth Advisory Service; and youth volunteer development. In 1983, there was a total of 45,384 new cases; total attendance at clinics was 261,992. A series of thirteen 5-minute segments on sex education was produced as part of a weekly television youth program. An 8-session sexual awareness seminar continued to receive a very good response. To meet the increasing demand of young couples for better preparation towards satisfactory sexual adjustment in marriage, a 3-session seminar on marriage was regularly conducted every month during 1983. 13 seminars were held, reaching a total of 374 participants. Other education efforts included a family planning talk, the Kwun Tong Population and Family Life Education Week, and 39 sessions of talks and lectures on various topics related to family planning and sex education. The year-long information campaign was organized in response to the 1982 Knowledge, Attitude, Practice findings that many couples still fail to recognize the concept of shared responsibility in family planning. Laboratory services include hepatitis screening, premarital check-up examinations, pap smear, the venereal disease research laboratory test (VDRL), and seminal fluid examinations. Throughout the year, 256 interviews were given to sexually assaulted victims. To arouse the awareness of the public with regard to preventing rape through education, counselors conducted talks and gave radio and television interviews on the Sexually Assaulted Victims Service. The records of the 3 sub-fertility clinics showed that altogether in 1983 there were 1355 new cases and 561 old cases, with a total attendance of 6682. 144 pregnancies also were recorded. Training programs included sex education seminars for social workers, a sex education course for secondary school teachers, a sex education seminar for student guidance officers, and an advanced course on human sexuality for teachers and social workers.
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  14. 14

    Annual report 1982/1983.

    Family Planning Association of Hong Kong

    Hong Kong, Family Planning Association of Hong Kong, 1983. [93] p.

    This 1982-83 Annual Report of the Family Planning Association (FPA) of Hong Kong reports on the following: program administration; activities of the International Planned Parenthood Federation (IPPF); personnel; clinical services; surgical services; laboratory services; affiliated volunteer groups; education; information; library services; motivation and promotion; statistics and evaluation; training; the Vietnamese Refugees Project; and the Youth Advisory Service. The Association's services are managed by 133 full-time and 21 part-time staff. The clinic attendance figures quoted are for the 1982 calendar year; otherwise, the report refers to the current financial year. There were 43,818 new cases and 51,031 old cases making a total clinic attendance figure of 257,185. Of the 772 female applicants for sterilization, 599 female clients were treated for sterilization in 1982, 502 having mini-laparotomy and 97 having culdoscopic sterilization. 367 vasectomies were performed, representing an increase of 8.6% over the previous year. Educational efforts took the form of Working Youth's Programs, Sexual Awareness Seminars, Sex in Marriage Seminars, Family Planning Talks, and talks and lectures on various topics related to family planning and sex education. Information activities included exhibitions, columns in newspapers and magazines, media coverage and advertisements, and talks by Association staff to various service clubs and community organizations and universities. Resource development efforts took the form of the production of new family life education resources as well as other resource materials; film, slide, and video production; and audiovisual services. The 1982 Knowledge, Attitude, and Practice Survey revealed that 59.2% of the 1403 currently married women interviewed approved, with or without reservation, of the provision of a contraceptive services to the unmarried. 30.5% disapproved of it, and 10.4% had no idea or gave no answer. Studies of the termination of pregnancy and a family life education survey also were conducted. Training efforts included sex education seminars for social workers, a sex education course for secondary school teachers, a sex education seminar for student guidance officers, and an advanced course on human sexuality for social workers and teachers. Total clinic attendance recorded for the Vietnamese Refugees project was 2680; 580 were new cases. The Youth Advisory Service recorded a big increase in the number of new clients (1723), old clients (270), with a total attendance of 3901.
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  15. 15

    Smallpox: post-eradication vigilance continues.

    WHO CHRONICLE. 1982; 36(3):87-91.

    This article summarizes the major findings and recommendations of the Committee on Orthopoxvirus Infections, established by the World Health Assembly to advise on posteradication policy. Although smallpox has been eradicated, there remains a need for the monitoring of vaccination practices, investigation of rumored smallpox cases, verification of virus and vaccine storage conditions, and surveillance of the other orthopoxviruses, including monkeypox. Routine vaccination for smallpox has been officially discontinued in 150 of the 158 Member States and Associate Members of the World Health Organization (WHO); Egypt and Kuwait continue to immunize, while the present status of vaccination remains unknown in 6 other countries. WHO is taking further steps to encourage all countries to cease this practice and is contracting laboratories that continue to produce smallpox vaccine to request that they cease commercial vaccine distribution. Since 1979, 124 rumors of smallpox cases from 55 countries have been investigated, most of which were misdiagnosed cases of chickenpox, measles, and other skin diseases; none has been smallpox. At present, variola virus is being stored in 4 laboratories, 3 of which are WHO collaborating centers. WHO will continue to inspect these laboratories to ensure that requirements for containment are being met. Programs for the surveillance of human monkeypox in west and central Africa are being initiated, although present data indicate that this disease is not of public health importance. The total number of known cases of human monkeypox since 1970 stands at 63. Important studies for the postsmallpox surveillance program include the development of simple and reliable screening tests for orthopoxvirus antibody and of reliable tests for antibody specific to monkeypoxvirus. Plans are underway to publish a book dealing with all aspects of the smallpox eradication campaign.
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  16. 16

    Guidelines for the laboratory diagnosis of diphtheria.

    Brooks R

    [Unpublished] 1981. 27 p. (LAB/81.7)

    WHO guidelines for the laboratory diagnosis of diphtheria are described in this booklet. The guidelines cover only selected laboratory methods that have been proved reliable. The health significance of diphtheria and the importance of the laboratory in diphtheria diagnosis are emphasized, because it is a frequently misdiagnosed disease. Procedures for the isolation and identification of Corynebacterium diphtheriae are outlined. Collection and transport of throat and nasopharyngeal swab specimens, including directions for taking swabs in skin diphtheria, are described. Processing recommendations, with instructions regarding the minimum culture media required for C. diphtheriae isolation, requirements for inoculation and incubation of culture media, and primary plating of specimens is provided. Examination of cultures for the presence of beta hemolytic streptococci and time frames for examination of plates are given, with a description of the method of obtaining pure cultures. A diagram depicts the primary plating of swabs, and the cellular morphology and toxigenicity testing of C. diphtheriae are explained. Biochemical testing and biotyping guidelines for C. diphtheriae, with notes on interpretation are offered in the final section. The appendix describes various reagents and culture media, with directions for preparation and transport.
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  17. 17

    Future use of new imaging technologies in developing countries: report of a WHO Scientific Group.

    World Health Organization [WHO]. Scientific Group on the Future Use of New Imaging Technologies In Developing Countries

    World Health Organization Technical Report Series. 1985; 1-67.

    This report was prepared by a World Health Organization (WHO) Scientific Group on the Future Use of New Imaging Technologies in Developing Countries, which met in Geneva in 1984 to consider the use of ultrasound and computed tomography. There is increasing demand for both techniques, necessitating careful examination of the costs, medical indications, and types of equipment needed. The primary need in diagnostic imaging is conventional radiology. It is stressed that the use of ultrasound or computed tomography should be considered only when conventional radiology is already available. In addition, neither technique should be considered unless the appropriate specialist physicians are well trained and the resources and manpower are available to provide the necessary treatment and care. Ultrasound is the method of choice for imaging during obstetric examinations, and has almost replaced radiography in this area. This document aims to delineate the conditions under which these 2 new imaging technologies will be of use in developing countries. Toward this end, it outlines the major clinical indications for the use of these techniques and specifies the particular areas where the most benefit can be obtained from their use. The Scientific Group concluded that use of these 2 technical advances confers definite advantages, as long as proper planning and education precede their purchase. In particular, it is noted that purchase of computed tomography equipment will have a significant effect on the total health budget of many countries. Finally, the document reviews all aspects of the specifications and choice of equipment, as well as the type of buildings, education, and maintenance that are essential.
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  18. 18

    Guide to equipment selection for M/F sterilization procedures. Guide du materiel utilise pour les procedures de sterilisation des hommes et des femmes.

    Reingold LA

    Population Reports. Series M: Special Topics. 1977 Sep; (1):[36] p.

    This is a guide to aid in selecting and maintaining the proper equipment used in the following sterilization procedures: 1) minilaparotomy, 2) laparoscopy, 3) conventional laparotomy, 4) colpotomy, 5) culdoscopy, and 6) vasectomy. Prototype, experimental, or infrequently used instruments are not discussed. Colpotomy, minilaparotomy, and conventional vasectomy are low-technology procedures requiring relatively simple, locally produced instruments, e.g., retractors, forceps, and scalpels. High-technology equipment consists of specialized items, e.g., laparoscopes and culdoscopes. These are produced in a limited number of technically advanced countries. Equipment donor agencies are discussed. The following factors must be considered in selecting equipment: 1) suitability for the intended procedures, 2) quality of the instrument, 3) ease of repair, and 4) initial cost. Each type of equipment is pictured, diagrammed, described, and charted against others of its kind. Maintenance and repair guidelines are provided.
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  19. 19

    The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.

    World Health Organization [WHO]. Global Commission for the Certification of Smallpox Eradication

    Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)

    The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
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  20. 20
    Peer Reviewed

    Progress towards improved tuberculosis diagnostics for developing countries.

    Perkins MD; Roscigno G; Zumla A

    Lancet. 2006 Mar 18; 367(9514):942-943.

    The lack of accurate, robust, and rapid diagnostics for tuberculosis impedes management of patients and disease control. For individual patients, the cost, complexity, and potential toxicity of 6 months of standard treatment demands certainty in diagnosis. For communities, the risk of transmission from undetected cases requires widespread access to diagnostic services and early detection. Unfortunately, diagnostic services in most places where tuberculosis is endemic fail both the individual and the community. Patients are often diagnosed after weeks to months of waiting, at substantial cost to themselves, and at huge cost to society. Many patients are never diagnosed, and contribute to the astonishing number of yearly deaths from tuberculosis worldwide. (excerpt)
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  21. 21
    Peer Reviewed

    Progress of DOTS in global tuberculosis control.

    Sharma SK; Liu JJ

    Lancet. 2006 Mar 18; 367(9514):951-952.

    In the early 1990s, the global public-health community woke up to the reality that despite the availability of effective diagnostic and therapeutic tools, tuberculosis was one of the world's leading killers. The strategy that was subsequently devised, DOTS, was based on decades-old principles and technologies, but was engendered by new energy and political will (panel); the aim, to achieve 70% case detection and 85% cure rate by 2005. Although these goals were not achieved on a global scale and implementation of the programme has been patchy and sporadic in places, overall its roll-out has been rapid and effective. That said, DOTS can only be the foundation for global tuberculosis control; to truly contain the disease, much more is needed in the control of multidrug-resistant tuberculosis (MDR-TB) and the development of drugs, diagnostics, and vaccines. (excerpt)
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  22. 22
    Peer Reviewed

    WHO's new Stop TB Strategy.

    Raviglione MC; Uplekar MW

    Lancet. 2006 Mar 18; 367(9514):952-955.

    Government commitment, diagnosis through microscopy, standardised and supervised treatment, uninterrupted drug supply, and regular monitoring, which together constitute DOTS--the WHO recommended tuberculosis control strategy--are all essential for controlling tuberculosis. DOTS has helped make remarkable progress in global control of the disease over the past decade. The gain is evident: nearly 20 million patients have been cured of tuberculosis. However, global statistics suggest that DOTS alone is not sufficient to achieve the 2015 tuberculosis-related Millennium Development Goals (MDG) and the Stop TB Partnership targets. The need for a new strategy that builds on, and goes beyond, DOTS has also been recognised by the Second Ad-hoc Committee on the Global TB Epidemic and the 2005 World Health Assembly. (excerpt)
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  23. 23
    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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  24. 24

    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. 25
    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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