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Peer Reviewed

Title: HIV prevalence and mortality among children undergoing treatment for severe acute malnutrition in sub-Saharan Africa: a systematic review and meta-analysis.
Author: Fergusson P; Tomkins A
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):541-8.
Abstract: This systematic review and meta-analysis explored HIV prevalence and mortality in children undergoing treatment for severe acute malnutrition (SAM) in sub-Saharan Africa. It included all studies reporting on HIV infection within a sample of children with SAM where HIV status was assessed using a blood test and SAM was defined using the WHO, Gomez, Wellcome or Waterlow definitions. Children from 17 studies were included in the analysis (n=4891), of whom 29.2% were HIV-infected. HIV-infected children were significantly more likely to die than HIV-uninfected children (30.4% vs. 8.4%; P<0.001; relative risk=2.81, 95% CI 2.04-3.87). HIV-negative children treated within community-based therapeutic care (CTC) programmes had lower mortality (4.3%) than those treated within an inpatient nutrition rehabilitation unit (NRU) (15.1%). There was no significant difference in mortality for HIV-infected children with SAM treated in the CTC (30.0%) or NRU (31.3%) settings. HIV prevalence is high in children with SAM in sub-Saharan Africa, and HIV-infected children are at significantly increased risk of mortality. There is an urgent need to integrate HIV testing and treatment into care for children with SAM in regions of high HIV prevalence.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | PREVALENCE | CHILD | CHILD MORTALITY | MALNUTRITION | HIV INFECTIONS | HIV TESTING | TESTING | HIV | RISK FACTORS | TREATMENT | Developing Countries | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Nutrition Disorders | Diseases | Viral Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342751

3.
Title: Causes for the decline in child under-nutrition in Brazil, 1996-2007.
Author: Monteiro CA; Benicio MH; Konno SC; Silva AC; Lima AL; Conde WL
Source: Revista De Saude Publica. 2009 Feb;43(1):35-43.
Abstract: OBJECTIVE: To describe the evolution of prevalence of under-nutrition among Brazilian underfives between 1996 and 2007, and to identify major factors responsible for this evolution. METHODS: Data analyzed are from two Demographic Health Surveys carried out in Brazil in 1996 and 2006/7 based on probabilistic samples of roughly 4 thousand children under five years of age. Identification of factors responsible for temporal variation in prevalence of under-nutrition (height-for-age below -2 Z-scores; WHO 2006 standard) took into account changes in the distribution of four potential determinants of nutritional status. Statistical modeling of the independent association between these determinants and risk of under-nutrition, and calculation of 'partial attributable fractions' were used to determine the relative importance of each factor in the evolution of infant under-nutrition. RESULTS: Prevalence of under-nutrition fell by approximately 50%, from 13.5% (95%CI: 12.1%; 14.8%) in 1996 to 6.8% (5.4%; 8.3%) in 2006/7. Two-thirds of this reduction could be attributed to favorable evolution in the four factors studied: 25.7% to increased maternal schooling; 21.7% to increased purchasing power of families; 11.6% to expansion of healthcare; and 4.3%to improvements in sanitation. CONCLUSIONS: The 6.3% annual rate of decline in the proportion of children with height-for-age deficits indicates that, in another ten years, child malnutrition in Brazil may no longer be a public health issue. Achieving this will depend on the maintenance of economic and social policies that have favored an increase in purchasing power among the poor, and on public investments aimed at completing the universalization of access to essential services such as education, health, and sanitation among the Brazilian population.
Language: EnglishPortuguese
Keywords:
BRAZIL | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CHILD | MALNUTRITION | PREVALENCE | CHILD NUTRITION | NUTRITION DISORDERS | SOCIOECONOMIC FACTORS | EDUCATIONAL STATUS | HEALTH SERVICES | SANITATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Diseases | Measurement | Research Methodology | Nutrition | Health | Economic Factors | Socioeconomic Status | Delivery of Health Care | Public Health
Document Number: 341847

Title: Child survival: India and China's challenges [editorial]
Source: Lancet. 2008 Aug 16;372(9638):508.
Abstract: Last week, UNICEF published The State of Asia-Pacific's Children 2008-its first annual report on maternal, newborn, and child survival in the region. The report has a particular focus on the challenges for India and China, since, with their huge populations, achievements in these countries can make a substantial difference to child survival in the region and worldwide. China has made good investments in health (10% of gross domestic product) and is on track to reach Millennium Development Goal (MDG) 4 on child survival. However, UNICEF notes that the country's progress has slowed down in the past 10 years and the coverage of essential interventions remains low in rural areas. The report singles out India. It states that the global attainment of the health-related MDGs will largely depend on the country's progress in improving health and addressing the social determinants of health. A fifth of all deaths (2.1 million) in children younger than 5 years occurred in India in 2006. Huge disparities in infant mortality rates exist-within cities and between urban and rural areas, and between the sexes, socioeconomic groups, and different castes. The privatisation of health care in India and China is set to widen the gaps between rich and poor people. Without progress on reducing disparities, efforts to provide primary health care to women and children could founder, says UNICEF. But there are reasons for optimism in India. The government launched the National Rural Health Mission in 2005 to tackle deepening disparities in the country, with the reduction of the infant mortality rate as a primary goal. Interventions, such as cash transfers for expectant mothers living below the poverty line, neonatal services, and the Integrated Management of Neonatal and Childhood Illness, are gradually being rolled out. Such initiatives show there is political will in India to address child survival. But this commitment is not backed-up by serious financial investment. The Indian Government spends less on health (3% of gross domestic product) than several other countries in the Asia-Pacific region, despite a gross domestic product growth rate of 9% in 2007. India can, and must, spend more on health if its mothers and children are to prosper. (full text)
Language: English
Keywords:
CHINA | INDIA | CRITIQUE | CHILD HEALTH SERVICES | CHILD MORTALITY | CHILD | INFANT | INFANT MORTALITY | POVERTY | RURAL HEALTH SERVICES | UNICEF | Asia, Eastern | Asia | Developing Countries | Asia, Southern | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Socioeconomic Factors | Economic Factors | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 328434

Peer Reviewed

Title: Every death counts: Use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa.
Author: South Africa Every Death Counts Writing Group
Source: Lancet. 2008 Apr 12;371(9620):1294-1304.
Abstract: South Africa is one of the few developing countries with a national confidential inquiry into maternal deaths. 164 health facilities obtain audit data for stillbirths and neonatal deaths, and a new audit network does so for child deaths. Three separate reports have been published, providing valuable information about avoidable causes of death for mothers, babies, and children. These reports make health-system recommendations, many of which overlap and are intertwined with the scarcity of progress in addressing HIV/AIDS. The leaders of these three reports have united to prioritise actions to save the lives of South Africa's mothers, babies, and children. The country is off -track for the health-related Millennium Development Goals. Mortality in children younger than 5 years has increased, whereas maternal and neonatal mortality remain constant. This situation indicates the challenge of strengthening the health system because of high inequity and HIV/AIDS. Coverage of services is fairly high, but addressing the gaps in quality and equity is essential to increasing the number of lives saved. Consistent leadership and accountability to address crosscutting health system and equity issues, and to prevent mother-to-child transmission of HIV, would save tens of thousands of lives every year. Audit is powerful, but only if the data lead to action. (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | DATA REPORTING | MOTHERS | CHILD | CHILD MORTALITY | MATERNAL MORTALITY | CAUSES OF DEATH | MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | QUALITY OF HEALTH CARE | CHILD SURVIVAL | ANTENATAL CARE | MANAGEMENT | GOALS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Transmission | Infections | Diseases | Viral Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Survivorship | Length of Life | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Planning
Document Number: 326156

Title: Validation of neonatal tetanus elimination in Zambia by lot quality-assurance cluster sampling.
Author: World Health Organization [WHO]
Source: Weekly Epidemiological Record. 2008 Apr 4;83(14):119-124.
Abstract: Zambia has a population of approximately 12 million. According to estimates from the 2001-2002 Zambia Demographic and Health Survey,1 between 1997 and 2001, the rate of neonatal mortality was 37/1000 births, the infant mortality rate was 95/1000 births and the maternal mortality ratio was 729/100 000 live births. In order to protect mothers and their newborn babies against tetanus, WHO recommends that tetanus toxoid (TT) vaccine be given to all pregnant women; Zambia follows WHO's recommendations. In 2006, 79% of all pregnant women received a protective dose of TT vaccine. A total of 60% of all deliveries took place in hygienic conditions (administrative data). WHO and UNICEF estimate that in 2006, 90% of births were protected against tetanus. (excerpt)
Language: English
Keywords:
ZAMBIA | SUMMARY REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | PREGNANT WOMEN | CHILD | IMMUNIZATION | TETANUS | WHO | RECOMMENDATIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Population Characteristics | Youth | Age Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Infections | Diseases | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 325932

Title: Immunogenicity, safety, and interchangeability of two inactivated hepatitis A vaccines in Chilean children.
Author: Abarca K; Ibanez I; Perret C; Vial P; Zinsou JA
Source: International Journal of Infectious Diseases. 2008 May;12(3):270-277.
Abstract: The objectives were to compare the immunogenicity, safety, and interchangeability of two pediatric hepatitis A vaccines, Avaxim 80U-Pediatric and Havrix 720, in Chilean children. In this randomized trial, 332 hepatitis A virus (HAV) seronegative children from 1 to 15 years of age received two doses of Avaxim, two doses of Havrix, or Havrix followed by Avaxim, 6 months apart. Anti-HAV antibody titers were measured before and 14 days after the first dose of vaccine, and before and 28 days after the second dose of vaccine. Immediate reactions were monitored; reactogenicity was evaluated from parental reports. Seroconversion rates after the first vaccination were 99.4% and 100% for Avaxim and Havrix, respectively. Anti-HAV geometric mean concentrations (GMCs) were 138 mIU/ml for Havrix (95% confidence interval (CI): 120; 159) and 311 mIU/ml for Avaxim (95% CI: 274; 353). GMCs increased to 4008 mIU/ml after two doses of Havrix, 8537 mIU/ml following two doses of Avaxim, and 7144 mIU/ml in children who received Havrix with Avaxim as the second dose. Following the first injection, 36% of subjects given Avaxim and 44% given Havrix reported local reactions; 38% of subjects in the Avaxim group and 40% in the Havrix group reported systemic reactions related to vaccination. Solicited reactions were less frequent after the second dose of Avaxim or Havrix, occurring in 27% to 37% of subjects. No significant difference in seroconversion rates was seen 14 days after a single dose of vaccine. A two-dose schedule with either vaccine or with Havrix/Avaxim provided a strong booster response. Both vaccines were well tolerated and can be recommended for routine vaccination of Chilean children. Avaxim 80 may be used to complete a vaccine schedule begun with Havrix 720. (author's)
Language: English
Keywords:
CHILE | RESEARCH REPORT | CLINICAL TRIALS | CHILD | HEPATITIS | VACCINES | ADMINISTRATION AND DOSAGE | IMMUNIZATION SCHEDULE | SAFETY | EVALUATION | Developing Countries | South America, Southern | South America | Latin America | Americas | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Immunization | Primary Health Care | Public Health
Document Number: 326211

10.

Peer Reviewed

Title: Febrile status, malarial parasitaemia and gastro-intestinal helminthiases in schoolchildren resident at different altitudes, in south-western Cameroon.
Author: Achidi EA; Apinjoh TO; Mbunwe E; Besingi R; Yafi C
Source: Annals of Tropical Medicine and Parasitology. 2008;102(2):103-118.
Abstract: In the many areas where human malaria and helminthiases are co-endemic, schoolchildren often harbour the heaviest infections and suffer much of the associated morbidity, especially when co-infected. In one such area, the Buea district, in south-western Cameroon, two cross-sectional surveys, together covering 263 apparently healthy schoolchildren aged 4-12 years, were recently conducted. The prevalences of fever, malarial parasitaemia and intestinal helminth infections, the seroprevalences of anti-Plasmodium falciparum IgG and IgE and antiglycosylphosphatidylinositol (anti-GPI) IgG, plasma concentrations of total IgE, and the incidence of anaemia were all investigated. The mean (S.D.) age of the study children was 7.56 (1.82) years. Overall, 156 (59.3%) of the children were found parasitaemic, with a geometric mean parasitaemia of 565 parasites/ml. Parasitaemia and fever were significantly associated (P = 0.042). The children who lived at low altitude, attending schools that lay 400-650 m above sealevel, had significantly higher parasitaemias than their high-altitude counterparts (P less than 0.01). At low altitude, the children attending government schools had significantly higher parasitaemias than their mission-school counterparts (P = 0.010). Of the 31 children (11.9%) found anaemic, 22 (70.4%) had mild anaemia and none had severe anaemia. A significant negative correlation (r = -0.224; P = 0.005) was observed between haemoglobin concentration and level of parasitaemia. Infection with Plasmodium appeared to reduce erythrocyte counts (P = 0.045), a condition that was exacerbated by co-infection with helminths (P = 0.035). Plasma concentrations of total IgE were higher in the children found to be excreting helminth eggs than in those who appeared helminth-free, while levels of anti-P. falciparum IgE were higher in the children with low-grade parasitaemias than in those with more intense parasitaemias. Levels of anti-GPI IgG increased with age and were relatively high in the children who lived at lowaltitude and in those who were aparasitaemic. The survey results confirm that asymptomatic malarial parasitaemia frequently co-exists with helminth infections in schoolchildren and indicate links with fever, altitude and school type. Immunoglobulin E may play a role in immune protection against helminthiasis whereas anti-GPI antibodies may be important in the development of antimalarial immunity in such children. In Cameroon, as in other areas with endemic malaria, control programmes to reduce the prevalences of infections with intestinal helminths and malarial parasites in schoolchildren, which may effectively reduce the incidence of anaemia, are clearly needed. (author's)
Language: English
Keywords:
CAMEROON | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CHILD | ALTITUDE | INFECTIONS | MORBIDITY | FEVER | MALARIA | SIGNS AND SYMPTOMS | ANEMIA | LABORATORY EXAMINATIONS AND DIAGNOSES | IMMUNOLOGIC FACTORS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Environment | Diseases | Body Temperature | Physiology | Biology | Parasitic Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Immunity | Immune System
Document Number: 325068

11.

Peer Reviewed

Title: Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites.
Author: Ajayi IO; Browne EN; Garshong B; Bateganya F; Yusuf B
Source: Malaria Journal. 2008 Jan 8;7:6.
Abstract: The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated. A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6-59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs. Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86-97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 79-97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 76%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported. ACTs can be successfully integrated into the HMM strategy. (author's)
Language: English
Keywords:
AFRICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SURVEYS | CHILD | MALARIA PREVENTION | FEVER | ANTIMALARIAL DRUGS | ADMINISTRATION AND DOSAGE | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | SAFETY | Developing Countries | Research Methodology | Sampling Studies | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Malaria | Parasitic Diseases | Diseases | Body Temperature | Physiology | Biology | Drugs | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning | Public Health
Document Number: 323519

12.

Peer Reviewed

Title: Who develops severe malaria? Impact of access to healthcare, socio-economic and environmental factors on children in Yemen: A case-control study.
Author: Al-Taia A; Jaffar S; Assabri A; Al-Habori M; Azazy A
Source: Tropical Medicine and International Health. 2008 Jun;13(6):762-770.
Abstract: The objective was to investigate the impact of socio-economic and environmental factors on developing severe malaria in comparison with mild malaria in Yemen. Case-control study comparing 343 children aged 6 months to 10 years diagnosed with WHO defined severe malaria (cases) at the main children's hospital in Taiz and 445 children with mild malaria (controls) diagnosed in the health centres, which serve the areas where the cases came from. In univariate analysis, age less than 1 year, distance from health centre, delay to treatment and driving time to health centre were associated with progression from mild to severe malaria. In multivariate analysis, distance to nearest health centre greater than 2 km was significantly associated with progression to severe disease. Environmental and vector control factors associated with protection from acquiring malaria (such as sleeping under bednets) were not associated with protection from moving from mild to severe disease. Innovative ways to improve accessto antimalarial treatment for those living more then 2 km away from health centres such as home management of malaria, especially for infants and young children, should be explored in malaria-endemic areas of Yemen. (author's)
Language: English
Keywords:
YEMEN | RESEARCH REPORT | CASE CONTROL STUDIES | CHILD | MALARIA | HEALTH SERVICES | PROGRAM ACCESSIBILITY | SOCIOECONOMIC FACTORS | ENVIRONMENT | BED NETS | ANTIMALARIAL DRUGS | TREATMENT | Middle East | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Economic Factors | Parasite Control | Public Health | Medical Procedures | Medicine
Document Number: 325999

13.

Peer Reviewed

Title: Confirming the impact of HIV/AIDS epidemics on household vulnerability in Asia: the case of Cambodia.
Author: Alkenbrack Batteh SE; Forsythe S; Martin G; Chettra T
Source: AIDS. 2008 Jul;22 Suppl 1:S103-111.
Abstract: This study explores the effects of HIV and AIDS on household economics and the social wellbeing of children in HIV-affected families in Cambodia. A purposive sample of parents living with HIV and their children was selected from networks of people living with HIV. 'Nearest-neighbour' households served as the comparison group. Interviews were conducted with the parent and at least one child or adolescent in each household between October 2003 and January 2004. The urban/rural sample included 1000 households, 1000 adults, and 1443 children aged 6-17 years, inclusive, and was drawn from Phnom Penh, Battambang and Takeo provinces. Despite similar overall expenditures, HIV-affected households incurred proportionately larger expenditures on medical care and funerals. Income among case households was lower than comparison households. HIV-affected households were more likely to sell off assets, borrow from family members, take out loans, and ration medical care and food for children. Children in HIV-affected households reported eating fewer meals in a day, increased frequency of hunger, and increased household and employment responsibilities compared with comparison children. School enrollment rates were similar between pairs of households. The results add to growing evidence that HIV and AIDS contribute to increased vulnerability to poverty and increased burdens on families and children. This study corroborates findings from previous studies in Asia, while providing country-specific information to stakeholders in Cambodia. At this stage in the epidemic, policy makers should focus on implementing and evaluating mitigation interventions.
Language: English
Keywords:
CAMBODIA | RESEARCH REPORT | CASE CONTROL STUDIES | FAMILY AND HOUSEHOLD | HOUSEHOLDS | HIV INFECTIONS | ECONOMIC FACTORS | SOCIOECONOMIC FACTORS | INCOME | CHILD | ADOLESCENTS | ADULTS | POVERTY | NUTRITION | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Sociocultural Factors | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health
Document Number: 328252

14.

Peer Reviewed

Title: Complexity of the msp2 locus and the severity of childhood malaria, in south-western Nigeria.
Author: Amodu OK; Oyedeji SI; Ntoumi F; Orimadegun AE; Gbadegesin RA
Source: Annals of Tropical Medicine and Parasitology. 2008;102(2):95-102.
Abstract: As the genetic diversity of Plasmodium falciparum infections in humans is implicated in the pathogenesis of malaria, the association between P. falciparum diversity at the merozoite surface protein-2 (msp2) locus and the severity of childhood malaria was investigated in Ibadan, in south-western Nigeria. The 400 children enrolled had acute uncomplicated malaria (144), cerebral malaria (64), severe malarial anaemia (67) or asymptomatic infections with P. falciparum (125). Nested PCR was used to investigate the msp2 genotype(s) of the parasites infecting each child. In terms of the complexity of infection and frequency of polyinfection, the children with asymptomatic infection were significantly different from those with uncomplicated malaria or severe malaria. The median number of FC27 alleles detected was higher in the asymptomatic children than in the symptomatic. After controlling for age and level of parasitaemia (with 'asymptomatic infection' as the reference category), a child in whom no FC27 alleles were detected was found to be at five-fold greater risk of uncomplicated malaria, and a child without polyinfection was found to have a three-fold increased risk of severe malarial anaemia and a six-fold increased risk of cerebral malaria. It therefore appears that msp2 genotypes are associated with asymptomatic carriage and that children with mono-infections are more likely to develop severe malaria than children with polyinfections. (author's)
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL TRIALS | STATISTICAL STUDIES | CHILD | MALARIA | POPULATION GENETICS | PARASITIC DISEASES | SIGNS AND SYMPTOMS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Genetics | Biology
Document Number: 325067

15.

Peer Reviewed

Title: Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children.
Author: Ashley EA; Pinoges L; Turyakira E; Dorsey G; Checchi F
Source: Malaria Journal. 2008 Aug 9;7:154.
Abstract: Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs) will result in different estimates being reported, with implications for changes in treatment policy. Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a) reinfections excluded from the analysis (standard WHO per-protocol analysis) or (1b) reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a) WHO (2001) definitions of failure, or (2b) failure defined using parasitological criteria only. Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N= 1702), artesunate-sulphadoxine-pyrimethamine (AS+SP, N=706) and artemether-lumefantrine (AL, N=518). Using method (1a), the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference) and the others were: (i) method 1b = 1.3% [0 to24.8], (ii) method 2a = 1.1% [0 to21.5], and (iii) method 2b = 0% [-38 to19.3]. The standard per-protocol method (1a) tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a). It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size was lost when failures were classified on the first day of parasite recurrence and survival analytical methods were used. The primary purpose of an in vivo study should be to provide a precise estimate of the risk of antimalarial treatment failure due to drug resistance. Use of survival analysis is the most appropriate way to estimate failure rates with parasitological recurrence classified as treatment failure on the day it occurs.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | DATA ANALYSIS | METHODOLOGICAL STUDIES | CHILD | MALARIA | ANTIMALARIAL DRUGS | TREATMENT | DRUG RESISTANCE | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 307985

16.

Title: Reduction of unnecessary transfusion and intravenous fluids in severely malnourished children is not enough to reduce mortality.
Author: Bachou H; Tumwine JK; Mwadime RK; Ahmed T; Tylleskar T
Source: Annals of Tropical Paediatrics. 2008 Mar; 28(1):23-33.
Abstract: The aim was to test whether standardising the use of blood transfusions and intravenous (IV) infusions could reduce fatality in severely malnourished children admitted to Mulago Hospital, Kampala. Improved adherence to the WHO protocol for blood transfusion and IV fluids was effected in patients with severe malnutrition by continuous medical education. A 'before and after' design was used to study 450 severely malnourished children (weight-for-height less than -3 Z-score or presence of oedema) under 60 months of age. A total of 220 pre- and 230 post-'improved practice' patients were enrolled consecutively during the periods September to November 2003 and September to December 2004, respectively. Patients were followed up until discharge or death. The Kaplan-Meier survival curve and the Cox regression hazard model were used for univariate and multivariate analyses, respectively. Overall case fatality was 23.6% (52/220) in the pre-period and 24.8% (57/230) in the post-period (p = 0.78). Most of the deaths occurred in the 1st week of admission (73%, 38/52 in the pre-period and 61%, 35/57 in the post-period) and were of children who had received blood transfusion or IV infusion or both in the pre-period. Mortality in children transfused and/or infused was significantly reduced in the post-period (82%, 31/38 in the preperiod vs 23%, 8/35 in the post-period, p = 0.008). In the post-period, there was a significant reduction in the number of inappropriate blood transfusions (18%, 34/194 vs 3.5%, 8/230, p = 0.01) and IV fluid infusions (27%, 52/194 vs 9%, 20/230, p less than 0.001). Survival improved in children who received blood transfusions in the post-period [hazards ratio (HR) 0.22, 95% CI 0.30-1.67 vs HR 4.80, 95% CI 1.71-13.51], as did that of children who received IV infusions (HR 2.10, 95% CI 0.84-5.23 vs HR 3.91, 95% CI 1.10-14.04). Management according to the WHO protocol for severe malnutrition can reduce the need for blood and IV infusions. However, further studies are required to verify whether full implementation of the WHO protocol reduces the high case fatality in sub-Saharan hospitals. (author's)
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CHILD | MALNUTRITION | BODY WEIGHT | DEHYDRATION | TREATMENT | BLOOD TRANSFUSION | CHILD SURVIVAL | MORTALITY | PREVENTION AND CONTROL | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Physiology | Biology | Metabolic Effects | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Survivorship | Length of Life | Population Dynamics
Document Number: 325072

17.

Peer Reviewed

Title: Contextual correlates of child malnutrition in rural Maharashtra.
Author: Bawdekar M; Ladusingh L
Source: Journal of Biosocial Science. 2008 Sep;40(5):771-786.
Abstract: This paper examines the role of observed contextual factors like topography, development and literacy on severe malnutrition among social groups in rural Maharashtra based on the Reproductive and Child Health District Level Household Survey (RCH-DLHS) Round II (2002-04) data. Multilevel modelling techniques were applied in order to examine the district-wise variations in severe malnutrition associated with the characteristics of the places (contextual effects), as the relationships with the type of people (compositional effects) have already been well established. The results show that developmental aspects such as road connectivity, community literacy, toilet facilities and household standard of living contribute positively to the status of severe malnutrition. Also, the scheduled tribe, aboriginal underprivileged group are more at risk of severe malnourishment due to a lack of proper development, poor awareness about maintaining and enhancing the nutritional value of food and lack of hygiene and sanitation as compared with the scheduled castes, another aboriginal group.
Language: English
Keywords:
INDIA | RESEARCH REPORT | DATA ANALYSIS | CENSUS | RURAL AREAS | TRIBES | CHILD | MALNUTRITION | LITERACY | AGRICULTURE | POVERTY | STANDARD OF LIVING | HYGIENE | SANITATION | Developing Countries | Asia, Southern | Asia | Research Methodology | Population Statistics | Geographic Factors | Population | Cultural Background | Population Characteristics | Demographic Factors | Youth | Age Factors | Nutrition Disorders | Diseases | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Macroeconomic Factors | Public Health | Health
Document Number: 308355

18.

Title: Discourses of childhood innocence in primary school HIV / AIDS education in South Africa.
Author: Bhana D
Source: African Journal of AIDS Research. 2008 May;7(1):149-158.
Abstract: This article draws from interview data to examine the meanings that teachers in two race and class-specific contexts in greater Durban, South Africa, may give to children's right to sexual health information as a part of HIV/ AIDS education. The article focuses on the regulation and production of childhood innocence by means of the ways the primary school teachers talked about sex in their HIV/AIDS education lessons to grade-four students. I argue that discourses of childhood innocence regulate and limit the possibilities of conversing about sex in such a context. The dominant discourses construct children as 'too young to know' and displace children's right to sexual health information to older children, while stressing anxieties about parent hostility to sex education, which precludes effective coverage of sexual topics in HIV/AIDS education. Showing how race, class and culture are deployed in upholding innocence, I contend that the notion of childhood innocence is embedded within the varying social contexts that make up the South African landscape. But, I suggest that an assumption that primary school teachers will engage with HIV/AIDS education while mediating information about sex in health promotion is simplistic. In conclusion, I propose a need for ongoing theoretical and practical work with teachers and the need to build alliances with parents. (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | INTERVIEWS | TEACHERS | STUDENTS | CHILD | PARENTS | PRIMARY SCHOOLS | SEXUALITY | SEX EDUCATION | HEALTH EDUCATION | PARENTAL INVOLVEMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Education | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Schools | Personality | Psychological Factors | Behavior | Child Rearing
Document Number: 327166

19.

Peer Reviewed

Title: Guidelines and mindlines: Why do clinical staff over-diagnose malaria in Tanzania? A qualitative study.
Author: Chandler CI; Jones C; Boniface G; Juma K; Reyburn H
Source: Malaria Journal. 2008 Apr 2;7:53.
Abstract: Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were observed over a period of three months at each hospital. All clinicians were also interviewed individually as well as being observed during routine working activities with colleagues. Interviews with five tutors and 10 clinical officer students at a nearby clinical officer training college were subsequently conducted. Four, primarily social, spheres of influence on malaria over-diagnosis were identified. Firstly, the influence of initial training within a context where the importance of malaria is strongly promoted. Secondly, the influence of peers, conforming to perceived expectations from colleagues. Thirdly, pressure to conform with perceived patient preferences. Lastly, quality of diagnostic support, involving resource management, motivation and supervision. Rather than following national guidelines for the diagnosis of febrile illness, clinician behaviour appeared to follow 'mindlines': shared rationales constructed from these different spheres of influence. Three mindlines were identified in this setting: malaria is easier to diagnose than alternative diseases; malaria is a more acceptable diagnosis; and missing malaria is indefensible. These mindlines were apparent during the training stages as well as throughout clinical careers. Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the variety of social influences into account. (author's)
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | QUALITATIVE RESEARCH | CHILD | MORBIDITY | MORTALITY | EXAMINATIONS AND DIAGNOSES | ERROR SOURCES | MALARIA | SIGNS AND SYMPTOMS | TREATMENT | DRUGS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Population Dynamics | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Parasitic Diseases
Document Number: 325947

20.

Title: Prevalence of undernutrition in Santal children of Puruliya district, West Bengal.
Author: Chowdhury SD; Chakraborty T; Ghosh T
Source: Indian Pediatrics. 2008 Jan 17;45:43-46.
Abstract: This study was carried out to determine the prevalence of undernutrition among the Santal children of Puruliya district of West Bengal. 442 Santal children (216 boys and 226 girls) aged 5-12 years were taken from randomly selected schools of Balarampur and Baghmundi areas of Puruliya. Nutritional status was analyzed by Z-score values according to the height-for-age, weight-for-age and weight-for-height reference data of National Center for Health Statistics (NCHS). The prevalence of undernutrition among Santal children was as follows: stunting (17.9%), underweight (33.7%) and wasting (29.4%). Severe (below -3 Z-score) stunting, underweight and wasting were found in 4.98%, 7.92% and 9.51% of Santal children, respectively. In girls, prevalence of stunting (21.7%) and wasting (35.8%) was higher in comparison to boys (13.8% stunting and 22.7% wasting). (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | PREVALENCE | NUTRITION INDEXES | TRIBES | CHILD | MALNUTRITION | ANTHROPOMETRY | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Nutrition | Health | Cultural Background | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Nutrition Disorders | Diseases
Document Number: 324486

21.

Title: Diagnosis of pulmonary tuberculosis in young children.
Author: Coulter JB
Source: Annals of Tropical Paediatrics. 2008 Mar;28(10):3-12.
Abstract: The Stop TB Strategy encompasses promotion and support for childhood TB including diagnosis. The diagnosis of TB in low-income countries needs to be improved using existing technology. All hospitals involved in managing children with TB should have a regular stock of tuberculin. A chest radiograph (CXR) is an integral part of the diagnosis of pulmonary TB and hospitals should be able to take satisfactory CXRs of young children. If there is a reliable laboratory service, bacterial confirmation should be undertaken in selected cases. The laboratory should be able to deal satisfactorily with paediatric specimens. Gastric aspiration is the method of choice to obtain sputum from young children and generally produces higher yields than other methods, and, with good technique, results in outpatients may not be much lower than in inpatients. Nasopharyngeal aspiration is a simple alternative method requiring limited equipment. Sputum induction requires a special room, capital and recurrent equipment and a dedicated nurse. Laryngeal swabs are suitable for older outpatients unable to produce adequate sputum. Each hospital should have a clinician trained in the diagnosis and management of childhood TB, including the interpretation of CXRs and skill in fine-needle aspiration. Radiologists and clinicians should use a simple, clear, internationally accepted classification of paediatric CXRs. The clinician(s) in charge of TB services should oversee all inpatients with TB and be at the forefront in running the TB clinic. A TB nurse specialist(s) should be part of the team. There is now a will to improve the diagnosis and management of childhood TB but bringing it to fruition requires efforts by the local TB service, paediatricians, radiology departments and laboratory services. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | CHILD | PULMONARY EFFECTS | TUBERCULOSIS | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | PREVENTION AND CONTROL | TESTING | LABORATORY PROCEDURES | TREATMENT | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Research Methodology | Laboratory Examinations and Diagnoses
Document Number: 325070

22.

Title: Ways of coping with AIDS: opinions of mothers with HIV children.
Author: da Silva RA; da Rocha VM; Davim RM; Torres GD
Source: Revista Latino-Americana de Enfermagem. 2008 Mar-Apr;16(2):260-265.
Abstract: The research aims at identifying strategies of coping with AIDS used by mothers of HIV positive children to live better with their children's disease. The method used was a descriptive qualitative study. Thirty three structured interviews were conducted with HIV positive women voluntaries and registered as users in the clinic of the public hospital of reference for the treatment of AIDS in Natal/RN. For data analysis, the method used was thematic content analysis. From the analysis, prevalent categories regarding forms of facing AIDS came up, they were: overprotection and fear; donation; hope; religious belief; underestimation of HIV; hiding the diagnosis; and resignation. This study shows that despite AIDS limitations and barriers, relatives develop strategies that make it possible to face every day problems and live better with it. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | INTERVIEWS | AIDS | MOTHERS | HIV INFECTIONS | PERSONS LIVING WITH HIV/AIDS | CHILD | CARE AND SUPPORT | SOCIAL ADJUSTMENT | FEAR | RELIGION | Developing Countries | South America, Eastern | South America | Latin America | Americas | Data Collection | Research Methodology | Viral Diseases | Diseases | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Social Behavior | Behavior | Emotions | Psychological Factors
Document Number: 327450

23.

Peer Reviewed

Title: The origin of violent behaviour among child labourers in India.
Author: Dalal K; Rahman F; Jansson B
Source: Global Public Health. 2008 Jan;3(1):77-92.
Abstract: We explored the causes and circumstances of violent behaviour among a group of child labourers in the Indian unorganized sectors. From 14 categories of occupations, a total of 1,400 child labourers were interviewed in both urban and rural areas. The average family size of these mostly illiterate child labourers is seven, and average family income is 3,200 INR per month. In the short term child labourers become violent, aggressive, and criminal, following a pyramid of violent behaviour, including socio-economic pressure, cultural deviance, and psychological pressure. When considering family history it seems that the problem is part of a vicious cycle of violence, which persists through generations and evolves with financial crisis, early marriage, and violence in the family and workplace. Our study demonstrates that the most vulnerable groups of child labourers belong to the following workplaces: dhabas, food stalls, rail/bus stations, rail-floor cleaning, and rag picking. Giving high priority to capacity building within the community, including support for locally-generated solutions, is warranted. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CHILD | CHILD LABOR | BEHAVIOR | VIOLENCE | PSYCHOLOGICAL FACTORS | POVERTY | CHILD HEALTH | INEQUALITIES | SAFETY | PROMOTION | Developing Countries | Asia, Southern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Labor Force | Human Resources | Economic Factors | Socioeconomic Factors | Health | Public Health | Marketing
Document Number: 325324

24.

Peer Reviewed

Title: CD4 cell response before and after HAART initiation according to viral load and growth indicators in HIV-1-infected children in Abidjan, Cote d'Ivoire.
Author: De Beaudrap P; Rouet F; Fassinou P; Kouakoussui A; Mercier S
Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Sep 1;49(1):70-6.
Abstract: OBJECTIVE: To analyze the determinants of CD4 change in children during 3 periods: before highly active antiretroviral therapy (HAART), during the first year after HAART initiation, and past 1 year after HAART initiation. METHODS: One hundred seventy-seven children enrolled in a prospective cohort in Abidjan received HAART during a mean follow-up of 30 months. A linear mixed-effects model was used for the first period, a mixed-effects piecewise model for the second period, and an asymptotic mixed-effects model for long-term CD4 dynamics. RESULTS: Before HAART initiation, CD4 percentage decreased along time [beta = -0.59 (-0.92 to -0.26)] was positively associated with body mass index for age [beta = 0.47 (0.22 to 0.72)] and negatively associated with viral load [beta = -1.01 (-1.90 to -0.13)]. During the first year of treatment, the CD4 decrease reverted to a steep increase that was negatively associated with age at HAART initiation [beta = -0.24 (-0.4 to -0.07)] and with the mean viral load underHAART [beta = -1.51 (-2.21 to -0.81)]. The long-term CD4 percentage was also negatively associated with the mean viral load under HAART [beta = -4.97 (-6.22 to -3.72)] and age at HAART initiation [beta = -0.82 (-1.12 to -0.51)]. CONCLUSIONS: Before HAART initiation, the CD4 cell percentage was associated with growth indicators whereas, after HAART, an early increase and a long-term plateau were negatively associated with the viral load and age at HAART initiation.
Language: English
Keywords:
COTE D'IVOIRE | RESEARCH REPORT | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | TREATMENT | GROWTH | BODY WEIGHT | CHILD | AGE FACTORS | INFANT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Child Development | Biology | Physiology | Youth | Population Characteristics | Demographic Factors | Population
Document Number: 328261

25.

Peer Reviewed

Title: Clinical profile of pleural empyema and associated factors with prolonged hospitalization in paediatric tertiary centre in Angola, Luanda.
Author: de Britto MC; Silvestre SM; Duarte MD; Bezerra PG
Source: Tropical Doctor. 2008 Apr;38(2):118-120.
Abstract: In a case series of 152 children aged from 2 to 132 months will pleural emphema from a paediatric tertiary hospital in Luanda, Angola between September 2004 and March 2005, the authors found a high prevalence of anaemia and malnutrition. The most prevalent bacteria in pleural fluid were: D pneumoniae, Haemophyllus and S aureus. The median for hospital stay was 25 days. The lethality was 7.8% and was not statistically associated with malnutrition, although this variable was associated, in multivariate analysis, with prolonged hospitalization time.
Language: English
Keywords:
ANGOLA | SUMMARY REPORT | INCIDENCE | CHILD | ANEMIA | MALNUTRITION | PNEUMONIA | PULMONARY EFFECTS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Nutrition Disorders | Physiology | Biology
Document Number: 308929

26.

Title: Treatment of severe malnutrition with 2-day intramuscular ceftriaxone vs 5-day amoxicillin.
Author: Dubray C; Ibrahim SA; Abdelmutlaib M; Guerin PJ; Dantoine F
Source: Annals of Tropical Paediatrics. 2008 Mar;28(1):13-22.
Abstract: Systemic antibiotics are routinely prescribed for severe acute malnutrition (SAM). However, there is no consensus regarding the most suitable regimen. In a therapeutic feeding centre in Khartoum, Sudan, a randomised, unblinded, superiority-controlled trial was conducted, comparing once daily intramuscular injection with ceftriaxone for 2 days with oral amoxicillin twice daily for 5 days in children aged 6-59 months with SAM. Commencing with the first measured weight gain (WG) following admission, the risk difference and 95% confidence interval (95% CI) for children with a WG greater than or equal to 10 g/kg/day were calculated over a 14-day period. The recovery rate and case fatality ratio (CFR) between the two groups were also calculated. In an intention-to-treat analysis of 458 children, 53.5% (123/230) in the amoxicillin group and 55.7% (127/228, difference 2.2%, 95% CI 26.9-11.3) in the ceftriaxone group had a WG greater than or equal to 10 g/kg/day during a 14-day period. Recovery rate was 70% (161/230) in the amoxicillin group and 74.6% (170/228) in the ceftriaxone group (p = 0.27). CFR was 3.9% (9/230) and 3.1% (7/228), respectively (p = 0.67). Most deaths occurred within the 1st 2 weeks of admission. In the absence of severe complications, either ceftriaxone or amoxicillin is appropriate for malnourished children. However, in ambulatory programmes, especially where there are large numbers of admissions, ceftriaxone should facilitate the work of medical personnel. (author's)
Language: English
Keywords:
SUDAN | RESEARCH REPORT | CLINICAL TRIALS | CHILD | MALNUTRITION | COMPLICATIONS | ANTIBIOTICS | ADMINISTRATION AND DOSAGE | BODY WEIGHT | MORTALITY | Developing Countries | Africa, North | Africa | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Population Dynamics
Document Number: 325071

27.

Peer Reviewed

Title: A non-randomized vaccine effectiveness trial of accelerated infant hepatitis B immunization schedules with a first dose at birth or age 6 weeks in Cote d'Ivoire.
Author: Ekra D; Herbinger KH; Konate S; Leblond A; Fretz C
Source: Vaccine. 2008 May;26(22):2753-2761.
Abstract: Most African countries do not initiate hepatitis B vaccination at birth. We conducted a non-randomized controlled trial comparing hepatitis B vaccination given at age 0, 6, and 14 weeks versus the current Cote d'Ivoire schedule of 6, 10, and 14 weeks. Pregnant women were enrolled at four health centers in Abidjan. At age 9 months, 0.5% of infants in both the birth and 6-week cohorts were positive for HBsAg and all were born to HBeAg-positive women. Among infants of HBeAg-positive mothers, 9 of 24 (37.5%) in the birth cohort and 10 of 17 (58.8%) in the 6-week cohort were HBsAg positive (adjusted OR, 2.7; 95% CI: 0.7-11.0). While both vaccine schedules prevented most cases of infant HBV transmission, both also had high failure rates among infants of HBeAg-positive mothers. African infants may benefit from a birth dose but additional studies are needed to verify this hypothesis. (author's)
Language: English
Keywords:
COTE D'IVOIRE | RESEARCH REPORT | CHILD | IMMUNIZATION SCHEDULE | HEPATITIS | VACCINES | AGE FACTORS | PREVENTION AND CONTROL | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Youth | Population Characteristics | Demographic Factors | Population | Immunization | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Medical Procedures | Medicine
Document Number: 326739

28.

Title: Estimating the burden of global mortality in children aged less than 5 years by pathogen-specific causes [letter]
Author: Elliott SR; Beeson JG
Source: Clinical Infectious Diseases. 2008;46:1794-1795.
Abstract: Globally, infectious diseases account for more than one-half of all deaths among children aged !5 years. Knowledge of the burden of mortality associated with individual pathogens is important for targeting interventions, managing and planning health care services, and guiding research and training priorities. A limitation of the current approach to estimating and reporting global mortality among children aged !5 years is that major causes of deaths are typically presented as a mixture of both pathogen-specific causes (e.g., tuberculosis or HIV infection) and clinical syndromes (e.g., respiratory infections or diarrheal diseases). Although the reporting of mortality statistics from developing countries by clinical syndrome is often pragmatic given the lack of diagnostic tools and vital registration data, it means that the health impact of individual pathogens may not be fully appreciated and the contribution of specific pathogens to global or regional mortality is not specified. (excerpt)
Language: English
Keywords:
GLOBAL | CRITIQUE | CHILD | CHILD MORTALITY | DEATH RATE | CAUSES OF DEATH | DIARRHEA | INFECTIONS | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Diseases
Document Number: 326638

29.

Peer Reviewed

Title: High efficacy of two artemisinin-based combinations (artemether-lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria.
Author: Falade CO; Ogundele AO; Yusuf BO; Ademowo OG; Ladipo SM
Source: Tropical Medicine and International Health. 2008 Mar;13(5):635-643.
Abstract: The objective was to test the hypothesis that artesunate plus amodiaquine (ASAQ) is as effective as artemether-lumefantrine (AL) in the treatment of acute uncomplicated malaria in Nigerian children. In an open label, randomized controlled clinical trial, children aged 6 months to 10 years were randomized to receive artesunate (4 mg/kg daily) plus amodiaquine (10 mg/kg daily) or AL (5-14 kg, one tablet; 15-24 kg, two tablets and 25-34 kg, three tablets twice daily). Both drug regimens were given for 3 days and follow-up was for 28 days. A total of 132 children (66 in each group) were randomized to receive either ASAQ or AL. Day 28 cure rates in the per protocol (PP) population were 93% for ASAQ and 95% for AL (OR = 0.71, 95% CI = 0.12-3.99, q = 0.66). Using Kaplan-Meier product-limit estimates of failure, the median survival time for ASAQ was 21 days and for AL 28 days (P = 0.294). PCR corrected day 28 cure rate for PP populations were 98.4% for ASAQ and 100% for AL. Both drugs were well-tolerated.ASAQ is as effective as AL and both combinations were efficacious and safe. (author's)
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL TRIALS | CHILD | MALARIA | TREATMENT | DRUGS | ADMINISTRATION AND DOSAGE | PARASITIC DISEASES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 325355

30.

Peer Reviewed

Title: Countdown to 2015 for maternal, newborn, and child survival [letter]
Author: Fenton PM
Source: Lancet. 2008 Aug 2;372(9636):369.
Abstract: 30 years ago, WHO declared "health for all". Where was surgery and anaesthesia? Not deemed relevant in 1978, that was for sure. But now? I see no mention of emergency obstetric care in the Countdown Series on maternal, newborn, and child survival. The figures are stark. In one impoverished Asian country, 80% of district hospitals do no surgery at all. In Africa the rate of caesarean sections is only 1.0-1.5%, despite the high incidence of obstructed labour. For 2 years (1993-95), data from the operations records of 18 African district hospitals were reported. Among major operations, 7500 caesarean sections were done per 10 million women in labour per year (rate 1.5%). On the basis of clinical presentations, if those caesarean sections had not been done, an increased annual fatality of 6750 would have occurred. The actual number of maternal deaths for this population in 1994 was 2200-2500. It seems from these simple sums that doing no caesarean sections at all would approximately quadruple maternal mortality, even from the high mortality that results from operating on only 1.5% of labouring mothers. The cost of anaesthesia for a 1.5% caesarean rate for sub-Saharan Africa was US$1.3 million in 1994-a tiny fraction of the costs talked about for Millennium Development Goal (MDG). So it cannot be that anaesthesia is too expensive. Until district hospitals provide comprehensive emergency obstetric care (i.e., anaesthesia and surgery), Countdown will achieve no more than previous attempts to meet MDG5. (full-text)
Language: English
Keywords:
AFRICA | CRITIQUE | MOTHERS | CHILD | MALNUTRITION | COUNSELING | BREASTFEEDING | MATERNAL NUTRITION | CHILD SURVIVAL | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Clinic Activities | Program Activities | Programs | Organization and Administration | Infant Nutrition | Nutrition | Health | Survivorship | Length of Life | Mortality | Population Dynamics
Document Number: 328435


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