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1.
Peer Reviewed

Title: Community-based promotional campaign to improve uptake of intermittent preventive antimalarial treatment in pregnancy in Burkina Faso.
Author: Gies S; Coulibaly SO; Ky C; Ouattara FT; Brabin BJ; D'Alessandro U
Source: American Journal of Tropical Medicine and Hygiene. 2009 Mar;80(3):460-9.
Abstract: Malaria preventive strategies in pregnancy were assessed in a health center randomized trial comparing intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) with and without community based promotional activities in rural Burkina Faso. The study involved 2,240 secundigravidae and secundigravidae and evaluated factors associated with antenatal clinic (ANC) attendance and uptake of IPTp-SP. With promotion, 64.2% completed > or = 3 ANC visits compared with 44.7% without (P = 0.05). Complete uptake of IPTp-SP was 71.8% with and 49.1% without promotion (P = 0.008). The IPTp-SP uptake was lowest in adolescents delivering during high malaria transmission with (29%) or without promotion (30%). Uptake of SP was higher during the low transmission season than in the high transmission season (adjusted odds ratio = 2.17, 95% confidence interval = 1.59-3.03). Community sensitization increased ANC attendance and IPTp-SP uptake. Adolescents were the most difficult to reach, particularly during the high malaria transmission period. The impact of IPTp-SP will be limited unless this high risk group is protected.
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | CASE CONTROL STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | COMMUNITY | ANTIMALARIAL DRUGS | PROMOTION | CAMPAIGNS | COMMUNITY HEALTH SERVICES | ANTENATAL CARE | PREVENTIVE MEDICINE | UTILIZATION OF HEALTH CARE | AGE FACTORS | SEASONAL VARIATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Residence Characteristics | Population Distribution | Geographic Factors | Malaria | Parasitic Diseases | Diseases | Marketing | Communication Programs | Communication | Primary Health Care | Health Services | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Medicine | Population Dynamics
Document Number: 331127

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Peer Reviewed

Title: Adolescent gynecology.
Author: Sanfilippo JS; Lara-Torre E
Source: Obstetrics and Gynecology. 2009 Apr;113(4):935-47.
Abstract: Given new developments in the field of adolescent reproductive health, this review focuses on highlighting new guidelines and practice patterns in evaluation and management of adolescent gynecologic problems. First, understanding the proper techniques for the initial examination is key to establishing a long-term relationship with this age group. Reservations about the first gynecologic examination are common, and the practitioner's goal is foremost to make the patient as comfortable as possible. Preventive health in this patient population is key, and practitioners should become comfortable with providing education about topics as diverse as sexuality, eating disorders, and dating violence. Furthermore, the frequency with which teenagers report sexual activity and the high unintended pregnancy rate in this age group makes counseling regarding effective contraception essential. Additionally, practitioners are encouraged to take the opportunity to discuss the availability of the human papillomavirus (HPV) vaccine with adolescents. In 2007, adolescents were designated as a special population, given the frequency with which they acquire and clear mild HPV-related cervical dysplasia. More conservative treatment in this population is generally favored. During their transition through puberty, disorders of menstruation become the most common complaint requiring the attention of the gynecologist. Most commonly, anovulation serves as the cause behind such abnormal bleeding. Polycystic ovarian syndrome can develop in early puberty and carry its consequences into adulthood. Infertility, diabetes, and hirsutism mark the most important components of the syndrome and require age-appropriate management. Finally, the consequences of endometriosis on the future fertility of adolescents have brought early intervention to light. Recognition and prompt treatment are advocated to prevent the future implications of this disease.
Language: English
Keywords:
UNITED STATES OF AMERICA | VIRGINIA | RESEARCH REPORT | ADOLESCENTS, FEMALE | EXAMINATIONS AND DIAGNOSES | ADOLESCENT HEALTH | GYNECOLOGY | PREVENTIVE MEDICINE | HPV | CYTOLOGY | HISTOLOGY | BLEEDING | UTERINE EFFECTS | ORAL CONTRACEPTIVES | TREATMENT | IUD | VAGINAL BARRIER METHODS | Developed Countries | North America | Americas | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Biology | Signs and Symptoms | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Contraceptive Methods | Contraception | Family Planning | Barrier Methods
Document Number: 341227

Peer Reviewed

Title: Plasmodium vivax dhfr and dhps mutations in isolates from Madagascar and therapeutic response to sulphadoxine-pyrimethamine.
Author: Barnadas C; Tichit M; Bouchier C; Ratsimbasoa A; Randrianasolo L
Source: Malaria Journal. 2008 Feb 26;7:35.
Abstract: Four of five Plasmodium species infecting humans are present in Madagascar. Plasmodium vivax remains the second most prevalent species, but is understudied. No data is available on its susceptibility to sulphadoxine-pyrimethamine, the drug recommended for intermittent preventive treatment during pregnancy. In this study, the prevalence of P. vivax infection and the polymorphisms in the pvdhfr and pvdhps genes were investigated. The correlation between these polymorphisms and clinical and parasitological responses was also investigated in P. vivax-infected patients. Plasmodium vivax clinical isolates were collected in eight sentinel sites from the four major epidemiological areas for malaria across Madagascar in 2006/2007. Pvdhfr and pvdhps genes were sequenced for polymorphism analysis. The therapeutic efficacy of SP in P. vivax infections was assessed in Tsiroanomandidy, in the foothill of the central highlands. An intention-to-treat analysis of treatment outcome was carried out. A total of 159 P. vivax samples were sequenced in the pvdhfr/pvdhps genes. Mutant-types in pvdhfr gene were found in 71% of samples, and in pvdhps gene in 16% of samples. Six nonsynonymous mutations were identified in pvdhfr, including two novel mutations at codons 21 and 130. For pvdhps, beside the known mutation at codon 383, a new one was found at codon 422. For the two genes, different combinations were ranged from wild-type to quadruple mutant-type. Among the 16 patients enrolled in the sulphadoxine-pyrimethamine clinical trial (28 days of follow-up) and after adjustment by genotyping, 3 (19%, 95% CI: 5%-43%) of them were classified as treatment failure and were pvdhfr 58R/117N double mutant carriers with or without the pvdhps 383G mutation. This study highlights (i) that genotyping in the pvdhfr and pvdhps genes remains a useful tool to monitor the emergence and the spread of P. vivax sulphadoxine-pyrimethamine resistant in order to improve the national antimalarial drug policy, (ii) the issue of using sulphadoxinepyrimethamine as a monotherapy for intermittent preventive treatment of pregnant women or children. (author's)
Language: English
Keywords:
MADAGASCAR | RESEARCH REPORT | GENETIC TECHNIQUES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | TARGET POPULATION | MALARIA | PARASITE CONTROL | PREVENTIVE MEDICINE | DRUGS | PREVALENCE | CHROMOSOME ABNORMALITIES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Research Methodology | Program Design | Programs | Organization and Administration | Parasitic Diseases | Diseases | Public Health | Treatment | Measurement | Neonatal Diseases and Abnormalities
Document Number: 324966

Peer Reviewed

Title: Optimizing resource allocation for HIV/AIDS prevention programmes: an analytical framework.
Author: Bautista-Arredondo S; Gadsden P; Harris JE; Bertozzi SM
Source: AIDS. 2008 Jul;22 Suppl 1:S67-74.
Abstract: INTRODUCTION: Although investment in HIV/AIDS prevention has increased worldwide, it remains uncertain how the additional resources can be most efficiently allocated to maximize the number of infections averted, especially at the country, regional and local levels. METHODS: Data from developing countries in Africa, Asia and Latin America were reviewed on the allocation of HIV/AIDS prevention funds in relation to the prevalence of infection, as well as budgetary allocations for specific population groups at high risk of infection, such as sex workers, intravenous drug users and men who have sex with men. The variation in unit costs of voluntary counselling and testing in five countries was also examined. RESULTS: Evidence was found of three distinct sources of inefficiency in the allocation of HIV/AIDS prevention resources: inefficiency in the mix of interventions selected; inefficient targeting of key populations; and technical inefficiency in the production of HIV prevention services. CONCLUSION:A general conceptual framework for evaluating the efficiency of HIV/AIDS prevention programmes at the country, regional and local levels is proposed. This framework stresses three equally important components of programme efficiency: cost-effectiveness (the choice of the mix of interventions); targeting (the choice of the mix of target populations); and technical efficiency (the delivery of prevention services at least cost).
Language: English
Keywords:
AFRICA | ASIA | LATIN AMERICA | HIV INFECTIONS | HIV PREVENTION | COST BENEFIT ANALYSIS | DEVELOPING COUNTRIES | PROGRAM EVALUATION | RESOURCE ALLOCATION | HEALTH SERVICES | PREVENTIVE MEDICINE | FUNDS | POPULATION AT RISK | SEX WORKERS | IV DRUG USERS | MEN HAVING SEX WITH MEN | Americas | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Delivery of Health Care | Health | Medicine | Research Methodology | Sex Behavior | Behavior | Drug Use and Abuse
Document Number: 328239

Peer Reviewed

Title: A randomized, controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, amodiaquine, or the combination in pregnant women in Ghana.
Author: Clerk CA; Bruce J; Affipunguh PK; Mensah N; Hodgson A
Source: Journal of Infectious Diseases. 2008 Oct 15;198(8):1202-11.
Abstract: BACKGROUND: The use of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) is threatened by the spread of resistance to SP. Therefore, we studied the efficacy, safety, and tolerance of amodiaquine (AQ) or the combination of AQ and SP (SPAQ) as possible alternative treatments. METHODS: The study was performed in Ghana from June 2004 through February 2007. Women were individually randomized to receive IPTp with SP (n=1328), AQ (n= 986), or SPAQ (n=1328). Incidences of anemia, peripheral anemia, and placental parasitemia at delivery were assessed for paucigravidae, as were the birth weights of their infants. Delivery outcomes and the incidence of adverse events were investigated for all women. RESULTS: The prevalences of anemia (as defined by a hemoglobin concentration of <11.0 g/dL) at delivery were comparable between the SP and AQ groups and between the SP and SPAQ groups. Similarly, there was no significant difference between the SP and AQ groups or between the SP and SPAQ groups with regard to the incidences of low birth weight (LBW). Women who received AQ or SPAQ were more likely to report adverse events than were those who received SP. CONCLUSION: The effects of IPTp with AQ or SPAQ on maternal anemia and LBW were comparable to the effects of IPTp with SP; however, IPTp regimens that contain AQ are unlikely to be useful as an alternative to IPTp with SP in Ghana, because of a high frequency of associated adverse events. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00146783 .
Language: English
Keywords:
GHANA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREVENTIVE MEDICINE | ANTIMALARIAL DRUGS | DRUG RESISTANCE | SAFETY | BIRTH WEIGHT | ANEMIA | PREGNANCY OUTCOMES | PREVALENCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Malaria | Parasitic Diseases | Diseases | Treatment | Medical Procedures | Public Health | Body Weight | Physiology | Biology | Pregnancy | Reproduction | Measurement
Document Number: 328925

8.
Title: Perception and practice of malaria prophylaxis in pregnancy among primary health care providers in Ibadan, Nigeria.
Author: Fawole AO; Onyeaso NC
Source: West African Journal of Medicine. 2008 Apr;27(2):92-6.
Abstract: BACKGROUND: Pregnant women and their unborn babies are especially vulnerable to malaria. Malaria infection during pregnancy is associated with increased risk of maternal anaemia, spontaneous abortion, stillbirth, low birth weight and neonatal death. OBJECTIVE: To assess knowledge and practice of malaria prophylaxis during pregnancy among primary health care providers in Ibadan, south-western Nigeria. METHODS: Participants were randomly selected from primary health centres and private health facilities in two local governments within Ibadan municipality. All cadres of health professionals in the selected health facilities were interviewed using a semi-structured self -administered questionnaire. RESULTS: Two hundred and eighty-seven participants selected from 42 primary healthcare facilities comprising of 48 (16.7%) CHEWs, 133 (46.3%) auxiliary nurses, 84 (29.3%) trained nurses and 22 (7.7%) medical doctors completed the questionnaires. Healthcare providers in private health facilities formed the bulk (80.5%) of respondents. Respondents' knowledge of malaria prevention strategies was generally poor across all professional cadres. Only 40 (13.9%) respondents had correct knowledge of WHO strategies. Awareness of IPT was significantly higher among respondents from public health facilities compared with private health facilities--93.0% versus 80.9% (p < 0.05) One hundred and fifty-six (54.4%) respondents knew the correct drug, dosage and timing of IPT. Only forty-six (16.0%) respondents were aware that at least three doses of IPT were required for HIV patients. Pyrimethamine was significantly more commonly prescribed in private health facilities compared with public health facilities (p < 0.05) Chloroquine was still commonly prescribed by respondents in public and private health facilities. The use of insecticide treated nets was recommended by 77.4% of respondents. CONCLUSION: Knowledge about current malaria prevention strategies during pregnancy is poor among health care providers at the primary level of care. Efforts aimed at improving malaria prevention in the primary health care setting must incorporate providers in private health facilities who are responsible for a larger proportion of health care delivery at this level.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLIENTS | RESPONDENTS | PRIMARY HEALTH CARE | HEALTH FACILITIES | KNOWLEDGE | BEHAVIOR | MALARIA PREVENTION | PREGNANCY | MALARIA | ANTIMALARIAL DRUGS | PREVENTIVE MEDICINE | TREATMENT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Surveys | Sampling Studies | Studies | Research Methodology | Health Services | Delivery of Health Care | Health | Sociocultural Factors | Parasitic Diseases | Diseases | Reproduction | Medicine | Medical Procedures
Document Number: 329842

Peer Reviewed

Title: Symptom-based screening of child tuberculosis contacts: improved feasibility in resource-limited settings.
Author: Kruk A; Gie RP; Schaaf HS; Marais BJ
Source: Pediatrics. 2008 Jun;121(6):e1646-52.
Abstract: OBJECTIVE: National tuberculosis programs in tuberculosis-endemic countries rarely implement active tracing and screening of child tuberculosis contacts, mainly because of resource constraints. We aimed to evaluate the safety and feasibility of applying a simple symptom-based approach to screen child tuberculosis contacts for active disease. METHODS: We conducted a prospective observational study from January through December 2004 at 3 clinics in Cape Town, South Africa. All of the children <5 years old in household contact with an adult tuberculosis source case were assessed by documenting current symptoms and tuberculin skin test and chest radiograph results. RESULTS: During the study period, 357 adult tuberculosis cases were identified; 195 cases (54.6%) had sputum smear and/or culture positive results and were in household contact with children aged <5 years. Complete information was available for 252 of 278 children; 176 (69.8%) were asymptomatic at the time of screening. Tuberculosis treatment was administered to 33 (13.1%) of 252; 27 were categorized as radiologically "certain tuberculosis," the majority (n = 22) of which had uncomplicated hilar adenopathy. The negative predictive value of symptom-based screening varied according to the case definition used, with 95.5% including all of the children treated for tuberculosis and 97.1% including only those with radiologically "certain tuberculosis." CONCLUSIONS: Our findings support current World Health Organization recommendations, demonstrating that symptom-based screening of child tuberculosis contacts should improve feasibility in resource-limited settings and seems to be safe.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | COMPARATIVE STUDIES | CLINICAL RESEARCH | PROSPECTIVE STUDIES | CHILDREN | SIGNS AND SYMPTOMS | TUBERCULOSIS | SCREENING | PHYSICAL EXAMINATIONS AND DIAGNOSES | PREVENTIVE MEDICINE | CHILD SURVIVAL | LABORATORY EXAMINATIONS AND DIAGNOSES | WHO | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Infections | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Survivorship | Length of Life | Mortality | Population Dynamics | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 328040

10.

Peer Reviewed

Title: Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission.
Author: Kumwenda NI; Hoover DR; Mofenson LM; Thigpen MC; Kafulafula G
Source: New England Journal of Medicine. 2008;:[11] p.
Abstract: Effective strategies are urgently needed to reduce mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding in resource-limited settings. Women with HIV-1 infection who were breast-feeding infants were enrolled in a randomized, phase 3 trial in Blantyre, Malawi. At birth, the infants were randomly assigned to one of three regimens: single-dose nevirapine plus 1 week of zidovudine (control regimen) or the control regimen plus daily extended prophylaxis either with nevirapine (extended nevirapine) or with nevirapine plus zidovudine (extended dual prophylaxis) until the age of 14 weeks. Using Kaplan-Meier analyses, we assessed the risk of HIV-1 infection among infants who were HIV-1-negative on DNA polymerase-chain-reaction assay at birth. Among 3016 infants in the study, the control group had consistently higher rates of HIV-1 infection from the age of 6 weeks through 18 months. At 9 months, the estimated rate of HIV-1 infection (the primary end point) was 10.6% in the control group, as compared with 5.2% in the extended-nevirapine group (P less than 0.001) and 6.4% in the extended-dual-prophylaxis group (P = 0.002). There were no significant differences between the two extended-prophylaxis groups. The frequency of breastfeeding did not differ significantly among the study groups. Infants receiving extended dual prophylaxis had a significant increase in the number of adverse events (primarily neutropenia) that were deemed to be possibly related to a study drug. Extended prophylaxis with nevirapine or with nevirapine and zidovudine for the first 14 weeks of life significantly reduced postnatal HIV-1 infection in 9-month-old infants. (author's)
Language: English
Keywords:
MALAWI | RESEARCH REPORT | CLINICAL TRIALS | MOTHERS | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | INFANT | PREVENTIVE MEDICINE | ANTIRETROVIRAL DRUGS | HIV PREVENTION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Infant Nutrition | Nutrition | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Treatment | Medical Procedures
Document Number: 327026

11.

Title: An aging world - demographics and challenges [editorial]
Author: Lunenfeld B
Source: Gynecological Endocrinology. 2008 Jan;24(1):1-3.
Abstract: The world has seen enormous changes over the past century, including historically unprecedented declines in mortality rates and increases in population, followed by equally unprecedented declines in fertility rates. This century will see a new set of demographic challenges, including a mix of falling fertility rates alongside persisting worldwide population growth, and the subsequent aging of populations in both developing and developed countries. The 20th century was the century of population growth; the 21st century will go into the history books as the century of aging. A holistic approach to this new challenge of the 21st century will necessitate a quantum leap in multidisciplinary and internationally coordinated research efforts, supported by a new partnership between industry and governments, philanthropic and international organizations. This collaboration we hope will enrich us with a better understanding of healthy aging, permit us to help to improve quality of life, prevent the preventable, and postpone and decrease the pain and suffering of the inevitable. (author's)
Language: English
Keywords:
GLOBAL | CRITIQUE | INTERDISCIPLINARY STUDIES | OLDER ADULTS | POPULATION | DEMOGRAPHIC AGING | FERTILITY RATE | QUALITY OF LIFE | POPULATION PROJECTION | FERTILITY DECLINE | LIFE EXPECTANCY | ENVIRONMENTAL PROTECTION | LIFE STYLE | RISK REDUCTION BEHAVIOR | PREVENTIVE MEDICINE | Adults | Age Factors | Population Characteristics | Demographic Factors | Population Dynamics | Birth Rate | Fertility Measurements | Fertility | Social Welfare | Economic Factors | Estimation Techniques | Research Methodology | Fertility Changes | Length of Life | Mortality | Natural Resources | Environment | Behavior | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 324751

12.

Peer Reviewed

Title: From strategy development to routine implementation: the cost of Intermittent Preventive Treatment in Infants for malaria control.
Author: Manzi F; Hutton G; Schellenberg J; Tanner M; Alonso P; Mshinda H; Schellenberg D
Source: BMC Health Services Research. 2008;8:165.
Abstract: BACKGROUND: Achieving the Millennium Development Goals for health requires a massive scaling-up of interventions in Sub Saharan Africa. Intermittent Preventive Treatment in infants (IPTi) is a promising new tool for malaria control. Although efficacy information is available for many interventions, there is a dearth of data on the resources required for scaling up of health interventions. METHOD: We worked in partnership with the Ministry of Health and Social Welfare (MoHSW) to develop an IPTi strategy that could be implemented and managed by routine health services. We tracked health system and other costs of (1) developing the strategy and (2) maintaining routine implementation of the strategy in five districts in southern Tanzania. Financial costs were extracted and summarized from a costing template and semi-structured interviews were conducted with key informants to record time and resources spent on IPTi activities. RESULTS: The estimated financial cost to start-up and run IPTi in the wholeof Tanzania in 2005 was US$1,486,284. Start-up costs of US$36,363 were incurred at the national level, mainly on the development of Behaviour Change Communication (BCC) materials, stakeholders' meetings and other consultations. The annual running cost at national level for intervention management and monitoring and drug purchase was estimated at US$459,096. Start-up costs at the district level were US$7,885 per district, mainly expenditure on training. Annual running costs were US$170 per district, mainly for printing of BCC materials. There was no incremental financial expenditure needed to deliver the intervention in health facilities as supplies were delivered alongside routine vaccinations and available health workers performed the activities without working overtime. The economic cost was estimated at 23 US cents per IPTi dose delivered. CONCLUSION: The costs presented here show the order of magnitude of expenditures needed to initiate and to implement IPTi at national scale in settings with high Expanded Programme on Immunization (EPI) coverage. The IPTi intervention appears to be affordable even within the budget constraints of Ministries of Health of most sub-Saharan African countries.
Language: English
Keywords:
TANZANIA | EVALUATION REPORT | COST BENEFIT ANALYSIS | INFANT | PREVENTIVE MEDICINE | MALARIA PREVENTION | COST EFFECTIVENESS | MANAGEMENT | MONITORING | EXPENDITURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Quantitative Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Malaria | Parasitic Diseases | Diseases | Evaluation Indexes | Organization and Administration | Financial Activities | Economic Factors
Document Number: 328436

13.
Title: Contraception is the best kept secret for prevention of mother-to-child HIV transmission [letter]
Author: Petruney T; Robinson E; Reynolds H; Wilcher R; Cates W
Source: Bulletin of the World Health Organization. 2008 Jun;86(6):B.
Abstract: We commend Stringer et al. for addressing the importance of developing and implementing a monitoring and evaluation model for measuring the effectiveness of prevention of mother-to- child HIV transmission (PMTCT) programmes. We also recommend broadening our PMTCT lexicon and developing additional metrics for preventing both HIV acquisition by uninfected women and unintended pregnancies among HIV-infected women. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | CONTRACEPTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | PREVENTIVE MEDICINE | Economic Development | Economic Factors | Family Planning | Disease Transmission Control | Prevention and Control | Diseases | HIV Infections | Viral Diseases | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 328066

14.

15.

Title: Maternal mortality in 2005. Estimates developed by WHO, UNICEF, UNFPA and the World Bank.
Author: World Health Organization [WHO]; UNICEF; United Nations Population Fund [UNFPA]; World Bank
Source: Geneva, Switzerland, WHO, 2007. [46] p.
Abstract: Improving maternal health and reducing maternal mortality have been key concerns of several international summits and conferences since the late 1980s, including the Millennium Summit in 2000. One of the eight Millennium Development Goals (MDGs) adopted at the Millennium Summit is improving maternal health (MDG5). Within the MDG monitoring framework, the international community committed itself to reducing the maternal mortality ratio (MMR) by three quarters between 1990 and 2015. In this context, country estimates of maternal mortality over time are crucial to inform planning of sexual and reproductive health programmes and to guide advocacy efforts and research at the national level. These estimates are also needed at the international level, to inform decision-making concerning resource allocation by development partners and donors. However, assessing the extent of progress towards the MDG5 target has been challenging, due to the lack of reliable maternal mortality data - particularly in developing-country settings where maternal mortality is high. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | MATERNAL MORTALITY | GOALS | MATERNAL HEALTH | EMERGENCY SERVICES | OBSTETRICS | PREVENTIVE MEDICINE | PREVENTION AND CONTROL | PROGRAM EFFECTIVENESS | Mortality | Population Dynamics | Demographic Factors | Population | Planning | Organization and Administration | Health | Health Services | Delivery of Health Care | Medicine | Diseases | Program Evaluation | Programs
Document Number: 323035

16.
Title: Adding zinc to supplemental iron and folic acid does not affect mortality and severe morbidity in young children.
Author: Bhandari N; Taneja S; Mazumder S; Bahl R; Fontaine O
Source: Journal of Nutrition. 2007 Jan;137(1):112-117.
Abstract: Studies have found a substantial reduction in diarrhea and respiratory morbidity in young children receiving zinc supplementation. The impact of daily zinc supplementation administered with iron plus folic acid (IFA) in young children on all-cause hospitalizations and mortality in comparison with IFA alone was evaluated. In a double blind cluster-randomized controlled trial, 94,359 subjects aged 1-23 mo were administered a daily dose of zinc plus IFA or IFA alone for a duration of 12 mo after enrollment. The intervention group tablet contained 10 mg of elemental zinc, 12.5 mg of iron, and 50 mg of folic acid. The control group tablets were similar except that they contained a placebo for zinc. Infants aged < 6 mo were administered half a tablet, and those older received 1 tablet dissolved in breast milk or water. Hospitalizations were captured by trained study physicians through the surveillance of 8 hospitals. Deaths and hospitalizations were ascertained through visits to households by study supervisors once every 2 mo. The overall death rates did not differ significantly between the 2 groups when adjusted for cluster randomization (hazard ratio = 1.02, 95% CI 0.87, 1.19). Zinc and IFA supplementation compared with IFA alone did not affect adjusted hospitalization rates (overall rate ratio = 1.08, 95% CI 0.98, 1.19; diarrhea-specific rate ratio = 1.15, 95% CI 0.99, 1.34; or pneumonia-specific rate ratio = 1.09, 95% CI 0.94, 1.25). The lack of impact of zinc on mortality and hospitalization rates in this study may have been due to the use of lower daily zinc dosing than used in some of the morbidity prevention trials or from an interaction between zinc and iron, where the addition of iron may have adversely affected potential effects of zinc on immune function and morbidity. Future research should address iron and zinc interaction effects on important functional outcomes. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL TRIALS | CHILDREN | INFANT | FOOD SUPPLEMENTATION | FOLIC ACID | ZINC | DIARRHEA | RESPIRATORY INSUFFICIENCY | IRON | ADMINISTRATION AND DOSAGE | DEATH RATE | PNEUMONIA | PREVENTIVE MEDICINE | Asia, Southern | Asia | Developing Countries | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Vitamins and Minerals | Physiology | Biology | Metals | Diseases | Pulmonary Effects | Drugs | Treatment | Medical Procedures | Medicine | Mortality | Population Dynamics
Document Number: 310586

17.

Title: [Women's perceptions of preventive examinations for cervical-uterine cancer: a case study] A percepcao da mulher sobre o exame preventivo do cancer cervico-uterino: estudo de caso.
Author: Duavy LM; Batista FL; Jorge MS; dos Santos JB
Source: Ciencia and Saude Coletiva. 2007 May-Jun;12(3):733-742.
Abstract: Cervical-uterine cancer is among the most feared chronic degenerative diseases, due its high mortality and morbidity rates. This study describes women's feelings before a preventive examination for cervical-uterine cancer, through a case study based on observations and semi-structured interviews as data collection techniques. A total of 24 women were interviewed, between eighteen and sixty years old, who attended the cancer prevention unit at a basic healthcare clinic in Fortaleza, Cear� State between April and August 2004. This study shows that women generally request these preventive examinations only when symptoms appear. They view this procedure with apprehension and fear, due to the possibility of a positive diagnosis of cervical-uterine cancer; they feel embarrassed at exposing their bodies for examination, particularly by male physicians; and they are poorly informed about their own bodies and even their own sexuality. These findings highlight the need for healthcare practitioners to conduct educational activities for women, in order to enhance professional relationships between healthcare providers and users, helping lower the rate of this type of cancer through more frequent preventive examinations. (author's)
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | CASE STUDIES | INTERVIEWS | WOMEN | CERVICAL CANCER | PERCEPTION | PREVENTIVE MEDICINE | EXAMINATIONS AND DIAGNOSES | Developing Countries | South America, Eastern | South America | Latin America | Americas | Studies | Research Methodology | Data Collection | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Psychological Factors | Behavior | Medicine | Health Services | Delivery of Health Care | Health | Medical Procedures
Document Number: 320493

18.

Peer Reviewed

Title: Intermittent preventive treatment of malaria in pregnancy: the effect of new delivery approaches on access and compliance rates in Uganda.
Author: Mbonye AK; Magnussen P; Bygbjerg IB
Source: Tropical Medicine and International Health. 2007 Apr;12(4):519-531.
Abstract: The objective was to assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer intermittent preventive treatment (IPT) with sulfadoxine-pyremethamine to pregnant women, and reach those most at risk of malaria and increase access and compliance to it. The study was designed to assess new approaches of delivering IPT through these groups and compare it with IPT at health units. The primary outcome measures were: the proportion of adolescents and primigravidae accessed; gestational age at recruitment and the proportion of women who completed two doses of sulfadoxine-pyremethamine. Two thousand seven hundred and eighty-five pregnant women (78% of those in the study area) participated. With new approaches, 92.4% of the women received IPT during the second trimester as recommended by the policy, vs. 76.1% at health units, P < 0.0001. Of the women who received two doses of sulfadoxine-pyremethamine, 39.9% were at health units (control) vs. 67.5% through new approaches (P < 0.0001). Women using the new approaches also accessed IPT early: the mean gestational age when receiving the first dose of sulfadoxine-pyremethamine was 21.0 weeks vs. 23.1 weeks at health units (P < 0.0001). However, the health units were used by a higher proportion of primigravidae (23.6% vs. 20.0%, P < 0.04), and this was also the case for adolescents (28.4% vs. 25.0%, P < 0.03). This intervention was acceptable with 89.1% of the women at the new approaches intending to use IPT in future. The new approaches increased access to and compliance with IPT. We recommend a review of the policy to allow the provision of IPT through the new approaches. (author's)
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | PEER EDUCATORS | PHARMACISTS | HEALTH PERSONNEL | ADOLESCENTS | COMMUNITY WORKERS | PREVENTIVE MEDICINE | PREGNANCY COMPLICATIONS | MALARIA PREVENTION | USER COMPLIANCE | PROGRAM ACCESSIBILITY | PHARMACY DISTRIBUTION | NONCLINICAL DISTRIBUTION | DISTRIBUTIONAL ACTIVITIES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Education | Delivery of Health Care | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medicine | Health Services | Diseases | Malaria | Parasitic Diseases | Behavior | Program Evaluation | Programs | Organization and Administration | Program Activities
Document Number: 315387

19.

Title: Haemorrhage and maternal morbidity and mortality in Pakistan.
Author: Pal SA
Source: Journal of Pakistan Medical Association. 2007 Dec;57(12):576-577.
Abstract: Haemorrhage whether antepartum (APH), postpartum (PPH), abortion or ectopic pregnancy related, remains one of the major killers of childbearing women all over the world. In Pakistan, audit into the causes of maternal mortality in public and private hospitals, points towards postpartum haemorrhage as the main cause of death after childbirth. Even highly skilled obstetricians can be incompetent when dealing with women in dire situations of life and death without access to life saving medicines and safe blood transfusion services. This can happen even in the best equipped hospitals in the major cities of Pakistan. The majority of deliveries occur at home under the supervision of traditional birth attendants or "dais". However, this may be changing as more and more women are choosing to go to hospitals or maternity homes for their delivery. Most rural areas lack emergency obstetric care facilities. Poor transportation and lack of financial resources further complicate matters. Women often become pregnant without planning in a less than ideal nutritional state. Prepregnancy anaemia is common. Lack of empowerment, especially for rural women results in seeking medical attention, often when it is too late. Their lack of nutritional reserve, leaves very little margin of error for the health professional when faced with a bleeding pregnant or recently delivered woman. (excerpt)
Language: English
Keywords:
PAKISTAN | RECOMMENDATIONS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | PREGNANCY COMPLICATIONS | PREVENTIVE MEDICINE | MISOPROSTOL | OXYTOCIN | UTERINE PERFORATION | Developing Countries | Asia, Southern | Asia | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Diseases | Medicine | Health Services | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pituitary Hormones | Hormones | Perforations
Document Number: 323925

20.

Title: Appraisal on the prevalence of malaria and anaemia in pregnancy and factors influencing uptake of intermittent preventive therapy with sulfadoxine-pyrimethamine in Kibaha district, Tanzania.
Author: Tarimo DS
Source: East African Journal of Public Health. 2007 Oct;4(2):80-83.
Abstract: The objective was to appraise the prevalence of malaria and anaemia in antenatal mothers; and explore the factors influencing coverage of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) under operational conditions in the national programme for malaria control in pregnancy. The design used was a descriptive cross-sectional survey. The setting for the study was the reproductive and child health clinic in Kibaha district hospital, Tanzania The subjects of the study were pregnant mothers on routine antenatal visits Main outcome measures: Prevalence of malaria (peripheral parasitaemia) and anaemia, coverage of IPT with SP and the factors influencing coverage. A total of 395 mothers were recruited; 27.3% had malaria. Moderate anaemia i.e. haemoglobin (Hb) level 8.0 - 10.9 g/dl was detected in 56.7% of mothers; 34.2% had severe anaemia (Hb less than 8.0 g/dl). Hb greater than 8.0 g/dl was strongly associated with negative parasitaemia while Hb less than 8.0 g/dl was strongly associated with positive parasitaemia. About a third (40.0%) of the mothers did not receive SP for IPT because of unavailability. Of those receiving, about a third (40.0%) did not swallow the tablets at the clinic because of empty stomach and sharing of water cups. Majority (90.1%) were aware that SP was the drug for IPT and 77.2% held the perception that IPT with SP has health benefits; however, 70.0% were not aware on the timing for IPT. Severe malarial anaemia is still a health problem in pregnancy, conceivably due to low coverage of IPT with SP because of erratic availability of SP. There is a major gap on appropriate timing for IPT with SP that should be corrected. (author's)
Language: English
Keywords:
TANZANIA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MALARIA | PREVALENCE | ANEMIA | PREGNANCY COMPLICATIONS | MALARIA PREVENTION | PREVENTIVE MEDICINE | PARASITE CONTROL | ADMINISTRATION AND DOSAGE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Measurement | Medicine | Health Services | Delivery of Health Care | Health | Public Health | Drugs | Treatment | Medical Procedures
Document Number: 324437

21.

Title: Towards universal access to prevention, treatment and care: experiences and challenges from the Mbeya region in Tanzania -- a case study.
Author: Vogel UF
Source: Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2007 Mar. 49 p. (UNAIDS Best Practice CollectionUNAIDS/07.11EJC1291E) Also available in French.
Abstract: This study takes stock of the situation in Mbeya in 2005, documenting the region's continuing efforts to build on the Regional Programme's strong comprehensive prevention approaches to further increase their coverage while strengthening the new district focus, expanding multisectoral work and making available antiretroviral treatment. In doing so, this study describes Mbeya's progress towards universal access and identifies ongoing challenges. Through its comprehensive, decentralized and multisectoral approaches and the continuing efforts of a variety of actors, the region appears to be in a better position to reach universal access than other parts of Tanzania and Africa in general. The experiences of the Mbeya region to date can serve as lessons learnt to other parts of the country and, more broadly, the continent. This publication is neither a scientific study nor an evaluation of the Regional Programme. It is an analytical description of HIV control activities in the region to date and their status to date. Its focus is mainly on access. The programmes presented here follow national and international recommendations. The quality of the individual programmes, however, has not been assessed for the purpose of this publication. (excerpt)
Language: English
Keywords:
TANZANIA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | CASE STUDIES | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | PREVENTIVE MEDICINE | PREVENTIVE HEALTH CARE | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | BEST PRACTICES | UNAIDS | HIV PREVENTION | HEALTH STATUS INDEXES | ORGANIZATION AND ADMINISTRATION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Studies | Research Methodology | Quantitative Evaluation | Evaluation | HIV Infections | Viral Diseases | Diseases | Medicine | Health Services | Health | Program Evaluation | Programs | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 322577

22.
Peer Reviewed

Title: Seasonal intermittent preventive treatment with artesunate and sulfadoxine-pyrimethamine for prevention of malaria in Senegalese children: a randomised, placebo-controlled, double-blind trial. [Traitement pr�ventif saisonnier intermittent avec l'artesunate et la sulfadoxine-pyrim�thamine pour la pr�vention du paludisme chez les enfants s�n�galais : un essai randomis� � double insu contr�l� par placebo.
Author: Ciss� B; Sokhna C; Boulanger D; Milet J; B� el H
Source: Lancet. 2006 Feb 25;367(9511):659-667.
Abstract: In the Sahel and sub-Sahelian regions of Africa, malaria transmission is highly seasonal. During a short period of high malaria transmission, mortality and morbidity are high in children under age 5 years. We assessed the efficacy of seasonal intermittent preventive treatment--a full dose of antimalarial treatment given at defined times without previous testing for malaria infection. We did a randomised, placebo-controlled, double-blind trial of the effect of intermittent preventive treatment on morbidity from malaria in three health-care centres in Niakhar, a rural area of Senegal. 1136 children aged 2-59 months received either one dose of artesunate plus one dose of sulfadoxine-pyrimethamine or two placebos on three occasions during the malaria transmission season. The primary outcome was a first or single episode of clinical malaria detected through active or passive case detection. Primary analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00132561. During 13 weeks of follow-up, the intervention led to an 86% (95% CI 80-90) reduction in the occurrence of clinical episodes of malaria. With passive case detection, protective efficacy against malaria was 86% (77-92), and when detected actively was 86% (78-91). The incidence of malaria in children on active drugs was 308 episodes per 1000 person-years at risk, whereas in those on placebo it was 2250 episodes per 1000 person-years at risk. 13 children were not included in the intention-to-treat analysis, which was restricted to children who received a first dose of antimalarial or placebo. There was an increase in vomiting in children who received the active drugs, but generally the intervention was well tolerated. Intermittent preventive treatment could be highly effective for prevention of malaria in children under 5 years of age living in areas of seasonal malaria infection. (author's)
French Abstract: Au Sahel et dans les r�gions au sud du Sahel en Afrique, la transmission du paludisme est extr�mement saisonni�re. Pendant une courte p�riode de haute transmission du paludisme, la mortalit� et la morbidit� sont tr�s �lev�es chez les enfants de moins de 5 ans. Nous avons �valu� l'efficacit� d'un traitement pr�ventif saisonnier intermittent - une dose compl�te de traitement anti paludisme administr�e � des moments d�finis, sans d�pistage pr�alable d'infection par le paludisme. Nous avons effectu� un essai randomis� � double insu contr�l� par placebo pour �valuer l'effet du traitement pr�ventif saisonnier intermittent sur la morbidit� due au paludisme dans trois centres sanitaires � Niakhar, dans une zone rurale du S�n�gal. 1 136 enfants entre 2 et 59 mois ont re�u soit une dose d'artesunate plus une dose de sulfadoxine-pyrim�thamine, soit deux placebos en trois occasions pendant la saison de transmission du paludisme. Le principal r�sultat �tait un premier ou seul �pisode de paludisme clinique d�tect� par le biais d'une d�tection active ou passive. La principale analyse �tait en intention de traiter. Cette �tude est enregistr�e aupr�s de ClinicalTrials.gov, sous le num�ro NCT00132561. Au cours des 13 semaines de suivi, l'intervention a entra�n� une r�duction des �pisodes de paludisme clinique de 86 % (intervalle de confiance de 95 % : 80 � 90). Dans le cas d'une d�tection passive, l'efficacit� de la protection contre le paludisme �tait de 86 % (77 � 92) et de 86 % (78 � 91) pour une d�tection active. L'incidence de paludisme chez les enfants prenant des m�dicaments actifs �tait de 308 �pisodes par 1 000 ann�es-personnes � risque, tandis que chez ceux qui avaient re�u un placebo, elle �tait de 2 250 �pisodes par 1 000 ann�es-personnes � risque. 13 enfants n'avaient pas �t� inclus dans l'analyse en intention de traiter, du fait que celle-ci �tait r�serv�e aux enfants qui avaient re�u une premi�re dose de m�dicament anti paludisme ou de placebo. Les enfants auxquels avaient �t� administr�s les m�dicaments actifs pr�sentaient une plus grande fr�quence de vomissements mais, dans l'ensemble, cette intervention �tait bien tol�r�e. Un traitement pr�ventif saisonnier intermittent pourrait �tre hautement efficace dans la pr�vention du paludisme chez les enfants de moins de 5 ans vivant dans des r�gions d'infection saisonni�re au paludisme. (de l'auteur)
Language: English
Keywords:
SENEGAL | RESEARCH REPORT | CLINICAL TRIALS | CHILD | MALARIA | TRANSMISSION | SEASONAL VARIATION | TIME FACTORS | MORBIDITY | MORTALITY | PREVENTIVE MEDICINE | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Infections | Population Dynamics | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 297664

23.
Title: A case-control study of protection against tuberculosis by BCG revaccination in Recife, Brazil.
Author: Dantas OM; Ximenes RA; de Albuquerque Mde F; da Silva NL; Montarroyos UR
Source: International Journal of Tuberculosis and Lung Disease. 2006 May;10(5):536-541.
Abstract: SETTING: Metropolitan region of Recife, Brazil. The objective was to estimate the additional protection against tuberculosis (TB) provided by a second dose of bacille Calmette-Gu�rin (BCG) vaccine. DES: Case-control study. Cases were cases of TB newly diagnosed by the TB control programme, independent of clinical form. Three matched neighbourhood controls were selected using a systematic routine, starting from the case's address. The matching was within the age groups 7--9, 10--14 and 15--19 years. Analysis was conducted among 169 cases and 477 controls. For the efficacy of BCG revaccination against TB overall, matched (crude) vaccine effectiveness (VE) was -3 (95%CI _50--29) and matched (adjusted) VE was 8 (95%CI -77--52). This study suggests that a second dose of BCG does not offer additional protection. Revaccination should not be offered. As large numbers of subjects are already vaccinated and vaccine appears to offer some protection in older subjects, further studies with larger sample sizes could investigate the potential efficacy of revaccination with BCG in the age group = 15 years. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CASE STUDIES | CLIENTS | TUBERCULOSIS | IMMUNIZATION SCHEDULE | VACCINATION | CONTRACEPTIVE USE-EFFECTIVENESS | PREVENTIVE MEDICINE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Immunization | Primary Health Care | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning | Medicine
Document Number: 306226

24.

Title: [Current status of breast cancer chemoprevention] Quimioprevencao do cancer de mama.
Author: de Oliveira VM; Aldrighi JM; Rinaldi JF
Source: Revista da Associacao Medica Brasileira. 2006 Nov-Dec;52(6):453-459.
Abstract: Chemoprevention is defined as the use of natural or synthetic chemical agents to reverse, suppress or prevent carcinogenic progression of invasive cancer. Drugs that act as chemoprevention agents for breast cancer are divided into two major groups: drugs that prevent Estrogen Receptor (ER) - positive breast cancers [selective estrogen receptor modulators (SERM), aromatase inhibitors GnKH agonists and phytoestrogens] and drugs that prevent ER - negative breast cancers [cyclooxygenase-2 (COX-2) inhibitors, retinoids, statins, receptor tyrosine, kinase inhibitors, monoclonal antibody against HER-2 and telomerase inhibitors]. Results from the NSABP Study of Tamoxifen and Raloxifene (STAR), which compared the risk-reducing efficacy as well as toxicity of these two SERMs in a similar high-risk for breast cancer population, showed that Raloxifene is as effective as Tamoxifen in reducing the risk of non-invasive breast cancer (p=.83). It has a statistically significant lower risk of thromboembolic events and cataracts, however a non-statistically significant higher risk of noninvasive breast cancer. Based on promising data involving reduction of contralateral breast cancer risk in adjuvant studies, several aromatase inhibitors, including letrozole, anastrozole and exemestane, are being included in trials to evaluate their efficacy in breast cancer prevention in both case-control and cohort studies As such randomized studies to confirm this efficacy are needed. Positive results of several recent clinical trials for preventing breast cancer in high-risk populations suggest that chemoprevention is a rational and attractive strategy. (author's)
Language: Portuguese
Keywords:
LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN | BREAST CANCER | DRUGS | PREVENTIVE MEDICINE | ESTROGENS | HORMONE RECEPTORS | ANTIBODIES | TOXICITY | THROMBOEMBOLISM | SIDE EFFECTS | EYESIGHT | Research Methodology | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormones | Endocrine System | Physiology | Biology | Membrane Proteins | Immunologic Factors | Immunity | Immune System | Embolism | Vascular Diseases
Document Number: 316308

25.
Peer Reviewed

Title: Review: Intermittent preventive treatment - a new approach to the prevention of malaria in children in areas with seasonal malaria transmission.
Author: Greenwood B
Source: Tropical Medicine and International Health. 2006 Jul;11(7):983-991.
Abstract: Intermittent preventive treatment, the administration of a full course of an anti-malarial treatment to a population at risk at specified time points regardless of whether or not they are known to be infected, is now a recommended approach to the prevention of malaria in pregnancy and is being explored as a potential way of preventing malaria in infants. However, in many malaria endemic areas, the main burden of malaria is in older children and increasing use of insecticide treated bednets is likely to increase further the proportion of episodes of malaria that occur in older children. Recently, it has been shown in Senegal and in Mali that intermittent preventive treatment given to older children during the malaria transmission season can be remarkably effective in preventing malaria. This approach to malaria control is likely to be most effective in areas with a high level of malaria transmission concentrated in a short period of the year. However, several issues need to be addressed before intermittent preventive treatment in children can be advocated for use in malaria control programmes. These include: (1) determination of whether intermittent preventive treatment adds to the protection afforded by other control measures such as insecticide-treated bednets; (2) whether an effective and sustainable delivery system can be found; (3) choice of drug to be used; (4) optimum timing of drug administration; (5) the requisite interval between treatments. The potential benefits of intermittent preventive treatment in children are substantial; more research is needed to determine if this is a practical approach to malaria control. (author's)
Language: English
Keywords:
UNITED KINGDOM | LITERATURE REVIEW | PREGNANCY | CHILD | MALARIA PREVENTION | PREVENTIVE MEDICINE | TREATMENT | ADMINISTRATION AND DOSAGE | Developed Countries | Europe, Western | Europe | Reproduction | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Malaria | Parasitic Diseases | Diseases | Medicine | Health Services | Delivery of Health Care | Health | Medical Procedures | Drugs
Document Number: 302851

26.

Title: Diarrheal diseases.
Author: Keusch GT; Fontaine O; Bhargava A; Boschi-Pinto C; Bhutta ZA
Source: In: Disease control priorities in developing countries. 2nd ed., edited by Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson et al. Washington, D.C., World Bank, 2006. :371-387.
Abstract: Diarrheal diseases remain a leading cause of preventable death, especially among children under five in developing countries. This chapter reviews and prioritizes a number of available interventions. The normal intestinal tract regulates the absorption and secretion of electrolytes and water to meet the body's physiological needs. More than 98 percent of the 10 liters per day of fluid entering the adult intestines are reabsorbed. The remaining stool water, related primarily to the indigestible fiber content, determines the consistency of normal feces from dry, hard pellets to mushy, bulky stools, varying from person to person, day to day, and stool to stool. This variation complicates the definition of diarrhea, which by convention is present when three or more stools are passed in 24 hours that are sufficiently liquid to take the shape of the container in which they are placed. The frequent passage of formed stool is not diarrhea. Although young nursing infants tend to have five or more motions per day, mothers know when the stooling pattern changes and their children have diarrhea. The interval between two episodes is also arbitrarily defined as at least 48 hours of normal stools. These definitions enable epidemiologists to count incidence, relapses, and new infections. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | CHILDREN | DIARRHEA | INFECTION TRANSMISSION | BACTERIAL AND FUNGAL DISEASES | LABORATORY EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | POVERTY | ORAL REHYDRATION | PREVENTIVE MEDICINE | BREASTFEEDING, EXCLUSIVE | ROTAVIRUS | IMMUNIZATION | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Infections | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Socioeconomic Factors | Economic Factors | Treatment | Breastfeeding | Infant Nutrition | Nutrition | Viral Diseases | Primary Health Care
Document Number: 323145

27.
Peer Reviewed

Title: Mapping indicators of sexually transmitted infection services in the South African public health sector.
Author: Kleinschmidt I; Ramkissoon A; Morris N; Mabude Z; Curtis B
Source: Tropical Medicine and International Health. 2006 Jul;11(7):1047-1057.
Abstract: Prevention and early treatment of sexually transmitted infections (STIs) is a high public health priority in South Africa. In 2002 a national survey of public health care (PHC) facilities was conducted to develop measurable indicators for monitoring and evaluation of the National STI programme. In this paper we present maps of key indicators obtained from the survey, and discuss their programmatic implications. We also address some methodological issues that arise in the context of producing appropriate maps. A national sample, stratified by subdistrict/municipality, of 962 PHC facilities was randomly selected. In each facility the senior nurse was telephonically contacted and interviewed to answer questions related to the implementation of STI prevention and management from a structured questionnaire. Responses were validated through a second phone call, and inconsistencies recorded. The following key variables were mapped: stock-outs of drugs and condoms, knowledge of correct treatment procedures, consistent record keeping, number of STI clients seen per month per 1000 adult population, number of condoms distributed per adult male, and number of trained nurses per 1000 population. Using conditional autoregressive models and Markov Chain Monte Carlo (MCMC) simulation, smoothed subdistrict level clinic responses were computed and 95% confidence limits estimated. Drug stock-outs were reported by 13% [95% CI 10--15%] and condom stock-outs were reported by 4% [95% CI 2--5%] of facilities. Underlying geographical patterns of risk were more clearly observed when maps had been smoothed and were not dominated by sampling error. Smoothed maps show that there is a finite, low risk of drug stock-outs in all areas with higher risk regions more clearly identified. The maps of indicators of STI services at PHC facilities show that there are important differences in quality of service within South Africa and underscore the usefulness of facility level routine data both for local programme monitoring and planning and for providing a national 'bird's eye view' of programme performance. (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | HEALTH SURVEYS | MONITORING | CLINICS | HEALTH SERVICES | SEXUALLY TRANSMITTED DISEASE PREVENTION | PREVENTIVE MEDICINE | QUALITY OF HEALTH CARE | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Health | Evaluation | Health Facilities | Delivery of Health Care | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Medicine | Health Services Evaluation | Programs | Organization and Administration
Document Number: 302856

28.
Peer Reviewed

Title: Dengue: setting the global research agenda.
Author: Kroeger A; Nathan MB
Source: Lancet. 2006 Dec 23;368(9554):2193-2195.
Abstract: The global incidence of dengue has increased exponentially over past decades. Fuelled by conditioning factors such as rapid urbanisation, demographic change, large-scale migration, and travel, the disease is now endemic in most countries of the tropics, and about 925 million people now live in urban areas that are at risk of dengue infection. The increasing incidence, intensity, and geographical expansion of dengue epidemics pose a growing threat to the health and economic well-being of populations living in endemic areas, where the introduction of new virus strains to regions affected by existing serotypes is a risk factor for outbreaks and severe disease. Dengue is a major international public-health concern, as expressed in World Health Assembly resolution WHA 55.17 and in the 2005 revision of the International Health Regulations (WHA 58.3). We do have strategies, methods, and guidelines with which we can greatly reduce dengue case-fatality rates and virus transmission, but weak implementation of these plans and an inability to respond effectively to conditioning factors (such as those mentioned above) outside the health sector is causing concern. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | PROGRESS REPORT | RESEARCH PROPOSAL | CLINICAL RESEARCH | TARGET POPULATION | DENGUE | WHO | STANDARDIZATION | TREATMENT | ANTIBIOTICS | RESEARCH ACTIVITIES | PREVENTIVE MEDICINE | PUBLIC HEALTH | INTERNATIONAL COOPERATION | Research Methodology | Program Design | Programs | Organization and Administration | Viral Diseases | Diseases | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Data Adjustment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs
Document Number: 310968

29.
Peer Reviewed

Title: Intermittent preventive treatment for malaria control administered at the time of routine vaccinations in Mozambican infants: a randomized, placebo-controlled trial.
Author: Macete E; Aide P; Aponte JJ; Sanz S; Mandomando I
Source: Journal of Infectious Diseases. 2006 Aug 1;194(3):276-285.
Abstract: There is an urgent need to deploy and develop new control tools that will reduce the intolerable burden of malaria. Intermittent preventive treatment in infants (IPTi) has the potential to become an effective tool for malaria control. We performed a randomized, double-blind, placebo-controlled trial of sulfadoxine-pyrimethamine (SP) treatment in 1503 Mozambican children. Doses of SP or placebo were given at 3, 4, and 9 months of age. The intervention was administered alongside routine vaccinations delivered through the Expanded Program on Immunization (EPI). Hematological and biochemical tests were done when infants were 5 months old. Morbidity monitoring through a hospital-based passive case-detection system was complemented by cross-sectional surveys when infants were 12 and 24 months old. IPTi was well tolerated, and no adverse events associated with SP were documented. During the first year of life, intermittent SP treatment reduced the incidence of clinical malaria by 22.2% (95% confidence interval [CI], 3.7%--37.0%; P=.020) and the rate of hospital admissions by 19% (95% CI, 4.0%--31.0%; P=.014). Although the incidence of severe anemia (packed cell volume of < 25%) did not differ significantly between the 2 groups (protective effect, 12.7% [95% CI, - 17.3% to 35.1%]; P = .36), there was a significant reduction in hospital admissions for anemia during the month afte