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Title: Male circumcision: a cancer prevention strategy?
Source: Lancet Oncology. 2009 May;10(5):431.
Abstract: Given that less than 20% of males are circumcised in many developing countries, and that male circumcision is relatively simple and reduces viral infection, might this practice be more widely used as a preventive measure against cancer? In developing countries, male circumcision could have a vital role in specific segments of the population depending on the answers to specific scientific and infrasturcture related questions. Discussions around male circumcision strategies should be encouraged within the context of cancer prevention, and these should include local communities alongside assessments of current capacities, measurable targets, cost analyses and modelling, and the development of practicable guidelines, so as to place male circumcision within the possible options available for disease prevention.
Language: English
Keywords:
UGANDA | SUMMARY REPORT | PREVALENCE | MEN | MALE CIRCUMCISION | CANCER | PREVENTION AND CONTROL | HIV PREVENTION | STANDARDS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Neoplasms | Diseases | HIV Infections | Viral Diseases
Document Number: 341199

Title: Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. Recommendations and Reports. 2009 Apr 10;58(RR-4):[216] p..
Abstract: Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for the prevention and treatment of opportunistic infections (OIs), especially those OIs for which no specific therapy exists; 2) information regarding the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information regarding the use of interferon-gamma release assays for the diagnosis of latent tuberculosis (TB) infection; 4) updated information about drug interactions that affect the use of rifamycin drugs for prevention and treatment of TB; 5) the addition of a section on hepatitis B virus infection; and 6) the addition of malaria to the list of OIs that might be acquired during international travel.
Language: English
Keywords:
UNITED STATES OF AMERICA | SUMMARY REPORT | STANDARDS | MANUAL | ADULTS | ADOLESCENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | HIV PREVENTION | TREATMENT | ANTIRETROVIRAL THERAPY | DRUG INTERACTIONS | EXAMINATIONS AND DIAGNOSES | Developed Countries | North America | Americas | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Youth | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Drugs
Document Number: 339985

3.
Title: Impact of new WHO growth standards on the prevalence of acute malnutrition and operations of feeding programs - Darfur, Sudan, 2005-2007.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Jun 5;58(21):591-4.
Abstract: Acute malnutrition among children aged 6-59 months is a key indicator routinely used for describing the presence and magnitude of humanitarian emergencies. In the past, the prevalence of acute malnutrition and admissions to feeding programs has been determined using the growth reference developed by the World Health Organization (WHO), CDC, and the National Center for Health Statistics (NCHS). In 2006, WHO released new international growth standards and recommended their use in all nutrition programs. To evaluate the impact of transitioning to the new standards, CDC analyzed anthropometric data for children aged 6-59 months from Darfur, Sudan, collected during 2005-2007. This report describes the results of that analysis, which indicated that use of the new standards would have increased the prevalence of global acute malnutrition on average by 14% and would have increased the prevalence of severe acute malnutrition on average by 100%. Admissions to feeding programs would have increased by 56% for moderately malnourished children and by 260% for severely malnourished children. For programs in Darfur, this would have resulted in approximately 23,200 more children eligible for therapeutic feeding programs. For the immediate future, the prevalence of acute malnutrition in children should be reported using both the old WHO/CDC/NCHS reference and the new WHO standards. More research is needed to better ascertain the validity of the admission criteria based on the new WHO standards in predicting malnutrition-related morbidity and mortality.
Language: English
Keywords:
SUDAN | SUMMARY REPORT | WHO | STANDARDS | PREVALENCE | CHILD DEVELOPMENT | GROWTH | MALNUTRITION | NUTRITION PROGRAMS | EVALUATION | Developing Countries | Africa, North | Africa | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Research Methodology | Measurement | Biology | Nutrition Disorders | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health
Document Number: 341622

Title: Family Health International's Site Identification and Development Initiative (SIDI).
Author: Family Health International [FHI]
Source: [Research Triangle Park, North Carolina], FHI, [2009]. [3] p. (Research Briefs on HIV Prevention)
Abstract: Successful HIV prevention research requires the participation of tens of thousands of women and men at risk for HIV infection. Ultimately, success hinges on the development of multiple international research sites. To increase the number and readiness of such sites, Family Health International (FHI) began the Site Identification and Development Initiative (SIDI) in July 2006.
Language: English
Keywords:
AFRICA | ASIA | PROGRESS REPORT | CLINICAL RESEARCH | HIV PREVENTION | INCIDENCE | NEEDS | USAID | GOALS | STANDARDS | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Measurement | Economic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Planning | Organization and Administration
Document Number: 331712

Title: FHI quality improvement guidelines for care and support programs for orphans and other vulnerable children.
Author: Family Health International [FHI]
Source: Research Triangle Park, North Carolina, FHI, 2009 Jan. 18 p.
Abstract: The guidelines are organized into nine areas of support that respond to the basic needs and human rights of children. They are also aligned with the core areas of support for programs for orphans and vulnerable children established by the U.S. government in the President's Emergency Plan for AIDS Relief (PEPFAR). The areas covered by the guidelines are cross-cutting issues, care coordination, health, food and nutrition, education, psychosocial support, shelter and care, protection, and household economic strengthening.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | STANDARDS | MANUAL | ORPHANS AND VULNERABLE CHILDREN | CHILD HEALTH | EDUCATION | NUTRITION | FOOD SECURITY | HOME CARE | MENTAL HEALTH | SOCIAL PROTECTION | IMPLEMENTATION | Research Methodology | Family and Household | Sociocultural Factors | Health | Food Supply | Natural Resources | Environment | Care and Support | Health Services | Delivery of Health Care | Political Factors | Programs | Organization and Administration
Document Number: 339984

Title: Laboratory logistics handbook: A guide to designing and managing laboratory logistics systems.
Author: John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2009 Jun. 83 p. (USAID Contract No. GPO-I-01-06-00007-00)
Abstract: The importance of quality laboratory services is indisputable. The expansion of programs for human immunodeficiency virus and acquired immunodeficiency syndrome (AIDS), tuberculosis, and malaria requires strong and supportive laboratory services. For antiretroviral therapy (ART) in particular, there has been a growing recognition of this importance, given the number of laboratory tests required to effectively diagnose and monitor AIDS treatment. The need to improve laboratory services for all of these disease programs provides an opportunity to strengthen laboratories in health systems overall so they can accommodate the needs of the communities they serve. This document describes the function and organization of laboratory services and the commodities needed for laboratory services, and it discusses supply chain considerations for management of laboratory commodities.
Language: English
Keywords:
GLOBAL | MANUAL | LABORATORY | LOGISTICS | EQUIPMENT AND SUPPLIES | INGREDIENTS AND CHEMICALS | INFORMATION RETRIEVAL SYSTEMS | STANDARDS | QUALITY CONTROL | STORAGE AND WAREHOUSES | PERSONNEL MANAGEMENT | HEALTH POLICY | FINANCIAL ACTIVITIES | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Organization and Administration | Data Storage and Retrieval | Information Processing | Information | Research Methodology | Policy | Political Factors | Sociocultural Factors | Economic Factors
Document Number: 331659

Title: Public health procurement guide 2010.
Author: United States. Agency for International Development [USAID]; John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2009. [45] p. (USAID Contract No. GPO-I-01-06-00007-00)
Abstract: USAID's Public Health Procurement Guide 2010 is an annual publication of current contraceptive and condom ordering procedures for missions. It includes USAID contraceptive ordering procedures and guidance on how to use logistics data and forecasts to calculate contraceptive requirements.
Language: English
Keywords:
DEVELOPING COUNTRIES | MANUAL | STANDARDS | LOGISTICS | CONTRACEPTION | CONDOMS | COLD CHAIN | CONTRACEPTIVE DISTRIBUTION | DISTRIBUTIONAL ACTIVITIES | CONTRACEPTIVE SECURITY | Research Methodology | Management | Organization and Administration | Family Planning | Barrier Methods | Contraceptive Methods | Program Activities | Programs | Contraceptive Availability
Document Number: 331472

Title: Building laboratory infrastructure to support scale-up of HIV/AIDS treatment, care, and prevention: in-country experience.
Author: Abimiku AG
Author: Institute of Human Virology, University of Maryland School of Medicine PEPFAR
Source: American Journal of Clinical Pathology. 2009 Jun;131(6):875-86.
Abstract: An unprecedented influx of funds and support through large programs such as the Global Fund for AIDS, Malaria and Tuberculosis and the World Health Organization's and President's Emergency Plan for AIDS Relief (PEPFAR) has made it possible for more than 1 million persons in resource-limited settings to access AIDS treatment and several million more to be in care and prevention programs. Nevertheless, there remain major challenges that prevent AIDS drugs and care from reaching many more in need, especially in rural settings. The roll-out of a high-quality treatment, care, and prevention program depends on an effective and reliable laboratory infrastructure. This article presents a strategy used by the Institute of Human Virology (IHV)-University of Maryland and its affiliate IHV-Nigeria to establish a multifaceted, integrated tier laboratory program to support a PEPFAR-funded scale-up of its AIDS Care Treatment in Nigeria program, in collaboration with the Centers for Disease Control and Prevention and the Nigerian government, as a possible model for overcoming a key challenge that faces several resource-limited countries trying to roll out and scale-up their HIV/AIDS treatment, care, and prevention program.
Language: English
Keywords:
NIGERIA | CRITIQUE | HIV INFECTIONS | CARE AND SUPPORT | TREATMENT | HIV PREVENTION | LABORATORY | EQUIPMENT AND SUPPLIES | LABORATORY EXAMINATIONS AND DIAGNOSES | TESTING | TUBERCULOSIS | INTEGRATED PROGRAMS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Examinations and Diagnoses | Measurement | Research Methodology | Infections | Programs | Organization and Administration | Training Programs | Education
Document Number: 341766

10.

Peer Reviewed

Title: Sensitivity of paediatric AIDS score vs. WHO case classification in Indian children--a retrospective study.
Author: Banerjee T; Pensi T; Banerjee D
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):91-6.
Abstract: This study was conducted at the Department of Paediatrics, Dr Ram Manohar Lohia Hospital, to test the statistical significance of existing World Health Organization (WHO) clinical case definition (CCD) for diagnosis of AIDS in areas where diagnostic resources are limited. A total of 360 cases between 18 months and 12 years of age satisfying WHO case definitions of AIDS were included in study group. Our study detected 16.66% (60) of HIV incidence in children visiting the paediatrics outpatient clinic. Twenty percent of cases manifested three major and two minor signs, which had sensitivity of 73.33%; specificity, 90.66% and positive predictive value (PPV), 61.11%. Stepwise logistic analysis identified weight loss, chronic fever >1 month and total lymphocyte count <1500 cells mm(-3) as important predictors. Eighty-six cases (23.89%) showed two major and two minor signs with sensitivity and specificity of 86.66 and 88.66%, respectively. Thus a CCD based on 13 clinical signs/symptoms was proposed for paediatric AIDS with better sensitivity and PPV than the WHO case definition but with almost similar specificity.
Language: English
Keywords:
INDIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV TESTING | AIDS | LABORATORY PROCEDURES | EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | STANDARDS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331192

11.

Peer Reviewed

Title: Evidence behind the WHO guidelines: hospital care for children: what is the evidence that BCG vaccination should not be used in HIV-infected children?
Author: Bannister C; Bennett L; Carville A; Azzopardi P
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):78-82.
Abstract: The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. The WHO guidelines, and more reviews are available at: http://www.ichrc.org. This review addresses the question: What is the evidence that BCG vaccination should not be used in HIV-infected children? The limited evidence currently available has been the basis of the WHO recommendation that BCG vaccination should not be used in HIV-positive children, as severe complications appear more commonly in HIV-infected individuals [8]. This decision is supported by the findings from the Fallo [13] and Hesseling [18, 20] studies. Although the WHO have suggested that HIV-infected infants should not be vaccinated this is obviously difficult in countries where BCG vaccination is administered before HIV status can be detected. Many high HIV-burden countries do not have viral-specific testing (such as PCR) routinely available to adequately assess the infection status of every new born infant. More research needs to be undertaken in this area to clarify the situation, and treating clinicians need to be made aware of this issue with all its complexity. The WHO recommendation highlights the need for viral-specific testing to be widely available in developing countries. This will ensure HIV-infected infants are not exposed to BCG which may be potentially dangerous and HIV-exposed but uninfected infants are not denied this important vaccine.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | WHO | STANDARDS | CHILDREN | HOSPITALS | DELIVERY OF HEALTH CARE | VACCINES | HIV INFECTIONS | Oceania | Developed Countries | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Health | Medical Procedures | Medicine | Health Services | Viral Diseases | Diseases
Document Number: 341013

12.

Title: Water safety plan manual: Step-by-step risk management for drinking-water suppliers.
Author: Bartram J; Corrales L; Davison A; Deere D; Drury D
Source: Geneva, Switzerland, World Health Organization [WHO], 2009. 101 p.
Abstract: The most effective means of consistently ensuring the safety of a drinking-water supply is through the use of a comprehensive risk assessment and risk management approach that encompasses all steps in water supply from catchment to consumer. In these Guidelines, such approaches are called water safety plans (WSPs). The aim of this Manual is to provide that practical guidance to facilitate WSP development focusing particularly on organized water supplies managed by a water utility or similar entity. (Excerpts)
Language: English
Keywords:
GLOBAL | MANUAL | CASE STUDIES | WATER SUPPLY | SAFETY | PLANNING | QUALITY CONTROL | RISK ASSESSMENT | STANDARDS | MONITORING | MANAGEMENT | PROCEDURES | Studies | Research Methodology | Natural Resources | Environment | Public Health | Health | Organization and Administration | Evaluation
Document Number: 331413

13.

Title: Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.
Author: Birx D; de Souza M; Nkengasong JN
Source: American Journal of Clinical Pathology. 2009 Jun;131(6):849-51.
Abstract: Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | HIV INFECTIONS | TUBERCULOSIS | MALARIA | LABORATORY | NEEDS | INTEGRATED PROGRAMS | HUMAN RESOURCES | LOGISTICS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Viral Diseases | Diseases | Infections | Parasitic Diseases | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Factors | Programs | Organization and Administration | Management | Training Programs | Education | Research Methodology
Document Number: 341768

14.

Peer Reviewed

Title: Antiretroviral resistance patterns and HIV-1 subtype in mother-infant pairs after the administration of combination short-course zidovudine plus single-dose nevirapine for the prevention of mother-to-child transmission of HIV.
Author: Chalermchockcharoenkit A; Culnane M; Chotpitayasunondh T; Vanprapa N; Leelawiwat W; Mock PA; Asavapiriyanont S; Teeraratkul A; McConnell MS; McNicholl JM; Tappero JW
Source: Clinical Infectious Diseases. 2009 Jul 15;49(2):299-305.
Abstract: BACKGROUND: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. METHODS: Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). RESULTS: Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, [Formula: see text] for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). CONCLUSIONS: The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | WHO | MANUAL | STANDARDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | MOTHERS | INFANT | PERSONS LIVING WITH HIV/AIDS | HIV | DRUG RESISTANCE | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | TREATMENT | LABORATORY PROCEDURES | HIV TESTING | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Research Methodology | Disease Transmission Control | Prevention and Control | Diseases | Parents | Family Relationships | Family Characteristics | Family and Household | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 342429

15.

Peer Reviewed

Title: Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger.
Author: Dale NM; Grais RF; Minetti A; Miettola J; Barengo NC
Source: Archives of Pediatrics and Adolescent Medicine. 2009 Feb;163(2):126-30.
Abstract: OBJECTIVE: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death. DESIGN: Retrospective data analysis. SETTING: A Medecins Sans Frontieres (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children. PARTICIPANTS: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included. INTERVENTIONS: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children. OUTCOME MEASURES: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program. RESULTS: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program. CONCLUSIONS: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs.
Language: English
Keywords:
NIGER | UNITED STATES OF AMERICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | CLASSIFICATION | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | EVALUATION INDEXES | CHILDREN | GROWTH | MALNUTRITION | STANDARDS | HEALTH STATUS INDEXES | WHO | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Developed Countries | North America | Americas | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Development | Biology | Nutrition Disorders | Diseases | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 330228

16.

Title: Radiology services for children in HIV- and TB-endemic regions: scope for greater collaboration between radiologists and clinicians caring for children.
Author: Dramowski A; Morsheimer MM; Frigati L; Schaaf HS; Rabie H; Sorour G; Cotton MF
Source: Pediatric Radiology. 2009 Jun;39(6):541-4.
Abstract: There is limited literature documenting the interaction between radiologists and clinicians caring for children, especially in regions where HIV and tuberculosis (TB) are endemic. The dual burden of these diseases in resource-limited settings creates unique challenges for radiographic interpretation and utilization. This review aims to heighten awareness of issues confronting radiologists and clinicians caring for children and to encourage greater collaboration between these two disciplines in HIV- and TB-endemic regions. The Child-Friendly Healthcare Initiative is discussed, emphasizing opportunities to promote child friendliness in radiology services.
Language: English
Keywords:
GLOBAL | CRITIQUE | PHYSICIANS | HIV INFECTIONS | TUBERCULOSIS | CHILD HEALTH SERVICES | EXAMINATIONS AND DIAGNOSES | INTERPERSONAL COMMUNICATION | TECHNOLOGY | PRIVACY | STANDARDS | Health Personnel | Delivery of Health Care | Health | Viral Diseases | Diseases | Infections | Maternal-Child Health Services | Primary Health Care | Health Services | Medical Procedures | Medicine | Communication | Economic Factors | Behavior | Research Methodology
Document Number: 342187

17.
Peer Reviewed

Title: Trends in infant nutrition in Saudi Arabia: compliance with WHO recommendations.
Author: El Mouzan MI; Al Omar AA; Al Salloum AA; Al Herbish AS; Qurachi MM
Source: Annals of Saudi Medicine. 2009 Jan-Feb;29(1):20-3.
Abstract: BACKGROUND AND OBJECTIVE: The WHO recommends exclusive breastfeeding in the first 6 months of life. Our objective was to evaluate trends in infant nutrition in Saudi Arabia and the degree of compliance with WHO recommendations. SUBJECTS AND METHODS: A nationwide nutritional survey of a sample of Saudi households was selected by the multistage probability sampling procedure. A validated questionnaire was administered to mothers of children less than 3 years of age. RESULTS: Of 5339 children in the sample, 4889 received breast milk at birth indicating a prevalence of initiation of 91.6%. Initiation of breastfeeding was delayed beyond 6 hours after birth in 28.1% of the infants. Bottle feeding was introduced by 1 month of age to 2174/4260 (51.4%) and to 3831/4260 (90%) by 6 months of age. The majority of infants 3870/4787 (80.8%) were introduced to "solid foods" between 4 to 6 months of age and whole milk feedings were given to 40% of children younger than 12 months of age. CONCLUSIONS: The current practice of feeding of Saudi infants is very far from compliance with even the most conservative WHO recommendations of exclusive breastfeeding for 4 to 6 months. The high prevalence of breastfeeding initiation at birth indicates the willingness of Saudi mothers to breastfeed. However, early introduction of complementary feedings reduced the period of exclusive breastfeeding. Research in infant nutrition should be a public health priority to improve the rate of breastfeeding and to minimize other inappropriate practices.
Language: English
Keywords:
SAUDI ARABIA | RESEARCH REPORT | NUTRITION SURVEYS | INFANT | HOUSEHOLDS | INFANT NUTRITION | WHO | STANDARDS | BREASTFEEDING, EXCLUSIVE | PREVALENCE | TIME FACTORS | SUPPLEMENTARY FEEDING | AGE FACTORS | BREASTFEEDING | Middle East | Developing Countries | Nutrition | Health | Youth | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | UN | International Agencies | Organizations | Political Factors | Research Methodology | Measurement | Population Dynamics
Document Number: 331138

18.

19.

Peer Reviewed

Title: Rates of serious infection after changes in regimens for medical abortion.
Author: Fjerstad M; Trussell J; Sivin I; Lichtenberg ES; Cullins V
Source: New England Journal of Medicine. 2009 Jul 9;361(2):145-51.
Abstract: BACKGROUND: From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concern about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration from vaginal to buccal and required either routine provision of antibiotics or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine treatment with antibiotics for all medical abortions. METHODS: We performed a retrospective analysis assessing the rates of serious infection after medical abortion during a time when misoprostol was administered vaginally (through March 2006), as compared with rates after a change to buccal administration of misoprostol and after initiation of additional infection-reduction measures. RESULTS: Rates of serious infection dropped significantly after the joint change to buccal misoprostol from vaginal misoprostol and to either testing for sexually transmitted infection or routine provision of antibiotics as part of the medical abortion regimen. The rate declined 73%, from 0.93 per 1000 abortions to 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidence interval [CI], 0.44 to 0.94; P<0.001). The subsequent change to routine provision of antibiotics led to a further significant reduction in the rate of serious infection - a 76% decline, from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction, 0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03). CONCLUSIONS: The rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with routine administration of antibiotics.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | STATISTICAL STUDIES | ABORTION | RU-486 | MISOPROSTOL | ADMINISTRATION AND DOSAGE | STANDARDS | INFECTION PREVENTION | ANTIBIOTICS | MONITORING | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Evaluation
Document Number: 342147 Notification

20.
Peer Reviewed

Title: Operational effectiveness of guidelines on complete breast-feeding cessation to reduce mother-to-child transmission of HIV: results from a prospective observational cohort study at routine prevention of mother-to-child transmission sites, South Africa.
Author: Goga AE; Van Wyk B; Doherty T; Colvin M; Jackson DJ; Chopra M
Author: Good Start Study Group
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Apr 15;50(5):521-8.
Abstract: OBJECTIVE: Until 2006, HIV-positive women who chose to exclusively breast-feed were advised to completely stop breast-feeding by 6 months. We investigated operational feasibility and predictors of complete breast-feeding cessation (CBC). DESIGN: A prospective observational cohort study at 3 routine prevention of mother-to-child transmission sites, South Africa. METHODS: Data on "complete breast-feeding cessation at 24 weeks" and "not breast-feeding (NBF) for 4 days before the last follow-up visit at or before 24 weeks" were gathered during home visits (3, 5, 7, 9, 12, 16, 20, and 24 weeks). The main subgroup of interest for this analysis was women practicing exclusive breast-feeding/predominant breast-feeding at 3 weeks. Univariate analysis, logistic regression, Kaplan-Meier Survival analysis, and Cox regression were performed. RESULTS: Eighty-eight women (43.6%) reported CBC. "Health staff suggesting formula use: [OR(a) 4.39 (1.76-10.97)] and "infant hospitalization" [OR(a) 3.27 (1.37-7.79)] were the only significant predictors of CBC. The probability of NBF at 5, 7, 9, 12, 16, 20, and 24 weeks was 2.8% [95% confidence interval (CI) 1.8% to 3.8%], 4.3% (3.0% to 5.6%), 5.9% (4.4% to 7.4%, 9.8% (7.9% to 11.7%), 16.1 (13.8% to 18.4%), 23.1% (20.5% to 25.7%), and 37.6% (34.6% to 40.6%), respectively. Infant HIV status [hazard ratio 5.5 95% CI 2.4 to 12.5] was the only predictor of infant death. NBF was not protective against 9-month infant HIV or death in univariate and multivariable analysis. CONCLUSIONS: At programmatic level, CBC by 24 weeks is uncommon, and success seems unrelated to predetermined social, economic, and environmental (acceptable, feasible, affordable, sustainable, and safe AFASS) criteria. Thus at this level, activities that encourage CBC (amongst women meeting AFASS criteria) need to be identified and tested.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | STANDARDS | MOTHERS | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | MOTHER-TO-CHILD TRANSMISSION | WEANING | HIV PREVENTION | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Disease Transmission Control | Prevention and Control | Diseases | Transmission | Infections | HIV Infections | Viral Diseases | Program Evaluation | Programs | Organization and Administration
Document Number: 341054

21.

Peer Reviewed

Title: Scheduled and unscheduled bleeding patterns with two combined hormonal contraceptives: application of new recommendations for standardization.
Author: Hampton RM; Fisher AC; Pagano S; LaGuardia KD
Source: Fertility and Sterility. 2009 Aug;92(2):434-40.
Abstract: OBJECTIVE: To reassess and compare cycle control attained with two combined hormonal contraceptives, norgestimate (NGM)/ethinyl estradiol (EE) 25 microg and norethindrone acetate (NETA)/EE 20 microg, by new general criteria recommendations for all combined hormonal contraceptives. DESIGN: Analysis of bleeding data for cycles 1-6 from a randomized, multicenter trial. SETTING: 221 North American centers. PATIENT(S): Healthy, sexually active women (18-45 years old). INTERVENTION(S): NETA/EE: 1 mg NETA/20 microg EE, days 1-21 of each cycle and 75 mg of ferrous fumarate, days 22-28; NGM/EE: triphasic NGM in 7-day increments (days 1-7: 180 microg; days 8-14: 215 microg; days 15-21: 250 microg) and 25 microg EE, placebo on days 22-28. MAIN OUTCOME MEASURE(S): Cycle control evaluated from patients' daily diaries. RESULT(S): For cycles 1-6, there was a statistically significant lower incidence of unscheduled bleeding/spotting with NGM/EE 25 microg (range 21.0%-34.4%) than with NETA/EE 20 microg (range 33.0%-46.6%). Of the women who had unscheduled bleeding/spotting, the mean number of days per cycle of bleeding/spotting was comparable. A statistically significant higher incidence of scheduled bleeding was seen with NGM/EE 25 microg (95.2%-97.5%) than with NETA/EE 20 microg (78.5%-84.2%). CONCLUSION(S): The NGM/EE 25 microg has a lower incidence and comparable length of unscheduled bleeding and a higher incidence of scheduled bleeding than NETA/EE 20 microg in this post hoc analysis.
Language: English
Keywords:
NORTH AMERICA | RESEARCH REPORT | CLINICAL TRIALS | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | NORETHINDRONE ACETATE | BLEEDING | STANDARDS | EVALUATION | RECOMMENDATIONS | Developed Countries | Americas | Clinical Research | Research Methodology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Norethindrone | Contraceptive Agents, Progestin | Signs and Symptoms | Diseases
Document Number: 342585

22.

Title: Total lymphocyte count and World Health Organization pediatric clinical stage as markers to assess need to initiate antiretroviral therapy among human immunodeficiency virus-infected children in Moshi, Northern Tanzania.
Author: Johnson OO; Benjamin DK; Benjamin DK Jr; Schimana W; Gayani Tillekeratne L; Crump JA; Landman KZ; Kinabo GD; Mmbaga B; Msuya LJ; Shao JF; Swai ME; Cunningham CK
Source: Pediatric Infectious Disease Journal. 2009 Jun;28(6):493-7.
Abstract: BACKGROUND: The World Health Organization (WHO) has recommended the use of clinical staging alone and with total lymphocyte count to identify HIV infected children in need of antiretroviral therapy (ART) in resource-limited settings, when CD4 cell count is not available.METHODS: We prospectively enrolled children obtaining care for HIV infection at the Kilimanjaro Christian Medical Centre Pediatric Infectious Diseases Clinic in Moshi, Tanzania between March 2004 and May 2006 for this cohort study.RESULTS: One hundred ninety two (89.7%) of 214 children met WHO ART initiation criteria based on clinical staging or CD4 cell count. Several low-cost measures identified individuals who met WHO ART initiation criteria to the following degree: WHO stages 3 or 4 had 87.5% (95% CI, 82.8-92.1) sensitivity and, by definition, 100% (CI, 100-100) specificity; WHO recommended advance disease TLC cutoffs: sensitivity = 23.9% (95% CI, 17.3-30.5) specificity = 78.2% (95% CI, 67.3-89.1). Low TLC was a common finding, (50 of 214; 23%); however, it did not improve the sensitivity or specificity of clinical staging in identifying the severely immunosuppressed stage 2 children. Growth failure or use of total lymphocyte counts in isolation were not reliable indicators of severe immunosuppression or need to initiate ART.CONCLUSION: The use of total lymphocyte count does not improve the ability to identify children in need of ART compared with clinical staging alone. Low absolute lymphocyte count did not correlate with severe immunosuppression based on CD4 cell count in this cohort.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | CHILDREN | ANTIRETROVIRAL THERAPY | NEEDS | IMMUNOLOGIC FACTORS | WHO | STANDARDS | IMMUNOLOGICAL EFFECTS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Economic Factors | Immunity | Immune System | Physiology | Biology | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 342640

23.

Title: The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda.
Author: Kiggundu V; Watya S; Kigozi G; Serwadda D; Nalugoda F; Buwembo D; Settuba A; Anyokorit M; Nkale J; Kighoma N; Ssempijja V; Wawer M; Gray RH
Source: BJU International. 2009 Aug;104(4):529-32.
Abstract: OBJECTIVE: To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention. PATIENTS AND METHODS: In a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15-20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician. RESULTS: The median age of the patients was 24 years. The number of procedures per surgeon was 20-981. The mean time required to complete surgery was approximately 40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20-99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management. CONCLUSION: The completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL TRIALS | PHYSICIANS | HIV PREVENTION | MALE CIRCUMCISION | COMPLICATIONS | TRAINING PROGRAMS | SUPERVISION | ANESTHESIA | STANDARDS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Education | Management | Organization and Administration | Treatment | Population Dynamics | Demographic Factors | Population
Document Number: 342642

24.
Title: [The need for high-quality training and surgical standards for adult male circumcision in China]
Author: Li PS; Lu NQ; Cheng Y; Peng YF; Tian L; Liu YD; Ben KL; Xu JC; Lee R; Kim H; Sokal DC
Source: Zhonghua Nan Ke Xue. 2009 May;15(5):390-4.
Abstract: Although HIV is a significant problem in Africa, HIV infection rates are rising rapidly in other regions such as Asia and South America. International health organizations have recognized the need to develop effective strategies to check the worldwide transmission of HIV. Studies have demonstrated the significant reduction of HIV, HPV, HSV-2 and other STD infection rates with male circumcision (MC). Although numerous MC techniques are available, there are no standardized protocols and surgical training programs. Studies have shown that the standardization of MC techniques coupled with training programs can significantly reduce complication rates. High complication rates have been a primary obstacle to the implementation of MC services. We recommend the establishment of surgical standards and training protocols prior to the promotion of MC services in China.
Language: Chinese
Keywords:
CHINA | RESEARCH REPORT | PREVALENCE | CLIENTS | MEN | MALE CIRCUMCISION | HIV INFECTIONS | TRAINING PROGRAMS | QUALITY OF HEALTH CARE | STANDARDS | HEALTH SERVICES | SURGERY | Asia, Eastern | Asia | Developing Countries | Measurement | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Medical Procedures | Medicine | Delivery of Health Care | Health | Viral Diseases | Diseases | Education | Health Services Evaluation | Program Evaluation | Treatment
Document Number: 342636

25.
Title: Two vs. three sputum samples for microscopic detection of tuberculosis in a high HIV prevalence population.
Author: Noeske J; Dopico E; Torrea G; Wang H; Van Deun A
Source: International Journal of Tuberculosis and Lung Disease. 2009 Jul;13(7):842-7.
Abstract: SETTING: A busy urban hospital in Cameroon. OBJECTIVES: To compare the yield in bacteriologically proven tuberculosis (TB) cases examining two morning vs. three spot-morning-spot sputum specimens (MM vs. SMS) by direct microscopy for acid-fast bacilli (AFB). DESIGN: Repeated temporal cross-over between MM and SMS sampling for successive TB suspects, using culture as gold standard. RESULTS: A total of 799 suspects were screened using the MM strategy, identifying 223 smear-positives, and 808 suspects with the SMS strategy, yielding 236 smear-positives. Of the MM, 256 were culture-positive, of whom 195 (76%) were smear-positive. For SMS, these figures were respectively 281 and 206 (73%), a non-significant difference. The MM and SMS strategies also detected respectively 28 and 30 smear-positive cases not confirmed by culture. No cases were lost to treatment with either strategy. CONCLUSIONS: In this population with a high prevalence of human immunodeficiency virus (HIV) with late case presentation, smear microscopy of two morning specimens detected at least as many positive cases as the classical strategy, and no cases were lost before treatment. Two specimens for initial TB suspect screening can thus be recommended, also without excessive workload. Comparative studies in populations presenting with paucibacillary sputum are needed to determine the equivalent quality and yield of an alternative strategy with two spot specimens at consultation.
Language: English
Keywords:
CAMEROON | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | TUBERCULOSIS | LABORATORY EXAMINATIONS AND DIAGNOSES | HIV INFECTIONS | PREVALENCE | SCREENING | WHO | STANDARDS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Measurement | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 342823

26.

Title: Mexico City Policy and assistance for voluntary population planning [memorandum]
Author: Obama BH
Source: Washington, D.C., White House, 2009 Jan 23. [2] p.
Abstract: Memorandum for the Secretary of State and the administrator of the United States Agency for International Development with appended statement of President Barack Obama on rescinding the Mexico City policy, including the following: "It is clear that the provisions of the Mexico City Policy are unnecessarily broad and unwarranted under current law, and for the past eight years, they have undermined efforts to promote safe and effective voluntary family planning in developing countries. For these reasons, it is right for us to rescind this policy and restore critical efforts to protect and empower women and promote global economic development.", The White House, Office of the Press Secretary (23 Jan 2009). White House press statement appended 31 Mar 2009. (Excerpts)
Language: English
Keywords:
UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | GOVERNMENT PUBLICATION | NONGOVERNMENTAL ORGANIZATIONS | GOVERNMENT AGENCIES | GOVERNMENT OFFICIALS | ABORTION LAW | FAMILY PLANNING POLICY | FOREIGN AID | USAID | GRANTS | STANDARDS | POPULATION POLICY | Developed Countries | North America | Americas | Organizations | Political Factors | Sociocultural Factors | Administrative Personnel | Organization and Administration | Fertility Control, Postconception | Family Planning | Social Policy | Policy | Financial Activities | Economic Factors | Research Methodology
Document Number: 331358 Notification

27.
Peer Reviewed

Title: Pilot testing of WHO child growth standards in Chandigarh: implications for India's child health programmes.
Author: Prinja S; Thakur JS; Bhatia SS
Source: Bulletin of the World Health Organization. 2009 Feb;87(2):116-22.
Abstract: OBJECTIVE: To compare the prevalence of underweight as calculated from Indian Academy of Paediatrics (IAP) growth curves (based on the Harvard scale) and the new WHO Child Growth Standards. METHODS: We randomly selected 806 children under 6 years of age from 45 primary anganwadi (childcare) centres in Chandigarh, Punjab, India, that were chosen through multistage stratified random sampling. Children were weighed, and their weight for age was calculated using IAP curves and WHO growth references. Nutritional status according to the WHO Child Growth Standards was analysed using WHO Anthro statistical software (beta version, 17 February 2006). The chi2 test was used to determine statistical significance at the 0.05 significance level. FINDINGS: The prevalence of underweight (Z score less than -2) in the first 6 months of life was nearly 1.6 times higher when calculated in accordance with the new WHO standards rather than IAP growth curves. For all ages combined, the estimated prevalence of underweight was 1.4 times higher when IAP standards instead of the new WHO standards were used. Similarly, the prevalence of underweight in both sexes combined was 14.5% higher when IAP standards rather than the new WHO growth standards were applied (P < 0.001). By contrast, severe malnutrition estimated for both sexes were 3.8 times higher when the new WHO standards were used in place of IAP standards (P < 0.001). CONCLUSION: The new WHO growth standards will project a lower prevalence of overall underweight children and provide superior growth tracking than IAP standards, especially in the first 6 months of life and among severely malnourished children.
Language: English
Keywords:
INDIA | RESEARCH REPORT | PILOT PROJECTS | SAMPLING STUDIES | CHILDREN | CHILD DEVELOPMENT | GROWTH | WHO | STANDARDS | BODY WEIGHT | CHILD HEALTH SERVICES | MALNUTRITION | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Biology | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Physiology | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Nutrition Disorders | Diseases
Document Number: 341788

28.

Peer Reviewed

Title: Maternal and child health in the occupied Palestinian territory.
Author: Rahim HF; Wick L; Halileh S; Hassan-Bitar S; Chekir H; Watt G; Khawaja M
Source: Lancet. 2009 Mar 14;373(9667):967-77.
Abstract: The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (age Language: English
Keywords:
MIDDLE EAST | RESEARCH REPORT | INTERVENTIONS | MATERNAL HEALTH | CHILD HEALTH | MATERNAL-CHILD HEALTH SERVICES | QUALITY OF HEALTH CARE | DELIVERY OF HEALTH CARE | QUALITY OF LIFE | STANDARDS | PROGRAM ACCESSIBILITY | Programs | Organization and Administration | Health | Primary Health Care | Health Services | Health Services Evaluation | Program Evaluation | Social Welfare | Economic Factors | Research Methodology
Document Number: 330802

29.

Peer Reviewed

Title: A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin.
Author: Rowe AK; Onikpo F; Lama M; Osterholt DM; Rowe SY; Deming MS
Source: American Journal of Public Health. 2009 May;99(5):837-46.
Abstract: OBJECTIVES: We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality. METHODS: We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence. RESULTS: We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P < .05), and both groups outperformed untrained workers. CONCLUSIONS: IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements.
Language: English
Keywords:
BENIN | RESEARCH REPORT | STANDARDS | HEALTH PERSONNEL | PERFORMANCE IMPROVEMENT | HEALTH SERVICES | QUALITY OF HEALTH CARE | CHILD MORTALITY | PREVENTION AND CONTROL | MANAGEMENT | TRAINING PROGRAMS | PROGRAM EVALUATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Delivery of Health Care | Health | Organization and Administration | Health Services Evaluation | Programs | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Education
Document Number: 341000

30.

Peer Reviewed

Title: Use of active management of the third stage of labour in seven developing countries.
Author: Stanton C; Armbruster D; Knight R; Ariawan I; Gbangbade S
Source: Bulletin of the World Health Organization. 2009 Feb 13;87:207-215.
Abstract: Objective: To document the use of active management of the third stage of labour for preventing postpartum haemorrhage and to explore factors associated with such use in seven developing countries. Methods: Nationally representative samples of facility-based deliveries were selected and observed to determine the use of active management of the third stage of labour and associated factors. Policies on active management were assessed through document review and interviews with relevant professionals. Findings: Use of a uterotonic during the third or fourth stages of labour was nearly universal. Correct use of active management of the third stage of labour was found in only 0.5% to 32% of observed deliveries due to multiple deficiencies in practice. In every country except Indonesia, policies regarding active management were conflicting. Conclusion: Developing countries have not targeted decreasing postpartum haemorrhage as an achievable goal; there is little use of active management of the third stage of labour, and policies regarding such management often conflict. Studies are needed to identify the most effective components of active management so that the most efficient package of practices can be promoted.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | SAMPLING STUDIES | CHILDBIRTH | PREGNANCY COMPLICATIONS | POSTPARTUM | BLEEDING | DRUGS | ADMINISTRATION AND DOSAGE | OXYTOCIN | OBSTETRICS | TRAINING ACTIVITIES | STANDARDS | Studies | Research Methodology | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Puerperium | Signs and Symptoms | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pituitary Hormones | Hormones | Endocrine System | Physiology | Biology | Training Programs | Education
Document Number: 340209


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