1.  Title: Child and Adolescent Health and Development progress report 2008. Highlights. Author: World Health Organization [WHO]. Department of Child and Adolescent Health and Development Source: Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2009. 32 p. Abstract: This report presents highlights of work done in 2008 by the World Health Organization’s Department of Child and Adolescent Health and Development. It provides an overview of key achievements in newborn, child, and adolescent health and development at the headquarters, regional, and country levels. It also includes a statistical annex covering key indicators for child health in a selection of countries with high under-five mortality rates, as well as adolescent health profiles for five countries. Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | ADOLESCENTS | CHILD | CHILD HEALTH | ADOLESCENT HEALTH | CHILD SURVIVAL | ANTENATAL CARE | BREASTFEEDING | PNEUMONIA | MALNUTRITION | MORBIDITY | STANDARDS | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Survivorship | Length of Life | Mortality | Population Dynamics | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Infant Nutrition | Nutrition | Pulmonary Effects | Physiology | Biology | Nutrition Disorders | Diseases | Research Methodology Document Number: 342030 |
2.  Peer Reviewed Title: Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria. Author: Agaba PA; Sule HM; Ojoh RO; Hassan Z; Apena L; Mu'azu MA; Badung B; Agbaji OO; Idoko JA; Kanki P Source: International Journal of STD and AIDS. 2009 Jun;20(6):410-3. Abstract: AIDS-related Kaposi's sarcoma (AIDS-KS) remains a significant cause of morbidity and mortality. We describe the pattern of presentation and survival in Jos, Nigeria. We identified 48 HIV-positive patients with AIDS-KS and matched them for age and sex with an equal number of HIV-positive patients without AIDS-KS. We compared their clinical, immunological, virological characteristics and survival. They were similar in age and body mass index profile but patients with AIDS-KS had more tuberculosis co-infection (P, 0.02), lower median CD4 count (P, 0.003) and higher mortality (P, 0.002). Surprisingly, patients with AIDS-KS had lower levels of median viral load (29,347 copies/mL) compared with controls (80,533 copies/mL). We recommend specific AIDS-KS therapy in addition to highly active antiretroviral therapy in order to improve survival. Language: English Keywords: NIGERIA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | AIDS | SIGNS AND SYMPTOMS | ANTIRETROVIRAL THERAPY | LIFE EXPECTANCY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | HIV | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 342440 |
| 3. Peer Reviewed Title: Expanding antiretroviral options in resource-limited settings--a cost-effectiveness analysis. Author: Bendavid E; Wood R; Katzenstein DA; Bayoumi AM; Owens DK Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):106-13. Abstract: BACKGROUND: Current World Health Organization (WHO) guidelines for treatment of HIV in resource-limited settings call for 2 antiretroviral regimens. The effectiveness and cost-effectiveness of increasing the number of antiretroviral regimens is unknown. METHODS: Using a simulation model, we compared the survival and costs of current WHO regimens with two 3-regimen strategies: an initial regimen of 3 nucleoside reverse transcriptase inhibitors followed by the WHO regimens and the WHO regimens followed by a regimen with a second-generation boosted protease inhibitor (2bPI). We evaluated monitoring with CD4 counts only and with both CD4 counts and viral load. We used cost and effectiveness data from Cape Town and tested all assumptions in sensitivity analyses. RESULTS: Over the lifetime of the cohort, 25.6% of individuals failed both WHO regimens by virologic criteria. However, when patients were monitored using CD4 counts alone, only 6.5% were prescribed additional highly active antiretroviral therapy due to missed and delayed detection of failure. The life expectancy gain for individuals who took a 2bPI was 6.7-8.9 months, depending on the monitoring strategy. When CD4 alone was available, adding a regimen with a 2bPI was associated with an incremental cost-effectiveness ratio of $2581 per year of life gained, and when viral load was available, the ratio was $6519 per year of life gained. Strategies with triple-nucleoside reverse transcriptase inhibitor regimens in initial therapy were dominated. Results were sensitive to the price of 2bPIs. CONCLUSIONS: About 1 in 4 individuals who start highly active antiretroviral therapy in sub-Saharan Africa will fail currently recommended regimens. At current prices, adding a regimen with a 2bPI is cost effective for South Africa and other middle-income countries by WHO standards. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | THEORETICAL MODELS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | COST EFFECTIVENESS | MONITORING | WHO | IMMUNOLOGICAL EFFECTS | LIFE EXPECTANCY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Evaluation Indexes | Quantitative Evaluation | Evaluation | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Immunity | Immune System | Physiology | Biology | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 342908 |
| 4. Title: Mainstreaming early and exclusive breastfeeding for improving child survival. Author: Dadhich JP; Agarwal RK Source: Indian Pediatrics. 2009 Jan;46(1):11-7. Abstract: India is home to maximum number of under-five deaths and underweight children in the world. In 2006, for the first time, the number of children in the world dying before their fifth birthday fell below 10 million, to 9.7 million annually. South Asia's contribution to this figure was 3.1 million out of which 2.1 million deaths occurred in India i.e., 21 percent of the global burden of under five deaths. Most of these deaths occur during the neonatal period. A reduction in the number of deaths among the under-five children reflects the country's progress on the fourth Millennium Development Goal (MDG 4). About 55 million, or one-third of the world's underweight children under the age of five years, live in India. Malnutrition has been estimated to be an underlying cause of up to 50-60 percent of under five deaths. The number of young underweight children reflects the country's progress on the first Millennium Development Goal (MDG 1), which deals with eradication of extreme poverty and hunger. In India, the average annual rate of decline in malnutrition has been around 0.9% since 1990. Considerably accelerated progress is needed for India to meet its MDG target of halving the percentage of underweight children by 2015. Despite breastfeeding's numerous recognized advantages, early and exclusive breastfeeding rates in most states of the India are low. There are many gaps in policy and programs related to infant and young child feeding in India. The big challenge is how to mainstream IYCF counseling and support interventions to help women to succeed both in early and exclusive breastfeeding. The rationale for supporting a major program to protect, promote and support breastfeeding action, backed by a budgetary support, is compelling for our country. Child health and development policies should urgently address this major concern. Language: English Keywords: INDIA | RECOMMENDATIONS | HEALTH SURVEYS | MOTHERS | INFANT | BREASTFEEDING, EXCLUSIVE | CHILD SURVIVAL | MALNUTRITION | BODY WEIGHT | TIME FACTORS | POSTPARTUM PROGRAMS | LONGTERM EFFECTS | INTELLIGENCE | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | Asia, Southern | Asia | Developing Countries | Health | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Breastfeeding | Infant Nutrition | Nutrition | Survivorship | Length of Life | Mortality | Population Dynamics | Nutrition Disorders | Diseases | Physiology | Biology | Family Planning Programs | Family Planning | Personality | Psychological Factors | Behavior | HIV Infections | Viral Diseases | Disease Transmission Control | Prevention and Control Document Number: 331250 |
| 5. Peer Reviewed Title: Validation of community health workers' assessment of neonatal illness in rural Bangladesh. Author: Darmstadt GL; Baqui AH; Choi Y; Bari S; Rahman SM; Mannan I; Ahmed AS; Saha SK; Rahman R; Chang S; Winch PJ; Black RE; Santosham M; El Arifeen S Author: Bangladesh Projahnmo-2 (Mirzapur) Study Group Source: Bulletin of the World Health Organization. 2009 Jan;87(1):12-9. Abstract: OBJECTIVE: To estimate the validity (sensitivity, specificity, and positive and negative predictive values) of a clinical algorithm as used by community health workers (CHWs) to detect and classify neonatal illness during routine household visits in rural Bangladesh. METHODS: CHWs evaluated breastfeeding and symptoms and signs of illness in 395 neonates selected randomly from neonatal illness surveillance during household visits on postnatal days 0, 2, 5 and 8. Neonates classified with very severe disease (VSD) were referred to a community-based hospital. Within 12 hours of CHW assessments, physicians independently evaluated all neonates seen in a given day by one CHW, randomly chosen from among 36 project CHWs. Physicians recorded symptoms and signs of illness, classified the illness, and determined whether the newborn needed referral-level care at the hospital. Physicians' identification and classification were used as the gold standard in determining the validity of CHWs' identification of symptoms and signs of illness and its classification. FINDINGS: CHWs' classification of VSD showed a sensitivity of 73%, a specificity of 98%, a positive predictive value of 57% and a negative predictive value of 99%. A maternal report of any feeding problem as ascertained by physician questioning was significantly associated (P < 0.001) with 'not sucking at all' and 'not attached at all' or 'not well attached' as determined clinically by CHWs during feeding assessment. CONCLUSION: CHWs identified with high validity the neonates with severe illness needing referral-level care. Home-based illness recognition and management, including referral of neonates with severe illness by CHWs, is a promising strategy for improving neonatal health and survival in low-resource developing country settings. Language: English Keywords: BANGLADESH | RESEARCH REPORT | VALIDITY | RURAL POPULATION | HEALTH PERSONNEL | NEONATAL DISEASES AND ABNORMALITIES | HOME CARE | PERFORMANCE IMPROVEMENT | CHILD SURVIVAL | CHILD HEALTH | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Diseases | Care and Support | Health Services | Management | Organization and Administration | Survivorship | Length of Life | Mortality | Population Dynamics | Medical Procedures | Medicine Document Number: 341189 |
| 6. Peer Reviewed Title: The 1991-2004 evolution in life expectancy by educational level in Belgium based on linked census and population register data. L'evolution de l'esperance de vie par niveau d'instruction en Belgique de 1991 a 2004 sur la base de donnees de recensement liees au registre de la population. Author: Deboosere P; Gadeyne S; Oyen HV Source: European Journal of Population. 2008 May;25(2):175-196. Abstract: The aim of this study is to determine trends in life expectancy by educational level in Belgium and to present elements of interpretation for the observed evolution. The analysis is based on census data providing information on educational level linked to register data on mortality for the periods 1991-1994 and 2001-2004. Using exhaustive individual linked data allows to avoid selection bias and numerator-denominator bias. The trends reveal a general increase in life expectancy together with a widening social gap. Summary indices of inequality based on life expectancies show, however, a more complex pattern and point to the importance to include the shifts in population composition by educational level in an overall assessment of the evolution of inequality by educational level. Language: English Keywords: BELGIUM | RESEARCH REPORT | DATA LINKAGE | LIFE EXPECTANCY | EDUCATIONAL STATUS | HEALTH | INEQUALITIES | MORTALITY | DEATH RECORDS | CENSUS | Europe, Western | Europe | Developed Countries | Data Collection | Research Methodology | Length of Life | Population Dynamics | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Vital Statistics | Population Statistics Document Number: 340174 |
| 8. Peer Reviewed Title: Assessment of insecticide-treated bednet use among children and pregnant women across 15 countries using standardized national surveys. Author: Eisele TP; Keating J; Littrell M; Larsen D; Macintyre K Source: American Journal of Tropical Medicine and Hygiene. 2009 Feb;80(2):209-14. Abstract: Impact of insecticide-treated bednets (ITNs) on preventing malaria may be minimized if they are not used by vulnerable populations. Among ITN-owning households from 15 standardized national surveys from 2003 to 2006, we identify factors associated with ITN use among children younger than 5 years of age and make comparisons of ITN use among children and pregnant women across countries. Within ITN-owning households, many children and pregnant women are still not using them. Between-country analysis with linear regression showed child ITN use increases as intra-household access to ITNs increases (P = 0.020, R2 = 0.404), after controlling for season and survey year. Results from within-country logistic regression analyses were consistent with between-country analysis showing intra-household access to ITNs is the strongest and most consistent determinant of use among children. The gaps in ITN use and possession will likely persist in the absence of achieving a ratio of no more than two people per ITN. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | KAP SURVEYS | CROSS-CULTURAL COMPARISONS | STATISTICAL REGRESSION | CHILDREN | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PESTICIDES | BED NETS | MALARIA PREVENTION | CHILD SURVIVAL | Surveys | Sampling Studies | Studies | Research Methodology | Comparative Studies | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Ingredients and Chemicals | Parasite Control | Public Health | Health | Malaria | Parasitic Diseases | Diseases | Survivorship | Length of Life | Mortality | Population Dynamics Document Number: 330299 |
| 9. Title: Reaching every district - development and testing of a health micro-planning strategy for reaching difficult to reach populations in Mongolia. Author: Enkhtuya B; Badamusuren T; Dondog N; Khandsuren L; Elbegtuya N; Jargal G; Surenchimeg V; Grundy J Source: Rural and Remote Health. 2009 Apr-Jun;9(2):1045. Abstract: CONTEXT: Since the 1990s, Mongolia has undergone a rapid social and economic transition with migration to the urban areas of the national capital Ulaanbaatar. The main reasons for the migration are social sector decline in rural areas and the potential for employment opportunities in urban areas. There are also new internal patterns of migration in rural and remote areas relating to recent developments in the economic sector. Despite recent innovations in health system management in Mongolia, in some urban and rural and remote locations health services are not sufficiently accessed by the most socially and economically disadvantaged populations. These concerns provided the motivation for the Ministry of Health of Mongolia and development partners to attempt to access the most difficult to reach populations through the development of a micro-planning process referred to as the 'Reaching Every District strategy' (RED). This article describes and analyses RED micro-planning processes and content, and highlights the lessons learned. The main source of data for this planning system development was in the development and testing of the micro-planning process in Byanzurkh District, Ulaanbaatar in June 2008. INTERVENTION: The principal intervention developed and trialed was a health micro-planning strategy for improved access to immunization and maternal and child health services for difficult to reach populations. The planning methodology was a problem-solving approach progressing from health mapping to barrier analysis, to activity planning and costing and finally to monitoring and evaluation. LESSONS LEARNED: Main success factors in the development of the planning methodology were the use of barrier analysis and mapping approaches for data analysis and problem solving at the local level, and re-orientation of management approaches from 'inspection' to supportive supervision. Additionally, although the RED strategy is intended to be an immunization-specific intervention internationally, evidence from the development and trial of the process in Mongolia indicates its potential for wider health systems applications. This is particularly so for detecting and responding to the maternal and child health service needs of the more difficult to reach sub-populations. Language: English Keywords: MONGOLIA | RESEARCH REPORT | CHILDREN | CHILD SURVIVAL | CHILD HEALTH | IMMUNIZATION | HEALTH SERVICES | PLANNING | MONITORING | Developing Countries | Asia, Northern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Survivorship | Length of Life | Mortality | Population Dynamics | Health | Primary Health Care | Delivery of Health Care | Organization and Administration | Evaluation Document Number: 341537 |
| 10. Title: Early motherhood, high mortality, and HIV/AIDS rates in Sub-Saharan Africa. Author: Gant L; Heath KM; Ejikeme GG Source: Social Work In Public Health. 2009 Jan-Apr;24(1-2):39-46. Abstract: Despite billions of dollars devoted to HIV/AIDS prevention since 1990, rates of infection continue to climb worldwide, primarily through heterosexual contact, and Sub-Saharan Africa is the worst case scenario (UNAIDS, 2004). Traditional intervention programs based on the ABCs (abstinence, being faithful, and condom use) of safe sex practices have shown mixed success. Engaging in risky sexual behavior (behaviors not adhering to the ABCs of safe sex practices) continues to escalate the HIV/AIDS epidemic. Although research abounds with correlates to HIV/AIDS rates, few studies have addressed the basis of sexual behavior. Here we show that not only are HIV/AIDS rates significantly higher in Sub-Saharan Africa than in the rest of the world but also infant mortality rates and teenage birth rates are higher as well. Based on these findings, we argue that engaging in risky sexual behavior, in many circumstances associated with deplorable living conditions and high mortality, is the only viable option for avoiding reproductive failure: dying without leaving surviving descendents. We suggest that initiatives that improve overall health and living conditions in the at-risk populations are necessary before traditional intervention programs can effectively combat the spread of HIV/AIDS in Sub-Saharan Africa. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | STATISTICAL STUDIES | HIV INFECTIONS | AIDS | PREVALENCE | MORTALITY | LIFE EXPECTANCY | INFANT MORTALITY | AGE SPECIFIC FERTILITY RATE | ADOLESCENT PREGNANCY | SEX BEHAVIOR | Africa | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Population Dynamics | Demographic Factors | Population | Length of Life | Fertility Rate | Birth Rate | Fertility Measurements | Fertility | Reproductive Behavior | Behavior Document Number: 341955 |
| 11. Peer Reviewed Title: Sexual behavior change in countries with generalised HIV epidemics? Evidence from population-based cohort studies in sub-Saharan Africa. Author: Gregson S; Todd J; Zaba B Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i1-i2. Abstract: This introductory article describes the contents of the current issue which presents 10 recent analyses of sexual behaviour data from longitudinal studies in five countries-Uganda, Tanzania, Malawi, Zimbabwe and South Africa- experiencing different sizes and stages of the HIV epidemic. The results provide valuable information for use in evaluating trends in HIV epidemics and the impact of HIV prevention programmes. An underlying purpose of this is to highlight appropriate methods and to encourage better analysis and presentation of sexual behaviour data, especially as they relate to HIV and HIV prevention. Language: English Keywords: AFRICA, SUB SAHARAN | LITERATURE REVIEW | KAP SURVEYS | COHORT ANALYSIS | DEMOGRAPHIC AND HEALTH SURVEYS | LONGITUDINAL STUDIES | TARGET POPULATION | HIV TRANSMISSION | EPIDEMICS | SEX BEHAVIOR | RISK BEHAVIOR | SURVIVORSHIP | RISK FACTORS | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Program Design | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Behavior | Length of Life | Mortality | Health Document Number: 340100 |
| 12. Title: Evaluating the President's Emergency Plan for AIDS Relief: time to scale it up [editorial] Author: Gross R; Bisson G Source: Annals of Internal Medicine. 2009 May 19;150(10):727-8. Abstract: This editorial examines the President's Emergency Plan for AIDS Relief (PEPFAR) and measures the effects of the program by comparing trends in AIDS-related death rates and HIV prevalence rates. It also discusses PEPFAR's achievement of some of its goals but will have to meet a higher standard and document impact by gathering credible evidence in the future and note which aspects of the program are working and which are not. Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | SUMMARY REPORT | EVALUATION | AIDS PREVENTION | HIV PREVENTION | LIFE EXPECTANCY | GOVERNMENT PROGRAMS | PROGRAM EVALUATION | PROGRAM EFFECTIVENESS | Developed Countries | North America | Americas | AIDS | HIV Infections | Viral Diseases | Diseases | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration Document Number: 341603 |
| 13. Peer Reviewed Title: Changing health status and health expectancies among older adults in China: gender differences from 1992 to 2002. Author: Gu D; Dupre ME; Warner DF; Zeng Y Source: Social Science and Medicine. 2009 Jun;68(12):2170-9. Abstract: Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of non-institutionalized adults in China aged 65 years and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population. Language: English Keywords: CHINA | RESEARCH REPORT | MULTIVARIATE ANALYSIS | ADULTS | GENDER ISSUES | LIFE EXPECTANCY | DISEASES | LIFE STYLE | QUALITY OF LIFE | DEMOGRAPHIC AGING | Asia, Eastern | Asia | Developing Countries | Data Analysis | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | Length of Life | Mortality | Population Dynamics | Behavior | Social Welfare | Economic Factors Document Number: 342740 |
| 14. Peer Reviewed Title: Polygynous marital structure and child survivorship in sub-Saharan Africa: some empirical evidence from Ghana. Author: Gyimah SO Source: Social Science and Medicine. 2009 Jan;68(2):334-42. Abstract: Although studies have found children in married families to have better health outcomes than those in other family types, this strand of research implicitly views marriage as monolithic and, by default, monogamous as found in western industrialized societies. In polygynous cultures, there is a need to make a distinction between polygynous and monogamous families, because these marital arrangements might imply varying levels of parental support necessary for optimum child outcomes. Using pooled children's data from the 1998 and 2003 (N=4938) Ghana Demographic and Health Surveys, this study investigates the effects of polygynous marital structure on child survivorship and assesses whether the effect is uniform over the entire childhood period. In models that did not allow for age-specific effects of polygyny, children in polygynous marriages were found to have an elevated risk of death. Further analysis revealed that only older children experienced the survival disadvantages associated with polygyny. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | CHILDREN | POLYGYNY | MARRIAGE | CHILD MORTALITY | FAMILY RELATIONSHIPS | CHILD SURVIVAL | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Marriage Patterns | Nuptiality | Mortality | Population Dynamics | Family Characteristics | Family and Household | Sociocultural Factors | Survivorship | Length of Life Document Number: 331179 |
| 15. Peer Reviewed Title: Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial. Author: Isanaka S; Nombela N; Djibo A; Poupard M; Van Beckhoven D; Gaboulaud V; Guerin PJ; Grais RF Source: JAMA. 2009 Jan 21;301(3):277-85. Abstract: CONTEXT: Ready-to-use therapeutic foods (RUTFs) are an important component of effective outpatient treatment of severe wasting. However, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated. OBJECTIVE: To evaluate the effect of a 3-month distribution of RUTF on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. All children in the study villages aged 6 to 60 months were eligible for recruitment. INTERVENTION: Children with weight-for-height 80% or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF (92 g [500 kcal/d]) from August to October 2006. Children in the 6 nonintervention villages received no preventive supplementation. Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007. MAIN OUTCOME MEASURES: Changes in weight-for-height z score (WHZ) according to the World Health Organization Child Growth Standards and incidence of wasting (WHZ <-2) over 8 months of follow-up. RESULTS: The number of children with height and weight measurements in August, October, December, and February was 3166, 3110, 2936, and 3026, respectively. The WHZ difference between the intervention and nonintervention groups was -0.10 z (95% confidence interval [CI], -0.23 to 0.03) at baseline and 0.12 z (95% CI, 0.02 to 0.21) after 8 months of follow-up. The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z (95% CI, 0.13 to 0.30). The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year (140 events/841 child-years) and 0.03 events per child-year (29 events/943 child-years) in the intervention villages, compared with 0.26 events per child-year (233 events/895 child-years) and 0.07 events per child-year (71 events/1029 child-years) in the nonintervention villages. The intervention thus resulted in a 36% (95% CI, 17% to 50%; P < .001) reduction in the incidence of wasting and a 58% (95% CI, 43% to 68%; P < .001) reduction in the incidence of severe wasting. There was no reduction in mortality, with a mortality rate of 0.007 deaths per child-year (7 deaths/986 child-years) in the intervention villages and 0.016 deaths per child-year (18 deaths/1099 child-years) in the nonintervention villages (adjusted hazard ratio, 0.51; 95% CI, 0.25 to 1.05). CONCLUSION: Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00682708. Language: English Keywords: NIGER | RESEARCH REPORT | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | CHILDREN | FOOD SUPPLEMENTATION | CHILD MORTALITY | CHILD SURVIVAL | CHILD NUTRITION | PREVENTIVE HEALTH CARE | DISTRIBUTIONAL ACTIVITIES | BODY WEIGHT | GROWTH | MALNUTRITION | PREVALENCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Survivorship | Length of Life | Nutrition | Program Activities | Programs | Organization and Administration | Physiology | Biology | Child Development | Nutrition Disorders | Diseases | Measurement Document Number: 330049 |
| 16. Title: An update on HIV and infant feeding issues in developed and developing countries. Author: Jackson DJ; Goga AE; Doherty T; Chopra M Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2009 Mar-Apr;38(2):219-29. Abstract: The field of mother to child transmission of human-immunodeficiency virus is rapidly evolving. In the United States, prevention focuses on implementation of universal human-immunodeficiency virus testing to assure compliance with recommended treatment regimens and infant-feeding strategies. In most cases, this is the avoidance of all breastfeeding. In developing countries, avoidance of breastfeeding places infants at higher risk of morbidity and mortality. Current World Health Organization recommendations require individualized counseling to determine the best feeding method for each woman. Language: English Keywords: GLOBAL | RECOMMENDATIONS | INFANT NUTRITION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | RISK FACTORS | CHILD SURVIVAL | ANTIRETROVIRAL THERAPY | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | COUNSELING | INTERVENTIONS | Nutrition | Health | Disease Transmission Control | Prevention and Control | Diseases | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | HIV | HIV Infections | Viral Diseases | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 341948 |
| 17. Peer Reviewed Title: Marked increase in child survival after four years of intensive malaria control. Author: Kleinschmidt I; Schwabe C; Benavente L; Torrez M; Ridl FC; Segura JL; Ehmer P; Nchama GN Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):882-8. Abstract: In malaria-endemic countries in Africa, a large proportion of child deaths are directly or indirectly attributable to infection with Plasmodium falciparum. Four years after high coverage, multiple malaria control interventions were introduced on Bioko Island, Equatorial Guinea, changes in infection with malarial parasites, anemia, and fever history in children were estimated and assessed in relation to changes in all-cause under-5 mortality. There were reductions in prevalence of infection (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.2-0.46), anemia (OR = 0.11, 95% CI = 0.07-0.18), and reported fevers (OR = 0.41, 95% CI = 0.22-0.76) in children. Under-5 mortality fell from 152 per 1,000 births (95% CI = 122-186) to 55 per 1,000 (95% CI = 38-77; hazard ratio = 0.34 [95% CI = 0.23-0.49]). Effective malaria control measures can dramatically increase child survival and play a key role in achieving millennium development goals. Language: English Keywords: EQUATORIAL GUINEA | RESEARCH REPORT | SAMPLING STUDIES | CHILD SURVIVAL | INTERVENTIONS | MALARIA PREVENTION | ANTIMALARIAL DRUGS | PESTICIDES | BED NETS | IEC | MONITORING | CHILD MORTALITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration | Malaria | Parasitic Diseases | Diseases | Ingredients and Chemicals | Parasite Control | Public Health | Health | Program Activities | Evaluation Document Number: 341764 |
| 18. Peer Reviewed Title: Effect of early exclusive breastfeeding on morbidity among infants born to HIV-negative mothers in Zimbabwe. Author: Koyanagi A; Humphrey JH; Moulton LH; Ntozini R; Mutasa K; Iliff P; Black RE Source: American Journal of Clinical Nutrition. 2009 May;89(5):1375-82. Abstract: BACKGROUND: Early exclusive breastfeeding (EBF) is recommended by the World Health Organization, but EBF rates remain low throughout the world. For infants born to breastfeeding HIV-positive mothers, early EBF is associated with a lower risk of postnatal transmission than is feeding breast milk together with other liquids or foods. No studies conducted in Africa have reported any benefits of EBF for infants born to HIV-negative women. OBJECTIVE: The objective was to compare the rate of sick clinic visits by infants aged 43-182 d according to breastfeeding exclusivity [EBF, predominant breastfeeding (PBF), and mixed breastfeeding (MBF)]. DESIGN: We compared rates of all-cause clinic visits and clinic visits related to diarrhea and lower respiratory tract infection (LRTI) among a cohort of 9207 infants of HIV-negative mothers during 2 age intervals: 43-91 and 92-182 d according to exclusivity of breastfeeding. Breastfeeding exclusivity was defined in 2 ways ("ever since birth" and "previous 7 d") and was assessed at 43 and 91 d. RESULTS: EBF between birth and 3 mo was significantly protective against diarrhea between 3 and 6 mo of age with the "ever since birth" definition [incidence rate ratios (IRRs) of 8.83 (95% CI: 1.07, 65.53) and 8.76 (95% CI: 1.13, 68.09) for PBF and MBF, respectively] and with the "previous 7 d" definition [2.04 (95% CI: 1.11, 3.77) and 2.05 (95% CI: 1.13, 3.72) for PBF and MBF, respectively]. The adverse effect of MBF on LRTI visits was weaker, reaching borderline significance only by the "ever since birth" definition during the 43-91-d interval (IRR: 1.91; 95% CI: 0.99, 3.67). CONCLUSION: Early EBF is associated with a significant reduction in sick clinic visits, especially those due to diarrhea. Language: English Keywords: ZIMBABWE | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | INFANT | BREASTFEEDING, EXCLUSIVE | CHILD SURVIVAL | CLINIC VISITS | DIARRHEA | RESPIRATORY INFECTIONS | TIME FACTORS | PREVALENCE | MOTIVATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Breastfeeding | Infant Nutrition | Nutrition | Health | Survivorship | Length of Life | Mortality | Population Dynamics | Service Statistics | Program Activities | Programs | Organization and Administration | Diseases | Infections | Measurement | Psychological Factors | Behavior Document Number: 341153 |
| 19. Peer Reviewed Title: Impact of maternal human immunodeficiency virus infection on birth outcomes and infant survival in rural Mozambique. Author: Naniche D; Bardaji A; Lahuerta M; Berenguera A; Mandomando I; Sanz S; Aponte JJ; Sigauque B; Alonso PL; Menendez C Source: American Journal of Tropical Medicine and Hygiene. 2009 May;80(5):870-6. Abstract: We assessed the effect of maternal human immunodeficiency virus (HIV) infection on birth outcomes and infant survival in rural Mozambique. Pregnant women attending the antenatal clinic were recruited. These women and their infants were followed-up for one year. Birth outcomes were assessed at delivery and infant HIV status was determined at 1 and 12 months of age. Women positive for HIV were more likely to have anemia at delivery than women negative for HIV (51.3% versus 35.4%; P < 0.001). Infants born to HIV-positive mothers had a significantly higher post-neonatal mortality rate than infants born to HIV-negative mothers (7.8% versus 1.9%; P < 0.001). The rate of transmission of HIV by breastfeeding during the first year of life was 15.1% (95% confidence interval = CI 7.6-22.4). Assessment of the impact of HIV infection on birth outcomes in rural Africa is essential for tailoring public health measures to reduce mother-to-child transmission of HIV and excess infant mortality. Language: English Keywords: MOZAMBIQUE | RESEARCH REPORT | RURAL POPULATION | MOTHERS | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | CHILD SURVIVAL | ANEMIA | PREGNANCY OUTCOMES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Survivorship | Length of Life | Mortality | Population Dynamics | Pregnancy | Reproduction Document Number: 341332 |
| 20. Peer Reviewed Title: Insecticide-treated net coverage in Africa: mapping progress in 2000-07. Author: Noor AM; Mutheu JJ; Tatem AJ; Hay SI; Snow RW Source: Lancet. 2009 Jan 3;373(9657):58-67. Abstract: BACKGROUND: Insecticide-treated bednets (ITNs) provide a means to improve child survival across Africa. Sales figures of these nets and survey coverage data presented nationally mask inequities in populations at biological and economic risk, and do not allow for precision in the estimation of unmet commodity needs. We gathered subnational ITN coverage sample survey data from 40 malaria-endemic countries in Africa between 2000 and 2007. METHODS: We computed the projected ITN coverage among children aged less than 5 years for age-adjusted population data that were stratified according to malaria transmission risks, proximate determinants of poverty, and methods of ITN delivery. FINDINGS: In 2000, only 1.7 million (1.8%) African children living in stable malaria-endemic conditions were protected by an ITN and the number increased to 20.3 million (18.5%) by 2007 leaving 89.6 million children unprotected. Of these, 30 million were living in some of the poorest areas of Africa: 54% were living in only seven countries and 25% in Nigeria alone. Overall, 33 (83%) countries were estimated to have ITN coverage of less than 40% in 2007. On average, we noted a greater increase in ITN coverage in areas where free distribution had operated between survey periods. INTERPRETATION: By mapping the distribution of populations in relation to malaria risk and intervention coverage, we provide a means to track the future requirements for scaling up essential disease-prevention strategies. The present coverage of ITN in Africa remains inadequate and a focused effort to improve distribution in selected areas would have a substantial effect on the continent's malaria burden. Language: English Keywords: AFRICA | RESEARCH REPORT | LONGITUDINAL STUDIES | HEALTH SURVEYS | CHILDREN | HUMAN GEOGRAPHY | BED NETS | PESTICIDES | CHILD SURVIVAL | INEQUALITIES | MALARIA PREVENTION | MAPS | Developing Countries | Studies | Research Methodology | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Geography | Social Sciences | Science | Sociocultural Factors | Parasite Control | Public Health | Ingredients and Chemicals | Survivorship | Length of Life | Mortality | Population Dynamics | Socioeconomic Factors | Economic Factors | Malaria | Parasitic Diseases | Diseases Document Number: 330036 |
| 21. Peer Reviewed Title: Preventive measures in infancy to reduce under-five mortality: a case-control study in The Gambia. Author: Rutherford ME; Dockerty JD; Jasseh M; Howie SR; Herbison P; Jeffries DJ; Mulholland K; Adegbola RA; Hill PC Source: Tropical Medicine and International Health. 2009 Feb;14(2):149-55. Abstract: OBJECTIVE: To investigate the relationship between child mortality and common preventive interventions: vaccination, trained birthing attendants, tetanus toxoid during pregnancy, breastfeeding and vitamin A supplementation. METHODS: Case-control study in a population under demographic surveillance. Cases (n = 141) were children under five who died. Each was age and sex-matched to five controls (n = 705). Information was gathered by interviewing primary caregivers. RESULTS: All but one of the interventions - whether the mother had received tetanus toxoid during pregnancy - were protective against child mortality after multivariate analysis. Having a trained person assisting at child birth (OR 0.2 95% CI 0.1-0.4), receiving all vaccinations by 9 months of age (OR 0.1; 95% CI 0.01-0.3), being breastfed for more than 12 months (Children breastfed between 13 and 24 months OR 0.1 95% CI 0.03-0.3, more than 25 months OR 0.1 95% CI 0.01-0.5) and receiving vitamin A supplementation at or after 6 months of age (OR 0.05; 95% CI 0.01-0.2) were protective against child death. CONCLUSIONS: This study confirms the value of at least four available interventions in the prevention of under-five death in The Gambia. It is now important to identify those who are not receiving them and why, and to intervene to improve coverage across the population. Language: English Keywords: GAMBIA | RESEARCH REPORT | CASE STUDIES | CHILDREN | CHILD SURVIVAL | BREASTFEEDING | IMMUNIZATION | CHILD MORTALITY | PREVENTION AND CONTROL | INTERVENTIONS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Survivorship | Length of Life | Mortality | Population Dynamics | Infant Nutrition | Nutrition | Health | Primary Health Care | Health Services | Delivery of Health Care | Diseases | Programs | Organization and Administration Document Number: 341034 |
| 22. Peer Reviewed Title: Determinants of survival in AIDS patients on antiretroviral therapy in a rural centre in the Far-North Province, Cameroon. Author: Sieleunou I; Souleymanou M; Schonenberger AM; Menten J; Boelaert M Source: Tropical Medicine and International Health. 2009 Jan;14(1):36-43. Abstract: OBJECTIVE: To analyse the outcomes of antiretroviral therapy (ART) in routine conditions in a rural hospital in the Far-North province of Cameroon. METHOD: Retrospective cohort study of 1187 patients >15 years who started ART between July 2001 and December 2006. The survival time was estimated by Kaplan-Meier analysis and Cox proportional hazard models were fitted to explain survival. RESULTS: Upon enrollment, 90.4% patients were in WHO stage III or IV and 56.1% had a BMI <18.5. Median CD4 count was 105 cells/mm(3) (IQR 40-173). At the end of the study period, 338/1187 had died and 59/1187 were lost to follow-up. The survival probability was 77% at 1 year [95% CI: 75-80] and 47% at 5 years [95% CI: 40-55]. The median survival time was 58 months. CD4 count, haemoglobin, BMI, sex and clinical stage at enrollment were independent predictors of mortality. CONCLUSION: This study confirms the clinical benefit of ART programs in a remote and resource-constrained setting operating in routine conditions. The challenge ahead is to secure earlier access to ART and to maintain its longer-term benefit. Language: English Keywords: CAMEROON | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | RETROSPECTIVE STUDIES | COHORT ANALYSIS | RURAL POPULATION | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | TIME FACTORS | SURVIVORSHIP | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | HIV | Population Dynamics | Length of Life | Mortality Document Number: 330263 |
| 23. Title: Early breast-feeding cessation and infant mortality in low-income countries: workshop summary. Author: Simondon KB Source: Advances In Experimental Medicine and Biology. 2009;639:319-29. Abstract: The importance of breast-feeding for infant and child health and survival in less developed countries has been the subject of a number of studies over the last 25 years. However, the epidemic of AIDS in low-income countries, together with the discovery of an important risk of mother-to-child transmission of HIV-1 through breast-milk, has prompted renewed interest in this subject. Indeed, in order to weigh the mortality risks associated with different infant feeding practices against the risk of mother-to-child transmission of the virus, it is essential to have precise estimates of relative risk of death of non-breastfed infants within narrow age intervals. Available 'decision guides' mostly use relative mortality risks published by a WHO working group, based on 6 retrospective or prospective studies, among which 3 contributed to risk estimations during infancy. The mortality risk was not analysed by mode of breast-feeding (i.e. exclusive, predominant or partial), because such data were not available for all studies included. In addition, exclusive breast-feeding is rare in many settings and sample sizes are therefore insufficient to assess mortality risks associated with this mode of feeding. This is unfortunate since a cohort study in South Africa suggested that exclusive breast-feeding up to 3 months postpartum may be associated with a lower risk of postnatal HIV-1 transmission to the child than when other fluids or foods are added. As for all observational epidemiological studies, those dealing with the association between child mortality and breast-feeding may be subject to a number of methodological problems. The objective of this workshop was to illustrate some of these, using examples from the literature, and mostly consider confounding, reverse causality and bias by indication. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | LOW INCOME POPULATION | MOTHERS | BREASTFEEDING | INFANT MORTALITY | CHILD SURVIVAL | WEANING | TIME FACTORS | RISK FACTORS | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Mortality | Population Dynamics | Demographic Factors | Population | Survivorship | Length of Life Document Number: 330899 |
| 24. Title: Family planning saves lives. 4th ed. Author: Smith R; Ashford L; Gribble J; Clifton D Source: Washington, D.C., Population Reference Bureau [PRB], 2009. [2], 23 p. Abstract: To better address the cost implications of investing in mothers and children, the report provides useful data on the cost-benefits of family planning programs. Long considered a "best buy" among health investments, family planning is even more important in today's financially strapped environment. As countries grapple with recession and search for better ways to stretch limited budgets, family planning stands out as one of the most cost-effective, high-yield interventions available. At an average supply cost of US$1.55 per user annually, it offers a safe, affordable, and effective way for governments to reduce maternal and child illness and deaths, as well as reduce national health expenditures on reproductive and children's health problems. This latest edition also includes new information on how family planning reduces the rate of new HIV infections and deaths from AIDS as well as a "Special Focus" section on the challenges of repositioning family planning in sub-Saharan Africa, where programs have languished in many countries over the last decade. Language: English Keywords: DEVELOPING COUNTRIES | FAMILY PLANNING | CHILD SURVIVAL | INFANT MORTALITY | BIRTH INTERVALS | BREASTFEEDING | BIRTH SPACING | MATERNAL MORTALITY | REPRODUCTIVE HEALTH | ABORTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | HIV PREVENTION | AIDS PREVENTION | MATERNAL HEALTH | CHILD HEALTH | ADOLESCENTS | CONTRACEPTION | NEEDS | PROGRAM ACCESSIBILITY | ATTITUDES | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Fertility Measurements | Fertility | Infant Nutrition | Nutrition | Health | Fertility Control, Postconception | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | HIV Infections | Viral Diseases | AIDS | Youth | Age Factors | Population Characteristics | Economic Factors | Program Evaluation | Programs | Organization and Administration | Psychological Factors | Behavior Document Number: 325185 Notification |
| 25. Title: Life expectancy and welfare in Latin America and the Caribbean. Author: Soares RR Source: Health Economics. 2009 Apr;18 Suppl 1:S37-54. Abstract: This paper analyses the recent evolution of life expectancy in Latin American and Caribbean countries, and evaluates how much it has contributed to the overall improvements in welfare. We argue that increases in life expectancy between 1960 and 2000, which were largely independent of income, represented gains in welfare comparable to the ones derived from income growth. For countries in the region, estimates of welfare improvements accounting for health increase the numbers obtained from income alone by 40% on average. The available evidence suggests that improvements in public health infrastructure - such as provision of treated water and sewerage services - and large-scale immunization programs may have been the key factors behind the mortality reductions observed in the period. Language: English Keywords: CARIBBEAN | LATIN AMERICA | CRITIQUE | LIFE EXPECTANCY | SOCIAL WELFARE | PUBLIC HEALTH | IMMUNIZATION | WATER QUALITY | SANITATION | INCOME | INEQUALITIES | MORTALITY DECLINE | Developing Countries | Americas | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Economic Factors | Health | Primary Health Care | Health Services | Delivery of Health Care | Water | Natural Resources | Environment | Socioeconomic Factors Document Number: 341985 |
| 26. Peer Reviewed Title: Impact of HAART therapy on co-infection of tuberculosis and HIV cases for 9 years in Taiwan. Author: Tseng SH; Jiang DD; Hoi HS; Yang SL; Hwang KP Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):675-7. Abstract: Free highly active antiretroviral therapy (HAART) was made available by The Department of Health since April 1997. As a result, the incidence rate of tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection among HIV cases rose from 1.90% to 3.82% during 1993 to 1998 and decreased from 3.82% to 0.94% during 1998 to 2006. The incidence rate of TB/HIV co-infection among HIV cases reached its peak in 1998 and then started to reverse, although the next year the TB disease burden (incidence rate: 62.7 cases per 100,000 persons) remained consistently high, and this continued in the following years. The survival rate of TB/HIV co-infection cases was 62.16% during the period 1993-1996 (pre-free HAART era) and increased to 86.60% during the period 1998-2006 (P < 0.0001) (post-free HAART era). Highly active antiretroviral therapy decreased the incidence rate of new TB/HIV co-infection cases among HIV cases and increased the survival rate of TB/HIV co-infection cases. Language: English Keywords: TAIWAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | TUBERCULOSIS | COMPLICATIONS | ANTIRETROVIRAL THERAPY | SURVIVORSHIP | Asia, Eastern | Asia | Developed Countries | Research Methodology | Viral Diseases | Diseases | Measurement | Infections | HIV | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 331276 |
| 27. Title: When to start antiretroviral therapy in resource-limited settings. Author: Walensky RP; Wolf LL; Wood R; Fofana MO; Freedberg KA; Martinson NA; Paltiel AD; Anglaret X; Weinstein MC; Losina E Author: CEPAC (Cost-Effectiveness of Preventing AIDS Complications)-International Source: Annals of Internal Medicine. 2009 Aug 4;151(3):157-66. Abstract: BACKGROUND: The results of international clinical trials that are assessing when to initiate antiretroviral therapy (ART) will not be available for several years. OBJECTIVE: To inform HIV treatment decisions about the optimal CD4 threshold at which to initiate ART in South Africa while awaiting the results of these trials. DESIGN: Cost-effectiveness analysis by using a computer simulation model of HIV disease. DATA SOURCES: Published data from randomized trials and observational cohorts in South Africa. TARGET POPULATION: HIV-infected patients in South Africa. TIME HORIZON: 5-year and lifetime. PERSPECTIVE: Modified societal. INTERVENTION: No treatment, ART initiated at a CD4 count less than 0.250 x 10(9) cells/L, and ART initiated at a CD4 count less than 0.350 x 10(9) cells/L. OUTCOME MEASURES: Morbidity, mortality, life expectancy, medical costs, and cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: If 10% to 100% of HIV-infected patients are identified and linked to care, a CD4 count threshold for ART initiation of 0.350 x 10(9) cells/L would reduce severe opportunistic diseases by 22,000 to 221,000 and deaths by 25,000 to 253,000 during the next 5 years compared with ART initiation at 0.250 x 10(9) cells/L; cost increases would range from $142 million (10%) to $1.4 billion (100%). Either ART initiation strategy would increase long-term survival by at least 7.9 years, with a mean per-person life expectancy of 3.8 years with no ART and 12.5 years with an initiation threshold of 0.350 x 10(9) cells/L. Compared with an initiation threshold of 0.250 x 10(9) cells/L, a threshold of 0.350 x 10(9) cells/L has an incremental cost-effectiveness ratio of $1200 per year of life saved. RESULTS OF SENSITIVITY ANALYSIS: Initiating ART at a CD4 count less than 0.350 x 10(9) cells/L would remain cost-effective over the next 5 years even if the probability that the trial would demonstrate the superiority of earlier therapy is as low as 17%. LIMITATION: This model does not consider the possible benefits of initiating ART at a CD4 count greater than 0.350 x 10(9) cells/L or of reduced HIV transmission. CONCLUSION: Earlier initiation of ART in South Africa will probably reduce morbidity and mortality, improve long-term survival, and be cost-effective. While awaiting trial results, treatment guidelines should be liberalized to allow initiation at CD4 counts less than 0.350 x 10(9) cells/L, earlier than is currently recommended. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases and the Doris Duke Charitable Foundation. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | COST BENEFIT ANALYSIS | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | LIFE EXPECTANCY | MORBIDITY | MORTALITY | TIME FACTORS | ANTIRETROVIRAL THERAPY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Quantitative Evaluation | Evaluation | Clinical Research | Research Methodology | Viral Diseases | Diseases | Length of Life | Population Dynamics | Demographic Factors | Population | HIV Document Number: 342686 |
| 28. Peer Reviewed Title: Improving maternal and child health in difficult environments: the case for "cross-border" health care. Author: Walraven G; Manaseki-Holland S; Hussain A; Tomaro JB Source: PLoS Medicine. 2009 Jan 13;6(1):e5. Abstract: Health indicators, including levels of maternal and infant mortality, are very different in adjacent geographical border areas of Afghanistan, Pakistan, and Tajikistan. These differences reflect the combined and complex interplay of elements within the different health systems, as well as political, economic, social, and cultural factors. Reducing maternal and child mortality requires focus and balance in all of these dimensions and can best be achieved through service interventions underpinned by general development. A policy promoting "cross-border" health programmes could immediately make available existing resources that could contribute to reducing maternal and child mortality in all three geographical locations. (excerpt) Language: English Keywords: ASIA | CRITIQUE | RECOMMENDATIONS | CROSS-CULTURAL COMPARISONS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | INFANT | BORDER CROSSING | MATERNAL-CHILD HEALTH SERVICES | CULTURE | ECONOMIC FACTORS | POLITICAL FACTORS | CHILD SURVIVAL | MATERNAL HEALTH | INTERNATIONAL COOPERATION | Developing Countries | Comparative Studies | Studies | Research Methodology | Economic Development | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | International Migration | Migration | Population Dynamics | Primary Health Care | Health Services | Delivery of Health Care | Health | Sociocultural Factors | Survivorship | Length of Life | Mortality Document Number: 330709 |
| 29. Peer Reviewed Title: Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Author: Antiretroviral Therapy Cohort Collaboration Source: Lancet. 2008 Jul 26;372(9635):293-299. Abstract: Background: Combination antiretroviral therapy has led to significant increases in survival and quality of life, but at a population-level the effect on life expectancy is not well understood. Our objective was to compare changes in mortality and life expectancy among HIV-positive individuals on combination antiretroviral therapy. Methods: The Antiretroviral Therapy Cohort Collaboration is a multinational collaboration of HIV cohort studies in Europe and North America. Patients were included in this analysis if they were aged 16 years or over and antiretroviral-naive when initiating combination therapy. We constructed abridged life tables to estimate life expectancies for individuals on combination antiretroviral therapy in 1996-99, 2000-02, and 2003-05, and stratified by sex, baseline CD4 cell count, and history of injecting drug use. The average number of years remaining to be lived by those treated with combination antiretroviral therapy at 20 and 35 years of age was estimated. Potential years of life lost from 20 to 64 years of age and crude mortality rates were also calculated. Findings: 18 587, 13 914, and 10 854 eligible patients initiated combination antiretroviral therapy in 1996-99, 2000-02, and 2003-05, respectively. 2056 (4.7%) deaths were observed during the study period, with crude mortality rates decreasing from 16.3 deaths per 1000 person-years in 1996-99 to 10.0 deaths per 1000 person-years in 2003-05. Potential years of life lost per 1000 person-years also decreased over the same time, from 366 to 189 years. Life expectancy at age 20 years increased from 36.1 (SE 0.6) years to 49.4 (0.5) years. Women had higher life expectancies than did men. Patients with presumed transmission via injecting drug use had lower life expectancies than did those from other transmission groups (32.6 [1.1] years vs 44.7 [0.3] years in 2003-05). Life expectancy was lower in patients with lower baseline CD4 cell counts than in those with higher baseline counts (32.4 [1.1] years for CD4 cell counts below 100 cells per µL vs 50.4 [0.4] years for counts of 200 cells per µL or more). Interpretation: Life expectancy in HIV-infected patients treated with combination antiretroviral therapy increased between 1996 and 2005, although there is considerable variability between subgroups of patients. The average number of years remaining to be lived at age 20 years was about two-thirds of that in the general population in these countries. (author's) Language: English Keywords: EUROPE | NORTH AMERICA | RESEARCH REPORT | COHORT ANALYSIS | LIFE TABLE METHOD | PERSONS LIVING WITH HIV/AIDS | QUALITY OF LIFE | ANTIRETROVIRAL THERAPY | TREATMENT | LIFE EXPECTANCY | Developed Countries | Americas | Research Methodology | Demographic Analysis | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Social Welfare | Economic Factors | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 327889 |
| 30. Peer Reviewed Title: Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. Author: Countdown to 2015 Core Group. Countdown Coverage Writing Group Source: Lancet. 2008 Apr 12-18;371(9620):1247-1258. Abstract: The Countdown to 2015 for Maternal, Newborn, and Child Survival initiative monitors coverage of priority interventions to achieve the Millennium Development Goals (MDG) for reduction of maternal and child mortality. We aimed to report on 68 countries which have 97% of maternal and child deaths worldwide, and on 22 interventions that have been proven to improve maternal, newborn, and child survival. We selected countries with high rates of maternal and child deaths, and interventions with the most potential to avert such deaths. We analysed country-specific data for maternal and child mortality and coverage of selected interventions. We also tracked cause-of-death profiles; indicators of nutritional status; the presence of supportive policies; financial flows to maternal, newborn, and child health; and equity in coverage of interventions. Of the 68 priority countries, 16 were on track to meet MDG 4. Of these, seven had been on track in 2005 when the Countdown initiative was launched, three (including China) moved into the on-track category in 2008, and six were included in the Countdown process for the first time in 2008. Trends in maternal mortality that would indicate progress towards MDG 5 were not available, but in most (56 of 68) countries, maternal mortality was high or very high. Coverage of different interventions varied widely both between and within countries. Interventions that can be routinely scheduled, such as immunisation and antenatal care, had much higher coverage than those that rely on functional health systems and 24-hour availability of clinical services, such as skilled or emergency care at birth and care of ill newborn babies and children. Data for postnatal care were either unavailable or showed poor coverage in almost all 68 countries. The most rapid increases in coverage were seen for immunisation, which also received significant investment during this period. Rapid progress is possible, but much more can and must be done. Focused efforts will be needed to improve coverage, especially for priorities such as contraceptive services, care in childbirth, postnatal care, and clinical case management of illnesses in newborn babies and children. (author's) Language: English Keywords: GLOBAL | DEVELOPING COUNTRIES | RESEARCH REPORT | PROGRESS REPORT | SURVEYS | INTERVENTIONS | INFANT HEALTH | CHILD HEALTH | MATERNAL HEALTH | IMMUNIZATION | CHILD SURVIVAL | PROGRAM ACCESSIBILITY | INEQUALITIES | Sampling Studies | Studies | Research Methodology | Programs | Organization and Administration | Health | Primary Health Care | Health Services | Delivery of Health Care | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Program Evaluation | Socioeconomic Factors | Economic Factors Document Number: 325844 |
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