Bulletin of the World Health Organizationhttps://www.scielosp.org/feed/bwho/2006.v84n9/2016-01-01T00:02:00ZUnknown authorVol. 84 No. 9 - 2006WerkzeugIn this month's BulletinS0042-968620060009000012016-01-01T00:02:00Z2001-01-28T00:08:00ZAre drugs for rare diseases "essential"?S0042-968620060009000022016-01-01T00:02:00Z2001-01-28T00:08:00ZReidenberg, Marcus M
<em>Reidenberg, Marcus M</em>;
<br/><br/>
Health and foreign policyS0042-968620060009000032016-01-01T00:02:00Z2001-01-28T00:08:00ZFidler, David PDrager, Nick
<em>Fidler, David P</em>;
<em>Drager, Nick</em>;
<br/><br/>
Reaching the targets for TB control: call for papersS0042-968620060009000042016-01-01T00:02:00Z2001-01-28T00:08:00ZBlanc, LéopoldMartinez, Lindsay
<em>Blanc, Léopold</em>;
<em>Martinez, Lindsay</em>;
<br/><br/>
WHO launches taskforce to fight counterfeit drugsS0042-968620060009000052016-01-01T00:02:00Z2001-01-28T00:08:00ZBurns, William
<em>Burns, William</em>;
<br/><br/>
Free access to journals gives Kenyan science a boostS0042-968620060009000062016-01-01T00:02:00Z2001-01-28T00:08:00ZOsanjo, Tom
<em>Osanjo, Tom</em>;
<br/><br/>
Can better health statistics save lives?S0042-968620060009000072016-01-01T00:02:00Z2001-01-28T00:08:00ZElash, Anita
<em>Elash, Anita</em>;
<br/><br/>
XVI International AIDS conference in Toronto, CanadaS0042-968620060009000082016-01-01T00:02:00Z2001-01-28T00:08:00ZA century in public healthS0042-968620060009000092016-01-01T00:02:00Z2001-01-28T00:08:00ZWHO response to the humanitarian crisis in LebanonS0042-968620060009000102016-01-01T00:02:00Z2001-01-28T00:08:00ZRecent news from WHOS0042-968620060009000112016-01-01T00:02:00Z2001-01-28T00:08:00ZCauses of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countriesS0042-968620060009000122016-01-01T00:02:00Z2001-01-28T00:08:00ZNgoc, Nhu Thi NguyenMerialdi, MarioAbdel-Aleem, HanyCarroli, GuillermoPurwar, ManoramaZavaleta, NellyCampódonico, LianaAli, Mohamed MHofmeyr, G JustusMathai, MatthewsLincetto, OrnellaVillar, José
<em>Ngoc, Nhu Thi Nguyen</em>;
<em>Merialdi, Mario</em>;
<em>Abdel-Aleem, Hany</em>;
<em>Carroli, Guillermo</em>;
<em>Purwar, Manorama</em>;
<em>Zavaleta, Nelly</em>;
<em>Campódonico, Liana</em>;
<em>Ali, Mohamed M</em>;
<em>Hofmeyr, G Justus</em>;
<em>Mathai, Matthews</em>;
<em>Lincetto, Ornella</em>;
<em>Villar, José</em>;
<br/><br/>
OBJECTIVE: To report stillbirth and early neonatal mortality and to quantify the relative importance of different primary obstetric causes of perinatal mortality in 171 perinatal deaths from 7993 pregnancies that ended after 28 weeks in nulliparous women. METHODS: A review of all stillbirths and early newborn deaths reported in the WHO calcium supplementation trial for the prevention of pre-eclampsia conducted at seven WHO collaborating centres in Argentina, Egypt, India, Peru, South Africa and Viet Nam. We used the Baird-Pattinson system to assign primary obstetric causes of death and classified causes of early neonatal death using the International classification of diseases and related health problems, Tenth revision (ICD-10). FINDINGS: Stillbirth rate was 12.5 per 1000 births and early neonatal mortality rate was 9.0 per 1000 live births. Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively). Prematurity was the main cause of early neonatal deaths (62%). CONCLUSIONS: Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries.Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmesS0042-968620060009000132016-01-01T00:02:00Z2001-01-28T00:08:00ZBaqui, AHDarmstadt, GLWilliams, EKKumar, VKiran, TUPanwar, DSrivastava, VKAhuja, RBlack, RESantosham, M
<em>Baqui, Ah</em>;
<em>Darmstadt, Gl</em>;
<em>Williams, Ek</em>;
<em>Kumar, V</em>;
<em>Kiran, Tu</em>;
<em>Panwar, D</em>;
<em>Srivastava, Vk</em>;
<em>Ahuja, R</em>;
<em>Black, Re</em>;
<em>Santosham, M</em>;
<br/><br/>
OBJECTIVE: To assess the rates, timing and causes of neonatal deaths and the burden of stillbirths in rural Uttar Pradesh, India. We discuss the implications of our findings for neonatal interventions. METHODS: We used verbal autopsy interviews to investigate 1048 neonatal deaths and stillbirths. FINDINGS: There were 430 stillbirths reported, comprising 41% of all deaths in the sample. Of the 618 live births, 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week. The primary causes of death on the first day of life (i.e. day 0) were birth asphyxia or injury (31%) and preterm birth (26%). During days 1-6, the most frequent causes of death were preterm birth (30%) and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia occurred during the first week of life. The proportion of deaths attributed to sepsis or pneumonia increased to 45% and 36% during days 7-13 and 14-27, respectively. CONCLUSION: Stillbirths and deaths on the day of birth represent a large proportion of perinatal and neonatal deaths, highlighting an urgent need to improve coverage with skilled birth attendants and to ensure access to emergency obstetric care. Health interventions to improve essential neonatal care and care-seeking behavior are also needed, particularly for preterm neonates in the early postnatal period.Community surveys and risk factor analysis of human alveolar and cystic echinococcosis in Ningxia Hui autonomous region, ChinaS0042-968620060009000142016-01-01T00:02:00Z2001-01-28T00:08:00ZYang, Yu RongSun, TaoLi, ZhengzhiZhang, JianzhongTeng, JingLiu, XongzhouLiu, RuiqiZhao, RuiJones, Malcolm KWang, YunhaiWen, HaoFeng, XiaohuiZhao, QinZhao, YuminShi, DazhongBartholomot, BrigitteVuitton, Dominique APleydell, DavidGiraudoux, PatrickIto, AkiraDanson, Mark FBoufana, BelchisCraig, Philip SWilliams, Gail MMcManus, Donald P
<em>Yang, Yu Rong</em>;
<em>Sun, Tao</em>;
<em>Li, Zhengzhi</em>;
<em>Zhang, Jianzhong</em>;
<em>Teng, Jing</em>;
<em>Liu, Xongzhou</em>;
<em>Liu, Ruiqi</em>;
<em>Zhao, Rui</em>;
<em>Jones, Malcolm K</em>;
<em>Wang, Yunhai</em>;
<em>Wen, Hao</em>;
<em>Feng, Xiaohui</em>;
<em>Zhao, Qin</em>;
<em>Zhao, Yumin</em>;
<em>Shi, Dazhong</em>;
<em>Bartholomot, Brigitte</em>;
<em>Vuitton, Dominique A</em>;
<em>Pleydell, David</em>;
<em>Giraudoux, Patrick</em>;
<em>Ito, Akira</em>;
<em>Danson, Mark F</em>;
<em>Boufana, Belchis</em>;
<em>Craig, Philip S</em>;
<em>Williams, Gail M</em>;
<em>Mcmanus, Donald P</em>;
<br/><br/>
OBJECTIVE: To determine the true community prevalence of human cystic (CE) and alveolar (AE) echinococcosis (hydatid disease) in a highly endemic region in Ningxia Hui, China, by detecting asymptomatic cases. METHODS: Using hospital records and "AE-risk" landscape patterns we selected study communities predicted to be at risk of human echinococcosis in Guyuan, Longde and Xiji counties. We conducted community surveys of 4773 individuals from 26 villages in 2002 and 2003 using questionnaire analysis, ultrasound examination and serology. FINDINGS: Ultrasound and serology showed a range of prevalences for AE (0-8.1%; mean 2%) and CE (0-7.4%; mean 1.6%), with the highest prevalence in Xiji (2% for CE, 2.5% for AE). There were significant differences in the prevalence of CE, AE and total echinococcosis between the three counties and villages (with multiple degrees of freedom). While hospital records showed 96% of echinococcosis cases attributable to CE, our survey showed a higher prevalence of human AE (56%) compared to CE (44%). Questionnaire analysis revealed that key risk factors for infection were age and dog ownership for both CE and AE, and Hui ethnicity and being female for AE. Drinking well-water decreased the risk for both AE and CE. CONCLUSION: Echinococcosis continues to be a severe public health problem in this part of China because of unhygienic practices/habits and poor knowledge among the communities regarding this disease.Is mortality from heart failure increasing in Australia? An analysis of official data on mortality for 1997-2003S0042-968620060009000152016-01-01T00:02:00Z2001-01-28T00:08:00ZNajafi, FaridDobson, Annette JJamrozik, Konrad
<em>Najafi, Farid</em>;
<em>Dobson, Annette J</em>;
<em>Jamrozik, Konrad</em>;
<br/><br/>
OBJECTIVE: To assess whether trends in mortality from heart failure (HF) in Australia are due to a change in awareness of the condition or real changes in its epidemiology. METHODS: We carried out a retrospective analysis of official data on national mortality data between 1997 and 2003. A death was attributed to HF if the death certificate mentioned HF as either the underlying cause of death (UCD) or among the contributory factors. FINDINGS: From a total of 907 242 deaths, heart failure was coded as the UCD for 29 341 (3.2%) and was mentioned anywhere on the death certificate in 135 268 (14.9%). Between 1997 and 2003, there were decreases in the absolute numbers of deaths and in the age-specific and age-standardized mortality rates for HF either as UCD or mentioned anywhere for both sexes. HF was mentioned for 24.6% and 17.8% of deaths attributed to ischaemic heart disease and circulatory disease, respectively, and these proportions remained unchanged over the period of study. In addition, HF as UCD accounted for 8.3% of deaths attributed to circulatory disease and this did not change materially from 1997 to 2003. CONCLUSION: The decline in mortality from HF measured as either number of deaths or rate probably reflects a real change in the epidemiology of HF. Population-based studies are required to determine accurately the contributions of changes in incidence, survival and demographic factors to the evolving epidemiology of HF.The syndromic management of vaginal discharge using singledose treatments: a randomized controlled trial in West AfricaS0042-968620060009000162016-01-01T00:02:00Z2001-01-28T00:08:00ZPépin, JacquesSobela, FrançoisKhonde, NzambiAgyarko-Poku, ThomasDiakité, SoumailaDeslandes, SylvieLabbé, Annie-ClaudeSylla, MohamedAsamoah-Adu, ComfortFrost, Eric
<em>Pépin, Jacques</em>;
<em>Sobela, François</em>;
<em>Khonde, Nzambi</em>;
<em>Agyarko-Poku, Thomas</em>;
<em>Diakité, Soumaila</em>;
<em>Deslandes, Sylvie</em>;
<em>Labbé, Annie-Claude</em>;
<em>Sylla, Mohamed</em>;
<em>Asamoah-Adu, Comfort</em>;
<em>Frost, Eric</em>;
<br/><br/>
OBJECTIVE: To evaluate whether single-dose treatments are as effective as standard therapy in the syndromic management of vaginal discharge. METHODS: A randomized controlled effectiveness trial compared single-dose tinidazole plus fluconazole (TF) with treatment for 7 days with metronidazole plus 3 days of treatment with vaginal clotrimazole (MC) among 1570 women presenting with vaginal discharge at primary health care institutions in Ghana, Guinea, Mali and Togo. Participants were randomly allocated to one of the two treatments by research nurses or physicians using precoded envelopes. Effectiveness was assessed by symptomatic response on day 14. CLINICAL IDENTIFIER ClinicalTrials.gov NCT00313131. FINDINGS: The two treatment regimens had similar effectiveness: complete resolution was seen in 66% (TF) and 64% (MC) and partial resolution in 33% (TF) and 34% (MC) of participants (P = 0.26). Effectiveness was similar among subgroups with vulvovaginal candidiasis, Trichomonas vaginalis vaginitis or bacterial vaginosis. The two treatment regimens had a similar effectiveness among human immunodeficiency virus (HIV)-infected (TF: n = 76, 71% complete resolution, 28% partial; MC: n = 83, 72% complete resolution, 25% partial, P = 0.76) and HIV-uninfected women (TF: n = 517, 68% complete, 32% partial; MC: n = 466, 65% complete, 33% partial, P = 0.20). Cervical infections with Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium were uncommon among women not involved in sex work, were associated with bacterial vaginosis or T. vaginalis vaginitis, and did not alter response to treatment with agents active against vaginal infections. Four-fifths of women not relieved by a single dose of TF had a favourable response when MC was administered as second-line treatment. CONCLUSION: Single-dose TF is as effective as multiple-dose MC in the syndromic management of vaginal discharge, even among women with HIV-infection. Given its low price and easier adherence, TF should be considered as a first-line treatment for vaginal discharge syndrome.Measuring the impact of intimate partner violence on the health of women in Victoria, AustraliaS0042-968620060009000172016-01-01T00:02:00Z2001-01-28T00:08:00ZVos, TAstbury, JPiers, LSMagnus, AHeenan, MStanley, LWalker, LWebster, K
<em>Vos, T</em>;
<em>Astbury, J</em>;
<em>Piers, Ls</em>;
<em>Magnus, A</em>;
<em>Heenan, M</em>;
<em>Stanley, L</em>;
<em>Walker, L</em>;
<em>Webster, K</em>;
<br/><br/>
OBJECTIVE Using burden of disease methodology, estimate the health risks of intimate partner violence (IPV) among women in Victoria, Australia. METHODS We calculated population attributable fractions (from survey data on the prevalence of IPV and the relative risks of associated health problems in Australia) and determined health outcomes by applying them to disability-adjusted life year estimates for the relevant disease and injury categories for Victoria, Australia for 2001. FINDINGS For women of all ages IPV accounted for 2.9% (95% uncertainty interval 2.4-3.4%) of the total disease and injury burden. Among women 18-44 years of age, IPV was associated with 7.9% (95% uncertainty interval 6.4-9.5%) of the overall disease burden and was a larger risk to health than risk factors traditionally included in burden of disease studies, such as raised blood pressure, tobacco use and increased body weight. Poor mental health contributed 73% and substance abuse 22% to the disease burden attributed to IPV. CONCLUSION Our findings suggest that IPV constitutes a significant risk to women's health. Mental health policy-makers and health workers treating common mental health problems need to be aware that IPV is an important risk factor. Future research should concentrate on evaluating effective interventions to prevent women being exposed to violence, and identifying the most appropriate mental health care for victims to reduce short- and long-term disability.Rare essentials: drugs for rare diseases as essential medicinesS0042-968620060009000182016-01-01T00:02:00Z2001-01-28T00:08:00ZStolk, PieterWillemen, Marjolein JCLeufkens, Hubert GM
<em>Stolk, Pieter</em>;
<em>Willemen, Marjolein Jc</em>;
<em>Leufkens, Hubert Gm</em>;
<br/><br/>
Since 1977, the WHO Model List of Essential Medicines (EML), published by WHO, has provided advice for Member States that struggle to decide which pharmaceutical technologies should be provided to patients within their public health systems. Originating from outside WHO, an incentive system has been put in place by various governments for the development of medicines for rare diseases ("orphan drugs"). With progress in pharmaceutical research (e.g. drugs targeted for narrower indications), these medicines will feature more often on future public health agendas. However, when current definitions for selecting essential medicines are applied strictly, orphan drugs cannot be part of the WHO Essential Medicines Programme, creating the risk that WHO may lose touch with this field. In our opinion WHO should explicitly include orphan drugs in its policy sphere by composing a complementary Orphan Medicines Model List as an addition to the EML. This complementary list of "rare essentials" could aid policy-makers and patients in, for example, emerging countries to improve access to these drugs and stimulate relevant policies. Furthermore, inconsistencies in the current EML with regard to medicines for rare diseases can be resolved. In this paper we propose selection criteria for an Orphan Medicines Model List that could form a departure point for future work towards an extensive WHO Orphan Medicines Programme.Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable?S0042-968620060009000192016-01-01T00:02:00Z2001-01-28T00:08:00ZMalmborg, RasmusMann, GillianThomson, RachaelSquire, S Bertel
<em>Malmborg, Rasmus</em>;
<em>Mann, Gillian</em>;
<em>Thomson, Rachael</em>;
<em>Squire, S Bertel</em>;
<br/><br/>
Private-public mix (PPM) DOTS is widely advocated as a DOTS adaptation for promoting progress towards the international tuberculosis (TB) control targets of detecting 70% of TB cases and successfully treating 85% of these. Private health care plays a central role in health-care provision in many developing countries that have a high burden of TB. It is therefore encouraging that PPM projects are being set up in various countries around the world to explore possible interaction between the national TB programmes and other partners in the fight against TB. The objective of this review was to use the published literature to assess the range of providers included in PPMs for their ability to provide case-detection services for the vulnerable. From a case-detection perspective, we identify the essential elements of a pro-poor PPM model, namely, cost-effectiveness from a patient perspective, accessibility, acceptability and quality. The review revealed that a very large part of the total spectrum of potential PPM-participating partners has not yet been explored; current models focus on private-for-profit health-care providers and nongovernmental organizations. We conclude that it is important to think critically about the type of private providers who are best suited to meeting the needs of the poor, and that more should be done to document the socioeconomic status of patients accessing services through PPM pilots.One in a million: the first community trial of water fluoridationS0042-968620060009000202016-01-01T00:02:00Z2001-01-28T00:08:00ZLennon, Michael A
<em>Lennon, Michael A</em>;
<br/><br/>