Bulletin of the World Health Organizationhttps://www.scielosp.org/feed/bwho/2010.v88n1/2016-01-01T00:02:00ZUnknown authorVol. 88 No. 1 - 2010WerkzeugIn this month's bulletinS0042-968620100001000012016-01-01T00:02:00Z2001-01-28T00:08:00ZTobacco is a global paediatric concernS0042-968620100001000022016-01-01T00:02:00Z2001-01-28T00:08:00ZLando, Harry AHipple, Bethany JMuramoto, MyraKlein, Jonathan DProkhorov, Alexander VOssip, Deborah JWinickoff, Jonathan P
<em>Lando, Harry A</em>;
<em>Hipple, Bethany J</em>;
<em>Muramoto, Myra</em>;
<em>Klein, Jonathan D</em>;
<em>Prokhorov, Alexander V</em>;
<em>Ossip, Deborah J</em>;
<em>Winickoff, Jonathan P</em>;
<br/><br/>
Responding to the needs of adolescentsS0042-968620100001000032016-01-01T00:02:00Z2001-01-28T00:08:00ZChandra-Mouli, VenkatramanLawe-Davies, OliviaDick, Bruce
<em>Chandra-Mouli, Venkatraman</em>;
<em>Lawe-Davies, Olivia</em>;
<em>Dick, Bruce</em>;
<br/><br/>
The art of evaluating the impact of medical scienceS0042-968620100001000042016-01-01T00:02:00Z2001-01-28T00:08:00ZAllen, Liz
<em>Allen, Liz</em>;
<br/><br/>
China's new health plan targets vulnerableS0042-968620100001000052016-01-01T00:02:00Z2001-01-28T00:08:00ZWater woes in Senegal's holy cityS0042-968620100001000062016-01-01T00:02:00Z2001-01-28T00:08:00ZBreast is always best, even for HIV-positive mothersS0042-968620100001000072016-01-01T00:02:00Z2001-01-28T00:08:00ZEducation is key to controlling visceral leishmaniasisS0042-968620100001000082016-01-01T00:02:00Z2001-01-28T00:08:00ZRecent news from WHOS0042-968620100001000092016-01-01T00:02:00Z2001-01-28T00:08:00ZProvider-initiated symptom screening for tuberculosis in Zimbabwe: diagnostic value and the effect of HIV statusS0042-968620100001000102016-01-01T00:02:00Z2001-01-28T00:08:00ZCorbett, Elizabeth LZezai, AbbasCheung, Yin BunBandason, TsitsiDauya, EthelMunyati, Shungu SButterworth, Anthony ERusikaniko, SimbaChurchyard, Gavin JMungofa, StanleyHayes, Richard JMason, Peter R
<em>Corbett, Elizabeth L</em>;
<em>Zezai, Abbas</em>;
<em>Cheung, Yin Bun</em>;
<em>Bandason, Tsitsi</em>;
<em>Dauya, Ethel</em>;
<em>Munyati, Shungu S</em>;
<em>Butterworth, Anthony E</em>;
<em>Rusikaniko, Simba</em>;
<em>Churchyard, Gavin J</em>;
<em>Mungofa, Stanley</em>;
<em>Hayes, Richard J</em>;
<em>Mason, Peter R</em>;
<br/><br/>
OBJECTIVE: To assess the diagnostic value of provider-initiated symptom screening for tuberculosis (TB) and how HIV status affects it. METHODS: We performed a secondary analysis of randomly selected participants in a community-based TB-HIV prevalence survey in Harare, Zimbabwe. All completed a five-symptom questionnaire and underwent sputum TB culture and HIV testing. We calculated the sensitivity, specificity, and positive and negative predictive values of various symptoms and used regression analysis to investigate the relationship between symptoms and TB disease. FINDINGS: We found one or more symptoms of TB in 21.2% of 1858 HIV-positive (HIV+) and 9.9% of 7121 HIV-negative (HIV−) participants (P < 0.001). TB was subsequently diagnosed in 48 HIV+ and 31 HIV− participants. TB was asymptomatic in 18 culture-positive individuals, 8 of whom (4 in each HIV status group) had positive sputum smears. Cough of any duration, weight loss and, for HIV+ participants only, drenching night sweats were independent predictors of TB. In HIV+ participants, cough of > 2 weeks' duration, any symptom and a positive sputum culture had sensitivities of 48%, 81% and 65%, respectively; in HIV− participants, the sensitivities were 45%, 71% and 74%, respectively. Symptoms had a similar sensitivity and specificity in HIV+ and HIV− participants, but in HIV+ participants they had a higher positive and a lower negative predictive value. CONCLUSION: Even smear-positive TB may be missed by provider-initiated symptom screening, especially in HIV+ individuals. Symptom screening is useful for ruling out TB, but better TB diagnostics are urgently needed for resource-poor settings.Multiple types of child maltreatment and adolescent mental health in Viet NamS0042-968620100001000112016-01-01T00:02:00Z2001-01-28T00:08:00ZNguyen, Huong ThanhDunne, Michael PLe, Anh Vu
<em>Nguyen, Huong Thanh</em>;
<em>Dunne, Michael P</em>;
<em>Le, Anh Vu</em>;
<br/><br/>
OBJECTIVE: To examine the prevalence of multiple types of maltreatment (MTM), potentially confounding factors and associations with depression, anxiety and self-esteem among adolescents in Viet Nam. METHODS: In 2006 we conducted a cross-sectional survey of 2591 students (aged 12-18 years; 52.1% female) from randomly-selected classes in eight secondary schools in urban (Hanoi) and rural (Hai Duong) areas of northern Viet Nam (response rate, 94.7%). Sequential multiple regression analyses were performed to estimate the relative influence of individual, family and social characteristics and of eight types of maltreatment, including physical, emotional and sexual abuse and physical or emotional neglect, on adolescent mental health. FINDINGS: Females reported more neglect and emotional abuse, whereas males reported more physical abuse, but no statistically significant difference was found between genders in the prevalence of sexual abuse. Adolescents were classified as having nil (32.6%), one (25.9%), two (20.7%), three (14.5%) or all four (6.3%) maltreatment types. Linear bivariate associations between MTM and depression, anxiety and low self-esteem were observed. After controlling for demographic and family factors, MTM showed significant independent effects. The proportions of the variance explained by the models ranged from 21% to 28%. CONCLUSION: The combined influence of adverse individual and family background factors and of child maltreatment upon mental health in adolescents in Viet Nam is consistent with research in non-Asian countries. Emotional abuse was strongly associated with each health indicator. In Asian communities where child abuse is often construed as severe physical violence, it is important to emphasize the equally pernicious effects of emotional maltreatment.The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidityS0042-968620100001000122016-01-01T00:02:00Z2001-01-28T00:08:00ZBeck, StacyWojdyla, DanielSay, LaleBetran, Ana PilarMerialdi, MarioRequejo, Jennifer HarrisRubens, CraigMenon, RamkumarLook, Paul FA Van
<em>Beck, Stacy</em>;
<em>Wojdyla, Daniel</em>;
<em>Say, Lale</em>;
<em>Betran, Ana Pilar</em>;
<em>Merialdi, Mario</em>;
<em>Requejo, Jennifer Harris</em>;
<em>Rubens, Craig</em>;
<em>Menon, Ramkumar</em>;
<em>Look, Paul Fa Van</em>;
<br/><br/>
OBJECTIVE: To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies. METHODS: Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003-2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data. FINDINGS: We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%). CONCLUSION: Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care.Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortalityS0042-968620100001000132016-01-01T00:02:00Z2001-01-28T00:08:00ZVesel, LindaBahl, RajivMartines, JosePenny, MaryBhandari, NitaKirkwood, Betty R
<em>Vesel, Linda</em>;
<em>Bahl, Rajiv</em>;
<em>Martines, Jose</em>;
<em>Penny, Mary</em>;
<em>Bhandari, Nita</em>;
<em>Kirkwood, Betty R</em>;
<br/><br/>
OBJECTIVE: To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. METHODS: A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. FINDINGS: The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). CONCLUSION: Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.Analysis of the economic impact of cystic echinococcosis in SpainS0042-968620100001000142016-01-01T00:02:00Z2001-01-28T00:08:00ZBenner, ChristineCarabin, HélèneSánchez-Serrano, Luisa PBudke, Christine MCarmena, David
<em>Benner, Christine</em>;
<em>Carabin, Hélène</em>;
<em>Sánchez-Serrano, Luisa P</em>;
<em>Budke, Christine M</em>;
<em>Carmena, David</em>;
<br/><br/>
OBJECTIVE: To estimate the overall economic losses due to human and animal cystic echinococcosis (CE) in Spain in 2005. METHODS: We obtained data on annual CE incidence from surveillance and abattoir records, and on CE-related treatment and productivity losses (human and animal) from the scientific literature. Direct costs were those associated with diagnosis, surgical or chemotherapeutic treatment, medical care and hospitalization in humans, and condemnation of offal in livestock (sheep, goats, cattle and pigs). Indirect costs comprised human productivity losses and the reduction in growth, fecundity and milk production in livestock. The Latin hypercube method was used to represent the uncertainty surrounding the input parameters. FINDINGS: The overall economic loss attributable to CE in humans and animals in 2005 was estimated at 148 964 534 euros (€) (95% credible interval, CI: 21 980 446-394 012 706). Human-associated losses were estimated at €133 416 601 (95% CI: 6 658 738-379 273 434) and animal-associated losses at €15 532 242 (95% CI: 13 447 378-17 789 491). CONCLUSION: CE is a neglected zoonosis that remains a human and animal health concern for Spain. More accurate data on CE prevalence in humans (particularly undiagnosed or asymptomatic cases) and better methods to estimate productivity losses in animals are needed. CE continues to affect certain areas of Spain, despite several control initiatives since 1986. Given the high economic burden of CE, additional funding is needed to reduce human and animal infection rates through improved disease surveillance, regular treatment of dogs and greater cooperation between agencies.Compiling mortality statistics from civil registration systems in Viet Nam: the long road aheadS0042-968620100001000152016-01-01T00:02:00Z2001-01-28T00:08:00ZRao, ChalapatiOsterberger, BrigittaAnh, Tran DamMacDonald, MalcolmChúc, Nguyen Thi KimHill, Peter S
<em>Rao, Chalapati</em>;
<em>Osterberger, Brigitta</em>;
<em>Anh, Tran Dam</em>;
<em>Macdonald, Malcolm</em>;
<em>Chúc, Nguyen Thi Kim</em>;
<em>Hill, Peter S</em>;
<br/><br/>
Accurate mortality statistics, needed for population health assessment, health policy and research, are best derived from data in vital registration systems. However, mortality statistics from vital registration systems are not available for several countries including Viet Nam. We used a mixed methods case study approach to assess vital registration operations in 2006 in three provinces in Viet Nam (Hòa Bình, Thùa Thiên-Hué and Bình Duong), and provide recommendations to strengthen vital registration systems in the country. For each province we developed life tables from population and mortality data compiled by sex and age group. Demographic methods were used to estimate completeness of death registration as an indicator of vital registration performance. Qualitative methods (document review, key informant interviews and focus group discussions) were used to assess administrative, technical and societal aspects of vital registration systems. Completeness of death registration was low in all three provinces. Problems were identified with the legal framework for registration of early neonatal deaths and deaths of temporary residents or migrants. The system does not conform to international standards for reporting cause of death or for recording detailed statistics by age, sex and cause of death. Capacity-building along with an intersectoral coordination committee involving the Ministries of Justice and Health and the General Statistics Office would improve the vital registration system, especially with regard to procedures for death registration. There appears to be strong political support for sentinel surveillance systems to generate reliable mortality statistics in Viet Nam.Global control of hepatitis B virus: does treatment-induced antigenic change affect immunization?S0042-968620100001000162016-01-01T00:02:00Z2001-01-28T00:08:00ZClements, C JohnCoghlan, BenCreati, MickLocarnini, StephenTedder, Richard STorresi, Joseph
<em>Clements, C John</em>;
<em>Coghlan, Ben</em>;
<em>Creati, Mick</em>;
<em>Locarnini, Stephen</em>;
<em>Tedder, Richard S</em>;
<em>Torresi, Joseph</em>;
<br/><br/>
Since its widespread introduction, the hepatitis B vaccine has become an essential part of infant immunization programmes globally. The vaccine has been particularly important for countries where the incidence of hepatitis B virus-related hepatocellular carcinoma is high. Effective treatment options for individuals with chronic hepatitis B infection were limited until 1998 when lamivudine, the first nucleoside analogue drug, was introduced. As a single treatment agent, however, lamivudine has a significant drawback: it induces lamivudine-resistant hepatitis B virus strains that may pose a risk to the global hepatitis B immunization programme. Mutations associated with drug treatment can cause changes to the surface antigen protein, the precise part of the virus that the hepatitis B vaccine mimics. However, the emergence of antiviral drug-associated potential vaccine escape mutants (ADAP-VEMs) in treated patients does not necessarily pose a significant, imminent threat to the global hepatitis B immunization programme. Nonetheless, there is already evidence that current treatment regimens have resulted in the selection of stable ADAP-VEMs. Treatment is currently intended to prevent the long-term complications of hepatitis B virus infection, with little consideration given to potential adverse public health impacts. To address individual and public health concerns, trials are urgently needed to find the optimal combination of existing drugs that are effective but do not induce the emergence of ADAP-VEMs. This paper examines the mechanism of antiviral drug-selected changes in the portion of the viral genome that also affects the surface antigen, and explores their potential impact on current hepatitis B immunization programmes.The mixed health systems syndromeS0042-968620100001000172016-01-01T00:02:00Z2001-01-28T00:08:00ZNishtar, Sania
<em>Nishtar, Sania</em>;
<br/><br/>