Bulletin of the World Health Organizationhttps://www.scielosp.org/feed/bwho/2013.v91n1/2016-01-01T00:02:00ZUnknown authorVol. 91 No. 1 - 2013WerkzeugUnknow title10.2471/BLT.13.0001132016-01-01T00:02:00Z2001-01-28T00:08:00ZUniversal health coverage anchored in the right to health10.2471/BLT.12.1158082016-01-01T00:02:00Z2001-01-28T00:08:00ZOoms, GorikBrolan, ClaireEggermont, NatalieEide, AsbjørnFlores, WalterForman, LisaFriedman, Eric AGebauer, ThomasGostin, Lawrence OHill, Peter SHussain, SameeraMcKee, MartinMulumba, MosesSiddiqui, FarazSridhar, DeviVan Leemput, LucWaris, AttiyaJahn, Albrecht
<em>Ooms, Gorik</em>;
<em>Brolan, Claire</em>;
<em>Eggermont, Natalie</em>;
<em>Eide, Asbjørn</em>;
<em>Flores, Walter</em>;
<em>Forman, Lisa</em>;
<em>Friedman, Eric A</em>;
<em>Gebauer, Thomas</em>;
<em>Gostin, Lawrence O</em>;
<em>Hill, Peter S</em>;
<em>Hussain, Sameera</em>;
<em>Mckee, Martin</em>;
<em>Mulumba, Moses</em>;
<em>Siddiqui, Faraz</em>;
<em>Sridhar, Devi</em>;
<em>Van Leemput, Luc</em>;
<em>Waris, Attiya</em>;
<em>Jahn, Albrecht</em>;
<br/><br/>
No physical health without mental health: lessons unlearned?10.2471/BLT.12.1150632016-01-01T00:02:00Z2001-01-28T00:08:00ZKolappa, KavithaHenderson, David CKishore, Sandeep P
<em>Kolappa, Kavitha</em>;
<em>Henderson, David C</em>;
<em>Kishore, Sandeep P</em>;
<br/><br/>
Public health round-up10.2471/BLT.13.0101132016-01-01T00:02:00Z2001-01-28T00:08:00ZEmerging economies drive frugal innovation10.2471/BLT.13.0201132016-01-01T00:02:00Z2001-01-28T00:08:00ZOnline encyclopedia provides free health info for all10.2471/BLT.13.0301132016-01-01T00:02:00Z2001-01-28T00:08:00ZSetting research priorities for adolescent sexual and reproductive health in low- and middle-income countries10.2471/BLT.12.1075652016-01-01T00:02:00Z2001-01-28T00:08:00ZHindin, Michelle JChristiansen, Charlotte SigurdsonFerguson, B Jane
<em>Hindin, Michelle J</em>;
<em>Christiansen, Charlotte Sigurdson</em>;
<em>Ferguson, B Jane</em>;
<br/><br/>
OBJECTIVE: To conduct an expert-led process for identifying research priorities in adolescent sexual and reproductive health in low- and middle-income countries. METHODS: The authors modified the priority-setting method of the Child Health and Nutrition Research Initiative (CHNRI) to obtain input from nearly 300 researchers, health programme managers and donors with wide-ranging backgrounds and experiences and from all geographic regions. In a three-Phase process, they asked these experts to: (i) rank outcome areas in order of importance; (ii) formulate research questions within each area, and (iii) rank the formulated questions. FINDINGS: Seven areas of adolescent sexual and reproductive health were identified as important: (i) maternal health; (ii) contraception; (iii) gender-based violence; (iv) treatment and care of patients with human immunodeficiency virus (HIV) infection; (v) abortion; (vi) integration of family planning and HIV-related services and (vii) sexually transmitted infections. Experts generated from 30 to 40 research questions in each area, and to prioritize these questions, they applied five criteria focused on: clarity, answerability, impact, implementation and relevance for equity. Rankings were based on overall mean scores derived by averaging the scores for individual criteria. Experts agreed strongly on the relative importance of the questions in each area. CONCLUSION: Research questions on the prevalence of conditions affecting adolescents are giving way to research questions on the scale-up of existing interventions and the development of new ones. CHNRI methods can be used by donors and health programme managers to prioritize research on adolescent sexual and reproductive health.Effect of vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana: a secondary analysis from the ObaapaVitA trial10.2471/BLT.11.1004122016-01-01T00:02:00Z2001-01-28T00:08:00ZHurt, Lisaten Asbroek, AugustinusAmenga-Etego, SeebaZandoh, CharlesDanso, SamuelEdmond, KarenHurt, ChrisTawiah, CharlotteHill, ZeleeFenty, JustinOwusu-Agyei, SethCampbell, Oona MKirkwood, Betty R
<em>Hurt, Lisa</em>;
<em>Ten Asbroek, Augustinus</em>;
<em>Amenga-Etego, Seeba</em>;
<em>Zandoh, Charles</em>;
<em>Danso, Samuel</em>;
<em>Edmond, Karen</em>;
<em>Hurt, Chris</em>;
<em>Tawiah, Charlotte</em>;
<em>Hill, Zelee</em>;
<em>Fenty, Justin</em>;
<em>Owusu-Agyei, Seth</em>;
<em>Campbell, Oona M</em>;
<em>Kirkwood, Betty R</em>;
<br/><br/>
OBJECTIVE: To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. METHODS: A cluster-randomized, triple-blind, placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned, according to their cluster of residence, to receive oral vitamin A (7500 µg) or placebo once a week. Randomization was blocked, with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks, fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians, who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat, based on cluster of residence, with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. FINDINGS: The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms. CONCLUSION: Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age.Cost savings associated with 10 years of road safety policies in Catalonia, Spain10.2471/BLT.12.1100722016-01-01T00:02:00Z2001-01-28T00:08:00ZGarcÃa-Altes, AnnaSuelves, Josep MBarberÃa, Eneko
<em>Garcãa-Altes, Anna</em>;
<em>Suelves, Josep M</em>;
<em>Barberãa, Eneko</em>;
<br/><br/>
OBJECTIVE: To determine whether the road safety policies introduced between 2000 and 2010 in Catalonia, Spain, which aimed primarily to reduce deaths from road traffic collisions by 50% by 2010, were associated with economic benefits to society. METHODS: A cost analysis was performed from a societal perspective with a 10-year time horizon. It considered the costs of: hospital admissions; ambulance transport; autopsies; specialized health care; police, firefighter and roadside assistance; adapting to disability; and productivity lost due to institutionalization, death or sick leave of the injured or their caregivers; as well as material and administrative costs. Data were obtained from a Catalan hospital registry, the Catalan Traffic Service information system, insurance companies and other sources. All costs were calculated in euros (€) at 2011 values. FINDINGS: A substantial reduction in deaths from road traffic collisions was observed between 2000 and 2010. Between 2001 and 2010, with the implementation of new road safety policies, there were 26 063 fewer road traffic collisions with victims than expected, 2909 fewer deaths (57%) and 25 444 fewer hospitalizations. The estimated total cost savings were around €18 000 million. Of these, around 97% resulted from reductions in lost productivity. Of the remaining cost savings, 63% were associated with specialized health care, 15% with adapting to disability and 8.1% with hospital care. CONCLUSION: The road safety policies implemented in Catalonia in recent years were associated with a reduction in the number of deaths and injuries from traffic collisions and with substantial economic benefits to society.Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors10.2471/BLT.12.1045882016-01-01T00:02:00Z2001-01-28T00:08:00ZSkrahina, AlenaHurevich, HenadzZalutskaya, AksanaSahalchyk, EvgeniAstrauko, AndreiHoffner, SvenRusovich, ValiantsinDadu, AndreiColombani, Pierpaolo deDara, Masoudvan Gemert, WayneZignol, Matteo
<em>Skrahina, Alena</em>;
<em>Hurevich, Henadz</em>;
<em>Zalutskaya, Aksana</em>;
<em>Sahalchyk, Evgeni</em>;
<em>Astrauko, Andrei</em>;
<em>Hoffner, Sven</em>;
<em>Rusovich, Valiantsin</em>;
<em>Dadu, Andrei</em>;
<em>Colombani, Pierpaolo De</em>;
<em>Dara, Masoud</em>;
<em>Van Gemert, Wayne</em>;
<em>Zignol, Matteo</em>;
<br/><br/>
OBJECTIVE: To assess the problem of multidrug-resistant tuberculosis (MDR-TB) throughout Belarus and investigate the associated risk factors. METHODS: In a nationwide survey in 2010-2011, 1420 tuberculosis (TB) patients were screened and 934 new and 410 previously treated cases ofTB were found to meet the inclusion criteria. Isolates of Mycobacterium tuberculosis from each eligible patient were tested for susceptibility to anti-TB drugs. Sociobehavioural information was gathered in interviews based on a structured questionnaire. FINDINGS: MDR-TB was found in 32.3% and 75.6% of the new and previously treated patients, respectively, and, 11.9% of the 612 patients found to have MDR-TB had extensively drug-resistant TB (XDR-TB). A history of previous treatment for TB was the strongest independent risk factor for MDR-TB (odds ratio, OR: 6.1; 95% confidence interval, CI: 4.8-7.7). The other independent risk factors were human immunodeficiency virus (HIV) infection (OR: 2.2; 95% CI: 1.4-3.5), age < 35 years (OR: 1.4; 95% CI: 1.0-1.8), history of imprisonment (OR: 1.5; 95% CI: 1.1-2.0), disability sufficient to prevent work (OR: 1.9; 95% CI: 1.2-3.0), alcohol abuse (OR: 1.3; 95% CI: 1.0-1.8) and smoking (OR: 1.5; 95% CI: 1.1-2.0). CONCLUSION: MDR-TB is very common among TB patients throughout Belarus. The numerous risk factors identified for MDR-TB and the convergence of the epidemics of MDR-TB and HIV infection call not only for stronger collaboration between TB and HIV control programmes, but also for the implementation of innovative measures to accelerate the detection of TB resistance and improve treatment adherence.Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis10.2471/BLT.12.1070032016-01-01T00:02:00Z2001-01-28T00:08:00ZSuthar, Amitabh BHoos, DavidBeqiri, AlbaLorenz-Dehne, KarlMcClure, CraigDuncombe, Chris
<em>Suthar, Amitabh B</em>;
<em>Hoos, David</em>;
<em>Beqiri, Alba</em>;
<em>Lorenz-Dehne, Karl</em>;
<em>Mcclure, Craig</em>;
<em>Duncombe, Chris</em>;
<br/><br/>
OBJECTIVE: To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH) clinics could improve programmatic and patient outcomes. METHODS: The authors systematically searched PubMed, Embase, African Index Medicus and LiLACS for randomized controlled trials, prospective cohort studies, or retrospective cohort studies comparing outcomes in ANC or MCH clinics that had and had not integrated ART. The outcomes of interest were ART coverage, ART enrolment, ART retention, mortality and transmission of human immunodeficiency virus (HIV). FINDINGS: Four studies met the inclusion criteria. All were conducted in ANC clinics. Increased enrolment of pregnant women in ART was observed in ANC clinics that had integrated ART (relative risk, RR: 2.09; 95% confidence interval, CI; 1.78-2.46; /²: 15%). Increased ART coverage was also noted in such clinics (RR: 1.37; 95% CI: 1.05-1.79; /²: 83%). Sensitivity analyses revealed a trend for the national prevalence of HIV infection to explain the heterogeneity in the size of the effect of ART integration on ART coverage (P=0.13). Retention in ART was similar in ANC clinics with and without ART integration. CONCLUSION: Although few data were available, ART integration in ANC clinics appears to lead to higher rates of ART enrolment and ART coverage. Rates of retention in ART remain similar to those observed in referral-based models.Aid for Trade: an opportunity to increase fruit and vegetable supply10.2471/BLT.12.1069552016-01-01T00:02:00Z2001-01-28T00:08:00ZThow, Anne MariePriyadarshi, Shishir
<em>Thow, Anne Marie</em>;
<em>Priyadarshi, Shishir</em>;
<br/><br/>
Low fruit and vegetable consumption is an important contributor to the global burden of disease. In the wake of the United Nations High-level Meeting on Non-Communicable Diseases (NCDs), held in September 2011, a rise in the consumption of fruits and vegetables is foreseeable and this increased demand will have to be met through improved supply. The World Health Organization, the Food and Agriculture Organization and the World Bank have highlighted the potential for developing countries to benefit nutritionally and economically from the increased production and export of fruit and vegetables. Aid for Trade, launched in 2005 as an initiative designed to link development aid and trade holistically, offers an opportunity for the health and trade sectors to work jointly to enhance health and development. The Aid for Trade work programme stresses the importance of policy coherence across sectors, yet the commonality of purpose driving the Aid for Trade initiative and NCD prevention efforts has not been explored. In this paper food supply chain analysis was used to show health policy-makers that Aid for Trade can provide a mechanism for increasing the supply of fruits and vegetables in developing countries. Aid for Trade is an existing funding channel with clear accountability and reporting mechanisms, but its priorities are determined with little or no input from the health sector. The paper seeks to enable public health policy-makers, practitioners and advocates to improve coherence between trade and public health policies by highlighting Aid for Trade's potential role in this endeavour.Eliminating mother-to-child HIV transmission in South Africa10.2471/BLT.12.1068072016-01-01T00:02:00Z2001-01-28T00:08:00ZBarron, PeterPillay, YoganDoherty, TanyaSherman, GayleJackson, DebraBhardwaj, SanjanaRobinson, PreciousGoga, Ameena
<em>Barron, Peter</em>;
<em>Pillay, Yogan</em>;
<em>Doherty, Tanya</em>;
<em>Sherman, Gayle</em>;
<em>Jackson, Debra</em>;
<em>Bhardwaj, Sanjana</em>;
<em>Robinson, Precious</em>;
<em>Goga, Ameena</em>;
<br/><br/>
PROBLEM: The World Health Organization has produced clear guidelines for the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV). However, ensuring that all PMTCT programme components are implemented to a high quality in all facilities presents challenges. APPROACH: Although South Africa initiated its PMTCT programme in 2002, later than most other countries, political support has increased since 2008. Operational research has received more attention and objective data have been used more effectively. LOCAL SETTING: In 2010, around 30% of all pregnant women in South Africa were HIV-positive and half of all deaths in children younger than 5 years were associated with the virus. RELEVANT CHANGES: Between 2008 and 2011, the estimated proportion of HIV-exposed infants younger than 2 months who underwent routine polymerase chain reaction (PCR) tests to detect early HIV transmission increased from 36.6% to 70.4%. The estimated HIV transmission rate decreased from 9.6% to 2.8%. Population-based surveys in 2010 and 2011 reported transmission rates of 3.5% and 2.7%, respectively. LESSONS LEARNT: Critical actions for improving programme outcomes included: ensuring rapid implementation of changes in PMTCT policy at the field level through training and guideline dissemination; ensuring good coordination with technical partners, such as international health agencies and international and local nongovernmental organizations; and making use of data and indicators on all aspects of the PMTCT programme. Enabling health-care staff at primary care facilities to initiate antiretroviral therapy and expanding laboratory services for measuring CD4+ T-cell counts and for PCR testing were also helpful.Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China10.2471/BLT.12.1094472016-01-01T00:02:00Z2001-01-28T00:08:00ZDing, YanSmith, Helen JFei, YangXu, BiaoNie, ShaofaYan, WeirongDiwan, Vinod KSauerborn, RainerDong, Hengjin
<em>Ding, Yan</em>;
<em>Smith, Helen J</em>;
<em>Fei, Yang</em>;
<em>Xu, Biao</em>;
<em>Nie, Shaofa</em>;
<em>Yan, Weirong</em>;
<em>Diwan, Vinod K</em>;
<em>Sauerborn, Rainer</em>;
<em>Dong, Hengjin</em>;
<br/><br/>
PROBLEM: The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. APPROACH: To understand village doctors'perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. LOCAL SETTING: The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. RELEVANT CHANGES: Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. LESSONS LEARNT: Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors.Vaccine Presentation and Packaging Advisory Group: a forum for reaching consensus on vaccine product attributes10.2471/BLT.12.1107002016-01-01T00:02:00Z2001-01-28T00:08:00ZMansoor, Osman DavidKristensen, DebraMeek, AndrewZipursky, SimonaPopova, OlgaSharma, InderJitMiranda, GiseleMillogo, JulesLasher, Heidi
<em>Mansoor, Osman David</em>;
<em>Kristensen, Debra</em>;
<em>Meek, Andrew</em>;
<em>Zipursky, Simona</em>;
<em>Popova, Olga</em>;
<em>Sharma, Inderjit</em>;
<em>Miranda, Gisele</em>;
<em>Millogo, Jules</em>;
<em>Lasher, Heidi</em>;
<br/><br/>