Bulletin of the World Health Organizationhttps://www.scielosp.org/feed/bwho/2015.v93n8/2016-01-01T00:02:00ZUnknown authorVol. 93 No. 8 - 2015WerkzeugIn this month's Bulletin12.2471/BLT.15.0008152016-01-01T00:02:00Z2001-01-28T00:08:00ZGross national happiness and health: lessons from Bhutan10.2471/BLT.15.1607542016-01-01T00:02:00Z2001-01-28T00:08:00ZSithey, GyamboThow, Anne-MarieLi, Mu
<em>Sithey, Gyambo</em>;
<em>Thow, Anne-Marie</em>;
<em>Li, Mu</em>;
<br/><br/>
Public health round-up10.2471/BLT.15.0108152016-01-01T00:02:00Z2001-01-28T00:08:00ZBoosting health skills in Ukraine10.2471/BLT.15.0208152016-01-01T00:02:00Z2001-01-28T00:08:00ZSpace technologies for health10.2471/BLT.15.0308152016-01-01T00:02:00Z2001-01-28T00:08:00ZNew indicators for delay in initiation of antiretroviral treatment: estimates for Cameroon10.2471/BLT.14.1478922016-01-01T00:02:00Z2001-01-28T00:08:00ZNdawinz, Jacques DAAnglaret, XavierDelaporte, EricKoulla-Shiro, SinataGabillard, DelphineMinga, AlbertCostagliola, DominiqueSupervie, Virginie
<em>Ndawinz, Jacques Da</em>;
<em>Anglaret, Xavier</em>;
<em>Delaporte, Eric</em>;
<em>Koulla-Shiro, Sinata</em>;
<em>Gabillard, Delphine</em>;
<em>Minga, Albert</em>;
<em>Costagliola, Dominique</em>;
<em>Supervie, Virginie</em>;
<br/><br/>
AbstractObjective To propose two new indicators for monitoring access to antiretroviral treatment (ART) for human immunodeficiency virus (HIV); (i) the time from HIV seroconversion to ART initiation, and (ii) the time from ART eligibility to initiation, referred to as delay in ART initiation. To estimate values of these indicators in Cameroon.Methods We used linear regression to model the natural decline in CD4+ T-lymphocyte (CD4+ cell) numbers in HIV-infected individuals over time. The model was fitted using data from a cohort of 351 people in Côte d'Ivoire. We used the model to estimate the time from seroconversion to ART initiation and the delay in ART initiation in a representative sample of 4154 HIV-infected people who started ART in Cameroon between 2007 and 2010.Findings In Cameroon, the median CD4+ cell counts at ART initiation increased from 140 cells/μl (interquartile range, IQR: 66 to 210) in 2007-2009 to 163 cells/μl (IQR: 73 to 260) in 2010. The estimated average time from seroconversion to ART initiation decreased from 10.4 years (95% confidence interval, CI: 10.3 to 10.5) to 9.8 years (95% CI: 9.6 to 10.0). Delay in ART initiation increased from 3.4 years (95% CI: 3.1 to 3.7) to 5.8 years (95% CI: 5.6 to 6.2).Conclusion The estimated time to initiate ART and the delay in ART initiation indicate that progress in Cameroon is insufficient. These indicators should help monitor whether public health interventions to accelerate ART initiation are successful.Monitoring of HIV treatment in seven countries in the WHO Region of the Americas10.2471/BLT.14.1474472016-01-01T00:02:00Z2001-01-28T00:08:00ZBelaunzarán-Zamudio, Pablo FCaro-Vega, Yanink NShepherd, Bryan ECrabtree-Ramírez, Brenda ELuz, Paula MGrinsztejn, BeatrizCesar, CarinaCahn, PedroCortés, ClaudiaWolff, MarceloPape, Jean WPadgett, DenisGotuzzo, EduardoMcGowan, CatherineSierra-Madero, Juan G
<em>Belaunzarán-Zamudio, Pablo F</em>;
<em>Caro-Vega, Yanink N</em>;
<em>Shepherd, Bryan E</em>;
<em>Crabtree-Ramírez, Brenda E</em>;
<em>Luz, Paula M</em>;
<em>Grinsztejn, Beatriz</em>;
<em>Cesar, Carina</em>;
<em>Cahn, Pedro</em>;
<em>Cortés, Claudia</em>;
<em>Wolff, Marcelo</em>;
<em>Pape, Jean W</em>;
<em>Padgett, Denis</em>;
<em>Gotuzzo, Eduardo</em>;
<em>Mcgowan, Catherine</em>;
<em>Sierra-Madero, Juan G</em>;
<br/><br/>
AbstractObjective To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas. Methods We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated.Findings The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti.Conclusion In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.Estimating the burden of foodborne diseases in Japan10.2471/BLT.14.1480562016-01-01T00:02:00Z2001-01-28T00:08:00ZKumagai, YukoGilmour, StuartOta, ErikaMomose, YoshikaOnishi, ToshiroFeliciano Bilano, Ver LuanniKasuga, FumikoSekizaki, TsutomuShibuya, Kenji
<em>Kumagai, Yuko</em>;
<em>Gilmour, Stuart</em>;
<em>Ota, Erika</em>;
<em>Momose, Yoshika</em>;
<em>Onishi, Toshiro</em>;
<em>Feliciano Bilano, Ver Luanni</em>;
<em>Kasuga, Fumiko</em>;
<em>Sekizaki, Tsutomu</em>;
<em>Shibuya, Kenji</em>;
<br/><br/>
AbstractObjective To assess the burden posed by foodborne diseases in Japan using methods developed by the World Health Organization's Foodborne Disease Burden Epidemiology Reference Group (FERG).Methods Expert consultation and statistics on food poisoning during 2011 were used to identify three common causes of foodborne disease in Japan: Campylobacter and Salmonella species and enterohaemorrhagic Escherichia coli (EHEC). We conducted systematic reviews of English and Japanese literature on the complications caused by these pathogens, by searching Embase, the Japan medical society abstract database and Medline. We estimated the annual incidence of acute gastroenteritis from reported surveillance data, based on estimated probabilities that an affected person would visit a physician and have gastroenteritis confirmed. We then calculated disability-adjusted life-years (DALYs) lost in 2011, using the incidence estimates along with disability weights derived from published studies.Findings In 2011, foodborne disease caused by Campylobacter species, Salmonella species and EHEC led to an estimated loss of 6099, 3145 and 463 DALYs in Japan, respectively. These estimated burdens are based on the pyramid reconstruction method; are largely due to morbidity rather than mortality; and are much higher than those indicated by routine surveillance data.Conclusion Routine surveillance data may indicate foodborne disease burdens that are much lower than the true values. Most of the burden posed by foodborne disease in Japan comes from secondary complications. The tools developed by FERG appear useful in estimating disease burdens and setting priorities in the field of food safety.Effectiveness of emergency water treatment practices in refugee camps in South Sudan10.2471/BLT.14.1476452016-01-01T00:02:00Z2001-01-28T00:08:00ZAli, Syed ImranAli, Syed SaadFesselet, Jean-Francois
<em>Ali, Syed Imran</em>;
<em>Ali, Syed Saad</em>;
<em>Fesselet, Jean-Francois</em>;
<br/><br/>
AbstractObjective To investigate the concentration of residual chlorine in drinking water supplies in refugee camps, South Sudan, March-April 2013.Methods For each of three refugee camps, we measured physical and chemical characteristics of water supplies at four points after distribution: (i) directly from tapstands; (ii) after collection; (iii) after transport to households; and (iv) after several hours of household storage. The following parameters were measured: free and total residual chlorine, temperature, turbidity, pH, electrical conductivity and oxidation reduction potential. We documented water handling practices with spot checks and respondent self-reports. We analysed factors affecting residual chlorine concentrations using mathematical and linear regression models.Findings For initial free residual chlorine concentrations in the 0.5-1.5 mg/L range, a decay rate of ~5x10-3 L/mg/min was found across all camps. Regression models showed that the decay of residual chlorine was related to initial chlorine levels, electrical conductivity and air temperature. Covering water storage containers, but not other water handling practices, improved the residual chlorine levels.Conclusion The concentrations of residual chlorine that we measured in water supplies in refugee camps in South Sudan were too low. We tentatively recommend that the free residual chlorine guideline be increased to 1.0 mg/L in all situations, irrespective of diarrhoeal disease outbreaks and the pH or turbidity of water supplies. According to our findings, this would ensure a free residual chlorine level of 0.2 mg/L for at least 10 hours after distribution. However, it is unknown whether our findings are generalizable to other camps and further studies are therefore required.Climate change, cash transfers and health10.2471/BLT.14.1500372016-01-01T00:02:00Z2001-01-28T00:08:00ZPega, FrankShaw, CarolineRasanathan, KumananYablonski, JenniferKawachi, IchiroHales, Simon
<em>Pega, Frank</em>;
<em>Shaw, Caroline</em>;
<em>Rasanathan, Kumanan</em>;
<em>Yablonski, Jennifer</em>;
<em>Kawachi, Ichiro</em>;
<em>Hales, Simon</em>;
<br/><br/>
AbstractThe forecast consequences of climate change on human health are profound, especially in low- and middle-income countries and among the most disadvantaged populations. Innovative policy tools are needed to address the adverse health effects of climate change. Cash transfers are established policy tools for protecting population health before, during and after climate-related disasters. For example, the Ethiopian Productive Safety Net Programme provides cash transfers to reduce food insecurity resulting from droughts. We propose extending cash transfer interventions to more proactive measures to improve health in the context of climate change. We identify promising cash transfer schemes that could be used to prevent the adverse health consequences of climatic hazards. Cash transfers for using emission-free, active modes of transport - e.g. cash for cycling to work - could prevent future adverse health consequences by contributing to climate change mitigation and, at the same time, improving current population health. Another example is cash transfers provided to communities that decide to move to areas in which their lives and health are not threatened by climatic disasters. More research on such interventions is needed to ensure that they are effective, ethical, equitable and cost-effective.National health accounts data from 1996 to 2010: a systematic review10.2471/BLT.14.1452352016-01-01T00:02:00Z2001-01-28T00:08:00ZBui, Anthony LLavado, Rouselle FJohnson, Elizabeth KBrooks, Benjamin PCFreeman, Michael KGraves, Casey MHaakenstad, AnnieShoemaker, BenjaminHanlon, MichaelDieleman, Joseph L
<em>Bui, Anthony L</em>;
<em>Lavado, Rouselle F</em>;
<em>Johnson, Elizabeth K</em>;
<em>Brooks, Benjamin Pc</em>;
<em>Freeman, Michael K</em>;
<em>Graves, Casey M</em>;
<em>Haakenstad, Annie</em>;
<em>Shoemaker, Benjamin</em>;
<em>Hanlon, Michael</em>;
<em>Dieleman, Joseph L</em>;
<br/><br/>
AbstractObjective:To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010.Methods:We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD's first edition of A system of health accounts manual, (2000).Findings:We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/.Conclusion:Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.Emergency care in 59 low- and middle-income countries: a systematic review10.2471/BLT.14.1483382016-01-01T00:02:00Z2001-01-28T00:08:00ZObermeyer, ZiadAbujaber, SamerMakar, MaggieStoll, SamanthaKayden, Stephanie RWallis, Lee AReynolds, Teri A
<em>Obermeyer, Ziad</em>;
<em>Abujaber, Samer</em>;
<em>Makar, Maggie</em>;
<em>Stoll, Samantha</em>;
<em>Kayden, Stephanie R</em>;
<em>Wallis, Lee A</em>;
<em>Reynolds, Teri A</em>;
<br/><br/>
AbstractObjective To conduct a systematic review of emergency care in low- and middle-income countries (LMICs).Methods. We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards.Findings We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2-5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3-8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5-6.3%). The median number of patients was 30 000 per year (IQR: 10 296-60 000), most of whom were young (median age: 35 years; IQR: 6.9-41.0) and male (median: 55.7%; IQR: 50.0-59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care.Conclusion Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.Aggression in mental health settings: a case study in Ghana10.2471/BLT.14.1458132016-01-01T00:02:00Z2001-01-28T00:08:00ZJack, HelenCanavan, MaureenBradley, ElizabethOfori-Atta, Angela
<em>Jack, Helen</em>;
<em>Canavan, Maureen</em>;
<em>Bradley, Elizabeth</em>;
<em>Ofori-Atta, Angela</em>;
<br/><br/>
Corrigendum10.2471/BLT.14.145813e2016-01-01T00:02:00Z2001-01-28T00:08:00Z