Bulletin of the World Health Organizationhttps://www.scielosp.org/journal/bwho/feed/2016-01-01T00:02:00ZUnknown authorVol. 93 No. 12 - 2015WerkzeugIn This Month's Bulletin10.2471/BLT.15.0012152016-01-01T00:02:00Z2001-01-28T00:08:00ZLearning from Ebola: readiness for outbreaks and emergencies10.2471/BLT.15.1657202016-01-01T00:02:00Z2001-01-28T00:08:00ZChan, Margaret
<em>Chan, Margaret</em>;
<br/><br/>
Climate change and health in Pacific island states10.2471/BLT.15.1661992016-01-01T00:02:00Z2001-01-28T00:08:00ZKim, RokhoCostello, AnthonyCampbell-Lendrum, Diarmid
<em>Kim, Rokho</em>;
<em>Costello, Anthony</em>;
<em>Campbell-Lendrum, Diarmid</em>;
<br/><br/>
Public health round-up10.2471/BLT.15.0112152016-01-01T00:02:00Z2001-01-28T00:08:00ZEurope gears up to attend to refugees' health10.2471/BLT.15.0212152016-01-01T00:02:00Z2001-01-28T00:08:00Z
Countries already squeezed by the financial crisis are struggling to respond to the health needs of large numbers of refugees and migrants. Andréia Azevedo Soares and Menelaos Tzafalias report.WHO steps up its role in health emergencies10.2471/BLT.15.0312152016-01-01T00:02:00Z2001-01-28T00:08:00Z
The World Health Organization is on the brink of a major transformation into an agency that is fully mandated and equipped to respond to outbreaks and humanitarian emergencies. David Nabarro talks to Fiona Fleck.Tuberculosis-associated mortality in Shanghai, China: a longitudinal study10.2471/BLT.15.1541612016-01-01T00:02:00Z2001-01-28T00:08:00ZWang, WeibingZhao, QiYuan, ZhenganZheng, YihuiZhang, YixingLu, LipingHou, YunZhang, YueXu, Biao
<em>Wang, Weibing</em>;
<em>Zhao, Qi</em>;
<em>Yuan, Zhengan</em>;
<em>Zheng, Yihui</em>;
<em>Zhang, Yixing</em>;
<em>Lu, Liping</em>;
<em>Hou, Yun</em>;
<em>Zhang, Yue</em>;
<em>Xu, Biao</em>;
<br/><br/>
Abstract Objective To determine excess mortality in a cohort of people with tuberculosis in Shanghai. Methods Participants were local residents in 4 (of 19) districts in Shanghai, registered in one of four tuberculosis clinics between January 1, 2004 and December 31, 2008. Baseline data were collected at the most recent diagnosis of tuberculosis and mortality was assessed between March and May of 2014. We calculated standardized mortality ratios (SMR) and case-fatality rates for all participants and for subgroups. Univariate and multivariate Cox regression models were used to quantify associations between co-morbidities and mortality from all causes and from tuberculosis. Findings We registered 4569 subjects in the cohort. Overall, the cohort had an SMR for deaths from all causes of 5.2 (95% confidence interval, CI: 4.8-5.6). Males had a higher SMR than females (6.1 versus 3.0). After adjustment for age and sex, hazard ratios (HR) for deaths from all causes were significantly greater in previously treated people (HR: 1.26; 95% CI: 1.08-1.49) and sputum smear-test positive people (HR: 1.55; 95% CI: 1.35-1.78). The risk of death from tuberculosis was also significantly greater for previously treated people (HR: 1.88; 95% CI: 1.24-2.86) and smear positive people (HR: 3.16; 95% CI: 2.06-4.87). Conclusion People with tuberculosis in Shanghai have an increased risk of mortality. Earlier diagnosis and more vigilant follow-up may help to reduce mortality in this group.Improving outcomes for caregivers through treatment of young people affected by war: a randomized controlled trial in Sierra Leone10.2471/BLT.14.1391052016-01-01T00:02:00Z2001-01-28T00:08:00ZMcBain, Ryan KSalhi, CarmelHann, KatrinaKellie, JimKamara, AlimamySalomon, Joshua AKim, Jane JBetancourt, Theresa S
<em>Mcbain, Ryan K</em>;
<em>Salhi, Carmel</em>;
<em>Hann, Katrina</em>;
<em>Kellie, Jim</em>;
<em>Kamara, Alimamy</em>;
<em>Salomon, Joshua A</em>;
<em>Kim, Jane J</em>;
<em>Betancourt, Theresa S</em>;
<br/><br/>
Abstract Objective To measure the benefits to household caregivers of a psychotherapeutic intervention for adolescents and young adults living in a war-affected area. Methods Between July 2012 and July 2013, we carried out a randomized controlled trial of the Youth Readiness Intervention - a cognitive-behavioural intervention for war-affected young people who exhibit depressive and anxiety symptoms and conduct problems - in Freetown, Sierra Leone. Overall, 436 participants aged 15-24 years were randomized to receive the intervention (n = 222) or care as usual ( n = 214). Household caregivers for the participants in the intervention arm (n = 101) or control arm ( n = 103) were interviewed during a baseline survey and again, if available (n = 155), 12 weeks later in a follow-up survey. We used a burden assessment scale to evaluate the burden of care placed on caregivers in terms of emotional distress and functional impairment. The caregivers' mental health - i.e. internalizing, externalizing and prosocial behaviour - was evaluated using the Oxford Measure of Psychosocial Adjustment. Difference-in-differences multiple regression analyses were used, within an intention-to-treat framework, to estimate the treatment effects. Findings Compared with the caregivers of participants of the control group, the caregivers of participants of the intervention group reported greater reductions in emotional distress (scale difference: 0.252; 95% confidence interval, CI: 0.026-0.4782) and greater improvements in prosocial behaviour (scale difference: 0.249; 95% CI: 0.012-0.486) between the two surveys. Conclusion A psychotherapeutic intervention for war-affected young people can improve the mental health of their caregivers.Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia10.2471/BLT.15.1602672016-01-01T00:02:00Z2001-01-28T00:08:00ZSmith, ChrisNgo, Thoai DGold, JudyEdwards, PhilVannak, UkSokhey, LyMachiyama, KazuyoSlaymaker, EmmaWarnock, RubyMcCarthy, OnaFree, Caroline
<em>Smith, Chris</em>;
<em>Ngo, Thoai D</em>;
<em>Gold, Judy</em>;
<em>Edwards, Phil</em>;
<em>Vannak, Uk</em>;
<em>Sokhey, Ly</em>;
<em>Machiyama, Kazuyo</em>;
<em>Slaymaker, Emma</em>;
<em>Warnock, Ruby</em>;
<em>Mccarthy, Ona</em>;
<em>Free, Caroline</em>;
<br/><br/>
Abstract Objective To assess the effect of a mobile phone-based intervention (mHealth) on post-abortion contraception use by women in Cambodia. Methods The Mobile Technology for Improved Family Planning (MOTIF) study involved women who sought safe abortion services at four Marie Stopes International clinics in Cambodia. We randomly allocated 249 women to a mobile phone-based intervention, which comprised six automated, interactive voice messages with counsellor phone support, as required, whereas 251 women were allocated to a control group receiving standard care. The primary outcome was the self-reported use of an effective contraceptive method, 4 and 12 months after an abortion. Findings Data on effective contraceptive use were available for 431 (86%) participants at 4 months and 328 (66%) at 12 months. Significantly more women in the intervention than the control group reported effective contraception use at 4 months (64% versus 46%, respectively; relative risk, RR: 1.39; 95% confidence interval, CI: 1.17-1.66) but not at 12 months (50% versus 43%, respectively; RR: 1.16; 95% CI: 0.92-1.47). However, significantly more women in the intervention group reported using a long-acting contraceptive method at both follow-up times. There was no significant difference between the groups in repeat pregnancies or abortions at 4 or 12 months. Conclusion Adding a mobile phone-based intervention to abortion care services in Cambodia had a short-term effect on the overall use of any effective contraception, while the use of long-acting contraceptive methods lasted throughout the study period.The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries10.2471/BLT.15.1558462016-01-01T00:02:00Z2001-01-28T00:08:00ZSavell, EmilyGilmore, Anna BSims, MichelleMony, Prem KKoon, TeoYusoff, KhalidLear, Scott ASeron, PamelaIsmail, NoorhassimCalik, K Burcu TumerdemRosengren, AnnikaBahonar, AhmadKumar, RajeshVijayakumar, KrishnapillaiKruger, AnnamarieSwidan, HanyGupta, RajeevIgumbor, EhimarioAfridi, AsadRahman, OmarChifamba, JephatZatonska, KatarzynaMohan, VMohan, DeepaLopez-Jaramillo, PatricioAvezum, AlvaroPoirier, PaulOrlandini, AndresLi, WeiMcKee, MartinRangarajan, SumathyYusuf, SalimChow, Clara K
<em>Savell, Emily</em>;
<em>Gilmore, Anna B</em>;
<em>Sims, Michelle</em>;
<em>Mony, Prem K</em>;
<em>Koon, Teo</em>;
<em>Yusoff, Khalid</em>;
<em>Lear, Scott A</em>;
<em>Seron, Pamela</em>;
<em>Ismail, Noorhassim</em>;
<em>Calik, K Burcu Tumerdem</em>;
<em>Rosengren, Annika</em>;
<em>Bahonar, Ahmad</em>;
<em>Kumar, Rajesh</em>;
<em>Vijayakumar, Krishnapillai</em>;
<em>Kruger, Annamarie</em>;
<em>Swidan, Hany</em>;
<em>Gupta, Rajeev</em>;
<em>Igumbor, Ehimario</em>;
<em>Afridi, Asad</em>;
<em>Rahman, Omar</em>;
<em>Chifamba, Jephat</em>;
<em>Zatonska, Katarzyna</em>;
<em>Mohan, V</em>;
<em>Mohan, Deepa</em>;
<em>Lopez-Jaramillo, Patricio</em>;
<em>Avezum, Alvaro</em>;
<em>Poirier, Paul</em>;
<em>Orlandini, Andres</em>;
<em>Li, Wei</em>;
<em>Mckee, Martin</em>;
<em>Rangarajan, Sumathy</em>;
<em>Yusuf, Salim</em>;
<em>Chow, Clara K</em>;
<br/><br/>
Abstract Objective To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. Methods Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders. Findings Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11 842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. Conclusion Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.Rapid diagnostic tests for malaria10.2471/BLT.14.1511672016-01-01T00:02:00Z2001-01-28T00:08:00ZVisser, TheodoorDaily, JenniferHotte, NoraDolkart, CaitlinCunningham, JaneYadav, Prashant
<em>Visser, Theodoor</em>;
<em>Daily, Jennifer</em>;
<em>Hotte, Nora</em>;
<em>Dolkart, Caitlin</em>;
<em>Cunningham, Jane</em>;
<em>Yadav, Prashant</em>;
<br/><br/>
Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are challenges for governments and international agencies. In this paper we discuss these issues with reference to rapid diagnostic tests for malaria. Strategies to control and eliminate malaria depend on early and accurate diagnosis. Rapid diagnostic tests for malaria require little training and equipment and can be performed by non-specialists in remote settings. Use of these tests has expanded significantly over the last few years, following recommendations to test all suspected malaria cases before treatment and the implementation of an evaluation programme to assess the performance of the malaria rapid diagnostic tests. Despite these gains, challenges exist that, if not addressed, could jeopardize the progress made to date. We discuss recent developments in rapid diagnostic tests for malaria, highlight some of the challenges and provide suggestions to address them.Strategies for achieving global collective action on antimicrobial resistance10.2471/BLT.15.1531712016-01-01T00:02:00Z2001-01-28T00:08:00ZHoffman, Steven JCaleo, Grazia MDaulaire, NilsElbe, StefanMatsoso, PreciousMossialos, EliasRizvi, ZainRøttingen, John-Arne
<em>Hoffman, Steven J</em>;
<em>Caleo, Grazia M</em>;
<em>Daulaire, Nils</em>;
<em>Elbe, Stefan</em>;
<em>Matsoso, Precious</em>;
<em>Mossialos, Elias</em>;
<em>Rizvi, Zain</em>;
<em>Røttingen, John-Arne</em>;
<br/><br/>
Global governance and market failures mean that it is not possible to ensure access to antimicrobial medicines of sustainable effectiveness. Many people work to overcome these failures, but their institutions and initiatives are insufficiently coordinated, led and financed. Options for promoting global collective action on antimicrobial access and effectiveness include building institutions, crafting incentives and mobilizing interests. No single option is sufficient to tackle all the challenges associated with antimicrobial resistance. Promising institutional options include monitored milestones and an inter-agency task force. A global pooled fund could be used to craft incentives and a special representative nominated as an interest mobilizer. There are three policy components to the problem of antimicrobials - ensuring access, conservation and innovation. To address all three components, the right mix of options needs to be matched with an effective forum and may need to be supported by an international legal framework.The environmental and health impacts of tobacco agriculture, cigarette manufacture and consumption10.2471/BLT.15.1527442016-01-01T00:02:00Z2001-01-28T00:08:00ZNovotny, Thomas EBialous, Stella AguinagaBurt, LindsayCurtis, CliftonCosta, Vera Luiza daIqtidar, Silvae UsmanLiu, YuchenPujari, SameerTursan d'Espaignet, Edouard
<em>Novotny, Thomas E</em>;
<em>Bialous, Stella Aguinaga</em>;
<em>Burt, Lindsay</em>;
<em>Curtis, Clifton</em>;
<em>Costa, Vera Luiza Da</em>;
<em>Iqtidar, Silvae Usman</em>;
<em>Liu, Yuchen</em>;
<em>Pujari, Sameer</em>;
<em>Tursan D'espaignet, Edouard</em>;
<br/><br/>
The health consequences of tobacco use are well known, but less recognized are the significant environmental impacts of tobacco production and use. The environmental impacts of tobacco include tobacco growing and curing; product manufacturing and distribution; product consumption; and post-consumption waste. The World Health Organization's Framework Convention on Tobacco Control addresses environmental concerns in Articles 17 and 18, which primarily apply to tobacco agriculture. Article 5.3 calls for protection from policy interference by the tobacco industry regarding the environmental harms of tobacco production and use. We detail the environmental impacts of the tobacco life-cycle and suggest policy responses.A telemedicine network for remote paediatric cardiology services in north-east Brazil10.2471/BLT.14.1488742016-01-01T00:02:00Z2001-01-28T00:08:00ZMattos, Sandra da SilvaHazin, Sheila Maria VieiraRegis, Cláudio TeixeiraAraújo, Juliana Sousa Soares deAlbuquerque, Fernanda Cruz de LiraMoser, Lúcia Roberta Didier NunesHatem, Thamine de PaulaFreitas, Carolina Paim Gomes deMourato, Felipe AlvesTavares, Thiago RibeiroGomes, Renata Grigório SilvaSeveria, RossanSantosa, Cícera RochaSilva, Jailson Ferreira daRezende, Juliana LandimVieira, Paulo CoelhoLima Filho, José Luiz de
<em>Mattos, Sandra Da Silva</em>;
<em>Hazin, Sheila Maria Vieira</em>;
<em>Regis, Cláudio Teixeira</em>;
<em>Araújo, Juliana Sousa Soares De</em>;
<em>Albuquerque, Fernanda Cruz De Lira</em>;
<em>Moser, Lúcia Roberta Didier Nunes</em>;
<em>Hatem, Thamine De Paula</em>;
<em>Freitas, Carolina Paim Gomes De</em>;
<em>Mourato, Felipe Alves</em>;
<em>Tavares, Thiago Ribeiro</em>;
<em>Gomes, Renata Grigório Silva</em>;
<em>Severia, Rossan</em>;
<em>Santosa, Cícera Rocha</em>;
<em>Silva, Jailson Ferreira Da</em>;
<em>Rezende, Juliana Landim</em>;
<em>Vieira, Paulo Coelho</em>;
<em>Lima Filho, José Luiz De</em>;
<br/><br/>
Abstract Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births ( P< 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.Including migrant populations in health impact assessments10.2471/BLT.14.1423152016-01-01T00:02:00Z2001-01-28T00:08:00ZMiramontes, LaraPottie, KevinJandu, Maria BenkhaltiWelch, VivianMiller, KeithJames, MeganRoberts, Janet Hatcher
<em>Miramontes, Lara</em>;
<em>Pottie, Kevin</em>;
<em>Jandu, Maria Benkhalti</em>;
<em>Welch, Vivian</em>;
<em>Miller, Keith</em>;
<em>James, Megan</em>;
<em>Roberts, Janet Hatcher</em>;
<br/><br/>