Transactions of the Royal Society of Tropical Medicine and Hygiene
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Trans. R. Soc. Trop. Med. Hyg. · Mar 2006
ReviewThe double burden of communicable and non-communicable diseases in developing countries.
Now, at the dawn of the third millennium, non-communicable diseases are sweeping the entire globe. There is an increasing trend in developing countries, where the demographic and socio-economic transition imposes more constraints on dealing with the double burden of infectious and non-infectious diseases in a poor environment, characterized by ill-health systems. It is predicted that, by 2020, non-communicable diseases will cause seven out of every ten deaths in developing countries. ⋯ In parallel, despite the success of vaccination programmes for polio and some childhood diseases, other diseases like AIDS, tuberculosis, malaria and dengue are still out of control in many regions of the globe. This paper is a brief review of recent literature dealing with communicable and non-communicable diseases in developing countries. It gives a global view of the main diseases and their impact on populations living in low- and middle-income nations.
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Trans. R. Soc. Trop. Med. Hyg. · Jan 2006
ReviewIntegrating HIV management for children into the Integrated Management of Childhood Illness guidelines.
The WHO/UNICEF strategy of Integrated Management of Childhood Illness (IMCI) has been adopted as a strategy for improving paediatric care in resource-poor settings. The original IMCI guidelines recommend referral of children with severe or recurrent illnesses such as those common in HIV/AIDS, however the specific identification and management was not included. In many countries, especially in sub-Saharan Africa, HIV/AIDS contributes significantly to child morbidity and mortality. ⋯ Currently, very few children under 15 years of age receive antiretroviral therapy (ART). Chronic HIV care of children, including ART for children, has been developed within the Integrated Management of Adolescent and Adult Illness (IMAI) initiative of the WHO. Through this initiative, the WHO is assisting countries to facilitate care and treatment of children undergoing ART.
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Major changes in research and development (R&D) for drugs to treat tropical and neglected diseases have occurred in the past five years. Public-private partnerships for product development (PD PPPs) have emerged since rising drug development costs pushed pharmaceutical companies out of R&D for these diseases of the developing world and are now having an impact on the discovery and development of new medicines to treat them. PD PPPs can be an efficient model for bridging the translational research gap between basic research and clinical development by bringing together expertise from academia, the pharmaceutical industry and the public sector. ⋯ The partnerships need to widen their funding base and ensure that the funders understand the high level of attrition. Public-private partnerships have proved that they can move compounds quickly through the R&D pipeline. The challenge is to ensure that the products are delivered to the people who need them and to ensure that scientists in endemic countries are involved in the whole process.
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Trans. R. Soc. Trop. Med. Hyg. · Aug 2005
Cerebrospinal fluid levels of markers of brain parenchymal damage in Vietnamese adults with severe malaria.
A retrospective study of cerebrospinal fluid (CSF) markers of brain parenchymal damage was conducted in Vietnamese adults with severe malaria. Three markers were analysed by immunoassays: the microtubule-associated protein tau, for degenerated axons; neuron-specific enolase (NSE), for neurons; and S100B for astrocytes. The mean concentration of tau proteins in the CSF was significantly raised in patients with severe malaria compared with controls (P=0.0003) as reported for other central nervous system diseases. ⋯ Concentrations of axonal and astrocyte degeneration markers also were associated with vital organ dysfunction. No association was found between the level of markers of brain parenchymal damage on admission and a fatal outcome. On admission to hospital, patients with severe malaria had biochemical evidence of brain parenchymal damage predominantly affecting axons.
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Trans. R. Soc. Trop. Med. Hyg. · Apr 2005
Randomized Controlled Trial Clinical TrialPeriodic deworming with albendazole and its impact on growth status and diarrhoeal incidence among children in an urban slum of India.
This study was undertaken to measure the impact of periodic deworming with albendazole on growth status and incidence of diarrhoea in children aged 2-5 years in an urban setting in India and to assess the feasibility of local health workers implementing the procedures involved. This was a double-blind, placebo-controlled, randomized, community-based intervention trial with 702 children randomly allocated to receive either albendazole or placebo. The two study groups received two doses of albendazole (400 mg) or placebo six months apart. ⋯ The albendazole group also experienced fewer episodes of diarrhoea than their control counterparts (relative risk 1.3, 95% CI 1.07-1.53) with a 28% reduction. The health workers administered the correct dosage satisfactorily and there were no adverse effects. Thus, periodic mass deworming with albendazole would seem to be a safe and effective method that could be adopted at the community level or as an integral part of school health services and could be expected to improve growth and reduce the incidence of diarrhoea in children.