Bulletin of the World Health Organization
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Bull. World Health Organ. · Jan 1997
Comparative StudyEvaluation of an algorithm for integrated management of childhood illness in an area of Kenya with high malaria transmission.
In 1993, the World Health Organization completed the development of a draft algorithm for the integrated management of childhood illness (IMCI), which deals with acute respiratory infections, diarrhoea, malaria, measles, ear infections, malnutrition, and immunization status. The present study compares the performance of a minimally trained health worker to make a correct diagnosis using the draft IMCI algorithm with that of a fully trained paediatrician who had laboratory and radiological support. During the 14-month study period, 1795 children aged between 2 months and 5 years were enrolled from the outpatient paediatric clinic of Siaya District Hospital in western Kenya; 48% were female and the median age was 13 months. ⋯ There was substantial clinical overlap between pneumonia and malaria (n = 895), and between malaria and malnutrition (n = 811). Based on the initial analysis of these data, some changes were made in the IMCI algorithm. This study provides important technical validation of the IMCI algorithm, but the performance of health workers should be monitored during the early part of their IMCI training.
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Bull. World Health Organ. · Jan 1997
ReviewNational tuberculosis programme review: experience over the period 1990-95.
Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. ⋯ After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies.
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Bull. World Health Organ. · Jan 1997
ReviewFactors affecting the immunogenicity and potency of tetanus toxoid: implications for the elimination of neonatal and non-neonatal tetanus as public health problems.
An estimated 400,000 deaths occur annually from neonatal tetanus (NT). In 1989 WHO adopted the goal of eliminating NT as a public health problem worldwide. To achieve this, and to control non-neonatal tetanus (non-NT), WHO recommends that newborns be passively protected at birth by the antepartum administration of at least two doses of tetanus toxoid (TT) to their mothers and that all children subsequently receive at least three doses of diphtheria-tetanus-pertussis (DTP) vaccine. ⋯ Malnutrition does not appear to affect immunogenicity; nevertheless, one study suggests that vitamin A deficiency is associated with an impaired immune response. Although it has been postulated that placental transfer of tetanus antibody is impaired in African women, a survey of the published literature suggests that this is not the case. Freezing TT has been shown to decrease its potency, but its impact on immunogenicity needs more evaluation.
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Bull. World Health Organ. · Jan 1997
ReviewPrevention of diarrhoea in young children in developing countries.
An updated review of nonvaccine interventions for the prevention of childhood diarrhoea in developing countries is presented. The importance of various key preventive strategies (breast-feeding, water supply and sanitation improvements) is confirmed and certain aspects of others (promotion of personal and domestic hygiene, weaning education/food hygiene) are refined. Evidence is also presented to suggest that, subject to cost-effectiveness examination, two other strategies-vitamin A supplementation and the prevention of low birth weight-should be promoted to the first category of interventions, as classified by Feachem, i.e. those which are considered to have high effectiveness and strong feasibility.
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Bull. World Health Organ. · Jan 1997
Health expectancy calculations: a novel approach to studying population health in Bulgaria.
The measurement of life expectancy in terms of either good or poor health is a novel approach to studying the health of the population in Bulgaria. The pilot study reported here-carried out among people aged > or = 60 years in a middle-sized Bulgarian town-was designed to obtain information on the years of functional restrictions expected among the elderly. In accordance with the answers to a series of questions (recommended by WHO), subjects were categorized as disabled, handicapped, or having different states of perceived health. ⋯ At all ages, the proportion of life in a condition free of disability, free of handicap, or in perceived good health is substantially lower for women than for men. Women may expect to live longer, but a greater proportion of their life will be spent in poor health. The approach presented here for measuring the health status of the elderly may be helpful as an aid to planning medical and social care and for the development of public health policies.